Page 28 - Open versus closed Mandibular condyle fractures

Closed treatment of unilateral mandibular condyle fractures in adults
Fixation methods of MMF other than arch bars were also described. Rahn et al. used besides Schuchardt splints and head chin caps to achieve MMF.31 Yamamoto et al. applied MMF with a bite block in the molar region of the affected side in patients with malocclusion, particularly those with an open bite.32
In most cases, functional therapy with guiding elastics was initiated after a period of MMF. Some exceptions were reported. For example, Knak and Stoehr used activators to restore mandibular function after a period of MMF.27 Others used some form of bandage.29 Furthermore, MacLennan suggested that where necessary, a training flange could be used.29 Both of these studies were reported more than 50 years ago. In most reports, however, the functional therapy administered by a physiotherapist and any other additional therapies used were not described in detail.
Outcome measures
Table 6 shows an overview of the outcome measures. The most frequently described outcome measures were occlusion, mouth opening, range of motion of the mandible (ROM), pain, temporomandibular joint (TMJ) sounds, deviation on opening of the mouth, facial deformity, and function of the TMJ. Studies covering the four most clinically important and uniformly reported outcome measures, i.e., occlusion, mouth opening, ROM, and pain are shown in Table 7. Due to the wide variation in the descriptions of ‘function’, this outcome was not further analyzed.
In these studies, 89% of patients had no occlusal disturbances at the end of the follow-up period. The presence of some form of malocclusion ranged from 0% to 24%. Nonetheless, the need to perform orthognathic surgery was rare. Smets et al. reported that 2 of a total of 60 patients who responded to a request for follow-up examination had obvious malocclusion due to the condylar fracture and conservative treatment; osteotomies were subsequently performed in these 2 cases to achieve adequate results.11
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