Page 43 - Open versus closed Mandibular condyle fractures

Management of post-traumatic malocclusion: an alternative treatment
INTRODUCTION
Fractures of the mandibular condyle are common facial injuries accounting for 25 to 35% of all mandibular fractures.1-4 Treatment options for fractures of the mandibular condyle consist of open treatment with internal fixation or closed treatment. Presently, no consensus exists regarding the most appropriate method for the management of fractures of the mandibular condyle. High-quality evidence for the efficacy regarding both treatment options is lacking, and only a few randomized clinical trials exist comparing the two treatment options. Unfortunately these studies do not yield substantially reassuring evidence in support of either of the two treatment options, particularly because of small study groups and a large loss to follow-up.5
Closed treatment is the method of therapy most commonly chosen for the management of condylar fractures.6 Closed treatment is defined as a period of maxillomandibular fixation (MMF) to secure proper occlusion. In some cases, MMF is combined with additional functional rehabilitation therapy, and this approach may be impractical for the patient because of long duration of therapy and considerable limitations associated with functionality during MMF. Literature suggests that articulation/joint movements are beneficial to the outcome of condylar fracture treatment.6 Despite being often considered a modality with minor complications, closed treatment may yield complications like chronic pain, reduced mobility, and malocclusion.6
Malocclusion is a serious post-traumatic sequela and can result in an open bite with functional disturbances, reduced posterior facial height, and facial asymmetry.6 An explanation for post-traumatic malocclusion could be that not all patients are capable of physiologically adapting to the sequelae associated with their injury. Malocclusion may also occur if there is non-compliance of the patient to functional rehabilitation, if little instruction is provided to the patient regarding care, or if follow-up is poor.7 If post-traumatic malocclusion emerges, most clinicians opt for active intervention. Treatment options include occlusal adjustments, orthodontic treatment, temporomandibular joint (TMJ) reconstruction, and/or orthognathic surgery.7,8 Selecting a treatment modality usually depends on the degree of occlusal disturbance and the patient’s preference.
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