Advances in open reduction and internal fixation of multiple mandibular fractures with condylar involvement

Multiple mandibular fractures with condylar involvement are challenging to treat. This paper aims to present a series of steps to simplify the treatment and improve the outcomes in open reduction and internal fixation of multiple mandibular fractures with condylar involvement. The authors reviewed the developments in their practice in treating the above injuries. As a result, four new elements were identified: three-dimensional printing, model surgery, Kirschner wires to manipulate the segments in condylar fractures, and a top-to-bottom sequence. The above algorithm has contributed to streamlining the procedure and improving the outcomes of these challenging fractures. For the same operator, reduction and osteosynthesis require approximately 40 min. less than before the adoption of the new protocol. So far, the authors did not encounter suboptimal reductions or situations where the screws were too long and therefore had to be exchanged for shorter ones in revision surgery.