We present the first long-term data of osteosynthesis of condylar head fractures using 1.7 mm small fragment screws via a retroauricular approach. Functional and anatomic parameters regarding loss of vertical height, condylar and disk mobility were obtained. In addition indices of Helkimo and RDC/TMD, the incidence of stenosis of the external auditory canal, facial nerve function and sensitivity of the skin and scars of the retroauricular approach were assessed. 26 patients were examined in a first follow up trial (FFT) one year postoperatively. The second follow up trial (SFT) comprised 22 patients of the latter group and took place after 5–6 years. A second reference collective was used as a control that mainly underwent osteosynthesis by mini- or microplates (MMP) from 1993 to 2000. Beside no subjective complains fractured condyles treated with small fragment screw based osteosynthesis (SSBO) resulted in a higher range of motion ( p < 0.05) of the Upper Joint Space (UJS) during mouth opening and protrusion compared to the mini and microplates (MMP) collective. The medium range of movement of the Lower Joint Space (LJS) resulted in a significant higher level of median values in the SSBO than in the MMP ( p < 0.05). In addition no difference was found in the mobility of the UJS in-between FC and NFC of the SSBO, due to the mobility of the articular disc and the condyle during protrusion. These results were long-term stable for the FFT and SFT ( p < 0.05) without side effects. Due to better stability, less invasivity and therefore reduced articular scarification SSBO showed clearly superior functional and anatomic long-term results compared to MMP. The retroauricular approach to the condylar head is the approach of choice according to our results of the evaluation of the retroauricular scars and the unrestricted motor function of the facial nerve.
Long-term results of open reduction of condylar head fractures of the mandible: 5 years follow up of small fragment screw based osteosynthesis
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