Page 167 - Open versus closed Mandibular condyle fractures
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Chapter 6.1
Chapter 3 focuses on the open treatment modality.
In chapter 3.1, the systematic review on open treatment provides an overview of the studies published exclusively on open treatment and summarizes the existing open treatment modalities and their clinical outcomes. Seventy studies were selected for detailed analysis. Most studies reported good results with regard to outcome measures. Surgical complications including hematoma, wound infection, weakness of the facial nerve, sialocele, salivary fistula, sensory disturbance of the great auricular nerve, unsatisfactory scarring, and fixation failure were reported. This review suggests a high level of methodologic variance in the relevant studies published to date, such that no evidence-based conclusions or guidelines can be formulated with regard to the most appropriate open treatment at present. Establishment of such standards could potentially improve treatment outcomes.
Chapter 3.2 focuses on the approach used in the open treatment modality and provides an overview of the complications of extraoral approaches to condylar fractures. Given the diversity in fractures, approaches, and surgical techniques, it is difficult to objectively compare the surgical techniques used for condylar fractures and their complications. The literature suggests that there is no preference in terms of the skin incision but that a transparotid approach is advocated.
Chapter 4 discusses the ‘open versus closed’ controversy.
The outcomes of a cross-sectional study are presented. The outcomes of the treatment of condylar fractures according to responses on the MFIQ for (subjective) self-reported mandibular function, the Diagnostic Criteria for Temporomandibular Disorders for TMD complaints and jaw dysfunction (chapter 4.1), mixing ability test for masticatory performance (chapter 4.2), and cone beam computed tomography scans (chapter 4.3) were used to compare the open and closed treatment modalities. In total, 74 of 171 patients participated in this study. The mean MFIQ score was 10.70 (standard error 2.9) in the open group and 4.96 (standard error 1.3) in the closed group (P = 0.013), and thus an outcome in favor of the closed treatment group. Examination according to the Diagnostic Criteria for Temporomandibular Disorders did not reveal a significant prevalence of TMD complaints. The correlation between objective masticatory performance and self- reported mandibular function was positive (r = 0.250; P = 0.033).
  



























































































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