[New aspects for indications of surgical management of intra-articular and high temporomandibular dislocation fractures].

Conservative treatment of TMJ condylar fractures (groups V and VI according to Spiessl and Schroll 1972) often shows poor clinical results. This follow-up study was designed to objectify the benefits of an operative procedure by electronic computer-assisted recording of condylar movements. Sixty-three individuals with a total of 77 condylar fractures (42 diacapitular fractures, 35 high condylar process fractures) underwent surgery over a preauricular approach. Osteosynthesis was performed according to the intraoperative site either by PDS pins, titanium lag screws, microplates, miniplates or a combination of these materials. Radiological controls showed a considerable loss of height of the condylar process in the diacapitular group of fractures affecting the lateral condylar pole (n = 20). Condylar deformations in these cases were similar to the high condylar process group, whereas diacapitular fractures not affecting the lateral condylar pole (n = 22) had better radiological results. Axiographic tracings of TMJ movements in all groups as well as clinical functional analysis demonstrated highly satisfactory functional results within physiological limits. Compared to data referring to individuals treated conservatively, far fewer irregularities of axiographic tracings were observed in this group. Limitations of condylar movements nevertheless were found frequently in the high condylar process group (35%). As a severe complication, permanent facial nerve palsies occurred in six individuls due to the preauricular approach employed. After a modification using a temporal extension, only one minor partial lesion occurred in 97 operations.