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Botulinum Toxin in Closed Treatment of Mandibular Condylar Fracture

Canter, Halil Ibrahim MD*; Kayikcioglu, Aycan MD*; Aksu, Muge DDS, PhD; Mavili, Mehmet Emin MD*

doi: 10.1097/
Original Article

Background: The topic of condylar injury in adults has generated more discussion and controversy than any other in the field of maxillofacial trauma. The treatment of condylar fractures in adults is still a highly debated theme.

Methods: Patients with unilateral subcondylar or condylar neck fractures of the mandibula without any significant angulation of the condylar head were managed with closed-treatment protocol. Closed treatment was applied through the injection of 100 units of botulinum toxin A, diluted to a concentration of 20 IU/mL, into the muscles of mastication of the fractured side. Masseter and anterior fibers of temporalis muscles were reached through percutaneous extraoral route and 30 IU of the toxin was injected to each muscle. Additional 40 IU of the toxin was injected around the fractured bone fragments through transmucosal intraoral route to paralyze medial and lateral pterygoid muscles as much as possible. An asymmetric occlusal splint was applied for maxillomandibular fixation to restore the vertical height for 10 days. Functional therapy with intermaxillary guiding elastics was advocated for 2 months.

Results: There were no complications related to either toxin injections or splint application procedures. The toxin was effective on all occasions. Fractured condylar process and ramus of the mandibula were in good approximation and remained in reduced positions. None of the patients had any occlusal disturbance, mandibular asymmetry, or joint dysfunction in the follow-up period.

Conclusions: We believe that modification of treatment options concerning the clinical situation of the patients is the best method for condylar injury. The purpose of this study is to present and discuss the results achieved in closed treatment of a selected group of patients with mandibular condylar fractures to whom botulinum toxin A was injected to relieve the spasm of muscles of mastication, along with special splint application.

Ten unilateral subcondylar or condyle neck fractures were satisfactorily reduced with the assistance of 100 IU of botulinum toxin A injected into all 4 masticatory muscles, followed by 10 days in IMF with an asymmetric occlusal splint.

From the *Hacettepe University, Faculty of Medicine, Department of Plastic and Reconstructive Surgery, and †Faculty of Dentistry, Department of Orthodontics, Ankara, Turkey.

Received April 26, 2006, and accepted for publication, after revision, August 12, 2006.

Authors have no financial interest in any product mentioned in the study.

Reprints: Halil Ibrahim Canter, MD, Providence Hospital, Craniofacial Institute, 16001 W 9 Mile Rd, Third Floor Fisher Center, MI 48075. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.