Page 10 - Open versus closed Mandibular condyle fractures

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Chapter 1
Rigid plate and screw fixation dates back to 1886 when the first plate and screw system was developed by the German surgeon Carl Hansmann. Because of the high rate of complications, the system was not generally accepted. It took until 1968 when Hans-Georg Luhr developed the first compression plate for use in the maxillofacial area. Introduction of biocompatible implant materials and development of plating systems with adequate dimensions for use in different areas of the complex facial skeleton, led to a development of osteosynthesis material that was perfected for use in cranio-maxillofacial surgery.21 Use of plate fixation permitted open reduction and stable internal fixation of fractures of the mandibular condyle without the need for postoperative maxillomandibular fixation (MMF), which made early functional rehabilitation possible.
• Closed treatment
Closed treatment may be conservative or expectative. Conservative treatment normally consists of a period of MMF and it is thought that immobilization will maintain and/or reestablish normal occlusion and relieve post-traumatic pain.22 In contrast, expectative treatment does not involve immobilization and merely entails active mobilization with strict follow-up.23 Recent studies have generally investigated whether a mandibular condyle fracture should be treated using an open or closed method and have not focused on the outcomes of the different closed treatment procedures available.24,25 Given the wide variation in the definitions of closed treatment, further elucidation of closed treatment is required, particularly in regard to postoperative treatment strategies such as MMF, the fixation method used, and use of physiotherapy.
Chapter 2.1 focuses on closed treatment of unilateral mandibular condyle fractures in adults. Possible complications of closed treatment include malocclusion, particularly an open bite, diminished posterior facial height, facial asymmetry, chronic pain, and reduced mobility.14,26
Chapter 2.2 presents an alternative treatment modality for patients with post- traumatic malocclusion.