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CurrentConceptsintheMandibularCondyleFractureManagementPartI:OverviewofCondylarFracture

ArchPlastSurg.2012Jul39(4):291300.

PMCID:PMC3408272

Publishedonline2012Jul13.doi:10.5999/aps.2012.39.4.291

CurrentConceptsintheMandibularCondyleFractureManagementPartI:Overview
ofCondylarFracture
KangYoungChoi, JungDugYang,HoYunChung,andByungChaeCho
DepartmentofPlasticandReconstructiveSurgery,KyungpookNationalUniversitySchoolofMedicine,Daegu,Korea.
Correspondingauthor.
Correspondence:KangYoungChoi.DepartmentofPlasticandReconstructiveSurgery,KyungpookNationalUniversitySchoolofMedicine,130
Dongdukro,Junggu,Daegu700721,Korea.Tel:+82534205685,Fax:+82534253879,Email:kychoi@knu.ac.kr
Received2012Jun24Revised2012Jun25Accepted2012Jun26.
Copyright2012TheKoreanSocietyofPlasticandReconstructiveSurgeons
ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionNonCommercialLicense
(http://creativecommons.org/licenses/bync/3.0/),whichpermitsunrestrictednoncommercialuse,distribution,andreproductioninanymedium,provided
theoriginalworkisproperlycited.

ThisarticlehasbeencitedbyotherarticlesinPMC.

Abstract

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Theincidenceofcondylarfracturesishigh,butthemanagementoffracturesofthemandibularcondylecontinues
tobecontroversial.Historically,maxillomandibularfixation,externalfixation,andsurgicalsplintswithinternal
fixationsystemswerethetechniquescommonlyusedinthetreatmentofthefracturedmandible.Condylarfractures
canbeextracapsularorintracapsular,undisplaced,deviated,displaced,ordislocated.Treatmentdependsontheage
ofthepatient,thecoexistenceofothermandibularormaxillaryfractures,whetherthecondylarfractureisunilateral
orbilateral,thelevelanddisplacementofthefracture,thestateofdentitionanddentalocclusion,andthe
surgeonndsontheageofthepatient,thecoexistenceofothefromwhichitisdifficulttorecoveraestheticallyand
functionallyanappropriatetreatmentisrequiredtoreconstructtheshapeandachievethefunctionoftheuninjured
status.Todothis,accuratediagnosis,appropriatereductionandrigidfixation,andcomplicationpreventionare
required.Inparticular,asmandibularcondylefracturemaycauselongtermcomplicationssuchasmalocclusion,
particularlyopenbite,reducedposteriorfacialheight,andfacialasymmetryinadditiontochronicpainandmobility
limitation,greatcautionshouldbetaken.Accordingly,theauthorsreviewageneraloverviewofcondylefracture.
Keywords:Mandibularcondyle,Mandibularfractures,Temporomandibularjoint
INTRODUCTION

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Amongfacialbonefractures,themandiblefracturehasahighestincidencenexttonasalbonefractureandcondyle
fracturemostfrequentlyoccursinmandiblefracture[1].Condylefractureaccountsforapproximately30%and
37%ofmandiblefractureindentulousmandiblepatientsandedentulousmandiblepatients,respectively.The
reasonforahighincidenceofmandibularcondylefractureisattributabletothebindingofthemandibularramus
withhighstiffnessandmandibularcondyleheadwithlowstiffness[2].Thisisgenerallycausedbyindirectforce
thatisdeliveredtothemandibularcondylehead.Themostcommonexternalcausativefactorisphysicaltrauma,
andcaraccident,violence,industrialhazard,fall,sports,andgunshotwoundarealsoincludedintheexternal
causativefactors.Internalcausativefactorsincludeosteomyelitis,benignormalignanttumor,andmuscularspasm
duringelectricshocktreatment.
Asmandibularfracturemaycausedisordersthatishardtoberecoveraestheticandfunctionally,anappropriate
treatmentisrequiredtoreconstructtheshapeandfunctionofuninjuredstatus.Todothis,accuratediagnosis,
appropriatereductionandrigidfixation,andcomplicationpreventionarerequired.Inparticular,asmandibular
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condylefracturemaycauselongtermcomplicationssuchasmandibulargrowthandfunctionaldisorders,and
chronictemporomandibularjoint(TMJ)complication,amorecautionshouldbegiven.Accordingly,theauthors
reviewthegeneraloverviewoncondylefracturehere.
ANATOMYANDPHYSIOLOGYOFMANDIBLE

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Themandible

Themandible,whichisthehardestmonostoticboneamongfacialbones,isaUshapedlongbone(Fig.1).It
consistsofareaswithandwithoutteeth,andbindstothebilateraltemporalbonesattheleftandrightTMJ.Atthe
earlystageofdevelopment,itdevelopslaterallyandfusesatthemidline1to2yearsafterbirth,formingacomplete
structurelikethemaxilla.Nameofeachareahassomevariationdependingontheliteratures.However,themost
clinicallyusefulclassificationofeachareadividesthemandibleintothesymphysisandparasymphysis,body,angle
andramus,condylarprocess,coronoidprocess,andalveolarprocess.Thesymphysisandparasymphysisrefersto
anareabetweenbothcanine.Thebodyreferstoanareafromthecaninetothesecondmolar.Theangleandramus
referstotheareanexttothirdmolarexceptforthecoronoidandcondylarprocess.Themandibularcondyleconsists
ofthecondylarprocessandheadofthemandible.Thecondylarprocessandheadsubunitreferstoasuperiorarea
oftheextensionlineconnectingthemasseterictuberosityfromthedeepestareaofthesigmoidnotch.Thecondylar
processandheadsubunitconsistsofthehead,neck,andsubcondylararea.Thesearethreeheightlevellinesthat
dividethesubunit,anddefinetheboundary.Thethreeheightlevellinesconsistofanextensionlinethatisparallel
totheposteriorborderofthemandible,anextensionlinethatparallellyheadsfortheperpendicularfromthedeepest
areaofthesigmoidnotch,andanextensionlinethatisinferiortothecondylarheadlateralpole.Thecondylarhead
referstoanareathatissuperiortotheextensionlinethatisinferiortothecondylarheadlateralpole.Thecondylar
neckreferstoanareabetweentheextensionlinethatisinferiortothecondylarheadlateralpoleandtheextension
linethatparallellyheadsfortheperpendicularfromthedeepestareaofthesigmoidnotch.Thesubcondylararea
referstoanareathatisinferiortotheextensionlinethatparallellyheadsfortheperpendicularfromthedeepestarea
ofthesigmoidnotch.Meanwhile,thecondylarneckisdividedintothehighlevelandlowlevel,andthereference
linedividingthemisanextensionlinethatispositionedinthemiddleofthesigmoidnotchlineandthelateralpole
lineofthehead(Fig.1).
Fig.1
Theanatomyofmandibulararea
Theelevatedareaofthemidlineofthemandibleisdefinedasmentalprotuberance.Thementaltubercleexists
inferiortotheleftandrightelevatedareasandthementalforamenbywhichimportantfacialnervesandblood
vesselspassexistslaterallysuperiortotheaforementionednodulearea.Internally,apairofthementalspinesexists
inferiorlytothemidline,fromwhichthegenioglossusandstylohyoidmuscleoriginate.Themylohyoidlinethat
reachesthemandibularramusposterosuperiorlyexistsatthelateralsideofthementalspine.Themylohyoid
muscleoriginatesfromthemylohyoidline.Thenerverootispositionedbelowthemylohyoidmuscle,andcontrols
it.Themandibularangleandramusisarectangularbonypartthatexistssuperoposteriorlytothemandibularbody.
Mandibularanglesizevariesdependingonageandindividuals.Itisapproximately140inchildrenand110to
120inadults.Thetuberositasmassetericaandtuberositaspterygoideaexistatthelateralsideandinternalsideof
mandibularangle,respectively.Theyareinsertionpartsofthemassetermuscleandmedialpterygoidmuscle,
respectively.
Temporomandibularjoint

Themandibularcondyleformsarticulationwiththemandibularfossaofthetemporalbone,whichiscalledtemporo
mandibularjoint.Thearticulationdisc,whichisafibroustissue,existsbetweentheTMJ,andactsasabuffer.As
synovialfluidthathaslubricationfunctioninsidethejointcapsuleexistsaroundthejoint.Itminimizesfriction
duringjointmotion,andenablesthesmoothmovementofthejoint.Thearticulationdiscgenerallyhasanoval
shape.However,asitsshapeisdeterminedbytheshapeofthecondyleheadandmandibularfossa,itssizeand
shapemayvary.Thearticulationdisciscomposedoffibroustissueswithoutnerveorbloodvessel,anddisc
thicknessis1mmforthecenter,3mmfortheposterioraspect,and2mmfortheanterioraspect.Thus,ithasa
shapethatisthethinnestinthecenterandthethickestintheposterioraspect.Forthenormaljoint,themandibular
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condyleispositionedatthecenterwhichisthethinnest.Thus,discinjuryoccursatthecenterduetoagingor
chronicphysicalstimuli.Thediscisattachedtothecondyleheadviathebilateralarticulardiscligaments,which
preventsthedeviationofthediscfromthecondyleheadduringmandibularmovement.Thejointcapsulethat
surroundstheTMJproducesthesynovialfluidinternally,andtheproducedsynovialfluidactsasalubricantduring
mandibularmovement,andsuppliesnutrientstoanareawithoutbloodvessels.Inaddition,asthejointcapsulehas
substantialwrinkles,itchangesthecontactareaduringmandibularmovement,protectingthejoint.Thetemporo
mandibularligamentwithatriangularshapeexistsatthelateralsideofthearticularcapsule,anditprevents
excessivemovementthatisbeyondthenormalrangeofthemandibleduringmadibularmovement.Thetemporo
mandibularligamentisrigidlyfixedbythetemporalboneandmandible,whichprovidesthestabilityofTMJ
movement.Unlikehingetypedjointsofthefourextremities,theTMJhascharacteristicsofthesimultaneous
movementofthebilateraljointsduringmandibularmovementsuchastalkingoreating.TheleftandrightTMJcan
notmoveindependently,andiscloselyassociatedwithdentalocclusion(Fig.2).
Fig.2
Theanatomyoftemporomandibularjoint
Occlusionandmandibularmovement

Occlusionisintercuspationbetweentheteeth.Itisdividedintostaticocclusionwithoutjawmovement
andfunctionalordynamicocclusionwithjawmovement.Staticocclusionmayvarydependingoncondyle
location,amongwhichmaximumintercuspaloccclusionorintercuspalocclusionpositionreferstoasitethat
contacttheteethmostfrequently.Thisisknownascentricocclusion(CO).COisarelationshipbetweentheteeth
regardlessofcondyleposition.AsCOmaybechangedbyprosthodontictreatmentorjawsurgery,condylelocation
thatisalwaysconstantandreproducibleisrequired.Thisisbecausethecondylelocationthatactsasareferencefor
prosthodontictreatmentorjawsurgeryisrequired.Procedureswherethestabilityofcondylepositionisnot
maintainedeventuallycauseTMJdiseaseormalocclusion.Basedontheaforementionedconcept,occlusionat
condylepositionthatisstableandreproduciblewithoutintercupationisdefinedascentricrelation(CR),andcalled
centricrelationocclusion(CRO).IfCROissameasCO,itisconsideredasidealocclusion.Condylepositionin
CRhasbeencontroversialoveralongperiodoftime.Currently,mostanteriorsuperiorpositionreportedby
CelenzaandNasedkin[3]isconsideredtheclosestposition(Fig.3).
Occlusion

Fig.3
Theidealcondylepositionstate

Thisstaticocclusionoccursforashorttimeinadailyliving.Inmostcases,functionalocclusionwithjaw
movementoccurs.Duringjawmovementanteriormovement,occlusalcontactoccursattheanteriorteethand
disclusionoccursattheremainingteeth.Duringlateralmovement,occlusionoccursattheworkingsidedcanineor
caninepremolargroupteeth,anddisclusionoccursattheremainingteeth.Thisiscalledguidance(Fig.4).The
anteriorregionisfarawayfromforcepointsothatitistolerabletolateralforceduringanteriormovement.
Meanwhile,thecaninehasalongrootandthealveolarboneishardsothatitistolerabletolateralforceduring
lateralmovement.Ifteethotherthantheguidanceteethcontactduringtheaforementionedmovement,theyare
relativelymorevulnerabletolateralforce.Itcausesperiodontalligamentinjury,whichisvulnerabletoperiodontitis.
Eventually,teethsupportingbecomesweakduetoabsorptionbytheadjacentalveolarbone.Theteethbecome
exfoliated.Thisstatusreferstotraumafromocclusion(TFO).
Fig.4
Thesequenceoffunctionalocclusion
Mandibularmovement MandibularmovementoccursbytheinvolvementoftheTMJasaposteriorguidance,and

teethasananteriorguidance.TheTMJasaginglymoarthroidaljointhasamovementof25to30mmbytheupper
jointspace.Themouthopeningasahingejointhasrotationmovement.Beyondthat,themouthopeningassliding
jointhasamovementinadditiontorotationmovement(Fig.5).Inaddition,thebodilylateralmovementofthe
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mandibleoccursduringlateralexcursions,whichreferstobennettmovement(Fig.6).Ifnobennettmovement
occurduetointerferencecausedbychangesincondylepositionduringfractureorjawsurgerythoughocclusionis
normal,mandibularmovementdisorderoccurs.Ifthedisorderispersistentforalongtime,TMJdiseaseocclusion
instabilityrelapsemaybecaused.
Fig.5
Movementofthemandibularcondyle
Fig.6
Movementofthemandibularcondyle
CLASSIFICATIONOFMANDIBULARCONDYLEFRACTURE

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CondylefracturecanbeclassifiedasfollowsaccordingtoLindahlclassification.Itisclassifiedintocondylehead
fracture,condyleneckfracture,andsubcondylefractureaccordingtofactureposition.Condyleheadfractureisalso
calledintracapsularfractureasthejointcapsuleexistsuntilthecondyleneck.condyleneckfracture,whichoccurs
attheinferiorattachareaofthejointcapsule,referstoanareathatbecomesnarrowfromthecondylehead.Itisan
extracapsularfractureasitisnotincludedinthejointcapsule,andexistsattheinferiorattachareaofthelateral
pterygoid.Subcondylefracture,whichexistsinferiorlytothecondyleneck,referstoanareabetweenthe
mandibularsigmoidnotchandmandibularposterioraspect.Accordingtothedegreeoffracturefragment
displacement,condylefractureisclassifiedintonondisplacedfracturethathasfracturewithnodisplacementofthe
fracturesite,deviatedfracturewherefracturefragmentsaredisplacedbutsomeofthemcontactthemandibular
joint,displacedfracturewherefracturefragmentisseparatedfromthemandibularbodyanddisplaced,butexistsin
theTMJ,anddislocationwherethecondyleheadisdeviatedfromtheTMJ(Fig.7).Thedisplacementoffracture
fragmentisobservedincondylefracture.Itputmainlyintractionbythemassetermuscle,lateralpterygoidmuscle,
andtemporalismuscle.Themostcommonlyobservedtypeisthedisplacementofthecondyleheadtothe
anteromedialside,whichisshowninafracturethatoccursinferiorlytothelateralpterygoidmuscle(Fig.7).
Fig.7
TheclassificationofmandibularcondylefractureaccordingtoLindahl
classification
TREATMENTOFMANDIBULARCONDYLEFRACTURE

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Closedreductionandfunctionaltherapy

Forclosedreduction,intermaxillaryfixationisconductedusingarchbarandwire,followedbymaintainingofthe
fixationofthemaxillaandmandiblefor2to4weeks.Afterachievingstableunionofthefactoredsite,awirefor
intermaxillaryfixationisremoved.Then,normalocclusionisinducedafterfixationusingrubber,andsoftdietis
maintainedfor2weeks.Functionaltherapythatconsistsofpassivemandibularmovementexerciseandmouth
openingexerciseisconductedandthenclinicaloutcomesareobserved.
Openreductionandinternalfixation

Therearevariousoperationmethodsofopenreductionformadibularcondylefracturedependingonfracturesite
anddegreeofbonefragmentdisplacement.Ingeneral,theyincludepreauricularapproach,postauricularapproach,
submandibularapproch,Risdonapproach,combinedapproach,andretromandibularapproach.Treatmenttype
shouldbeselectedconsideringpatient'sage,preference,fracturetype,fractureofothersites,andteethstatus.
COMPLICATIONOFMANDIBULARCONDYLEFRACTURE

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Nonunionandmalunion

Nonunionisassociatedwithfracturefragmentstability,repeatedtrauma,infection,inappropriatereduction,
multiplefractures,mandibularatrophy,andpatientcompliance[4].Infectionofthefracturesitemorefacilitates
fibroblastgrowththantheactivitiesofosteoblastsorosteoclasts.Thismakesfibroustissuesdominantinthebone
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healingarea,andcausesfibrousbinding,whichresultsinnonunion[5].Inthecaseofexcessiveexposureofthe
periosteum,delayedfracturetreatmentisshown,particularly,incomminutedfractureandedentulousfracture.If
fracturedfragmentsareinappropriatelyassigned,andteethalignmentisinappropriatelypositioned.Inaseverecase,
nonunionmayoccur.Malocclusioniscausedbyfacialasymmetry.Ifthishappens,correctionshouldbeperformed
viaorthognathicsurgeryandbonetransplantation.
Malocclusion

Malocclusionisassociatedwithpatient'steethstatus,fracturetype,displacementofthebonesegments,incomplete
reductionofbonefragments,inappropriatefixationandfixationtime,delayedtreatment,andpatientcompliance[6
8].Formalocclusionthatoccursafterthecompletionofboneunion,occulsaladjustmentisrequiredorevenre
operationandorthodonticsurgeryisrequiredinaseverecase.Openreductionshouldbeconductedinanearly
phaseafterinjurytopreventmalocclusionaftermandibularcondylartrauma.Furthermore,accuratereductionand
fixationduringthesurgeryandregularfollowupafterthesurgeryarerequiredtopreventpostoperative
malocclusion(Fig.8).
Fig.8
A21yearoldwomanwithiatrogeniccondylefractureduringfacialbone
contouringsurgery
Temporomandibularjointdysfunction
Temporomandibularjointderangement Ifthefunctionaldisordersofthecondyledisccomplexoccurwithchanges

intheshapeofthediscduetotrauma,thisiscalledtemporomandibularjointderangement.Thefunctional
disordersofthecondyledisccomplexoccurscausediscdisplacement.Thisdisplacementisthemostimportant
characteristicsoftemporomandibularjointderangement,whichoccurswithmajorsymptomssuchasjointsound,
abnormalmovementofthecondylehead,impingementofcondylehead,mandibularmovementlimitationandjoint
pain.Fortemporomandibularjointderangement,changesindiscshapeandthefunctionaldisordersofthecondyle
disccomplexareminimizedandpreventedbytheearlyreductionandrigidfixationofthedisplacedbonefragments
adjacenttothejoint(Fig.9).
Fig.9
A24yearoldwomanwithiatrogeniccondylefractureduringorthognatic
surgery
Traumaticarthritisoftemporomandibularjoint Traumaticarthritisreferstoanarthritisthatoccurssecondarilyafter

thedeformityofthejointduetothedirectinjurytothearticularcartilageorfracturecausedbytrauma.Traumatic
arthritisgenerallyoccursafterfractureinvadingthearticularsurface,butalsooccursbyrepeatedmildtraumaor
jointinjurycausedbychronicload.Inparticular,forintracapsularfractureamongmandibularcondylefractures,
articularsurfaceinjuryoccursatthetimeoftraumaonset,andtraumaticarthritisisfurtherexpectedtooccurdueto
chronicandrepeatedjointmovement.Clinicalsymptomsthatmayoccurinanearlyphaseincludejointsoundand
painduringjointmovement.Asbonyarthritisprogresses,progressedclinicalfindingssuchasjointsoundincrease,
locksensation,pain,andmouthopeninglimitationareobserved[9].
Ankylosisoftemporomandibularjoint Ankylosisoftemporomandibularjointreferstoamovementdisorderofthe

TMJcausedbythegrowthoffibroustissuesorbonetissuesintheTMJstructureduetovariousfactors.Itcauses
severefunctionalandstructuralabnormalitiesinpatients.Ankylosisoftemporomandibularjointismainlydivided
intotwotypes.Oneistrueankylosisoftemporomandibularjointwherejointankylosisisattributabletothejoint
itself.Theotherispseudoankylosisoftemporomandibularjointwherecausativefactorsareattributabletoothers
exceptforthejoint.Inaddition,ankylosisoftemporomandibularjointisclassifiedintocompleteandpartialtypes,
andunilateralandbilateraltypesaccordingtotheintensityandpositionofankylosisoftemporomandibularjoint,
respectively.Ankylosisoftemporomandibularjointfrequentlyoccursbytrauma.Itoccursinallagebrackets,but
mainlyoccursinpatientsagedlessthan10years.Ithasclinicalsymptomssuchaspoornutritionalstatusdueto
mouthopeningormasticatorydisorders,severeinjuryofteethandperiodontaltissuesduetoinappropriateoral
hygiene,facialasymmetryoftheadjacentTMJ,dislocationofmandibleattheinjuredsite,thetoothmalalignement
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oftheinjuredsite,neuromuscularocclusion,shortnessofmandibluarramus,deepantegonialnotch,lossand
decreaseofthejointcapsule,andincreasedfracturedensityofthejointarea[10].Ifbilateralankylosisoftemporo
mandibularjointoccursatgrowthstage,aestheticdisordersuchasmicrognathiaandfacialasymmetrymayoccur
duetodecreasedmandibulargrowth(Fig.10).
Fig.10
An18yearoldmanwithmandibularankylosisatrightsideduetoprevious
facialtrauma

Growthdisorderandfacialasymmetry

Ithasbeenknownthatdecreasedmandibulargrowthoccursin20%to25%ofpatientswithmandibularcondyle
fracture.Thisgrowthdisorderhasbeenreportedtobeattributabletodirectcondylegrowthdisorderandsevere
functionaldisordercausedbytheadjacentmuscularstiffness,injuryofsofttissues,andscar.Inparticular,as
mandibularcondyle,whichisasecondarygrowthpointthatisaffectedbyexternalfactorssuchasperimandibular
growthandbiodynamicforce,hasspecialanatomicalstructuresandmanyfunctions,mandibularcondylefracture
maycausethegrowthdisorderoffracturesite.Inaddition,condylegrowthisprogressedoverthelongestperiod
amongotherpartsofthecraniofacial,atwhichmandibularasymmetryoccursduetolateralgrowth,traumaticand
neuronaldisorders.Asthemandiblesupportsthesofttissuesofthelowerface,changesinitspositionorshapeare
importantforfacialasymmetry.
Condyleresorption

Condylarresorption,aTMJ'snonfunctionalremodeling,isalsoknownascondylardissolution.Itisdefinedasa
statuswherecondyleshapechangeandsizedecreasegraduallyoccur[11].Despitethesuccessfulreductionof
condylefracture,excessivedissectionandinjuryoftheadjacentbloodvesselsduringthesurgerymaycause
condyleheadresorptionoveralongperiod.Asaresult,patientsmaycomplainoftheinstabilityofocclusionand
skeleton,TMJdysfunction,andpain,andfacialasymmetry,anterioropenbite,andmandibularsetbackmayoccur
[12].Forexample,Nam'smethod,whereosteotomyisconducedoncondylefractureatsubcondyleleveltopullout
thefragment,andthenputitbacktoitsoriginalpositionafterreduction,waspreviouslyusedasasurgerymethod
forcondylefracture.However,duetoresorptioncausedbypoorcondylarvascularization,itisnolongerused.
Nerveinjury

Variousopenreductionapproacheshavebeenusedtotreatmadibularfracture.Nerveinjurymayoccurduringflap
elevation,fracturereduction,andinsertionofametalplate[13,14].Axonotmesis,whichisamainnerveinjury,
causessensorylossfor4weeksormore.Ittakesapproximately4weekstorecoverfromneuropraxia.Inparticular,
aprecautionshouldbegivennottocausetheinjuryoffacialnervetemporalbranchduringpreauricularapproach.
Ifnerveinjuryisobservedafterthesurgery,steroidshouldbeimmediatelyadministeredtopreventtissueswelling,
therebyshorteningrecoverytimeandpreventingpermanentinjury.
Infection

Infectionshouldbepreventedbytheaccuratereductionofthedisplacedbonefragmentsattheearlystageof
mandibularfracture.Afterthesurgery,pulpvitalitytestofthefracturelineoradjacentteeth,andtheperiodontal
statusshouldbecarefullyfollowedup.Inaddition,anearlytreatmentisrequiredtominimizecomplicationscaused
byinfection.Manystudiesreportedthatinfectionoccurredin7%ofpatientswithmandibularfracture[15].In
addition,somestudiesreportedpreoperativeinfection,mostofwhichareassociatedwithdelayedearlytreatment
andtheteethpositionedonthefractureline.Postoperativeinfectionmayoccurbyvariousfactors.Inparticular,
bonesegmentinstability,patient'ssystemicstatus,fracturedegreeforeignmaterials,openwindow,and
preoperativeandpostoperativeoralhygienewithariskofcontaminationinthefracturesiteareimportantcausative
factors.Thus,infectionshouldbepreventedbytheaccuratereductionofthedisplacedbonefragmentsattheearly
stageofmandibularfracture.Afterthesurgery,pulpvitalitytestofthefracturelineoradjacentteeth,andthe
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periodontalstatusshouldbecarefullyfolloweduptominimizecomplicationcausedbyinfection.
CONCLUSIONS

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Thetreatmentofmandibularcondylefracturesdependsonthebiologiccharacterandadaptivecapabilityofthe
masticatorysystem.Thesewilldifferwidelyamongpatients,anditisthelackofsoundbiologyandadaptationthat
canleadtoanunfavorableoutcome.Thereforewemustunderstandthefunctionalmechanismofthemandible.
Furthermore,thesuccessfultreatmentofmandibularfracturesmaybeaccomplishedbyavarietyoftechniques
whenoneadherestosoundsurgicalprinciplesrelatedtothediagnosis,stablefixation,andrehabilitationofthe
patient.Therecoveryofpatient'spreinjuryocclusionandfunctionistheultimategoalwhentreatingfracturesof
themandible.Toobtainthisultimategoal,accuratediagnosis,appropriatereductionandrigidfixation,and
complicationpreventionarerequired.
Footnotes

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Thisarticlewasinvitedaspartofapanelpresentation,whichwasoneofthemosthighlyratedsessionsbyparticipants,atthe
69thCongressoftheKoreanSocietyofPlasticandReconstructiveSurgeonsonNovember11,2011inSeoul,Korea.
Nopotentialconflictofinterestrelevanttothisarticlewasreported.

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CurrentConceptsintheMandibularCondyleFractureManagementPartI:OverviewofCondylarFracture

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408272/

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