Page 120 - Open versus closed Mandibular condyle fractures

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Chapter 4.1 Open versus Closed
A possible explanation for the greater success of closed treatment in this regard is the use of a strict treatment protocol, especially the use of guiding elastics rather than firm elastics or steel wires; strict follow-up also favors a successful outcome. Compared to a healthy population, this study population performed well with respect to MMO and ROM.17 ROM, determined by laterotrusion and protrusion, was not significantly different from the laterotrusion measured in the normal population (female: left 11.5 mm (SD 2.4 mm), right 10.9 mm (SD 2.1 mm); male: left 12.1 mm (SD 2.3 mm), right 11.0 mm (SD 2.6 mm)).18 No cases of ankylosis were found.
The use of the DC/TMD in this field of maxillofacial surgery is new. The DC/TMD represent a well-described, evidence-based system for the assessment of TMD complaints and jaw dysfunction. The data showed that 90,5% of patients were pain-free, which is comparable to earlier findings.9,10 A systematic review showed a prevalence of myofascial pain of 6% to 12.9 %, intra-articular joint disorders of 8.9% to 15.8%, and arthralgia diagnoses of 2.6%.19 This indicates that the findings of this cross-sectional study are similar to those in the general population with regard to prevalence rates. The importance of psychosocial symptoms in TMD patients has been stated in different studies, showing an association between TMD pain and disorders such as depression, somatization, and anxiety.20,21 The axis II assessment in this study showed no difference between the open and closed treatment groups. Since the prevalence of Axis I TMD diagnoses was not different from the general population and no difference was found in Axis II data between the two groups, it appears that the treatment approach does not affect Axis I and II parameters.
The complications of open treatment reported in this study (Table 3) were minimal compared to the complications reported in the literature, i.e., temporary weakness of the facial nerve (12%, of which approximately 5% of cases were permanent), hematoma (1.7%), wound infections (≥ 2.9%), sialocele (2.6%), salivary fistula (≥ 4.8%), disturbance of the sensory component of the great auricular nerve (7.9%), and unsatisfactory scarring (≥1.6%).10 An explanation for the absence of facial nerve damage, as well as the prevalence of sialocele and salivary fistula, is most likely the use of a transparotid approach. In a systematic review it was stated that the rate of recovery of the facial nerve is significantly higher with the transparotid approach (97.5%) than with the anterior or posterior parotid approach (90.5%).22 Nevertheless, the percentages of sialocele and fistula in the present study are likely higher than those reported previously due to the use of the transparotid approach as well as the limited number of patients in the open treatment group.