10-year functional adaptation following condylar neck fracture associated with bilateral sagittal split osteotomy
Case Report
DOI:
https://doi.org/10.29166/od.v28i1.9832Keywords:
Orthognathic Surgery, Sagittal Split Ramus Osteotomy, Mandibular Condyle, Condylar Fracture, Facial AsymmetryAbstract
Bilateral sagittal split osteotomy is one of the most commonly performed orthognathic procedures for the correction of dentomaxillofacial deformities. Although generally predictable, intraoperative complications such as undesirable fractures may compromise postoperative outcomes. This case report describes a late-diagnosed unresolved condylar neck fracture following mandibular orthognathic surgery, with a 10-year clinical evolution. A 38-year-old male presented with progressive facial asymmetry characterized by mandibular deviation to the right side, without pain or functional limitation. Clinical examination and computed tomography showed that the right condylar head was not located within the glenoid fossa and appeared displaced anteromedially, consistent with a condylar neck fracture involving the proximal segment. Despite the lack of early postoperative imaging and surgical correction, the patient demonstrated long-term functional adaptation, with preserved mandibular range of motion, stable occlusion, and no signs of temporomandibular joint ankylosis. Conservative management with periodic follow-up was selected because there was no pain, functional impairment, occlusal instability, or progressive deterioration. Reports describing the long-term clinical evolution of untreated condylar fractures following orthognathic surgery remain scarce. This case suggests that functional adaptation may occur in selected asymptomatic patients despite marked structural alteration. However, conservative management should not be considered a standard approach and should be reserved for carefully selected cases under close clinical monitoring.
Downloads
References
1. Naran S, Steinbacher DM, Taylor JA. Current concepts in orthognathic surgery. Plastic & Reconstructive Surgery. 2018 Jun;141(6). doi:10.1097/prs.0000000000004438
2. Monson L. Bilateral sagittal split osteotomy. Seminars in Plastic Surgery. 2013 Oct 22;27(03):145–8. doi:10.1055/s-0033-1357111
3. Steenen SA, Becking AG. Bad splits in bilateral sagittal split osteotomy: Systematic Review of Fracture Patterns. International Journal of Oral and Maxillofacial Surgery. 2016 Jul;45(7):887–97. doi:10.1016/j.ijom.2016.02.001
4. Zaroni FM, Cavalcante RC, João da Costa D, Kluppel LE, Scariot R, Rebellato NL. Complications associated with orthognathic surgery: A retrospective study of 485 cases. Journal of Cranio-Maxillofacial Surgery. 2019 Dec;47(12):1855–60. doi:10.1016/j.jcms.2019.11.012
5. Robl MT, Farrell BB, Tucker MR. Complications in orthognathic surgery. Oral and Maxillofacial Surgery Clinics of North America. 2014 Nov;26(4):599–609. doi:10.1016/j.coms.2014.08.008
6. Jiang N, Wang M, Bi R, Wu G, Zhu S, Liu Y. Risk factors for bad splits during sagittal split ramus osteotomy: A retrospective study of 964 cases. British Journal of Oral and Maxillofacial Surgery. 2021 Jul;59(6):678–82. doi:10.1016/j.bjoms.2020.08.107
7. Seifert LB, Langhans C, Berdan Y, Zorn S, Klos M, Landes C, et al. Comparison of two surgical techniques (Hoo vs. BSSO) for mandibular osteotomies in orthognathic surgery—a 10-year retrospective study. Oral and Maxillofacial Surgery. 2022 May 20;27(2):341–51. doi:10.1007/s10006-022-01073-y
8. Telha W, Abotaleb B, Zhang J, Bi R, Zhu S, Jiang N. Correlation between mandibular anatomy and bad split occurrence during bilateral sagittal split osteotomy: A three-dimensional study. Clinical Oral Investigations. 2022 Aug 11;27(3):1035–42. doi:10.1007/s00784-022-04665-w
9. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. The care guidelines: Consensus-based Clinical case report guideline development. Journal of Clinical Epidemiology. 2014 Jan;67(1):46–51. doi:10.1016/j.jclinepi.2013.08.003
10. Falter B, Schepers S, Vrielinck L, Lambrichts I, Thijs H, Politis C. Occurrence of bad splits during sagittal split osteotomy. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010 Oct;110(4):430–5. doi:10.1016/j.tripleo.2010.02.003
11. Mensink G, Verweij JP, Frank MD, Eelco Bergsma J, Richard van Merkesteyn JP. Bad split during bilateral sagittal split osteotomy of the mandible with separators: A retrospective study of 427 patients. British Journal of Oral and Maxillofacial Surgery. 2013 Sept;51(6):525–9. doi:10.1016/j.bjoms.2012.10.009
12. Verweij JP, Houppermans PNWJ, Gooris P, Mensink G, van Merkesteyn JPR. Risk factors for common complications associated with bilateral sagittal split osteotomy: A literature review and meta-analysis. Journal of Cranio-Maxillofacial Surgery. 2016 Sept;44(9):1170–80. doi:10.1016/j.jcms.2016.04.023
13. Steenen SA, van Wijk AJ, Becking AG. Bad splits in bilateral sagittal split osteotomy: Systematic Review and meta-analysis of reported risk factors. International Journal of Oral and Maxillofacial Surgery. 2016 Aug;45(8):971–9. doi:10.1016/j.ijom.2016.02.011
14. Kim Y-K. Complications associated with orthognathic surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2017;43(1):3. doi:10.5125/jkaoms.2017.43.1.3
15. Lindahl L, Hollender L. Condylar fractures of the mandible. International Journal of Oral Surgery. 1977 Jun;6(3):153–65. doi:10.1016/s0300-9785(77)80048-3
16. Talwar RM, Ellis E, Throckmorton GS. Adaptations of the masticatory system after bilateral fractures of the mandibular condylar process. Journal of Oral and Maxillofacial Surgery. 1998 Apr;56(4):430–9. doi:10.1016/s0278-2391(98)90707-8
17. Al-Moraissi EA, Ellis E. Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: A systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2015 Mar;73(3):482–93. doi:10.1016/j.joms.2014.09.027
18. Chrcanovic BR. Surgical versus non-surgical treatment of mandibular condylar fractures: A meta-analysis. International Journal of Oral and Maxillofacial Surgery. 2015 Feb;44(2):158–79. doi:10.1016/j.ijom.2014.09.024
19. Merlet F-L, Grimaud F, Pace R, Mercier J-M, Poisson M, Pare A, et al. Outcomes of functional treatment versus open reduction and internal fixation of condylar mandibular fracture with articular impact: A retrospective study of 83 adults. Journal of Stomatology, Oral and Maxillofacial Surgery. 2018 Feb;119(1):8–15. doi:10.1016/j.jormas.2017.10.007
20. Minervini G, Franco R, Marrapodi MM, Di Blasio M, Isola G, Cicciù M. Conservative treatment of temporomandibular joint condylar fractures: A systematic review conducted according to prisma guidelines and the Cochrane Handbook for Systematic Reviews of interventions. Journal of Oral Rehabilitation. 2023 May 24;50(9):886–93. doi:10.1111/joor.13497
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Renata Alejandra Avecillas Rodas, Santiago Reinoso Quezada
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
