Abstract and Introduction
Abstract
Background: We experienced a case of malunion of condylar fracture after miniplate fixation in a patient with a 40 pack-year smoking history who restarted smoking at 5 weeks postoperatively.
Case: A 64-year-old man lost consciousness and fell down, hitting his chin on the floor. 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. Intermaxillary fixation was done using the skeletal anchorage system on the first post-trauma day. On the third post-trauma day, vertical ramus osteotomy, miniplate fixation of the fractured condylar neck, and free grafting were performed. When the wire was changed to a rubber band at 5 weeks postoperatively, he started smoking (half-pack a day). At 7 weeks postoperatively, the skeletal anchorage system was removed and some absorption of the condylar head was observed. At 3 months postoperatively, his mouth opening was 24 mm and no malocclusion was present, although the condylar head was distorted and malunion was observed. At 4 months postoperatively, his mouth opening was 30 mm but he complained of pain on do so. Distortion of the condylar head was aggravated. At 5 months postoperatively, his pain continued but was endurable. He continued smoking (half-pack a day) since 5 weeks postoperatively.
Conclusion: In smokers, a longer period of immobilization is needed in bone grafting of the 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.
Introduction
Nicotine negatively impacts bone healing.[1] In mandibular angle fractures, active smoking has a significant effect on the major complication rate (odds ratio = 4.04; P = .04).[2]
In high condylar fractures, we have used vertical ramus osteotomy, miniplate fixation of the fractured condylar neck, and free grafting.[3] Usually, smoking is strictly restricted from the time of the injury to 1 month postoperatively.
We experienced a case of malunion of a condylar fracture after miniplate fixation in a patient with a 40 pack-year smoking history who restarted smoking at 5 weeks postoperatively.