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Functional and Radiologic Outcome of Open Reduction and Internal Fixation of Condylar Head and Neck Fractures Using Miniplate or Microplate System

Xie, Si-Tian MD*; Singhal, Dhruv MD; Chen, Chien-Tzung MD; Chen, Yu-Ray MD

Annals of Plastic Surgery:
doi: 10.1097/SAP.0000000000000040
Clinical Papers
Abstract

Background: Although the appropriate management of condylar process fractures after miniplate or microplate fixation has been described, there has been no comparative analysis of these plating systems.

Methods: A retrospective review of patients who underwent open reduction and internal fixation (ORIF) of condylar head or neck fractures at our institution from January 2000 through August 2010 identified 70 patients. Of these, 38 were treated with microplates and 32 with miniplates. The primary functional and radiographic results were the maximal mouth opening and condylar bone resorption, respectively. The rates of complications, including malocclusion, chin deviation, temporomandibular joint complaints, and facial nerve palsy, were recorded.

Results: The maximal mouth opening was larger in the microplate group than in the miniplate group throughout the follow-up period; this difference was statistically significant 12 (P = 0.020), 18 (P = 0.026), and 24 (P = 0.032) months after ORIF. Similarly, the radiographic scores for bone resorption and condyle morphology were significantly better in the microplate group than in the miniplate group throughout the follow-up period [6 (P = 0.011), 12 (P = 0.035), 24 (P = 0.026), and 48 (P = 0.040) months after ORIF]. Moreover, patients who underwent miniplate fixation experienced a significantly higher incidence of temporomandibular joint click than those who underwent microplate fixation (P = 0.014).

Conclusions: Microplates limit dissection, providing excellent fixation for intracapsular condylar head fractures, and also provide adequate rigidity for fixation of condylar neck fractures. Microplate fixation of condylar head and neck fractures yielded excellent functional and radiographic results. The rates of complications after microplate fixation were equal to or less than those in the miniplate group. Prospective studies are needed to confirm these findings.

Author Information

From the *Department of Plastic and Burn Surgery, Cleft Lip and Palate Treatment Center, the Second Affiliated Hospital of Shantou University Medical Collage, Shantou, Guang Dong, China; †Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; and ‡Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Craniofacial Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China.

Received October 1, 2013, and accepted for publication, after revision, October 6, 2013.

Conflicts of interest and sources of funding: none declared.

Dr Si-Tian Xie was responsible for data collection, data analysis, concept review, and manuscript preparation; Dr Dhruv Singhal, data analysis, concept review, and manuscript preparation; and Dr Chien-Tzung Chen and Dr Yu-Ray Chen, concept design, data analysis, and editor of manuscript.

Reprints: Chien-Tzung Chen, MD, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung, 222 Maijin Rd, Keelung 20401, Taiwan, Republic of China. E-mail: ctchenap@cgmh.org.tw.

© 2013 by Lippincott Williams & Wilkins