Management of Adult Condylar and Subcondylar Mandibular Fractures in a Level 1 Trauma Center

Management of mandibular condylar and subcondylar fractures is heavily debated due to the proximity of important structures and complication risks. This study reviews the outcomes of 4 different treatment approaches: conservative, closed reduction with maxillomandibular fixation, open reduction and internal fixation, and open reduction and internal fixation with maxillomandibular fixation. A retrospective chart review of all patients with a facial fracture seen at a level one trauma center between 2012 and 2022 was performed. Demographics, fracture etiology, fracture type, treating team (plastic surgery versus otolaryngology), surgical approach and intervention, and complications were collected. Most condylar and subcondylar fractures were treated with closed reduction (60 of 103 condylar fractures, 58.25%, and 117 of 168 subcondylar fractures, 69.64%) followed by conservative management (36 of 103 condylar fractures, 34.95%, and 18 of 168 subcondylar fractures 10.71%), open reduction and internal fixation (without maxillomandibular fixation) (4 of 103 condylar fractures, 3.88%, and 16 of 168 subcondylar fractures, 9.52%, respectively), and open reduction and internal fixation with maxillomandibular fixation (3 of 103 condylar fractures, 2.91%, and 17 of 168 subcondylar fractures, 10.12%). Compared with condylar fractures, more subcondylar fractures were treated with open reduction and internal fixation (P<0.001), which led to an increased incidence of postoperative complications (P<0.001). Our findings demonstrate that closed reduction is the most common management of condylar and subcondylar fractures. Future directions include ideal timing for operative management and long-term follow-up for temporomandibular joint complications in closed reduction patients.