Page 72 - Open versus closed Mandibular condyle fractures

Open treatment of unilateral mandibular condyle fractures in adults
DISCUSSION
The ideal outcome of an open treatment of a condylar fracture would be restoration of occlusion, unrestricted mouth opening and ROM of the jaw, and no pain. Further, the treatment should be minimally invasive, without surgical complications, and the period of recovery should be short without use of prolonged MMF.
This systematic review found that most studies reported good results with regard to the outcome measures of open treatment. Instances of good recovery of occlusion ranged from 72.7 to 100%. Similar results were observed for full recovery of mouth opening, which ranged from 72.7 to 100%. Lateral movements, which are included in the ROM, were fully restored in 57.9 to 100% of patients, and 57.9 to 100% of patients were free of pain at their last visit.
Surgical complications including hematoma, wound infection, weakness of the facial nerve, sialocele, salivary fistula, sensory disturbance of the great auricular nerve, unsatisfactory scarring, and fixation failure were reported in the studies.
Facial nerve weakness occurred in 12% of patients; these weaknesses were seen in 55.4% of patients after using the transparotid approach, in 40.5% using a non- transparotid approach, and in 3.9% the approach was not described. With regard to permanent facial nerve weakness, 26.7% of cases occurred after a transparotid approach, but 73.3% occurred after a non-transparotid approach. No explanation for these outcomes was given, but one possible cause for this damage to the facial nerve might be traction on the nerve.
With respect to sialoceles and salivary fistulae, one could argue that the likelihood of these complications is higher when an approach through the parotid gland is used than when the parotid gland is avoided. Indeed, in the studies included in this review, sialoceles and salivary fistulae were only seen in patients in whom a transparotid approach was used. One exception was a patient with a salivary fistula in the study reported by Hou et al.37 after an anterior parotid approach. Most authors report that tight closure of the parotid fascia will prevent these complications.
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