Bilateral fracture of the mandibular condyle: a challenge in surgical management

Abstract

Fractures of the mandibular condyles are one of the facial traumas that cause the most impact on patients. They represent a therapeutic challenge and require adequate surgical planning because they involve an area rich in noble structures. The treatment aims to restore the patient's occlusion and mandibular movements. Objective: The aim of this paper is to describe the surgical management of a complex fracture of the mandible involving the symphysis and condyles bilaterally. Case Report: Female patient, a victim of a motorcycle accident, was admitted to the public reference service in CTBMF presenting occlusal dystopia, trismus, and sinking in the pre-auricular region. A facial tomography was requested, which showed a bilateral fracture of the mandibular condyle and symphysis. After stabilization of the general condition, the patient was released for osteosynthesis of the mandibular fractures. The procedure was performed under general anesthesia and nasal intubation. Proceeded with retromandibular accesses for reduction and fixation of the mandibular condyles and intraoral access for osteosynthesis of the fracture of the symphysis. The patient evolved without complications, with a good mouth opening, and without sequelae of the trauma both in the aesthetic and functional scope. Condyle fractures are challenging due to their unique anatomy, presenting several muscular, neurovascular, and cartilaginous structures that result in complex biomechanics. Conclusion: Open reduction with stable functional fixation with plates and screws is very well indicated for the treatment of low fractures of the mandibular condyles, being imperative for an adequate anatomical reduction and three-dimensional condylar repositioning.