Facial symmetry after closed and open treatment of fractures of the mandibular condylar process.

PURPOSE: This study compares vertical measures of mandibular and facial morphology after open or closed treatment for fractures of the mandibular condylar process.

PATIENTS AND METHODS: One hundred forty-six patients (121 male, 25 female), 81 treated by closed and 65 by open methods, were included in this study. Towne's and panoramic radiographs, taken at several intervals, were used to quantify the displacement of the condylar process fractures. Posteroanterior cephalograms taken at 6 weeks, 6 months, 1 year, and 2 to 3 years after treatment were used to assess posterior facial height and bigonial and occlusal plane angles. Additionally, panoramic radiographs were used to assess ramus height at the same periods. Standard statistical methods were used to assess differences between groups.

RESULTS: Patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods. Most of the asymmetry in patients treated by closed methods was present by 6 weeks after injury.

CONCLUSIONS: Patients treated by closed methods develop asymmetries characterized by shortening of the face on the side of injury. It is likely that loss of posterior facial height on the side of fracture in these patients is an adaptation that helps reestablish a new temporomandibular articulation.