Rigid versus semirigid fixation for condylar fracture: experience with the external fixation system.
OBJECTIVE
Although mandibular condylar fractures are very common, the treatment remains controversial. Many techniques of reduction and many devices have been suggested. The purpose of this study was to evaluate the advantages and drawbacks of semirigid fixation compared with rigid fixation using an external fixation system.


METHODS
Between 1990 and 2005, 137 patients (83 males, 54 females; median age, 24.2 years; 116 with monocondylar fracture and 21 with bicondylar fracture) were treated with an external fixation system (Mand-X-Fix, Leibinger, Germany). In these cases, the distal fragment was dislocated medially and out of the glenoid cavity (stadium IV of MacLennan).


RESULTS
At the 12-month follow-up, 91% of treated patients regained their pretrauma occlusion with good functional results (maximum mouth opening: 100% >30 mm, 81% >35 mm, 59% >40 mm; articular pain: <2%; clicking: <7%) and morphostructural results (fragment overlap significant in 2% of cases, light in 53% of cases, and absent in 45% of cases) and a very low rate of complications in the immediate postsurgical period (temporary paresis of the facial nerve: <7%; infection of the surgical wound: <2%). No long-term facial palsy was noted.


CONCLUSIONS
Our findings indicate that a semirigid fixation technique, represented by the external fixation system, seems to be a better approach to treating condylar fractures with luxation out of the glenoid fossa.
Cascone
Piero
P
Department of Craniomaxillofacial Surgery, La Sapienza University, Rome, Italy.
Spallaccia
Fabrizio
F
Fatone
Flavia Maria Graziana
FM
Rivaroli
Andrea
A
Saltarel
Andrea
A
Iannetti
Giorgio
G
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008335:Mandibular Condyle / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome