Page 11 - Open versus closed Mandibular condyle fractures

General Introduction and Outline
• Open treatment 1 The main advantages of open treatment are the ability to restore the condyle to its
most ideal anatomic position, thereby preventing diminished posterior facial height
and facial asymmetry, immediately restoring occlusion, and potentially allowing immediate mobilization of the joint, leading to more efficient functioning of the
joint.27–30 The strong indications for open treatment have been published.13–15,19
Chapter 3.1 provides an overview of the studies published exclusively on open treatment. The existing open treatment modalities and their clinical outcomes i.e., occlusion, mouth opening, range of motion of the mandible, and pain, are discussed.
Open treatment is associated with surgical complications because of the surgical approach used. The approach dictates the exposure, as well as the degree and number of complications arising from the layers of dissection and the surrounding anatomic structures, i.e., the facial nerve, the great auricular nerve, and the parotid gland. It is known that the choice of surgical approach is critical for reducing postoperative complications.34 The most feared complication is permanent damage to the facial nerve. Other surgical complications include plate fracture and screw loosening, as well as a visible scar.31–33
Chapter 3.2 provides an overview of the complications of extraoral approaches in the open treatment of condylar fractures.
Open versus closed
When evaluating either treatment modality, i.e., open or closed, it should be kept in mind that a satisfied surgeon is not necessarily synonymous with a satisfied patient. A striking feature in the relevant literature is that very few studies have considered clinically relevant subjective parameters, with most studies focusing solely on objective outcome measures.35 Therefore, without becoming involved in the controversy concerning indication, we embarked on a study that focused primarily on subjective and functional outcomes. This cross-sectional study evaluated the results of our treatment of condylar fractures in the Department of Oral and Maxillofacial Surgery at the Academic Medical Center between August 2008 and March 2016.
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