Mandibular Subcondylar Fracture:Improved Functional Outcomes in Selected Patients with Open Treatment
Kevin Chen, MD1, Alexander Gibstein, BA1, Bruce Nakfoor, BA2, Francesco Gargano, MD1, James P. Bradley, MD3.
1Hofstra Northwell School of Medicine, New York, NY, USA, 2University of Notre Dame, Notre Dame, IN, USA, 3Hofstra Northwell School of Medicine, New Hyde Park, NY, USA.
Background: Subcondylar fractures represent 25-35% of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery while open treatment is challenging and risks facial nerve injury. Perioperative, functional, and patient-reported outcomes were measured to compare methods of open vs closed treatment of subcondylar fractures.
Methods: Selected displaced subcondylar fracture cases with Open (ORIF +MMF) vs Closed (MMF) treatment were compared (n=60). Demographic, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded.
Results: Open vs Closed groups had similar demographics and perioperative data except the Open group had longer OR time (76.39 vs 56.15min). In long-term follow-up, Open treated patients had less symptoms (9%vs 67%), chin deviation (0% vs 40%), restricted mouth opening (3:5), and better functional scores (1.92 vs 0.861). Transient facial nerve weakness was seen in 6% of Open cases.
Conclusions: For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters.
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