Page 20 - Open versus closed Mandibular condyle fractures

Closed treatment of unilateral mandibular condyle fractures in adults
INTRODUCTION
The mandible is prone to external forces as a result of its exposed position in the maxillofacial skeleton. Thus, mandibular fractures are one of the most common facial fractures (42 to 66%).1-3 Of all mandibular fractures, 25 to 35% are fractures of the mandibular condyle.4-6 This can be explained by the fact that the mandible is similar to a hunting bow in shape - strongest in the midline (symphysis) and weakest at the ends (condyles).
Treatment options for fractures of the mandibular condyle consist of either closed treatment or open reduction with internal fixation (ORIF).7,8 Several studies have reported favorable clinical results with closed treatment of condylar fractures.9 Some of these studies have even concluded that the closed approach should be regarded as the first choice of treatment for condylar fractures,10-12 based on the assumption that closed treatment methods are favorable in terms of the potential complications arising from surgical treatment.
Potential complications of closed treatment include malocclusion (particularly open bites), reduced posterior facial height, facial asymmetry, chronic pain, and reduced mobility.8,13
Conservative treatment normally consists of a period of maxillomandibular fixation (MMF). It is widely held that immobilization is likely to maintain and/or re-establish normal occlusion and relieve post-traumatic pain.14
Recent studies have generally focused on whether to treat mandibular condyle fractures via open or closed methods. However, none of these studies has focused on the outcomes of different closed treatment procedures.15,16 Due to the substantial diversity of definitions of closed treatment, a uniform protocol/ guideline for closed treatment is required. Most closed therapy interventions require expert experience.
The aims of this systematic review were to provide an overview of the literature published exclusively on closed treatment, to generate a summary of the existing closed treatment modalities, and to define what the outcomes of these modalities are.
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