title: Management of malocclusion and facial asymmetry secondary to fractures of the mandibular condyle process.
abstract: BACKGROUND
  Most condylar process fractures can be managed conservatively with satisfactory outcome. However, unsuccessful treatment can result in malocclusion and facial asymmetry. We report our experience in surgical management of malunited condylar process fractures.
  
  
  METHODS
  This is a retrospective review of clinical records, photographs, imaging, and dental models of 12 consecutive patients who presented with malocclusion and facial asymmetry after nonoperative or failed treatment of condylar process fractures. Eight patients who presented relatively early (<6 months) after the initial trauma were treated with subcondylar osteotomy (SCO), whereas 4 patients who presented relatively late (>18 months) were treated with sagittal split osteotomy (SSO). These 2 groups were compared in terms of 3 parameters, namely, maximum mouth opening, aesthetic improvement, and patient satisfaction.
  
  
  RESULTS
  The 2 groups were statistically similar in all 3 parameters, with the SCO group trending toward higher scores in all 3 parameters. The mean increase in maximal mouth opening in the SCO group was 21 versus 2.5 mm in the SSO group.
  
  
  CONCLUSIONS
  Subcondylar osteotomy, performed at a relatively early time point, is at least as effective, if not more effective, than traditional SSO in the treatment of subcondylar malunions. Given this finding, a lower threshold should be adopted for the primary treatment of acute subcondylar fractures with open reduction and internal fixation, especially those with moderate displacement that may be at high risk for malunion.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung, Chang Gung University, College of Medicine, Chang Gung Research Center, Linkou, Taiwan; †Plastic Surgery Department, University of Texas MD Anderson Cancer Center, Houston, TX; ‡Division of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, Kaohsiung; and §Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Linkou, Taiwan.
authors.forename: Chien-Tzung
authors.initials: CT
authors.lastname: Chen
authors.forename: Sydney
authors.initials: S
authors.lastname: Ch'ng
authors.forename: Faye
authors.initials: F
authors.lastname: Huang
authors.forename: Yu-Ray
authors.initials: YR
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D005146:Facial Asymmetry / Q000209:etiology / Q000601:surgery*; D005260:Female; D017759:Fractures, Malunited / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000209:etiology / Q000601:surgery*; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000150:complications / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult