Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals.
BACKGROUND
The incidence of condylar fractures is high. Condylar fractures can be extracapsular (condylar neck or subcondylar) or intracapsular, undisplaced, deviated, displaced or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and the dental occlusion, and the surgeon's experience.


OBJECTIVE
This report presents the experience acquired in the treatment of 466 condylar fractures over 7 years, reviews the pertinent literature and proposes guidelines for treatment.


METHODS
The archives of KAT, General District Hospital between 1995 and 2002 were scrutinized and the condylar fractures were recorded. The aetiology, age, sex, level of fracture, degree of displacement, associated facial fractures, malocclusion, and type of treatment were noted.


RESULTS
Four hundred and sixty-six condylar fractures were admitted, the male:female ratio was 3.5:1. Road traffic accidents were the main cause and most fractures were unilateral, displaced, subcondylar, occurred on the left side and were treated conservatively.


CONCLUSIONS
Early mobilization is the key in treating condylar fractures. Whilst rigid internal fixation provides stabilization and allows early mobilization, conservative treatment is the treatment of choice for the majority of fractures. Children and intracapsular fractures are treated conservatively with or without maxillo-mandibular fixation. Open reduction is recommended in selected cases to restore the occlusion, in severely displaced and dislocated fractures, in cases of loss of ramus height, and in edentulous patients. It may be considered in those with 'medical problems' where intermaxillary fixation is not recommended.
Zachariades
Nicholas
N
Oral and Maxillofacial Department, KAT (Trauma Rehabilitation Center), General District Hospital of Attica, Kifissia, Athens, Greece. nzak@otenet.gr
Mezitis
Michael
M
Mourouzis
Constintine
C
Papadakis
Demetrius
D
Spanou
Athena
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002985:Clinical Protocols; D005147:Facial Bones / Q000293:injuries; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D019248:Jaw Fixation Techniques; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy; D008297:Male; D008310:Malocclusion / Q000150:complications; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000145:classification / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D012887:Skull Fractures / Q000150:complications