Surgical Evolution in the Treatment of Mandibular Condyle Fractures

Evaristo Belli; Gianmauro Liberatore; Mici Elidon; Giovanni Dell'Aversana Orabona; Pasquale Piombino; Fabio Maglitto; Luciano Catalfamo; Giacomo De Riu

Disclosures

BMC Surg. 2015;15(16) 

In This Article

Methods

From June 2003 to July 2007, 32 patients with mandibular condyle fractures (including 5 with bilateral fractures) underwent surgical treatment (Table 1). Ages ranged from 10 to 55 years and the sexes were represented by 7 females and 25 males. Clinical diagnosis was always accompanied by a radiological examination of the mandible using an Orthopantomograph (Figure 1), plus a CT scan of the mandible whenever the standard radiograph indicated surgical treatment (Figure 2).

Figure 1.

Pre operative Orthopantomograph.

Figure 2.

CT scan that indicat surgical treatment.

The technique proposed envisages tracing the path of the condyle and then repositioning it under video-endoscopic control, by an endoral approach through an incision at the level of the homolateral retromolar trigone, as well as opening the jaw below the periosteum and the posterior border of the mandible to find the fracture focus. Endoscopes with 0°, 30°, 45° and 70° angulations were used according to the type of surgery, with the aid of a Xenon light source.[5] Traditional surgical equipment was used for the open surgical treatment of maxillary-facial traumas in combination with the kind of angled aspirator used in endoscopic nasal surgery. Once the fracture had been reduced, it was stabilized by using a rigid external fixation system produced by the Stryker company (Figure 3). This system is called Hoffmann II Micro Stryker HowMedica and consists of a series of pins, clamps and connecting rods in light and ultra-light biocompatible material which were used in conjunction with yet another system for mandibular bone distraction, produced by Leibinger-Stryker and called Multi-guide II Mandibular Distraction Device. By using two systems readily available on the market, a mixed system was created which is adaptable to any type of fracture. The Rigid External Fixator (REF) consists of a series of pins which are introduced through atraumatic subcutaneous incisions at a pretragic level until the fractured stump of the condyle is reached, while other two pins are inserted near the corner or into the ramus of the mandible, again through atraumatic subcutaneous incisions (Figure 4a and b). The instrumental examinations included CT scan (Figure 5) and EKG examination which shows the functioning of the mandible on the computer. Unfortunately it was not possible to carry out this examination in all cases, nor was it possible to do so during the diagnostic, pre-operative phase. However, in our opinion, this examination becomes fundamental in remote check-ups since it is non-invasive and repeatable every time it is deemed opportune to compare the clinical evolution of the mandibular movements. As of mid-2006, thanks to collaboration with the Department of Orthognathology and Gnathology in our hospitals, we have begun to offer a phase of post-surgery rehabilitation to all patients treated with our surgical method, featuring variable cycles of functional therapy that use mandibular activators, such as the Balters' Bionator.

Figure 3.

Rigid external fixation system produced by the Stryker company.

Figure 4.

Endoscopic view of pins inserted into the condyle stump (a) and into the ramus (b).

Figure 5.

Post surgical CT scan.

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