|
Condylar and subcondylar fractures constitute 26-49% of all mandible fractures. There are two principal treatments in these fractures: closed and open reduction. Closed reduction is adopted most frequently. However, there are many reports about the sequelae of closed reduction such as occlusal disruption, varying degree of nonunion and arthritic change, etc. There have been many papers describing advantages of the surgical treatments. In 1989, Ellis et al. reported a new technique for subcondylar fracture. In severe anteromedial fracture dislocations where the condylar head is not retrievable, they recommended a submandibular incision and a vertical ramus osteotomy followed by removal of osteotomized segment. After rigid fixation between the ramus and condylar head, the union was returned as a free bone graft, and the osteotomy site was plated. During their original procedure, however, there are possibility of injury to the inferior alverolar nerve because the distance from posterior cortex of ramus to the canal for nerve has been reported 12.1mm.In this study we modified the Ellis’ method to avoid injury to the nearby inferior alveolar nerve. Our method, slight oblique vertical osteotomy of ramus from the sigmoid notch to 1 cm above from the gonion and short horizontal osteotomy, was applied to treat most cases where there are indications for open reduction, contrary to the original indication. Six patients were treated using our method. After 3 months follow-up, the maximal mouth opening showed 39.3cm, protrusion 5.6, lateral deviation 14.3(homolateral side), and 12.2(contralateral side). The occlusal states became good without openbite and crossbite. In this study, we could have satisfactory results from our modified procedure applying to most cases where closed reduction cannot be used or cannot guarantee restoration of TMJ integrity.
|