Page 84 - Open versus closed Mandibular condyle fractures

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Chapter 3.2 Open
METHODS
A systematic literature search (April 29, 2016) was performed on PubMed (all indexed years), Medline (all indexed years), and Embase (all indexed years), using multiple search terms. The search excluded case reports with 10 or fewer subjects and studies in which stainless steel wires were used for osteosynthesis. Furthermore, studies published on endoscopic or transoral approaches were excluded. Despite their advantages, i.e., no scarring (if no transcutaneous trocars are used) and no crossing of the facial nerve,18,19 it has been found that these intra- and transoral approaches are technically demanding, especially for fractures at higher levels or with medial dislocation of the proximal fragment.18,20,21 Therefore, in most cases, the intraoral approach is too difficult for most surgeons for both reduction of fractures and fixation. Some authors indicate that the intraoral approach can only be used in selected cases of low subcondylar fractures, and that this approach requires special instruments, additional training, and a longer operative duration.3,22-24
Only reports in English, German, or Dutch were considered. Prospective and retrospective human clinical studies that reported data relating to open treatment for unilateral fractures of the mandibular condyle, and the outcome of that treatment, were included. Our study was conducted using the data of a systematic review on open treatment of condylar fractures by the same authors.6 In our study, concerning solely the outcome of the approaches, we did include the bilateral fractures that were also described in the included studies.
First, two authors (RB and AR) screened the titles and abstracts of the retrieved articles for potential relevance. Second, full articles were retrieved and relevant articles were designated for inclusion. Disagreement was resolved via discussion with a third person (LD). The included articles were critically appraised by a checklist with key criteria (Table 1).25