Page 73 - Open versus closed Mandibular condyle fractures
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Chapter 3.1 Open
Of patients who were dissatisfied with their scar, 58.5% underwent a retromandibular approach, 22.6% a pre-auricular approach, 5.7% a submandibular approach, a minority underwent a peri-angular approach, and one patient had an anterior parotid approach. The rhytidectomy (or facelift approach) produced no unsatisfactory results.
No clear difference was found between fixation failure in the studies published recently and the studies published in earlier years. While one would expect that the hardware has developed over the years, some studies pointed out that one miniplate is not stable and that two miniplates,66 or at least a 2.0 mm-plate81 should be used.
As mentioned earlier, the potential advantages of an open treatment are restoration of correct anatomical position and a shorter duration of MMF, which would lead to immediate mobilization and more efficient functioning of the joint.7-9
Strikingly, MMF was used in the majority of studies involving open treatment, although it could be argued that the main advantage of open treatment is that MMF should not be needed, and mobilization of the jaw could be initiated straight after surgery. Additional treatment in the form of MMF was described in 65.3% of the studies; MMF was applied routinely after surgery in 26.4% of the studies, MMF was only applied in cases of malocclusion in 22.2%, no MMF was used in 16.7%, and was not described in 34.7%. If MMF was used, the duration varied from 3 days to a maximum of 4 weeks.
Additional treatments, such as physiotherapy, were poorly described. Most studies recommended a soft diet for 3 to 6 weeks and mouth opening exercises or physiotherapy after open reduction. However, it is not clear in the reports what these treatments constituted and what their potential or actually achieved benefits were.
  



























































































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