An adult has a displaced unilateral condylar-neck fracture, persistent malocclusion and ramus shortening despite an attempted closed reduction. What is the best management principle?
Persistent functional derangement and loss of ramus height after failed closed management favour anatomical reduction, balanced against facial-nerve and vascular risks of the chosen approach.
A. Repeat closed reduction and maintain rigid maxillomandibular fixation for six weeks: Further prolonged immobilisation risks ankylosis and is unlikely to restore persistent ramus shortening after failed reduction.
B. Open reduction and internal fixation when safe access can restore height and occlusion: Persistent functional derangement and loss of ramus height after failed closed management favour anatomical reduction, balanced against facial-nerve and vascular risks of the chosen approach.
C. Perform coronoidectomy alone to improve mouth opening: This does not reduce the condylar fracture or correct occlusal height.
D. Use physiotherapy alone despite persistent ramus shortening: Early mobilisation is important in selected closed treatment, but it cannot anatomically correct this failed reduction.
E. Replace the temporomandibular joint acutely: Primary prosthetic replacement is disproportionate for a reconstructable acute condylar-neck fracture.
If occlusion were reproducible, height preserved and displacement minimal, short closed treatment with early mobilisation could be preferable.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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