Page 133 - Open versus closed Mandibular condyle fractures

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Chapter 4.2 Open versus Closed
In this study, dental status did not have a significant effect on masticatory performance (according to the MAI), which is contradictory to the findings of a previous cohort study in healthy participants. In this cohort study, the presence of natural dentition had a positive effect on the masticatory performance (according to the MAI).2 On the other hand, satisfactory self-reported occlusion positively influenced masticatory performance in the present study. In another clinical study involving 44 participants, a correlation was found between mixing ability and occlusal and near contact areas (up to 200-μm interdental space).37 Furthermore, Wang et al.,38 reported that occlusal contact is crucial for efficient mastication, and that the occlusal contact area of the premolars and molars in this context is important for dentate adults.39 Though, Bourdiol et al.,40 stated that only severe malocclusion correlates with poor masticatory performance and that most patients seem to adapt to some degree of malocclusion.
In this matter, it would be interesting to be able to select the non-adapting patients. Maybe, not only malocclusion diminishes the masticatory function, but also other factors, e.g., decreased bite force and small lateral amplitudes of the masticatory cycles.40
The presence of other fractures appears to negatively impact masticatory performance. Sybil et al.25 reported comparable results and found that there was a reverse relationship between the bite force values and the number of fractures of the mandible. This is a plausible outcome, given the simple fact that it is more difficult to recover from multiple fractures than from a single fracture and, moreover, multiple fractures carry the associated risk for more biomechanical complications.
Physiotherapy applied in the context of condylar fractures had a significant positive effect on masticatory performance. A possible explanation for this would be that patients receiving physiotherapy become more aware of their mouth and chewing functions.
This warrants further exploration because a standardized protocol for physiotherapy in this particular patient population does not yet exist.