Page 166 - Open versus closed Mandibular condyle fractures

Chapter 2 describes the closed treatment modality.
In chapter 2.1, a systematic review provides an overview of the studies exclusively pertaining to closed treatment published to date and summarizes the existing closed treatment modalities and their clinical outcomes. A systematic search identified 16 studies with a total of 1535 patients with mandibular condyle fractures. The most frequently described outcome measures were occlusion, mouth opening, range of motion of the mandible (ROM) and pain. In these studies, 89% of patients had no occlusal disturbances by the end of the follow-up period. The presence of some form of malocclusion ranged from 0 to 24%. Overall, in these studies, the final review reported ‘good opening’ of the mouth in 86% of cases and an unlimited range of motion of the mandible in 84%. No cases of ankylosis were reported. The reported incidences of pain at rest ranged from 0 to 16%. Ninety-two percent of patients were free of pain. However, because of the heterogeneity of the study groups, high rates of loss to follow-up, poor descriptions of the different treatments given, and variability in the methods used to measure the outcome, no clear association between the treatments applied in the studies and outcomes could be determined. The present research confirms that there is currently no uniform standard for closed treatment of condylar fractures that ensures good clinical results, mainly because of a low level of evidence. Establishment of such a standard could potentially improve treatment outcomes.
In chapter 2.2, an alternative non-surgical procedure for managing malocclusion complications associated with closed treatment of condylar fractures is presented. Four patients with post-traumatic malocclusion following conservative treatment were referred to our center in 2013 and 2014 and treated with hypomochlions or occlusal stops to modulate the feedback mechanism that had developed in these patients.
After removal of the occlusal stops and a period of physiotherapy to restore proprioception, stable functional occlusion was achieved within 6 weeks in all patients. This result indicates that post-traumatic malocclusion complications following conservative (closed) treatments can be successfully resolved without the need for further invasive surgical procedures.
Summary
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6.1