Open reduction and internal fixation of condylar fracture through intraoral approach-technique and clinical results

다국어 초록 (Multilingual Abstract)

The methods of management ofr condylar fractures have been investigated and improved for several decades. The methods which have been used up to date are classified broadly into conservative and surgical treatment.
Conservative treatment is planned to restore normal function through intermaxillary fixation and early exercises of mandibular movement. It is chosen in the cases of children s or growing adolescent s fractures and adult s intracapsular or high condylar fracture. Although long term results proved conservative treatment to be satisfactory, it is impossible to restore the preexisting anatomic relation and it may cause dysfunction or limitation of mandibular movement. So surgical intervention has been advocated for various types of condylar fracture. Until now, most surgical treatments have been undertaken by the following methods such as preauricular or Risdon approach, Nam s method, and lag screw fixation method. All of them are through an extraoral approach, which can cause complications such as facial nerve injury, external scar, and resorption or necrosis of bone fragments. In order to overcome these complications, we attempted an intraoral approach.
In this article, the technique and the clinical results of an intraoral approach are presented.
We treated 5 patients having subcondylar (4) and low condylar neck (1) fractures with the use of an intraoral approach from May, 1993 to February, 1995. After 3 to 12 months follow-up, we could draw the following conclusions.
1. An intraoral approach has advantages over an extraoral approach ; No facial nerve damage, no facial scar, and the decrease of possibility of necrotic bone change.
2. The 5 patients treated in this technique had a stable occlusion state and all of them had no functional disturbance such as limitation of opening, protrusive and laterotrusive movements. Protrusive and opening deviation was not also noted.
3. Because the intraoral approach has some limitation in gaining enough visibility, it is better to use this method in cases of which fracture line is present below the condylar neck.