Page 26 - Open versus closed Mandibular condyle fractures

Closed treatment of unilateral mandibular condyle fractures in adults
Murakami et al.22 and Silvennoinen et al.24 both reported studies with sample sizes of 18. The methods used in these studies were poorly described.
Table 4. Overview of prospective studies on closed treatment of mandibular condyle fractures a
Dijkstra et al.20 Marker et al.21 Murakami et al.22 Niezen et al.23 Silvennoinen et al.24
116 + ++ 348 + + (4+) + 18 + -- 114 + ++ 18 + --
+ ++
+ ND ND
+ ++
+ ++
+ ND ND 1 year
ND, not described
a +, in the study; -, not in the study
Overview of the treatment modalities applied in the studies included
Table 5 shows an overview of the treatment modalities applied in the studies. In most studies, the closed treatment of fractures consisted of a period of MMF with elastic bands,5, 19, 20, 23, 25, 27-29 often fixed on archbars.20, 21, 23, 25, 27, 30 The mean duration of MMF was approximately 3 weeks, and ranged from 5 days to 49 days.11
In the studies included in the final review, little was written about the extent of fixation with elastics. Some studies used elastics primarily for guidance (guiding elastics), while others used elastics in an effort to achieve rigid MMF. In some studies, rigid MMF with stainless steel wires was used.5, 21, 28-30 Others used both stainless steel wires and elastics, and in some studies the method of MMF was not specified.
In most studies, the choice between expectative and conservative treatment was made based on occlusion. In cases where the patient could potentially reach maximal occlusion, or if the occlusion was only minimally disturbed, expectative treatment was initiated. In most studies this consisted of a soft diet, without MMF, sometimes complemented by functional therapy by a physiotherapist. Other indications for closed treatment with MMF were swelling, deviation on mouth opening, simultaneous mandibular fractures, and pain and restriction associated with mandibular movements.
1.2 years (mean) 1 year
6 months
6 months
29
2.1
Number
Adults Children
(<16 years)
Bilateral
Unilateral
Intra- capsular
Extra- capsular
Follow-up