Page 37 - Open versus closed Mandibular condyle fractures

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Chapter 2.1 Closed
After this 3-week period of MMF on guiding elastics, the occlusion can be guided with loose elastics for a further 6 weeks if necessary, and active physiotherapy should be started.
As in cases of expectative treatment, patients should be advised to adhere to a soft diet, instructions regarding movement of the jaw should be given, adequate pain medication should be prescribed, and a brochure describing exercises to practice at home should be provided. Again, the patient should be instructed to mobilize the jaw but not load it.
After the first contact, follow-up visits are normally scheduled at 5 to 7 days, 3 weeks, 6 weeks, and 12 weeks. If the patient has recovered well by this time, then follow-up is finished. If there are still complaints such as a persistent open bite, limited mouth opening, or pain, then follow-up can be extended to 6 months or even 1 year.
Due to the heterogeneity of the groups in the studies reviewed, the high loss-to- follow-up rates, the poor descriptions of the different treatments given, and the variability in the methods used to measure outcomes, no solid evidence-based conclusions or guidelines can be formulated with regard to the most appropriate closed treatment. A clear differentiation between expectative and conservative treatment is determined by the use or not of MMF in closed treatment. Further reproducible trials are needed to develop guidelines for closed treatment of fractures of the mandibular condyle.