title: Comparison of various approaches for the treatment of fractures of the mandibular condylar process.
abstract: Fractures of the mandibular condyle process are the most common fractures of the lower jaw. Unfortunately, the type of treatment is still a matter of debate.
  
  
  OBJECTIVE
  The aim of this investigation was to compare the outcome of different treatment approaches regarding function and surgical side-effects.
  
  
  METHODS
  111 fractures of the mandibular condyle representing all types according to the classification of Spiessl and Schroll were included. Both closed reduction (CR) and open reduction with internal fixation (ORIF) including the retromandibular/transparotid, submandibular, preauricular and intraoral approach were performed. The clinical examination included functional and aesthetic aspects at least 1 year after the fracture.
  
  
  RESULTS
  The majority of fractures (45%) were classified into Type II and IV according to Spiessl and Schroll followed by fractures without any displacement or dislocation (29.7%). The submandibular approach showed the worst outcome regarding permanent palsy of the facial nerve and hypertrophic scarring. No significant differences between the various approaches were detected in the functional status in any diagnosis group.
  
  
  CONCLUSIONS
  Inferior condylar neck fractures benefit from ORIF by an intraoral approach whereas in high condylar neck fractures the retromandibular/transparotid approach shows the best results. Fractures of the condylar head were almost all treated by CR and our results cannot contribute to the debate of CR vs. ORIF in this type of fracture.
authors.affiliation: Department for Cranio- and Maxillofacial Surgery, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany. handschel@med.uni-duesseldorf.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Handschel
authors.forename: Tim
authors.initials: T
authors.lastname: Rüggeberg
authors.forename: Rita
authors.initials: R
authors.lastname: Depprich
authors.forename: Frank
authors.initials: F
authors.lastname: Schwarz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Meyer
authors.forename: Norbert R
authors.initials: NR
authors.lastname: Kübler
authors.forename: Christian
authors.initials: C
authors.lastname: Naujoks
mesh_terms: D001860:Bone Plates; D017439:Cicatrix, Hypertrophic / Q000209:etiology; D020220:Facial Nerve Injuries / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D019248:Jaw Fixation Techniques; D017746:Joint Capsule / Q000293:injuries; D004204:Joint Dislocations / Q000145:classification / Q000601:surgery; D008297:Male; D008334:Mandible / Q000601:surgery; D008335:Mandibular Condyle / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D008337:Mandibular Fractures / Q000145:classification / Q000601:surgery*; D008410:Masticatory Muscles / Q000503:physiopathology; D010149:Postoperative Pain / Q000209:etiology; D010306:Parotid Gland / Q000601:surgery; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome