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CC BY-NC 4.0 · Arch Plast Surg 2018; 45(01): 23-28
DOI: 10.5999/aps.2017.00962
Original Article

Retromandibular reduction of medially dislocated condylar process fractures

Gyu Hyeong Lee
Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Korea
,
Dong Hee Kang
Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Korea
,
Sang Ah Oh
Department of Plastic and Reconstructive Surgery, Dankook University College of Medicine, Cheonan, Korea
› Author AffiliationsThis article was presented at the 2017 Korean Cleft Palate-Craniofacial Association Symposium on March 18–19, 2017, in Seoul, Korea.
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Background Condylar process fractures account for one-third of all mandibular fractures, and the distal fragment is prone to dislocate to the medial side due to the pulling of the lateral pterygoid muscle. Retromandibular approaches are commonly used, but the intraoperative view becomes limited in medially dislocated fractures. This study summarized a series of cases of retromandibular reduction for medially dislocated condylar process fractures and described our supplementary procedure to realign the dislocated condylar process.

Methods Nine patients with medially dislocated condylar process fractures underwent surgical correction from January 2012 to December 2016. In 6 of them, it was possible to realign the fractures with a conventional retromandibular approach, but for 3 cases of severe dislocation to the middle cranial fossa, a supplementary transoral procedure was carried out. The angle difference between the ramus and condyle, ramus height, and maximal mouth opening (MMO) were evaluated.

Results All 9 cases were restored to the proper anatomical alignment without any major complications, and postoperative images revealed successful union. The angle difference was 8.94°±4.11° preoperatively, and 0.99±0.49° at the 6-month follow-up. The pretreatment ramus height difference was 6.12±6.09 mm, and the postoperative difference was 0.18±0.10 mm. These changes after surgery were statistically significant. The MMO before surgery was 11.44±3.0 mm, and the postoperative MMO was 37.2±2.9 mm, reflecting a significant increase after reduction.

Conclusions Retromandibular reduction is a useful method in medially dislocated condylar process fractures, and additional transoral assistance should be considered to realign condylar processes that severely dislocate to the middle cranial fossa.

Keywords

Mandibular condyle - Mandibular fractures - Surgical incision


Publication History

Received: 31 May 2017

Accepted: 24 October 2017

Article published online:
03 April 2022

© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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