Strut plate for fractures of the mandibular condylar process

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Strut plate for fractures of the mandibular condylar process

Carl-Peter Cornelius

Fig 1: Strut Plate

Recent innovation in fracture management of the condylar process has witnessed the development of the Strut Plate (Fig 1). Consisting of a framework of slender beams with an overall conical molding, this three-dimensional structure provides exceptional resistance to lateral bending stresses and supports the condylar process fragments most efficiently. The terrace like plate hole arrangement at the top of the plate facilitates placement into the midneck region, since it coincides with the natural backward angulation of the condylar process. The plate placement zone moves best parallel to the posterior border of the ascending ramus thus precluding any interference with the mandibular foramen or canal.

The Strut Plate comes in a left and right version and is commonly applied via an external approach. A transoral use is conditional on the rare prerequisite that the condyle bearing fragment is stable upon reduction.

Details
Clinical Cases
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Case provided by Carl-Peter Cornelius, Munich, Germany

An 84-year-old female patient with a triple fracture in the edentulous atrophic mandible (Luhr Class II): displaced condylar based fractures bilaterally in combination with a fracture in the anterior body on the right. Prosthetic restoration with full dentures.

Fig 1 Preoperative 3-D CT scans:

a) Frontal view. Right anterior body fracture associated with slight widening of the mandibular arch.
b) Dorsal view. Shortening of both rami due to lateral override displacement and medial angulation of both condylar bearing fragments, partial medial dislocation out of the fossa of the right condylar head.
c) Right lateral view. Lateral override of posteriorly displaced condyle bearing fragment and decreased ramus height.
d) Left lateral view. Lateral override position and posteromedial angulation of condyle bearing fragment.

Fig 1 Preoperative 3-D CT scans

Fig 2:

e) Intraoperative situation. Reduced condyle bearing fragments fixed with strut plates via retromandibular transparotid approaches.

f) Intraoperative situation, showing the mandible after fracture reduction and right paramedian plate osteosynthesis.

g) Intraoperative situation. Reduced condyle bearing fragments fixed with strut plates via retromandibular transparotid approaches.

h) Intraoperative situation. Reestablished occlusion, with full dentures in place.

Fig 2

Fig 3: Postoperative panoramic x-ray

Fig 3

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