A Systematic Review on Controversies Related to Management of Condylar Fractures

Mini Review

J Dent App. 2015; 2(8): 287-290.

A Systematic Review on Controversies Related to Management of Condylar Fractures

Deshmukh S¹, Nayyar AS²*, Sabnis R¹, Panda A¹ and Bonde R¹

¹Department of Oral and Maxillofacial Surgery, Saraswati-Dhanwantari Dental College and Hospital and Post-Graduate Research Institute, India

²Department of Oral Medicine and Radiology, Saraswati- Dhanwantari Dental College and Hospital and Post- Graduate Research Institute, India

*Corresponding author: Abhishek Singh Nayyar, Department of Oral Medicine and Radiology, Saraswati- Dhanwantari Dental College and Hospital and Post- Graduate Research Institute, India

Received: May 30, 2015; Accepted: September 10, 2015; Published: September 12, 2015


In Maxillofacial Trauma, condylar fractures are the most common with a high incidence among the mandibular fractures. Management of the condylar fractures always remained a source of ongoing controversy in oral and maxillofacial trauma. Condylar fractures can be intracapsular or extracapsular, displaced, undisplaced, deviated or dislocated. There are various factors which have remained the deciding for the treatment indicated including presence of teeth, status of occlusion, unilateral or bilateral fracture, age of the patient, level and displacement of fracture, co-existence of other maxillary or mandibular fracture and other form of fractures which are difficult to recover functionally and aesthetically. Most of the researchers favor closed reduction with maxillomandibular fixation, but in the recent era, open reduction with internal fixation has become the most common. To overcome this problem, we are presenting this review to ascertain the main variables that determine the choice of treatment and to appraise the current evidence regarding the effectiveness of the treatment.

Keywords: Condylar fractures; Maxillofacial trauma


The incidence of mandibular fractures has a highest next to nasal fractures among facial bone fractures and approximately 30% involve the condyle [1]. The reason for high incidence of condylar fractures is attributable to binding of mandibular ramus with high stiffness and condylar head with low stiffness, due to the indirect force that is delivered to the condylar head [2]. There are several causative factors responsible for this; most common external factors being physical trauma, accident, fall, sports injury, gunshot wounds and industrial hazard while internal factors being, benign and malignant tumors, osteomyelitis and muscle spasms due to any reason. After the development of osteosynthesis materials, there has been an ongoing debate about the management of condylar fractures. There are two therapeutic approaches for management of condylar fractures: Functional (closed reduction) and Surgical (open reduction). In the past literature, closed reduction with concomitant active physical therapy after intermaxillary fixation during recovery period has been advisable. However, due to metastasis of fractured bone by muscle strength, inappropriate temporomandibular joint (TMJ) function, abnormal occlusion and disuse muscular atrophy, open reduction has overtaken attention. Many authors still recommend closed reduction because problems related to open reduction, nerve and blood vessel injury, scars, infections are over-ruled in the previously accepted method of treatment [3,4]. Decision in the management of condylar fractures is still controversial. So, we are presenting this systematic review to evaluate the main variables to determine the correct method for treatment of condylar fractures.


Klotch and Lundy [5] and Widmarket al [6] noted that closed reduction should be considered especially in situations such as elderly or pediatric patients or where there is difficulty in open reduction and in case of secured stable occlusion while open reduction is indicated if fractured mandibular condyle is severely displaced. Haug and Assael [7] showed that there was no statistically significant difference in occlusion status and complications between open and closed reduction. Differences were noted between groups for time since operation, scar perception and perception of pain. Ellis et al [8] reported that closed reduction is more advantageous than open reduction due to complications like intraoperative bleeding and postoperative infections, condylar growth disturbances, injury to auriculotemporal nerve and facial nerve paralysis. During this period, Brown and Jones [9] reported in their study that rigid fixation using miniplates did not require intermaxillary fixation. Tu and Tenhulzen [10] mentioned that screws and miniplates shortened period required for intermaxillary fixation and prevented disuse atrophy of masticatory muscles, thereby achieving early opening, in addition to the fact that postoperative complications were significantly reduced in this line of treatment. Ellis and Throckmorton [11] reported that those fractures which were treated by closed reduction had significantly shorter posterior facial and ramus heights on the side of injury and more tilting of occlusal and bigonial planes towards ipsilateral side than those treated by open reduction. Marker et al [12] recorded the results to find out there were any variables that were predictive of complications and concluded that closed reduction for management of condylar fractures is non-traumatic, safe and reliable and in only few cases, they were supposed to cause disturbances of function and malocclusion. With the objective of analyzing the main variables that determine the choice of method of treatment and outcome in condylar fractures, Villarreal et al [13] conducted a retrospective study to analyze and determine the relationship between the principal clinical variables and postoperative results. They analyzed the influence of preoperative variables, level of fracture, treatment, postoperative physical therapy, displacement and dislocation, comminution, loss of ramus height, age, gender, etiology, occlusion, dentition status, and presence of facial and mandibular fractures. The principal factors that determined the treatment decision were the level of fracture and degree of displacement. The functional improvement obtained by open methods was greater than that obtained by closed treatment. In the study conducted by Ellis et al [14] to compare the occlusal relationships after open and closed reductions for unilateral condylar fractures, the authors concluded that patients treated by closed reduction had a significantly greater percentage of malocclusion compared with those treated by open reduction, inspite of initial displacement of fractures greater in open reduction.

Mandibular condylar fractures are the most common facial fractures and there in enormous controversy in the management of it as mentioned in literature. Since Zide and Kent [15] (Table 1) reported the relative and absolute indications for condylar fractures in 1983, management became controversial and new approaches of surgical reduction and fixation were introduced and developed. In the same year, Mathes [16] (1983) (Table 2) mentioned that angulation between the fractured fragments, lateral override and lack of contact of fracture segments should be considered before open reduction and this was also suggested by Klotch and Lundy [5].