Page 61 - Open versus closed Mandibular condyle fractures

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Chapter 3.1 Open
especially for fractures at higher levels or with medial luxation of the proximal stump.14, 16, 17 Therefore, in most cases, the intraoral approach is too difficult for both stabilization of fractures and screw fixation. Thus, some say that the intraoral approach can only be used in select cases of low subcondylar fractures, and that this approach requires special instruments, additional training, and a longer operative duration.18-21 Therefore, we only addressed transcutaneous approaches in this review.
To date, controversies regarding the indications for the open treatment exist. Consequently, this systematic review focuses on the existing open treatment modalities and defines the outcome measures in accordance with our recently published review on closed treatment of mandibular condyle fractures.22
METHODS
A systematic literature search was performed on April 29, 2016, using PubMed (all indexed years), Medline (all indexed years), and Embase (all indexed years) with multiple search terms (Appendix 1). The search excluded case reports with 10 or fewer subjects, endoscopic or transoral treatment modalities, and studies in which stainless steel wires for osteosynthesis were used. Reports published in English, German, or Dutch were considered for inclusion.
All prospective and retrospective human clinical studies that reported data relating to any form of open treatment of unilateral fractures of the mandibular condyle and the outcome of that treatment, were included.
The following data were extracted from the selected studies: study design, period of follow-up, patient characteristics (age, gender), details of the fracture, details of the surgical approach, use of MMF, complications of the surgical approach and osteosynthesis material, and treatment outcomes.
Some studies included data on bilateral fractures and children; these data were excluded during data analysis.