Delayed Re-Osteotomy and Open Reduction of a Medially Displaced Condylar Neck Fracture Following Failed Conservative Treatment

Objectives
To present the surgical management and functional outcome of a delayed, medially displaced mandibular condylar neck fracture following unsuccessful conservative treatment.

Materials and Methods
A 58-year-old male sustained direct trauma to the right temporomandibular joint region during a physical assault, resulting in a right condylar neck fracture with medial displacement confirmed by cone-beam computed tomography. Initial management consisted of one month of intermaxillary fixation due to refusal of surgical intervention. Persistent malocclusion with premature occlusal contact and deviation to the left side remained unresolved. Four months after trauma, open reduction and internal fixation were performed via a retromandibular extraoral incision using a transparotid approach. Intraoperatively, partial bony union was observed, and controlled re-osteotomy was performed to mobilize the proximal fragment and allow anatomical repositioning. Stable fixation was achieved using two titanium miniplates and eight monocortical screws under intraoperative intermaxillary fixation guidance. Postoperative intermaxillary fixation was maintained for two weeks.

Results
Postoperative panoramic radiography and cone-beam computed tomography demonstrated anatomical reduction with restoration of ramus height and stable fixation. Clinical examination confirmed intact facial nerve function, including preserved marginal mandibular branch activity. No salivary fistula, infection, wound dehiscence, or hardware-related complications were observed. At six-month follow-up, occlusion remained stable without deviation. No temporomandibular joint pain, joint sounds, or functional limitation were detected.

Conclusion
Delayed surgical management of medially displaced condylar neck fractures presents technical challenges due to partial union. Controlled re-osteotomy combined with a retromandibular transparotid approach enables safe exposure, stable fixation, preservation of facial nerve function, and predictable functional recovery when conservative treatment fails.