Open reduction and internal fixation in temporomandibular joint traumatology: current concepts and future perspectives

Since the turn of the century a paradigm shift has challenged the centuries old tradition of non-surgical treatment for condylar fractures. The advent of functionally stable osteosynthesis introduced into condylar traumatology in the 1980ies step by step widened out the indications for surgical treatment, paralleled also by improvement in computerized tomography diagnostics and more recently by continuous refinement of indication-specific osteosynthesis materials, with three-dimensional-plates for the condylar base and neck and resorbable materials for the condylar head being the latest developments. Over the last decades, a series of new approaches was introduced, too, to cope with the specific demands for open reduction and rigid internal fixation (ORIF) in the different fracture locations, which according to the recent consensus based Arbeitsgemeinschaft für Osteosynthese comprehensive injury automatic classifier (AOCOIAC) classification are now defined as fractures of the condylar base, condylar neck and condylar head. By now even fractures of the condylar head, treated surgically by Rasse already in 1992, have moved into the focus of surgical interest and ORIF by now is far from being “experimental”, as dubbed only a decade ago. According to recent consensus (International Bone Research Association, 2012) and based on improved evidence, ORIF may now be considered as the golden standard for both displaced or dislocated condylar base and neck fractures in adults. Endoscopic approaches should be considered for base fractures with lateral displacement. Meanwhile, there is a growing tendency to perform ORIF in condylar head fractures and severely displaced or dislocated fractures in younger children with mixed dentition