Page 116 - Open versus closed Mandibular condyle fractures

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Chapter 4.1 Open versus Closed
Their mean age was 43.2 years. Fifty-eight (78.4%) had a unilateral fracture (29 on the left, 29 on the right; 11 intracapsular and 47 extracapsular) and 16 patients (21.6%) had bilateral fractures. With regard to other fractures interfering with the occlusion, there were 36 patients with mandibular fractures and 3 with bimaxillary fractures; 35 patients had no other fractures. There were five causes of trauma: bike accidents (n = 30; 40.5%), non-bike-related traffic accidents (n = 8; 10.8%), violence (n = 12; 16.2%), fall (n = 19; 25.7%) and sports (n = 5; 6.8%). Open treatment was performed in 14 patients (18.9%), while 60 patients (81.1%) received closed treatment. Within the closed treatment group, 24 patients (40.0%) received expectative treatment and 36 (60.0%) conservative treatment.
The fixation method for MMF was arch bars in 17 patients (28.3%), brackets in 16 patients (26.7%), and intermaxillary fixation screws in two patients (3.3%); the method of fixation was not described for one patient (1.7%). Sixty-nine of the included patients (93.2%) were dentate and 5 (6.8%) were edentulous. To improve the MMO, ROM, and/or occlusion, 35 patients (47.3%) underwent physiotherapy. In the comparison of those who did undergo physiotherapy and those who did not, physiotherapy was found not to have a significant influence on MMO (P = 0.764), left laterotrusion (P = 0.32), right laterotrusion (P = 0.19), or protrusion (P = 0.56). The mean duration of follow-up was 50.9 months (range 13 - 104 months).
OCCLUSION
On objective assessment, 62 patients (83.8%) had a stable occlusion and five (6.8%) had a malocclusion; occlusion could not be assessed in seven patients, including the edentulous patients (9.5%). The subjective evaluation of occlusion showed 10 patients (13.5%) with malocclusion, nine (12.2%) with a changed or mediocre occlusion, and 53 (71.6%) with a good occlusion. It was not possible to determine the occlusion for two patients.
Separate analysis of the open and closed treatment groups showed that the open group had one patient (7.1%) with an objective malocclusion and 12 (85.7%) with a stable occlusion. As one patient (7.1%) was edentulous, no occlusion could be quantified. Three patients (21.4%) subjectively reported their occlusion as compromised, one (7.1%) as changed or mediocre, and 10 (71.4%) as good.