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rev port estomatol med dent cir maxilofac . 2018;59(1):44-48 45

Tratamento não-cirúrgico de fratura bilateral de côndilo mandibular:
Seis anos de acompanhamento

r e s u m o

Palavras-chave: O côndilo mandibular é a área mais frequentemente afetada em fraturas mandibulares. O
Tratamento conservador tratamento destas fraturas pode ser não cirúrgico, através da redução fechada, ou por redu-
Côndilo mandibular ção aberta e fixação com mini-placas e parafusos. Este estudo relata o tratamento selecio-
Fratura mandibular nado para uma paciente com três fraturas mandibulares, sendo uma fratura em região de
sínfise mandibular e as outras fraturas nas regiões subcondilares bilateralmente após trauma
facial. A fratura de sínfise foi tratada com redução aberta e osteossíntese. Já as fraturas sub-
condilares foram tratadas pelo método não-cirúrgico. (Rev Port Estomatol Med Dent Cir Ma-
xilofac. 2018;59(1):44-48)
© 2018 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Publicado por SPEMD. Este é um artigo Open Access sob uma licença CC BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

the condyle and condylar process on the left side, both medi-
Introduction
ally displaced (Figures 1 and 2).
The mandibular condyle (MC) is the area most frequently af- Initially, the symphyseal fracture was temporarily stabi-
1
fected by mandibular fractures. The most common etiologies lized by tooth synthesis. After five days, transoperative inter-
of this type of fracture are interpersonal violence, accidents maxillary fixation (IMF) and surgical reduction and fixation of
with motor vehicles and falls. Frequently, one of the most af- the symphyseal fracture were performed with miniplates and
fected bones in facial trauma is the mandible, and 25-40% of
mandibular fractures involve the condyle. 2
Malocclusion, open bite, swelling, tenderness over the
joint, loss of mandibular function, deviation of the chin, cre-
pitus and laceration of the skin of the chin are clinical signs of
this type of fracture. 3
The treatment of mandibular condylar fractures depends
on their extension, which may be unilateral or bilateral, the
level of the fracture (condylar head, condylar neck or subcon-
dylar fractures) and the degree of displacement . The treat-
3
ment of these fractures may be conservative, with closed re-
duction, or with open reduction and fixation with miniplates
and screws. Some complications may occur after open reduc-
tion, such as paresthesia or paralysis of the facial nerve, infec-
tions, dysfunction of the auriculotemporal nerve, Frey syndro-
4
me and unsightly scars. On the other hand, the conservative Figure 1. Panoramic radiograph exhibiting mandibular
symphyseal fracture and bilateral mandibular condyle fracture.
or non-surgical treatment usually does not lead to such com-
plications and has been effectively performed with good func-
tional and esthetic outcomes. 5
The aim of this study is to report the treatment selected
for a patient affected by three mandibular fractures: two bila-
teral subcondylar fractures and a symphyseal fracture.

Case Report

The patient was a victim of a motorcycle accident and pre-
sented with polytrauma affecting the face. Clinical examina-
tion revealed a contused lacerated wound on the chin area, Figure 2. Coronal computerized tomography
bilateral preauricular edema, bone crepitation, and preserva- demonstrating a subcondylar fracture on the right side
tion of mandibular movements yet limited by pain. Image ex- with a 90º displacement in the medial direction and a
ams exhibited a mandibular fracture on the chin area, a sub- sagittal fracture of the condyle and condylar process on
the left side, in the medial direction.
condylar fracture on the right side and a sagittal fracture of