Page 52 - Open versus closed Mandibular condyle fractures

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Chapter 2.2 Closed
Normally, occlusal stops can be applied in the early treatment of condylar fractures and are usually placed ipsilaterally between the molars and premolars of the fracture site.5 The goal then is to distract the posterior mandible caudally along a vertical axis and to rotate the mandible counterclockwise to avoid the fractured parts from overriding when brought to occlusion,14 hence eliciting a reduction maneuver and proper anatomical alignment simultaneously. Closed treatment, however, will not result in fracture reduction because there is no mode of fixation of the fractured bones, and traction of the muscles will dislocate the bony fragments. Therefore, techniques involving occlusal stops are less frequently used nowadays.
In this report, the occlusal stops were used to correct persistent malocclusion in a later stage of closed condylar fracture treatment. Occlusal stops were used to disrupt the emerging malocclusions that developed during fracture healing and the loading of the joints, and in this way, we were able to gain time in the recovery after trauma. In these cases, occlusal stops were placed up to 11 weeks after trauma (table 1).
The results from the presented cases indicate that post-traumatic malocclusion complications following conservative (closed) treatments of condylar fractures can be successfully resolved without the need for further invasive surgical procedures to correct malocclusion. One way to explain the mechanism underlying the treatment with occlusal stops would be to consider that by placing occlusal stops the occlusion configuration the patient has grown accustomed to in the period of post-traumatic malocclusion can be altered. The occlusal stops will bring the patient out of an occlusal ‘comfort zone’ and will disrupt the feedback mechanisms that have developed during the period of post-traumatic malocclusion.
This results in a reset of the feedback mechanism enabling the possibility of developing a new-correct-habituation of the occlusion after removal of the occlusal stops. Since self-regulation of dysfunctional habits is unlikely,15 an important role is reserved for physiotherapy in the period of bite deregulation and in the period after the occlusal stops are removed. After removal of the occlusal stops, the most important task for the physiotherapist is supporting the patient in reaching proper occlusion. The physiotherapist accomplishes this by training adequate rotation and translation of the mandible and by tracing back the correct feedback mechanisms of the patient before trauma.