Page 60 - Open versus closed Mandibular condyle fractures

Open treatment of unilateral mandibular condyle fractures in adults
INTRODUCTION
Since the introduction of rigid internal fixation devices, more and more surgeons favor an open approach to treat condylar fractures of the mandible in adult patients.1 Different indications for open treatment have been published.2-5 Based on the literature, strong indications for open treatment are, for example, displacement into the middle cranial fossa, inappropriate occlusal restoration by closed reduction, lateral extracapsular displacement, and foreign material at the fracture site. Although there are other indications, such as bilateral mandibular condyle fractures in edentulous patients who cannot have a splint, where intermaxillary fixation and physical therapy are not possible because of internal disease, bilateral mandibular condyle fractures with comminuted fracture of other facial bones, bilateral mandibular condyle fractures with jaw deformities, and a certain amount of shortening of the ramus and angulation of the condyle, controversies regarding open and closed treatment exist.2, 6, 7
The main advantages of open treatment are the ability to restore the most ideal anatomical position. Further, open treatment can prevent complications, such as breathing problems, a pronunciation disorder, or severe nutritional imbalance because of the shorter duration of maxillomandibular fixation (MMF).
This will also potentially allow immediate mobilization of the joint, leading to more efficient functioning of the joint.7-10
Because of the technique employed, open treatment is associated with surgical complications. The most concerning complication is permanent damage to the facial nerve. Other surgical complications include malocclusion, pain, reduced mouth opening, restricted range of motion (ROM) of the mandible, weakness of the facial nerve, infection, hemorrhage, Frey syndrome, sialocele/sialofistula, damage of the great auricular nerve, plate fracture and screw loosening, and a visible scar.11-13
In this systematic review, studies published on endoscopic or transoral approaches were excluded. Despite the advantages, including absence of scarring (if no transcutaneous trocars are used) and not crossing the facial nerve,14, 15 it has been found that these intra- and transoral approaches are technically demanding,
65
31