Vertical Ramus Osteotomy With Free Condylar Replantation for Adult High Condylar Fractures: A Midterm Retrospective Study

Background: Due to the complex anatomy and confined operative field, the surgical management of high-level condylar fractures is still a technical challenge for craniofacial surgeons, particularly those involving the intracapsular region and the condylar neck. Vertical ramus osteotomy (VRO) with free condylar replantation may improve exposure and allow precise reduction. However, evidence regarding its long-term efficacy and safety profile remains limited. Objective: This study aimed to evaluate the clinical outcomes and safety of VRO with free condylar replantation for the treatment of high condylar fractures in adults. Methods: A retrospective case series was conducted on 25 adults (16 males, 9 females; mean age: 29.8 y) with high condylar fractures (total 37 joints). All the patients underwent VRO and free condylar replantation between August 2010 and May 2018. Follow-up ranged from 2 to 4 years. Clinical assessments included maximal mouth opening (MMO), occlusal relationship, temporomandibular joint (TMJ) pain assessed by a visual analog scale (VAS), patient satisfaction (5-point Likert scale), and radiographic assessment of healing. Results: The incidence of postoperative malocclusion decreased from 100% (25/25) preoperatively to 12% (3/25) immediately after surgery. Immediate postoperative CT scans confirmed anatomic reduction in 86% (32/37) of the involved joints. Follow-up CT images demonstrated bony union in all cases. The mean TMJ pain VAS score improved significantly from 9 preoperatively to 1 at the 2-year follow-up. The mean MMO increased significantly from 19.24±2.24 mm preoperatively to 38.44±2.60 mm at 2 years postoperatively ( P <0.001). Temporary weakness of the marginal mandibular branch of the facial nerve occurred in 1 patient (4%), with complete resolution within 3 months. The mean patient satisfaction score was 4.6±0.5. Conclusion: For high condylar fractures in adults with significant displacement, VRO with free condylar replantation is a safe and effective surgery. It provides adequate exposure for anatomic reduction, which leads to favorable functional recovery and high patient satisfaction. Our study provides midterm evidence supporting the clinical application of this technique.