Surgical Management Of Mandibular Subcondylar Fractures Under Local Anaesthesia - A Proposed Protocol

Publication date: Available online 14 January 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Debraj Howlader, Hari Ram, Shadab Mohammad, Vibha singh, Dr Jagdish Gamit, Dr Rubin S John

Abstract

Introduction

The optimal treatment for adult mandibular condylar fractures (MCFs) has largely shifted in favour of open reduction and rigid internal fixation (ORIF). However a sizeable portion of these injuries are still being treated closed based on old literature, convenience, "acceptable" results, and lesser associated morbidity.

Most MCFs with multiple associated facial trauma are appropriately treated under general anaesthesia(GA). However, some selected isolated MCFs or ones with minimal associated mandibular or low mid-facial fractures can be treated optimally under local anaesthesia(LA) following a protocol presented here, thus expediting and simplifying their management.

Purpose

To develop a safe sound and effective protocol for routine surgical management of mandibular subcondylar fractures under local anaesthesia.

Patients and methods

The investigators carried out a prospective clinical study to assess the feasibility of operating mandibular condylar fractures under local anaesthesia. 7 patients with MCFs and other associated facial fractures were operated after careful case selection following a protocol proposed by the authors. The outcome variables were 1. Duration of procedure 2. Intraoperative pain assessed by the visual analogue scale(VAS). 3. Fracture reduction assessed by measuring pre-op and post op average fracture gap 'G' 4. Presence of malocclusion pre and post-operatively 5. Deviation on mouth opening 6. Maximal mouth opening

Results

The mean duration of procedure was 35.14 min and mean intra-op pain/discomfort as reported by patient was 0.57 on the VAS. The mean mouth opening improved from 17.1 to 40.5mm while deviation on opening improved from 4.4 to 0.28mm. The average fracture gap was reduced from 6.32 to 0.97mm.

Conclusion

The protocol presented is a simple, efficient, safe and cost effective tool for operating mandibular condylar fractures, avoiding GA with its attendant risks and complications which can be used routinely and also for patients unfit for GA.

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