Page 158 - Open versus closed Mandibular condyle fractures

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Chapter 5
In the studies included in this review, the incidence of temporary weakness was higher with transparotid dissection than with non-transparotid dissection. However, the recovery rate was significantly higher with the transparotid approach than with the non-transparotid approach. A possible explanation might be that there is less need for traction on the nerve. Taking this into account, the incidence of permanent facial nerve damage was 0.4% with a non-transparotid approach and 0.07% with the transparotid approach. Differences in the subcutaneous approaches used, i.e., with and without retrograde nerve dissection for identification of the nerve, could have contributed to these outcomes.
The open and closed treatment modalities were compared in the cross-sectional study outlined in Chapter 4. When using the Mandibular Function Impairment Questionnaire (MFIQ) as the main outcome, closed treatment was preferable to open treatment (P = 0.023). This conflicts with the study reported by Eckelt et al., in which the open group (2.4 \[standard deviation (SD) 0.76\]) performed better than the closed group (10.5 \[SD 2.2\]; P = 0.001)38. A study by Schneider et al. also reported that their MFIQ results favored open treatment over closed treatment (2.7 vs 8.6; P = 0.009).
A possible explanation for the success of our closed treatment is the use of a strict treatment protocol, especially for guiding elastics rather than firm elastics or steel wires. Strict follow-up, as realized in our center, also favors a successful outcome.
Compared with the normal population, our study population performed well with regard to MMO39 and range of motion. The range of motion, determined by laterotrusion and protrusion, was not significantly different from the laterotrusion measured in the normal population (left, 11.5 mm \[SD 2.4\], right, 10.9 mm \[SD 2.1\] in female subjects; left, 12.1 mm \[SD 2.4\], right, 11.0 mm \[SD 2.6\] in male subjects).40 No cases of ankylosis were found.
Use of the Diagnostic Criteria for Temporomandibular Disorders in this field of maxillofacial surgery is relatively new. These criteria are a well-described, evidence- based system for assessment of temporomandibular joint complaints and jaw dysfunction.