I think, it allways depends on the clinic. If the patient shows bite irregularties and surgically reduceable fragments, it can besufficient to operate. If the lateral pole of the condyle remains in the fossa, you would usually not find any bite problems. In these cases conservative therapy can be sufficient.

Condylar fracture treatment has always been controversial. If feasible, they must be treated by ORIF. If there is no occlusal derangement, loss of vertical height or  splaying of the mandible, they may be treated without ORIF. But in bilateral cases, this is less likely and often they'd need ORIF. When there are other fractures in the mandible as it happens often, they will need to be treated by ORIF to stabilize and maintain the arch continuity during functional therapy (jaw physiotherapy). Condyle may be managed without ORIF. Open reduction without internal fixation with Intermaxillary fixation (IMF) for about 1 week may also be done after which functional therapy may be started. In bilateral fractures, ORIF of atleast one of the condyles has also been reported in literature. Treatment with IMF alone in bilateral cases often results in open bite after removal of IMF in few days. Use of elastics to guide into occlusion may be required. Repeated follow up and patient monitoring is required to achieve complete functional stabilization in cases treated without ORIF and may take upto even a year for achieving full range of mandibular motion and for adaptation of the condyles.

While planning treatment in such cases, pptimal functional and esthetic rehabilitation is of paramound importance without increasing the long term morbidity in these patients.

Regards,

Akilesh Ramasamy

The only indication of not doing ORIF is badly comminuted fragments, otherwise it should be fixed surgically as much as possible.

In my opinions all displaced condylar fractures except high condylar ,should be reduced and fixed to give early function in adults , whether unilateral or bilateral , it has given good results in terms of patient satisfaction (no disability of chewing) and no nerve damage in my experience . I feel chances of nerve damage Is more in high condylar fracture , and prefer to do conservative treatment even in bilateral high condylar fractures,  though literature says at least one has to be reduced to ramal height , I have not seen reduction of ramal height in my case .

So as i understand, the general consensus is to operate. Please do share your preferred incision & experience with endoscopic reduction on condyle. Did in couple of cases, not very happy as it  doesn't help in reduction much.

Hi prateek , for all condylar fractures ,retromandibular incision was used ,and many of the times transparotid , few times anteroparotid approaches , only few times encountered branches of favial nerve and well protected ,gives good access for reduction and fixation of neck and low condylar fractures .

Good to hear that you are doing endoscopic approach ,pl share some details

It's also depends from the level of soft tissues damage.