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Chapter 4.1 Open versus Closed
Patients were excluded from the study if they were younger than 18 years of age, were unable to understand and read Dutch, had any intellectual disability, or had a history of psychiatric disorders. Patients, with a follow-up period since the trauma of at least 1 year were invited by letter to attend an additional appointment. If the patient did not respond within 2 months after the letter was sent, they were contacted by telephone. All patients who participated received a patient ID number and signed an informed consent form.
At the extra follow-up appointment, each patient completed the MFIQ,12,13 an instrument to determine patient’s subjective mandible functioning. They were also examined according to Axis I and Axis II of the DC/TMD to assess musculoskeletal pain and dysfunction in the orofacial region.14 These axes consist of clinical examinations and questionnaires about the patient’s symptoms and psychosocial background. Facial nerve function was assessed using the Sunnybrook Facial Grading System (SB), and a cone-beam computed tomography (CBCT) scan was acquired to assess the healing morphology (field of view (FOV) 26 cm, diameter 23 cm, scan time 18s,voxelsize0.4mmat96kVand10mA).
Mandibular Function Impairment Questionnaire (MFIQ)
The MFIQ is a validated and reliable instrument that measures a patient’s subjective perception of mandible functioning.12,13 The instrument consists of 17 items; social activities (item 1), speech (item 2), masticatory performance (items 3, 4, 5, 9, 12, 13, 14, 15, 16, and 17), daily activities (item 6), drinking (item 7), laughing (item 8), yawning (item 10), and kissing (item 11). These are scored from 0 to 4 on a Likert scale by the patient, thus providing a total score for all items ranging from 0 to 68, in which ‘0’ is a good functional outcome and ‘68’ is a poor functional outcome.13
Diagnostic criteria for TemporoMandibular Disorders (DC/TMD)
The patients were examined according to the DC/TMD,14 a validated diagnostics system for the assessment of musculoskeletal pain and dysfunction in the orofacial region. The DC/TMD outcome consists of two axes, one for clinical examination, evaluation, and diagnosis (Axis I) and the second for the psychosocial background of the patient (Axis II).