Effect of Smoking on the Healing of a Mandibular Condyle Fracture

Kun Hwang, MD, PhD


ePlasty. 2021;21:e3 

In This Article


Our method (vertical ramus osteotomy, miniplate fixation of the fractured condylar neck, and free grafting) is a type of osteotomy-osteosynthesis, as described by previous authors.[4–6]

When totally removing the fractured condyle and placing some hydroxyapatite between the bony gaps, the following 2 things occur: remove it from its blood supply, and prevent revascularization once replaced.

Debates continue regarding the effect of smoking on dental implants. Lindfors et al[7] described the effect of smoking on guided bone regeneration with an autogenous bone graft and concluded that smoking was associated with poor treatment outcomes. Shibli et al[8] evaluated the effect of smoking on bone-to-implant contact and observed no osseointegration in 3 of 11 smokers. They insisted that smoking has a detrimental effect on the early bone tissue response around oxidized implant surfaces.

On the contrary, Chambrone et al,[9] in their meta-analysis reported that the detrimental effect of smoking was not confirmed when only prospective data were assessed. Peleg et al[10] analyzed the survival rates of sinus floor augmentation with simultaneous implant placement and stated that there were no statistically significant differences in implant failure rates between smokers and nonsmokers.

In the present case, we observed that the condylar head was in the glenoid fossa until 5 weeks postoperatively (the nonsmoking period), but 2 weeks after the patient started to smoke, the grafted condylar head started to be absorbed (Figure 3). It is thought that 5 weeks is inadequate in situations where the bones have not been devascularized by removing them from the fossa or capsule.

Figure 3.

Smoking history and hospital course. First row: Time, yr: year, m: month. Second row: Smoking. Third row: Treatment (Tx), IMF: intermaxillary fixation, Op: operation, SAS: skeletal anchorage system. Forth row: x-ray findings, Fx: fracture.

Since smoking decreases the alveolar oxygen pressure and subcutaneous wound-tissue oxygen, and nicotine causes vasoconstriction, smokers are more likely to experience flap loss, hematoma, or fat necrosis than nonsmokers (a phenomenon known as smoking flap).[11] As with flap surgery, in smokers, a longer period of immobilization is needed in bone grafting of a fractured condylar head. Longer immobilization provides sufficient time for healing and prevents smoking, since the patient cannot smoke easily when the intermaxillary fixation is applied.