Primary surgery of subcondylar mandibular fracture using patient-specific implant: the Helsinki protocol.

Purpose: Preoperative virtual planning and osteosynthesis with patient-specific implants (PSIs) have become a quotidian approach to many maxillofacial elective surgery setups. When a process is well-organized, a similar approach can be harnessed to serve the needs of exact primary reconstructions, especially in midfacial trauma cases. PSI osteosynthesis of the mandible is, however, more challenging because a mirror technique of the facial sides is often unreliable due to inherent lack of symmetry, and movement of the mandible increases the risk of loosening of the osteosynthesis. The purpose of this study was to present clinical results of the Helsinki protocol concept of utilizing PSIs in the primary surgery of unilateral mandibular subcondylar fractures as the first publication on the subject.

Methods: A single-center study of a new Helsinki protocol is presented for surgical treatment of subcondylar mandibular fractures using patient-specific, titanium-milled repositator plates. Ten patients with dislocated subcondylar mandibular fractures received surgery and osteosynthesis with PSI via a retromandibular approach.

Results: Clinical and radiological outcomes were excellent; none of the patients had fixation-related major complications or developed postoperative malocclusion.

Conclusions: Study results show that the Helsinki protocol, treating mandibular condylar fractures primarily with PSI plates, is a viable treatment option.