Page 65 - Open versus closed Mandibular condyle fractures

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Chapter 3.1 Open
In most studies, osteosynthesis (plates) was used for fixation (80.6%; 5.2% resorbable and 94.8% titanium). Lag screws were used in 6.9% of the studies and a combination of plates and lag screws was used in another 6.9% of the studies. In 5.6% of the studies, the method of fixation was not described.
In 34.3% of the studies, MMF was applied during surgery, but in 60% of the studies, the use of MMF during surgery was not reported. In 26.4% of the studies, MMF was continued after surgery as a standard postoperative therapy. In 22.2% of the studies, MMF was only used in the event of a malocclusion. In 16.7%, no MMF was used postoperatively and in 34.7% the use of MMF was not described.
The duration of postoperative MMF varied from 3 days to a maximum of 4 weeks. The most commonly used method of fixation was guiding elastics; however, Narayanan et al.62 used stainless steel wires. Most studies recommended a soft diet for 3 to 6 weeks and mouth opening exercises or physiotherapy after open reduction.
Indications mentioned for open treatment included malocclusion, inability to restore occlusion with closed treatment, patient not willing to have MMF, fracture displacement, and shortening of the ramus. Exclusion criteria for open treatment included undisplaced intracapsular and/or comminuted fractures, pediatric patients, or the patient being unfit for surgery.
Outcome measures
Table 1 gives an overview of the most uniformly reported outcome measures: occlusion, mouth opening, ROM of the mandible, and pain.
In the studies that reported these outcome measures, 72.7 to 100% of patients had no occlusal disturbances at the end of the follow-up period. The presence of some form of malocclusion ranged from 0 to 27.3%. Nonetheless, the need to perform orthognathic surgery was not described. The degree of mouth opening considered to constitute a ‘good’ outcome varied. Some authors reported that it was equivalent to that of more than 30 mm, some used a threshold of more than 35 mm, and others used a threshold of more than 40 mm. Overall, limited mouth opening was reported in 0 to 27.3% of patients and a reduced ROM of the mandible in 0 to 42.1% of patients. No cases of ankylosis were reported. The reported incidences of persistent pain ranged from 0 to 42.1%.