Treatment of mandibular condyle fractures with a rhombic 3D condylar fracture plate – Does the surgical approach matter?

• Published in: Journal of cranio-maxillo-facial surgery Vol. 53; no. 5; pp. 533 - 542
• Main Authors: Leonhardt, Henry, Matschke, Jan Bernard, Bräuer, Christian, Remschmidt, Bernhard, McLeod, Niall M.H., Lauer, Günter, Franke, Adrian
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.05.2025
• Subjects: Adolescent; Adult; Aged; Bone Plates; Condylar base fractures; Condylar neck fractures; Female; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Gonion angle; Humans; Male; Mandibular Condyle - diagnostic imaging; Mandibular Condyle - injuries; Mandibular Condyle - surgery; Mandibular Fractures - diagnostic imaging; Mandibular Fractures - surgery; Middle Aged; Radiography, Panoramic; Retromandibular transparotid approach; Retrospective Studies; Rhombic-shaped implant; Transoral endoscopic approach; Treatment Outcome; Young Adult; Transoral endoscopic approach; Condylar base fractures; Retromandibular transparotid approach; Condylar neck fractures; Gonion angle; Rhombic-shaped implant
• ISSN: 1010-5182; 1878-4119; 1878-4119
• DOI: 10.1016/j.jcms.2025.01.029

Fractures involving the mandibular condyle are a significant subset of mandibular fractures, demanding specialized implant design considerations for effective surgical treatment. The core objective of this study was to assess the clinical and radiographic results in patients treated with a single rhombic-shaped implant according to the surgical approach used. This retrospective cohort investigation, spanning a ten-year recruitment window, included individuals with unilateral fractures who underwent surgical treatment with a rhombic-shaped implant. These patients were subject to follow-up examinations at one, three, and six months post-surgery, along with corresponding orthopantomograms and clinical assessments. Patients were allocated into four groups depending on the fracture pattern and level as well as the approach used for fracture treatment. The primary outcome variables under scrutiny encompassed parameters such as occlusion, maximum interincisal distance, mandibular excursion across different postoperative time points, and radiographic measurements of mandibular height and the gonion angle. A total of 236 patients, comprising 161 males and 75 females, with an average age of 40.2 ± 19.2 years, were included in the study. Satisfactory occlusion was exhibited in 99.6% of patients at the six-month follow-up. Furthermore, all parameters associated with mandibular excursion displayed significant enhancements (p < 0.01). These improvements were accompanied by a reduction in ramus height and increased gonion angle on the fractured side. The investigation of the clinical and radiographic results suggest a tendency of the choice of the approach depending on the fracture pattern, but no statistically significant recommendations could be identified.