Page 36 - Open versus closed Mandibular condyle fractures
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Closed treatment of unilateral mandibular condyle fractures in adults
In conclusion, based on the literature studied in this review, a treatment protocol with respect to closed treatment is proposed, as outlined below. This treatment protocol will be used in a prospective trial implemented in the authors’ institution.
First, for patients who are able to bring their teeth into normal occlusion or almost normal occlusion (open bite with a maximum of 2 mm on the non-fractured side) and/or who have normal mandibular excursions, expectative treatment should be recommended. In cases of expectative treatment, patients should be advised to adhere strictly to a soft diet, they should be given instructions regarding active but careful movement of the jaw, and they should be prescribed adequate pain medication. In the authors’ department, a non-steroidal anti-inflammatory drug (600 mg ibuprofen three times a day) with a stomach protector (omeprazole 20 mg a day) in combination with paracetamol (maximum 2000 mg per day) is used for two weeks. The use of a patient brochure describing exercises to practice at home is also suggested. The patient should be advised to mobilize the jaw but not load it.
Furthermore, thorough follow-up should be provided, with the first appointment after 5 to 7 days. If there is a change to an open bite, or a persistent open bite, then either orthodontic brackets or MMF screws should be applied; if these are not applicable, arch bars with guiding elastics should be applied for 3 weeks.
Second, in cases of malocclusion with an open bite of more than 2 mm on the non-fractured side, conservative treatment consisting of a short period of MMF should be advised. The MMF should include guiding elastics fixed on brackets or MMF screws, or arch bars if these are not available; this should be done for a duration of 3 weeks so that early mobilization can be achieved. The MMF should put the patient into a correct occlusion, but should never induce total immobilization. Rigid fixation with stainless steel wires or elastics should not be used, otherwise degeneration of the TMJ by immobilization and ultimately fibrous or bony ankyloses can occur.
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