Page 114 - Open versus closed Mandibular condyle fractures
P. 114

122
Chapter 4.1 Open versus Closed
Treatment
The treatment protocol followed, was that described in a previous study by the present investigator group.9
In short, closed treatment was divided into expectative and conservative treatment. An expectative treatment policy was applied if the patients could bring their teeth into an (almost) normal occlusion or had normal mandibular excursions. These patients were recommended to follow a strict soft diet. They were instructed on active but careful movements of the jaw (without loading it) and prescribed sufficient pain medication. Thorough follow-up was provided, with the first appointment after 5 to 7 days.
Conservative treatment was given in the case of a persistent or developing malocclusion, with an open bite of more than 2 mm. Conservative treatment consisted of a short period of MMF, using brackets, MMF screws, or arch bars, including the use of guiding elastics for three weeks. The MMF only ensured correct occlusion, but never induced total immobilization. Patients were advised to follow a strict soft diet, to engage in active but careful movements of the jaw, and were provided sufficient pain medication.
If necessary, after this 3-week period of MMF on guiding elastics, the occlusion was further guided using loose elastics up until 6 weeks, and active physiotherapy consisting of exercises and guided closure was started.
Follow-up appointments after the first contact were scheduled at 5 to 7 days, 3 weeks, 6 weeks, and 12 weeks. If the patient had recovered well, follow-up was ended. If symptoms such as an open bite, limited mouth opening, or pain persisted, the follow-up was extended to 6 months or even 1 year.
In case of severe malocclusion, uncontrolled pain, or poor patient compliance, open treatment was considered. Open treatment was performed via a pre- auricular skin incision and a transparotid approach. In general, the protocol included no postoperative MMF; the patients were advised to maintain a strict soft diet, were given instructions on active but careful movement of the jaw, and were prescribed sufficient pain medication. Follow-up appointments after the first contact were scheduled at 5 to 7 days, 3 weeks, 6 weeks, and 12 weeks. If the patient had recovered well, follow-up was ended.
  

























































































   112   113   114   115   116