Page 75 - Open versus closed Mandibular condyle fractures

Chapter 3.1 Open
At present, there is no consensus regarding the most appropriate method for management of fractures of the mandibular condyle. Despite an inability to directly compare the outcomes noted in this systematic review on open treatment with the outcomes of the systematic review on closed treatment,22 we can state that both studies had good outcomes in general (Table 3). However, there is a lack of high-quality evidence for the effectiveness of either approach. The indications for open treatment are not conclusive. If open treatment is contemplated, to date there is no clear treatment protocol outlining the best approach and hardware, use of MMF, or the indication for and nature of aftercare.
The aim of this systematic review was to provide an overview of the studies published exclusively on open treatment, and to summarize the existing open treatment modalities and their clinical outcomes. A uniform protocol/guideline for open treatment could ensure better clinical practice. In order to construct such a treatment protocol, it is necessary to compare the results of open treatment reported in the different studies.
Further research in the form of a randomized clinical trial comparing the two treatment options is necessary to be able to make an informed choice between open and closed treatment for unilateral mandibular condyle fractures.
Table 3. A comparative analysis of open versus closed treatments for unilateral mandibular condyle fractures
Occlusion
(% cases with no malocclusion)
Open 72.7 to 100%. Closed 76 to 100%
Unlimited
mouth opening (% cases)
72.7 to 100% 68 to 100%
Unlimited ROM
(% cases)
57.9 to 100% 65 to 100%
Late pain
(% cases)
0 to 42.1 % 0 to 16%
80