Kotlarz Payton N, Park You Jeong, William Iii West, Schwartz Adam, Durham Devon, Su Rachel, Wainwright D'Arcy J, Payne Wyatt G, Troy Jared S
Department of Plastic Surgery, University of South Florida, Tampa, FL.
Division of Plastic & Reconstructive Surgery, Zucker School of Medicine at Hofstra, Northwell, Hempstead, NY.
J Craniofac Surg. 2025 May 5. doi: 10.1097/SCS.0000000000011405.
Management of mandibular condylar and subcondylar fractures is heavily debated due to the proximity of important structures and complication risks. This study reviews the outcomes of 4 different treatment approaches: conservative, closed reduction with maxillomandibular fixation, open reduction and internal fixation, and open reduction and internal fixation with maxillomandibular fixation. A retrospective chart review of all patients with a facial fracture seen at a level one trauma center between 2012 and 2022 was performed. Demographics, fracture etiology, fracture type, treating team (plastic surgery versus otolaryngology), surgical approach and intervention, and complications were collected. Most condylar and subcondylar fractures were treated with closed reduction (60 of 103 condylar fractures, 58.25%, and 117 of 168 subcondylar fractures, 69.64%) followed by conservative management (36 of 103 condylar fractures, 34.95%, and 18 of 168 subcondylar fractures 10.71%), open reduction and internal fixation (without maxillomandibular fixation) (4 of 103 condylar fractures, 3.88%, and 16 of 168 subcondylar fractures, 9.52%, respectively), and open reduction and internal fixation with maxillomandibular fixation (3 of 103 condylar fractures, 2.91%, and 17 of 168 subcondylar fractures, 10.12%). Compared with condylar fractures, more subcondylar fractures were treated with open reduction and internal fixation (P<0.001), which led to an increased incidence of postoperative complications (P<0.001). Our findings demonstrate that closed reduction is the most common management of condylar and subcondylar fractures. Future directions include ideal timing for operative management and long-term follow-up for temporomandibular joint complications in closed reduction patients.
由于重要结构的临近性和并发症风险，下颌髁突和髁突下骨折的治疗存在激烈争论。本研究回顾了4种不同治疗方法的结果：保守治疗、颌间固定闭合复位、切开复位内固定以及切开复位内固定联合颌间固定。对2012年至2022年期间在一级创伤中心就诊的所有面部骨折患者进行了回顾性病历审查。收集了人口统计学资料、骨折病因、骨折类型、治疗团队（整形外科与耳鼻喉科）、手术方法和干预措施以及并发症情况。大多数髁突和髁突下骨折采用闭合复位治疗（103例髁突骨折中的60例，占58.25%；168例髁突下骨折中的117例，占69.64%），其次是保守治疗（103例髁突骨折中的36例，占34.95%；168例髁突下骨折中的18例，占10.71%）、切开复位内固定（不联合颌间固定）（103例髁突骨折中的4例，占3.88%；168例髁突下骨折中的16例，分别占9.52%）以及切开复位内固定联合颌间固定（103例髁突骨折中的3例，占2.91%；168例髁突下骨折中的17例，占10.12%）。与髁突骨折相比，更多的髁突下骨折采用切开复位内固定治疗（P<0.001），这导致术后并发症发生率增加（P<0.001）。我们的研究结果表明，闭合复位是髁突和髁突下骨折最常见的治疗方法。未来的方向包括手术治疗的理想时机以及对闭合复位患者颞下颌关节并发症的长期随访。
