Extracorporeal Fixation and Re-Implantation for High Condylar Split Fractures: The Motamed Technique

BACKGROUND: Management of high sagittal split fractures of the mandibular condyle remains a formidable surgical challenge due to limited visualization, technical difficulties with direct in situ fixation, and the high risk of secondary avascular necrosis or temporomandibular joint (TMJ) ankylosis. OBJECTIVES: To evaluate the clinical outcomes and technical efficacy of the "Motamed Technique," a standardized protocol involving extracorporeal rigid internal fixation followed by anatomic re-implantation for complex high condylar split fractures. METHODS: A retrospective evaluation was conducted on a clinical series of 11 consecutive patients (9 males and 2 females) presenting with severe, displaced high sagittal split condylar fractures secondary to high-velocity trauma. In all cases, the fragmented condylar segments were completely retrieved, stabilized ex vivo on a back table using a titanium X-shaped 3D mini-plate system (1.5 mm), and meticulously reimplanted into the glenoid fossa. Total cold ischemia time was strictly maintained between 10 and 20 minutes. The postoperative longitudinal follow-up period ranged from 6 to 11 months (mean duration: 8.6 mo). Comprehensive postoperative tracking included clinical parameter checking, 3D Computed Tomography (3D-CT), and high-resolution dynamic Magnetic Resonance Imaging (MRI) to analyze bony union, vertical ramus height restoration, and articular disc kinetics. RESULTS: All 11 patients achieved predictable and stable functional outcomes. At the definitive milestones, the mean maximum mouth opening (MMO) was 37.3 mm (range: 33-45 mm), demonstrating excellent vertical clearance and stable lateral/protrusive excursions. Pretraumatic stable centric occlusion was perfectly restored and maintained in 100% of cases (n=11), with zero incidence of postoperative open bite or crossbite. Facial nerve motor function was entirely preserved across the cohort (100% House-Brackmann grade I at final follow-up). Longitudinal 3D-CT scans confirmed complete osseous union and anatomic alignment in all cases by the fourth postoperative month, with no radiographic evidence of condylar head resorption or hardware failure. Follow-up MRI findings demonstrated preservation of TMJ dynamics, functional articular disc movement (with stable reduction in 3 cases), and the complete absence of avascular necrosis or intra-articular effusion. No cases of TMJ ankylosis were reported. CONCLUSION: The Motamed Technique provides a reliable, reproducible, and biologically sound approach for managing intricate high condylar split fractures. By utilizing systematic extracorporeal mini-fixation, this protocol effectively overcomes intraoperative spatial limitations while ensuring excellent long-term anatomic stability, stable occlusion, and functional joint mobility without compromising facial nerve integrity.