Page 32 - Open versus closed Mandibular condyle fractures

Closed treatment of unilateral mandibular condyle fractures in adults
In most of the studies included in the final analysis, the definition of ‘closed treatment’ was not described in precise terms, and there was a lack of details reported with regard to treatment protocols. This rendered the results of the studies difficult to interpret, and compare. In addition, no randomized controlled trials were identified during this systematic review process, and while four prospective follow-up studies were identified, most of the studies adhering to the inclusion criteria were retrospective.
‘Closed treatment’ refers to any treatment that does not involve open treatment. In the majority of the studies reviewed, no distinction was made between expectative and conservative treatment. In the authors’ opinion, a distinction has to be made between expectative and conservative treatment. In this review, all treatments that did not entail MMF were considered expectative.
The circumstances described in the studies assessed that were deemed to warrant expectative treatment as a treatment modality, i.e., no placement of MMF, were for the most part the same: patients who were able to bring their teeth into normal occlusion and in whom mandibular excursions were assessed as normal.
In some studies, expectative treatment was prescribed in conjunction with the recommendation of a soft diet, and instructions relating to movement of the jaw and associated exercises.11, 19, 21, 28 Others prescribed physiotherapy.5, 22, 31, 32 On this basis, it could be argued that the exact demarcation between expectative and conservative treatment remains undefined.
There seems to be a general consensus that expectative treatment (without MMF) may be sufficient in patients who are able to bring their teeth into normal occlusion and/or have normal mandibular excursions.
The need for follow-up was not adequately addressed in the studies assessed. Ellis et al. reported that fractures of the head of the condylar process tend to become more displaced over the first 6 weeks.41 Therefore, it was concluded that it is imperative to control occlusion during this period.
The need for functional therapy should be made on a case-by-case basis. In cases of restricted function, e.g., for recovery of mouth opening, functional therapy should be initiated as soon as possible.
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