Page 101 - Open versus closed Mandibular condyle fractures

Open treatment of condylar fractures: extraoral approaches
Nevertheless, Biglioli and Colletti3 described difficulty with the use of this limited incision in overweight patients with redundant soft tissues of the cheek. Transient facial nerve weakness was explained by the relatively greater stretching of the soft tissues resulting from a small incision, and increased likelihood of excessive stretching of the nerve fibers and therefore of transient facial nerve weakness.4 Hou et al.36 designed the minor parotid anterior approach to treat medial and low condylar fractures. They describe three advantages of this approach: first, there is a lower risk of injuring the facial nerve; second, the length of the incision used is short (2 to 2.5 cm, compared with, for example, 3 to 3.5 cm in the retromandibular approach), and therefore, scarring is reduced; and third, because the location of the incision overlies the fracture site, it provides excellent visual exposure of the fracture fragments and makes the procedure quick and simple.
The great diversity in fractures, approaches, and surgical techniques makes it difficult to generate an objective, clear and usable comparison of surgical techniques for condylar fractures and their complications.15,39
To establish more evidence for the best approach to an open treatment, more research will be needed on, for example, different extraoral approaches and their comparisons, the use of antibiotics, the development of advanced and less technically demanding endoscopic techniques, the role of nerve integrity monitoring during surgery (e.g. the NIM stimulator; Medtronic, Minneapolis, MN),29 and perhaps in the future, the use of intraoperative surgical navigation. In this way, an evidence-based protocol for the treatment of this complex fracture will be accomplished.30
CONCLUSION
In our opinion, a clear treatment protocol is needed to attain predictable clinical practice. In cases of open treatment of condylar fractures, such a protocol should be interpreted and implemented by taking the skills of the surgeon into consideration. Based on the literature studied in this review, we would like to propose a treatment protocol with respect to open treatment approaches.
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