Evidence-Based Medicine ; Humans ; Practice Patterns, Dentists'

Dentists ; Dissent and Disputes ; Humans ; Malpractice ; Practice Patterns, Dentists' ; Professional Competence

OBJECTIVETo determine the current consensus in the management of condylar fractures among Chinese senior oral and maxillofacial (OM) surgeons and the difference between domestic and international.

METHODSForty-six senior OM surgeons, who were considered to be expert in management of maxillofacial trauma, were invited to participate in this investigation. A questionnaire was designed to appraise management strategies of surgical and non-surgical treatment on the 18 fractures of condylar process of mandible, which varied in fracture patterns, the degree of fragment displacement, uni-and bi-lateral involved and the age range of patients. The consensus was analyzed and then compared with the current international practice based on Baker's survey.

RESULTSThree fracture situations obtained a uniform opinion, 9 situations had tendency in the alternative of surgical and non-surgical approach, 6 situations had no preference. Of 18 fractures, 8 were advised to receive an open procedure in management of the condylar fracture compared with 4 which was considered to be in a close procedure. Others were obscure in the preference of treatment decision. Consensus was achieved in non-surgical treatment for the patients younger than 12 years in age, and the teenager patients were considered for an open treatment when fracture occurred at the base of condyle and the fragment located out of fossa. It was controversial over the treatment of sagittal or comminuted fracture and subcondylar fracture with slight displacement in the adults. The panel of surgeons admitted a practice that bilateral subcondylar dislocated fractures were indicated for open reduction and internal fixation. If the similar case occurred on the unilateral joint, most of the Chinese surgeon preferred a surgical intervention which was adverse opinion from international.

CONCLUSIONSIn regard to the decision of surgical and non-surgical treatment for condylar fracture of the mandible, much controversy remained in one third of the investigated cases. The shared opinion was that the children patients should be treated by the closed methods for the condylar fracture and the bilateral subcondylar dislocated fractures were identically indicated for surgical reduction. The domestic OM surgeons seem to have a more tendency to surgery compared with their international counterparts.

Adolescent ; Adult ; Age Factors ; Attitude of Health Personnel ; Child ; Consensus ; Humans ; Mandibular Condyle ; diagnostic imaging ; injuries ; surgery ; Mandibular Fractures ; classification ; diagnostic imaging ; pathology ; surgery ; therapy ; Practice Patterns, Dentists' ; statistics & numerical data ; Surgeons ; Surveys and Questionnaires ; Tomography, X-Ray Computed ; Young Adult