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d. Condyle

All condylar fractures can be treated closed with MMF and/or with

functional therapy using immediate function with elastics.

Open access may be external, transoral, or transoral endoscopic-

assisted ORIF. The endoscopic-assisted technique is similar in

fixation, but requires a learning curve for fragment manipulation and

one and two plate reduction strategies.

Open techniques may require facial nerve protection using a facial

nerve stimulator, or monitoring before induction of muscle relaxants

during general anesthesia.

Two techniques for plating are a single 2.0 mandibular plate with two

screws on each side of the fracture, or two miniplates in triangular

fashion, one below the sigmoid notch and one along the posterior

border.

Reduction and manipulation of the fracture are best accomplished

with a mobile jaw.

e. Additional Considerations

i. Locking versus Nonlocking Plates

Tightening screws on a malformed nonlocking plate will draw the bone

segments toward the plate, which may affect the occlusion. Locking

plates do not do this. They also preserve cortical bone perfusion and are

unlikely to loosen from the plate.

ii. Comminuted Fractures

Reduce the main fragments by fixing them into occlusion with MMF.

Then using miniplates, realign the comminuted fragments to establish

bony continuity before placing the reconstruction plate if indicated.

Figure 5.15

Insufficient fixation of a

mandibular fracture can

result in fixation failure,

infection, malocclusion,

and nonunion. Lack of a

tension band here allows

muscle pull and occlusal

forces to open the site.