Method to determine when open treatment of condylar process fractures is not necessary.

PURPOSE: The purpose of the present study is to report an intraoperative method of determining which condylar process fractures of the mandible do not require open reduction and internal fixation.

PATIENTS AND METHODS: A total of 332 patients with unilateral extracapsular fractures of the mandibular condylar process were retrospectively studied. After any other mandibular fractures had undergone open reduction and internal fixation, the maxillomandibular fixation was released and the occlusion checked to determine whether deviation of the mandible was present toward the side of the condylar fracture. In addition, digital posteriorly directed force was applied to the chin to determine how easily the mandible would deviate. Those cases in which the mandible dropped posteriorly toward the side of fracture, creating a malocclusion ("drop-back"), were treated either closed or by open reduction, according to several factors. Those whose mandibles either did not deviate toward the side of fracture or those in whom the mandible could be pushed posteriorly on the side of fracture but readily regained a midline position on release of pressure (nondrop-back) were treated closed. Displacement of the condylar process was examined using pretreatment Towne's and panoramic radiographs. The relationship between the intraoperative drop-back results and the pretreatment level and displacement of the condylar process fractures was statistically assessed.

RESULTS: Of the 332 fractures, 105 were in the nondrop-back group and 227 were in the drop-back group. The only demographic difference between the 2 groups was the displacement of the condylar process, which was greater in the drop-back group. All patients in the nondrop-back group, except for 1, had good occlusal and functional outcomes, with minimal need for interarch elastic guidance.

CONCLUSIONS: Determining which patients would not benefit from open reduction and internal fixation can be assessed clinically during surgery more reliably than using preoperative imaging studies.