Practical Tips for Open Reduction and Internal Fixation of Mandibular Subcondylar Fracture

Abstract

Mandibular subcondylar fractures are fractures below the most inferior point of the sigmoid notch. The reported incidence is 25% to 35%, depending on the study. Unlike most facial fractures, mandibular condyle fractures are due to indirect trauma. Typically, direct forces (i.e., trauma) to symphysis and/or parasymphysis will generate indirect forces. Transmitting the indirect forces (i.e., trauma) often results in mandibular condyle fracture/s. Several classification systems have been proposed. However, the most commonly used classification divides the mandibular condyle into three areas: (1) condylar head, (2) condylar neck, and (3) subcondyle. Condylar head fractures are located at the level of the temporomandibular joint (TMJ) capsule (i.e., intracapsular or diacapitular). Condylar neck fractures extend from the TMJ capsule superiorly to the level of the sigmoid notch inferiorly. Subcondylar fractures are below the sigmoid notch. Appropriate treatment of a mandibular condyle fracture re-establishes pre-injury occlusion, vertical facial height, speech, and mastication. There are various treatment approaches: (1) soft diet, (2) closed reduction (CR) with maxillomandibular fixation (MMF), and/or (3) open reduction and internal fixation (ORIF). The purpose of this chapter is to review pearls and pitfalls for ORIF of mandibular condyle/ subcondylar fractures.