Page 157 - Open versus closed Mandibular condyle fractures

Nowadays, quality of life and patient satisfaction are becoming increasingly important in clinical decision-making. Therefore, the subjective outcomes of treatment are also becoming more important. However, it is striking that so few studies in literature have considered clinically relevant subjective parameters, with most focusing on objective outcome measures, such as occlusion, mouth opening, range of motion, and pain.35 Most of the objective outcomes of both open and closed treatment have been critically reviewed.20,36
Two systematic reviews (Chapters 2.1 and 3.1) revealed substantial heterogeneity in the contemporary literature with regard to assessment of outcomes, indications for different treatment methods, treatment protocols, and duration of follow- up. This heterogeneity rendered the treatment modalities used and their clinical success hard to interpret and compare. Most of the studies have reported good results in general for both the open and closed treatment methods. However, there is still a lack of high-quality evidence for the effectiveness of either approach.
Chapter 3 discusses open treatment and states that this should be minimally invasive
with minimal risk of surgical complications and that the recovery period should be
shorter without use of maxillomandibular fixation (MMF). Chapter 3.1 shows that
most studies reported good results with regard to the outcome measures of open
treatment, i.e., occlusion, mouth opening, range of motion, and pain. Chapter
3.2 outlines the approach and surgical complications in more detail. Most likely,
the focus of debate should not be on the choice of skin incision but rather the
choice of subcutaneous dissection. According to the literature, the transparotid
approach has gained popularity on the basis that it is more straightforward with
direct visibility of the fracture and the shortest distance between the skin and the 5 mandibular condyle. The shorter working distance means there is less need to
forcefully retract the soft tissues, implying a limited complication rate, particularly with regard to facial nerve weakness.37
General Discussion and Future Prospects
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