Predictable and Effective Treatment of Bilateral Subcondylar Fractures Using Closed Reduction With a Novel Acrylic Wedge Splint

Abstract

Treatment of bilateral subcondylar fractures is a challenging clinical problem, and optimal management of these fractures remains controversial. Similar to unilateral subcondylar fractures, bilateral injuries present with significant malocclusion due to fracture segment displacement; however, the loss of vertical stops on both sides of the mandible mandate a more concerted approach to surgical management. Closed reduction and maxillomandibular fixation (MMF) alone in bilateral subcondylar fractures carry a higher risk of recurrent anterior open bite postoperatively secondary to the absence of a vertical stop with fracture segment displacement and persistent shortening of the posterior facial height. Therefore, some surgeons consider bilateral subcondylar fractures an indication for open reduction and internal fixation (ORIF). Unfortunately, open approaches involving the proximal subcondylar fracture segment are riddled with potential risks including facial nerve damage, parotid gland injury, and temporomandibular joint (TMJ) damage. Given that neither approach is optimal, investigation of new approaches for the treatment of bilateral subcondylar fractures is warranted. The objective of this paper is to present our novel technique for the treatment of bilateral subcondylar fractures, which utilizes a combination of traditional closed reduction and MMF with a custom “wedge” occlusal splint to overcorrect the traumatic shortening of the posterior mandibular height.