Page 121 - Open versus closed Mandibular condyle fractures

Clinical outcome in treatment of unilateral condylar fractures
None of the cases in this study reported unsatisfactory scarring. Esthetically acceptable outcomes were promoted using a pre-auricular and retromandibular skin incision.22 Despite the treatment protocol, in which no MMF was prescribed for patients after open treatment, some form of MMF was used postoperatively in 71.4% of the study patients. This is in accordance with a recently published review on open treatment.10 However, the type of MMF used was often not clearly documented and it therefore remains unknown whether elastic traction was used as MMF or as a guide for occlusion.
The use of physiotherapy in these patients did not significantly improve the outcome. This may be due to the lack of a standardized physiotherapy treatment protocol; the development of such a protocol may be useful. Nevertheless, the small number of patients included in the open treatment group in this study and the fact that this study has a cross-sectional design should be taken into consideration. Still, Dijkstra et al. had already published good results after closed treatment with one year of follow-up.23
Furthermore, the duration of follow-up did not influence the outcome measures, indicating that the outcomes at the 1-year follow-up are indicative of the long- term results.
To date, the literature on condylar fractures has reported good outcomes for both open and closed treatment methods.9,10 This study found a significant difference in the MFIQ, but not in the other outcomes, between open and closed treatments. Although good outcomes are achieved with both treatments, it would appear preferable to avoid surgery and the concomitant surgery-related complications. In addition, closed treatment avoids operating room time, more expensive hardware, a longer general anesthesia time, hospitalization and sickness leave costs.24
In conclusion, closed treatment should not be overlooked and should be considered for those cases in which this treatment can be performed by a competent surgeon following a strict treatment protocol, and where proper patient compliance is assured.
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