Indications for treatment of subcondylar mandibular fractures.
OBJECTIVE
The purpose of this study was to establish a reliable criteria for implementation of either an open surgical or a closed conservative treatment of subcondylar fractures, based on clinical data and analytical mathematical model.


METHODS
A total of 512 subcondylar fractures were treated during a 3-year period. Of these, 256 were fractures characterized by either displacement or dislocation of the proximal (condylar) segment. Patients were treated with open reduction and internal fixation (ORIF) or closed reduction (CR) techniques. Patients were evaluated pre- and postoperatively by clinical examination, 3-dimensional axiography, radiographic imaging, and ultrasonography. A mathematical model was developed for estimating the loss of vertical ramus height.


CONCLUSIONS
When the displacements were less than 37 degrees from the sagittal axis of the ascending ramus, the ensuing loss of vertical height was negligible when fractures were treated by conservative techniques. When the displacements exceeded 37 degrees, the fractures resulted in a significant decrease of vertical ramus height. Based on these data, 37 degrees appears to be the point for decision of whether to use closed or open treatment.
Kleinheinz
J
J
Department of Craniomaxillofacial Surgery and Plastic and Reconstructive Surgery, University of Muenster, Muenster, Germany.
Anastassov
G E
GE
Joos
U
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D019248:Jaw Fixation Techniques; D007574:Jaw Relation Record; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy; D008297:Male; D008335:Mandibular Condyle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D008954:Models, Biological; D009068:Movement; D010808:Physical Examination; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011862:Radiography, Panoramic; D014463:Ultrasonography; D014716:Vertical Dimension