Page 31 - Open versus closed Mandibular condyle fractures

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Chapter 2.1 Closed
DISCUSSION
The methods used for the closed treatment of condylar fractures are not adequately described in the literature to date. As revealed in this systematic review, there is substantial heterogeneity with regard to indications, treatment protocols, and the lengths of treatments.
Several classification systems have been used to define fracture types.34 For practical purposes, the condylar process is often divided into three anatomical levels at which the fracture can occur: the condylar head (intracapsular), the condylar neck (extracapsular), and the subcondylar region.35, 36 However, most of the reports did not differentiate between subcapsular and intracapsular fractures, or unilateral condylar and bilateral condylar fractures, or fractures in adults and children.
In children, the treatment of mandibular condyle fractures entails substantially different considerations than those that apply when the condition occurs in adults. First, in children there is a difference in surgical anatomy. This is why children have a propensity to fracture through the condylar head, rather than the low neck pattern seen in adults. In addition, the mandible is the last bone in the face to reach skeletal maturity. Fractures of the condyle in children can therefore have consequences for the growth of the mandible.37 On the other hand, children do have an increased remodeling capacity. While in adults closed treatment mostly results in forced adaptation to the altered anatomy, in children rapid and progressive remodeling of the condylar unit is common.38
Closed treatment in general is not a complex procedure, and it is associated with reduced overall morbidity.39 Ellis stated in a review article that the incidence of post-traumatic dysfunction after condylar fractures varied between 9% and 85%.40 This percentage reportedly increases with the degree of displacement, duration of MMF, and the age of the patient.