Page 34 - Open versus closed Mandibular condyle fractures

Closed treatment of unilateral mandibular condyle fractures in adults
The average period of MMF was approximately 2 to 3 weeks, but ranged from 5 days to 49 days.11 The reasoning behind the duration of MMF applied in the studies analysed was not explained. It is reported that occlusion must be maintained by MMF until fibrous union of the fractured fragments is established.51 Longer periods of MMF were in most cases associated with a need to correct the bite in patients with persistent malocclusion.
In recent publications, particularly studies reported after 2005, there seems to be a trend towards less rigid MMF and more functional treatment policies. One exception is Rutges et al..28 In their study published in 2007, rigid fixation with MMF wiring was used. As shown in Table 7, no clear difference in outcome measures was apparent between those that applied stainless steel wires and those that used elastics.
In agreement with previously published statements, the authors of the current review are of the opinion that in cases of malocclusion, a short period of MMF with guiding elastics is appropriate, so that early mobilization can be realized. Early mobilization of the jaw and functional rehabilitation are reportedly considered to be important.5, 39, 52-54
It has been proposed that in some cases it may be best not to use MMF at all, to allow the patient to obtain good mobility in as short a time as possible.41 However, Silvennoinen et al. cautioned that one should use a period of MMF in cases of displaced fractures.5 Whether MMF is necessary remains an unanswered question.41
Additional treatment (or the lack thereof) after removal of MMF was poorly described in the studies analyzed. Treatments that were repeatedly mentioned were the use of guiding elastics and physiotherapy. Neither the potential benefits nor the benefits actually achieved via either of these two treatment modalities were clarified in the reports. Zide and Kent stated that appropriate physiotherapy should be started in the early phase of non-surgical treatment.9 It is important to consider the ultimate aims of physiotherapy, specifically increased mouth opening, reduction of pain during functioning of the jaw, improvement of occlusion, and extension of the range of motion.
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