Page 126 - Open versus closed Mandibular condyle fractures
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INTRODUCTION
Chewing is of vital importance to humans. The physiological process of chewing food, together with several chemical processes, helps to break down large particles of food, reduces stress on the esophagus, and helps the stomach to metabolize food.1-3 Trauma to the oral cavity and the surrounding structures, such as the temporomandibular joint, could possibly compromise masticatory ability (e.g., by creating malocclusion, by reducing the mobility of the joints, or by creating chronic pain). Since the mandible is prone to external forces, due to its exposed position in the maxillofacial skeleton, mandibular fractures are one of the most common facial fractures (42% - 66%),4-6 with the condyle being involved in approximately 25% - 35% of mandibular fractures.7-9 From an anatomical perspective, the condyle can be divided in several fracture types. Numerous classification systems are published in recent literature. 10-14
How to optimally treat a fracture of the mandibular condyle is one of the most challenging controversies in maxillofacial trauma care. Studies examining the most appropriate treatment modality for condylar fractures are ongoing.15-17 Treatment options for fractures of the mandibular condyle consist of either closed treatment (i.e., a period of maxillomandibular fixation; MMF) or open treatment (i.e., open reduction with internal fixation; ORIF).18,19
Several studies have reported favorable clinical results with closed treatment of condylar fractures,17,20-22 whereas others have reported favorable results for open treatment.17-19,23 Some of these studies concluded that the closed approach should be regarded as the first choice of treatment for condylar fractures,17,20-22 based on the assumption that closed treatment methods are favorable in terms of the potential complications arising from surgical treatment. On the other hand, others have published different indications for open treatment.17-19,23
Historically, closed treatment was the treatment option of choice, with, in the majority of cases, satisfactory outcomes.24 Open treatment, on the other hand, has always been considered as a more challenging treatment procedure, mainly because of the complex anatomy, e.g., the facial nerve. Additionally, in the past, before the development of plate and screw fixation, open treatment consisted of an interosseous wire for stabilizing the fracture and a period of MMF for realizing an osseous union.
Mixing ability test
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