Page 74 - Open versus closed Mandibular condyle fractures

Open treatment of unilateral mandibular condyle fractures in adults
Hence, given that there seems to be no significant difference in outcomes between the open and closed treatment modalities, and taking into account that the open treatment of condylar fractures is associated with surgical complications and the advantages such as early mobilization and recovery seem small, in most cases MMF is still used, and the aftercare protocol for open and closed treatment does not seem to differ substantially, it is difficult to see the benefits of open treatment and what its indications should be.
A potential shortcoming of this study is that the studies included were focused on open treatment only. Therefore, it is possible that data on open treatment from studies investigating open versus closed treatment were omitted.
However, we are of the opinion that open versus closed studies tend to focus on the controversial aspects of this treatment and its indications rather than discussing separate treatment modalities, and that each hospital/center in these studies would most likely have a specific treatment that they focus on, whether open or closed, resulting in a skewed impression.91
There was substantial heterogeneity in the study populations included in this systematic review. Most studies did not differentiate between unilateral and bilateral condylar fractures, subcapsular and intracapsular fractures, or fractures in adults and children, nor did the studies in most cases clearly address any additional trauma/fractures. These data deficiencies made it difficult to interpret the data in a uniform manner. Moreover, there was substantial diversity with regard to indications for open treatment and the treatment protocols used. Further, the outcome measures and the way in which these were evaluated were often inadequately described and variable between studies. Owing to this heterogeneity of the groups, fractures, and approaches, as well as the variability in outcome measurements, no evidence-based conclusions or guidelines can be formulated with regard to the most appropriate open treatment.
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