A Modified External Fixator System in Treatment of Mandibular Condylar Fractures

Abstract

The purpose of this study is to evaluate patient's outcomes after condylar fractures treated with the modified external fixation system from 2008 to 2012.A group of 58 patients with unilateral and bilateral fractures of mandibular condyle was admitted in the authors' study.The final sample included a total of 44 patients, 24 males (54.6%) and 20 females (45.4%).The remaining 14 (24%) patients were excluded because they did not fulfill all the criteria requested.After 12 months from surgery, the functional-clinical evaluation of mouth's maximum opening and mostly extent of lateral excursion and of protrusion showed the following results: 8% of the sample showed a maximum mouth opening <30 mm, 72% of the sample showed a maximum mouth opening between 30 and 40 mm, 20% of the sample showed a maximum mouth opening >40 mm lateral excursion (contralateral to fracture) and protrusion was respectively of 9.5 and 3.9 mm.Only 2 (4.5%) of the 44 evaluated patients reported headaches. 86.5% of the patients showed no postoperative temporomandibular joint dysfunction; 9% of them reported occasional clicking, while 4.5% reported recurrent disorders. The average satisfaction score of surgery outcome reported by patients was 94.5/100, and it ranged between 50/100 and 100/100.

The Role of External Fixation in Trauma and Reconstruction of the Mandible in the Age of Rigid Fixation

“…While the fractured surfaces are not directly visible, contact between fractured segments can be determined through manual palpation and manipulation of bony fragments or via intraoperative radiologic imaging. 1,5 Only after the reduction is confirmed, the fixation device can be tightened. If using biphasic pin fixation, the pins are covered with silicone tubing (such as an endotracheal tube) which is then injected with a self-curing acrylic that, when hardened, creates a lightweight, yet customizable, rigid device.…”

“…Usually this can be done as early as 2 weeks after placement for a condylar fracture. 5,7,8 However, the duration of ex-fix can be significantly longer if it is being used for other indications, such as chronic infections requiring prolonged antibiotic treatment, or if it is used to achieve bony union without internal rigid fixation. 9…”

“…Fractures of the condyle represent 20 to 35% of all mandible fractures, and can result in long-term complications including malocclusion, reduced posterior facial height, trismus, chronic pain, and facial asymmetry. 5,11 Multiple techniques for treating condyle fractures exist, and the surgical indications for open reduction and internal fixation (ORIF) are a point of ongoing controversy and debate in literature. Ex-fix has been used as a sole treatment option without rigid fixation for isolated condylar fractures with clinical success.…”

“…For this indication, ex-fix device is applied for approximately 2 weeks and is removed in office. 5,8,11 In a retrospective review by Cascone et al, 44 patients with 53 condyle fractures were treated with ex-fix alone through a preauricular approach. All patients recovered their premorbid occlusion after surgery, and at 12 months, 91% reported no pain, while 87% reported no temporomandibular joint (TMJ) dysfunction.…”

“…Mouth opening was found to be > 30 mm in 92% of patients. 5 Similarly, Iannetti and Cascone treated 22 patients with 34 condylar fractures with ex-fix using a preauricular approach. While one patient required repositioning of the fractured segment postoperatively, all patients experienced a return to premorbid occlusion without any complications or permanent facial nerve injury.…”