Page 146 - Open versus closed Mandibular condyle fractures

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Chapter 4.3 Open versus Closed
In the present study, there was no significant difference in condylar volume between patients who were treated using the open method and those who underwent closed treatment. However, the condylar volume on the fractured side was notably smaller after closed treatment than after open treatment, indicating more adaptation in the condyles treated using the closed method. Segmentation difficulties were encountered in the open treatment group because of the presence of osteosynthesis materials.
3D-condylar volume is often evaluated in orthognathic surgery research.8,9,20 In the relevant studies, the same process of loss of condylar volume is seen after orthognathic surgery. In a study by da Silva et al.,20 the condylar volume after orthognathic surgery was significantly smaller than before surgery. In a study of 50 patients by Xi et al,9 there was a mean pre-treatment condylar volume of 1728 ± 498 mm3 before orthognathic surgery and a post-treatment condylar volume of 1703 ± 552 mm3. The pre-treatment and post-treatment volumes were similar in our study. Unfortunately, we were not able to compare pre-treatment and post- treatment volumes in fractured condyles. Most of the preoperative images were obtained by CT imaging and most of the post-treatment images were acquired by CBCT imaging, which might have had an effect on the segmented 3D condylar volume.21
Use of the condyle on the non-fractured side as a control against which to compare the post-treatment volume on the fractured side is questionable, given the existing difference between the left and right condylar volumes. Safi et al.22 found a significant difference between the volume of the left and right condyles (P<0.01) and Tecco et al.23 reported a difference in volume of 3.9% between the left and right condyles.
In the study by Xi et al.,9 the condylar volume was found to be significantly larger in men than in women. We also found a relationship between patient gender and condylar volume in the post-treatment scans, i.e., men had larger condylar volumes than women. It has been stated that patient gender is one of the most important risk factors for pain after treatment of condylar fractures.24