D126. Management of Adult Condylar and Subcondylar Mandibular Fractures in a Level 1 Trauma Center

PURPOSE: Management of mandibular condylar and subcondylar fractures is heavily debated due to the proximity of important structures and complication risks. This study reviews the outcomes of four different treatment approaches: conservative, closed reduction (CR) with maxillomandibular fixation (MMF), open reduction with internal fixation (ORIF), and ORIF+MMF. METHODS: Retrospective chart review of 238 adult patients with 271 condylar and/or subcondylar fractures was performed. Demographics, fracture etiology, fracture type, treating team (plastic surgery versus otolaryngology), surgical approach and intervention, and complications were collected. Statistical analysis included descriptive statistics, and categorical variables were analyzed using Pearson's χ2 test and Fisher's exact test. RESULTS: Most condylar and subcondylar fractures were treated with CR (65.3%) followed by conservative management (19.9%), ORIF (7.4%), and ORIF+MMF (7.4%). Subcondylar fractures were more likely to be treated with ORIF (p<0.001) and to develop postoperative complications (p<0.001); complication rates increased with fracture displacement (p=0.007) and with extraoral ORIF (p=0.006), when compared to condylar fractures. Among both subcondylar and condylar fractures, extraoral ORIF was more likely to have postoperative complications (p=0.030). In subcondylar fractures, plastic surgery was more likely than otolaryngology to treat displaced fractures (p=0.016) and perform extraoral ORIF (p=0.028). Complication rates did not differ between treating teams. CONCLUSION: Our findings demonstrate that CR is the most common management of condylar and subcondylar fractures. Complications were significantly increased with subcondylar fractures and extraoral ORIF management; follow-up time was limited. Future directions include ideal timing for operative management and long-term follow-up for temporomandibular joint complications in CR patients.