Position paper from the IBRA Symposium on Surgery of the Head--the 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012.
BACKGROUND
This is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades.


METHODS
Using a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used.


RESULTS
The consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (>12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children.


CONCLUSIONS
The experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations.
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Andreas Neff), UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany. Electronic address: mkg@med.uni-marburg.de.
Andreas
A
Neff
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Cyrille Chossegros), AP-HM, "La Timone" University Medical Centre, Aix-Marseille Univ, Marseille, France.
Cyrille
C
Chossegros
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Cyrille Chossegros), AP-HM, "La Timone" University Medical Centre, Aix-Marseille Univ, Marseille, France.
Jean-Louis
JL
Blanc
Department of Anatomy and Medical Imaging (Head and Chair: Prof. Pierre Champsaur), AP-HM, "La Timone" University Medical Centre, Aix-Marseille Univ, Marseille, France.
Pierre
P
Champsaur
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Cyrille Chossegros), AP-HM, "La Timone" University Medical Centre, Aix-Marseille Univ, Marseille, France.
François
F
Cheynet
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Bernard Devauchelle), Amiens-Picardie University Medical Centre, Amiens, France.
Bernard
B
Devauchelle
Department of Oral and Maxillofacial Surgery (Former Head and Chair: Prof. Uwe Eckelt; Current Head: Prof. Günter Lauer), "Carl Gustav Carus" University Hospital, Faculty of Medicine, Technical University (TU), Dresden, Germany.
Uwe
U
Eckelt
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Joël Ferri), "Roger Salengro" Hospital, University Medical Centre of Lille, Lille, France.
Joël
J
Ferri
Department of Diagnostics and Surgery (Head and Chair: Prof. Dr. Marisa A. C. Gabrielli), UNESP, Dental School of Araraquara, São Paulo State University, Araraquara, São Paulo, Brazil.
Mário Francisco Real
MF
Gabrielli
Department of Oral-Maxillofacial, Plastic and Reconstructive Surgery (Head: Prof. Laurent Guyot), AP-HM, North Hospital, Marseilles, France.
Laurent
L
Guyot
Regional Maxillofacial Unit, (Lead Clinician and Deputy Chairman SAC in OMFS: Dr. David Koppel), Southern General Hospital and Royal Hospital for Sick Children, Glasgow, United Kingdom.
David Andrew
DA
Koppel
Department of Oral-Maxillofacial, Plastic, Aesthetic and Reconstructive Surgery (Head and Chair: Prof. Christophe Meyer), University Medical Centre of Besançon, Besançon, France.
Christophe
C
Meyer
Biomaterials Science Center (BMC) (Head: Prof. Bert Müller), University of Basel and University Hospital Basel, Basel, Switzerland.
Bert
B
Müller
Oral and Maxillofacial Unit (Head and Chair: Dr. Timo Peltomäki), Tampere University Hospital, Tampere, Finland.
Timo
T
Peltomäki
Department of Maxillofacial Surgery (Head: Dr. Giorgio Giuliani), "S. Maria" Hospital, Terni, Italy.
Fabrizio
F
Spallaccia
Department of Radiology and Medical Imaging (Head and Chair: Prof. Pierre Champsaur), AP-HM, "La Timone" University Medical Centre, Aix-Marseille Univ, Marseille, France.
Arthur
A
Varoquaux
Department of Oral-Maxillofacial, Plastic, Aesthetic and Reconstructive Surgery (Head and Chair: Prof. Astrid Wilk), University Medical Centre of Strasbourg, Strasbourg, France.
Astrid
A
Wilk
Department of Oral and Maxillofacial Surgery (Head and Chair: Prof. Andreas Neff), UKGM GmbH, University Hospital of Marburg, Faculty of Medicine, Philipps University, Marburg, Germany.
Poramate
P
Pitak-Arnnop
D000328:Adult; D000367:Age Factors; D002648:Child; D004724:Endoscopy / Q000379:methods; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000601:surgery*; D009984:Orthopedic Fixation Devices
Condylar fracture; Consensus; Osteosynthesis; Paediatric fractures; Position paper