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

Mandibular subcondylar fracturesMandibular 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 fracturesMandibular condyle fractures are due to indirect traumaFacial 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 systemsMandibular condyle fracturesclassification systems have been proposed. However, the most commonly used classification divides the mandibular condyle into three areas: (1) condylar headCondylar head, (2) condylar neckCondylar neck, and (3) subcondyle. Condylar head fracturesCondylar head fractures are located at the level of the temporomandibular joint (TMJ) capsuleTemporomandibular joint (TMJ) capsule (i.e., intracapsular or diacapitular). Condylar neck fracturesCondylar neck fractures extend from the TMJ capsule superiorly to the level of the sigmoid notch inferiorly. Subcondylar fracturesSubcondylar fractures are below the sigmoid notch. Appropriate treatment of a mandibular condyle fracture re-establishes pre-injury occlusionMandibular condyle fracturepre-injury occlusion, vertical facial heightMandibular condyle fracturevertical facial height, speechMandibular condyle fracturespeech, and masticationMandibular condyle fracturemastication. There are various treatment approaches: (1) soft dietMandibular condyle fracturesoft diet, (2) closed reduction (CR) with maxillomandibular fixationMandibular condyle fractureclosed reduction (CR) with maxillomandibular fixation (MMF), and/or (3) open reduction and internal fixation (ORIF).Open reduction and internal fixation (ORIF). The purpose of this chapter is to review pearls and pitfalls for ORIF of mandibular condyle/ subcondylar fracturesMandibular condyle fractureORIF of mandibular condyle/ subcondylar fractures.