Page 111 - Open versus closed Mandibular condyle fractures

Clinical outcome in treatment of unilateral condylar fractures
INTRODUCTION
The treatment of mandibular condyle fractures has been the subject of considerable discussion, in particular whether open or closed treatment should be used, with multiple studies published on this topic.1–6 Since fractures of the mandibular condyle are common facial injuries, accounting for 25 to 35% of all mandibular fractures,7,8 and no clinical guidelines exist, there is a need for practical, evidence- based guidelines. In order to produce such guidelines, a more detailed description of both the population and the treatments used is needed. However, most studies have not differentiated between children and adults, or between unilateral and bilateral fractures, and they have lacked details on postoperative treatment strategies, such as the use of maxillomandibular fixation (MMF), the fixation method used, and the use of physiotherapy.9
Furthermore, with respect to the outcome measures, objective parameters have been applied to analyze the treatment modalities, e.g., the degree of malocclusion, maximum mouth opening,laterotrusion, protrusion, and pain.9,10 To date, few studies have considered clinically relevant subjective parameters.11 In an ideal study design, more subjective and functional parameters should be measured. Therefore, the goal of this study was two-fold: (1) to evaluate the subjective and functional outcomes of the treatment of condylar fractures using (a) the Mandibular Function Impairment Questionnaire (MFIQ) to determine the patient’s subjective perception of mandible functioning and (b) the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) to assess the musculoskeletal function of the orofacial region; and (2) to compare the open and the closed treatment modalities, and thereby derive practical advice for daily practice.
MATERIALS AND METHODS
Patients
This research was approved by the ethics committee of the Academic Medical Centre of Amsterdam. The cases of patients with unilateral or bilateral condylar fractures who were treated at the Department of Oral and Maxillofacial Surgery of the Academic Medical Centre of Amsterdam between August 2008 and March 2016 were reviewed.
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