Effect of Smoking on the Healing of a Mandibular Condyle Fracture

Kun Hwang, MD, PhD

Disclosures

ePlasty. 2021;21:e3 

In This Article

Case

A 64-year-old man lost consciousness and fell on the ground while working in a warm workplace. Upon falling down, he hit his chin on the floor.

Upon examination, he had malocclusion and open bite bilaterally. The mouth opening was 1.5-finger breadths. He had a 40 pack-year smoking history. Radiology revealed a bilateral condylar fracture and a fracture of the parasymphysis (Figure 1a).

Figure 1.

Panoramic view of the patient. (a) Bilateral condylar fracture and fracture of the parasymphysis. (b) Intermaxillary fixation was done using a skeletal anchorage system on the first PTD. (c) On PTD 3, vertical ramus osteotomy, miniplate fixation of the fractured condylar neck, and free grafting were performed. (d) The wire was changed to a rubber band at 5 weeks postoperatively. (e) At 7 weeks postoperatively, some absorption of the condylar head was observed. (f) At 3 months postoperatively, a distorted condylar head and malunion were observed. (g) At 4 months postoperatively, the condylar head was distorted and malunion was aggravated. (h) At 5 months postoperatively, the condylar head was distorted and malunion was similar at 4 months postoperatively. PTD indicates post-trauma day.

Intermaxillary fixation was done using a skeletal anchorage system (SAS) on the first post-trauma day (Figure 1b), which made it difficult for him to smoke.

On the third post-trauma day, vertical ramus osteotomy, miniplate fixation of the fractured condylar neck, and free grafting were performed (Figures 1c and 2). Defect was filled with tricalcium phosphate or Ca3(PO4)2 (Polybone; Kyungwon Medical Co, Cheongju-si, Korea). His course in the hospital was uneventful, and he was discharged on the seventh postoperative day.

Figure 2.

Intraoperative photographs. Vertical ramus osteotomy, miniplate fixation of the fractured condylar neck (top, middle), and free grafting (bottom) were performed. The defect was filled with tricalcium phosphate.

When the wire was changed to a rubber band at 5 weeks postoperatively (Figure 1d), he started smoking (a half-pack a day) against the medical advice. Starting at 6 weeks postoperatively, the rubber band was applied only at night.

At 7 weeks postoperatively, the SAS was removed but some absorption of the condylar head was observed in panoramic imaging (Figure 1e).

At 3 months postoperatively, his mouth opening was 24 mm and he showed no malocclusion. However, the condylar head was distorted and malunion was observed in a panoramic view (Figure 1f).

At 4 months postoperatively, his mouth opening was 30 mm and he showed no malocclusion, but he complained of pain on mouth opening. The condylar head was distorted and malunion was aggravated in a panoramic view (Figure 1g).

At 5 and 7 months postoperatively, his mouth opening was 30 mm and he showed no malocclusion; his pain on mouth opening continued but was endurable. He continued smoking (a half-pack a day) since 5 weeks postoperatively. At 5 months, the condylar head was distorted and malunion was similar in a panoramic view to the findings at 4 months postoperatively (Figure 1h).

The principles outlined in the Declaration of Helsinki were followed in this study.

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