Page 64 - Open versus closed Mandibular condyle fractures

Open treatment of unilateral mandibular condyle fractures in adults
Retrospective studies
Of the assessed studies, 38 (54.3%) were retrospective in nature, and included a heterogeneous series of mandibular condyle fractures and treatment modalities. The clinical outcome measurements in these studies were diverse and the follow- up periods were variable (range: 5 days to 119 months). Of all the included studies, Eckelt and Hlawitschka52 had the largest sample size (230 patients).
Prospective studies
Thirty-two (45.7%) prospective studies were identified. There were two randomized clinical trials, both comparing different osteosynthetic materials. Rai66 compared the use of single and double non-compression miniplates and Seemann et al.73 compared the use of locking and non-locking plates. The follow-up duration ranged from 1 month to 66 months.
Overview of treatment modalities applied in the included studies
The treatments varied in the approach and material used for osteosynthesis. In the order of most frequently employed to the least frequently employed, the treatment approaches were as follows: retromandibular (31.4%), pre-auricular (12.9%), submandibular (7.1%), peri-angular (8.6%), and other (8.6%). In some studies, more than one approach was employed (22.9%; of these, retromandibular 30.3%, pre-auricular 36.4%, submandibular 21.2%, and other 12.1%), and in some studies the approach was not described (8.6%). Retro-auricular, extended bicoronal, rhytidectomy/facelift were also noted to have been employed along with a supratemporal approach, a curved incision in the ear lobule area, or a parotid mini incision.
The approach was transparotid in 37.1% of the studies, non-transparotid in 21.4%, both transparotid and non-transparotid in 7.1%, and 34.3% of the studies did not describe whether the approach was transparotid.
Focusing on the individual approaches, 56.3% of the retromandibular approaches were transparotid, 12.5% were non-transparotid, 9.4% described both transparotid and non-transparotid, and in 21.9% it was not described whether the approach involved the parotid gland. Where the pre-auricular approach was used, 14.3% of the studies reported the involvement of the parotid gland, 19% did not, and in 66.7% of studies involvement of the parotid gland was not defined.
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