الفهرس 
Diagram shows average of condylar dimension in sagittal and transverse planeOnly 14 pages are availabe for public view
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Abstract
Suitable management of the fractured mandibular condyle is among the most controversial issues in maxillofacial trauma, creating a wide variety of opinions and proposed treatment modalities. Ideally, treatment of condylar fractures must realize main aims: anatomic correction of the segments, restoration of joint function, consolidation of the bony fragments, restoration of the preoperative occlusion, mouth opening and facial symmetry. The debate between the supporters of either open or closed reduction is still continuing and the issue has not been resolved, not a consensus reached. While the advocates of nonsurgical management rely on the remodeling ability of the TMJ and targeted exercise therapy to reach the pre-traumatic situation. The proponents of surgery list the main arguments for surgical approach, which include re-establishing the exact anatomical reduction to achieve the favorable conditions required for optimal restoration of function, to allow primary healing of unreducible or unstable fractures, to avoid MMF with a good possibility of quick restoration of functional activity, maintenance of face symmetry and less long-term TMJ malfunction For this purpose, this study was carried out on twelve patients with displaced low subcondylar mandibular fractures were collected from department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tanta University. Open reduction and internal fixation was utilized to treat those fractures using rhombic 3D plate. The evaluation of patients was done: (1) Clinically: one week, two weeks, three weeks, one month, three months and six months postoperatively. Evaluation was included: maximal mouth opening, mandibular movements, clicking and tenderness of TMJ, chewing and occlusion. (2) Radio graphically: panorama and coronal C.T. postoperatively. Evaluation was included: vertical height of the ramus and anteroposterior condylar angulation. The results of this study were: (1) The mean distance of maximal active interincisal opening six months postoperatively was 43.67 mm (range 38 to 48mm). (2) The range of lateral protrusive movement postoperatively was 10.54 mm to the fractured side and 10.57 mm to contralateral side, without differences between the contralateral and homolateral side. (3) In our study no cases reported postoperative tenderness, clicking or crepitation at opening and closing movements daily or sporadically from the TMJ on the operated side, also at the opposite side. (4) In our study, none of our cases with facial nerve injury, salivary fistula or Frey’s syndrome were observed. (5) Radiographic measurements showed that restoration of the original vertical ramus length and the position of the condyle were evident. The average of reduction of the vertical height of the mandibular ramus of less than 1 mm was calculated. The conclusion from the results of this study: - Open reduction and rigid internal fixation with three-dimensional stability is absolutely necessary for any sub condylar fractures for early functional rehabilitation. - Open reduction and internal fixation for condylar fractures with rhombic 3d plate gives good functional and radiological results with good patient satisfaction. - Using the new rhombic 3d plate for condylar neck fractures has 3 main advantages: i) neutralization of changing strains at the anterior, lateral, and posterior borders; ii) the additional stabilization provided by a compression miniplate; and iii) a small osteosynthesis plate. - The using of retro mandibular approach is associated with very low morbidity, sufficient exposure of the fracture site and good cosmetic results.