Page 89 - Open versus closed Mandibular condyle fractures

Open treatment of condylar fractures: extraoral approaches
Prospective studies
Of the assessed studies, 32 (45.7%) were prospective in nature. The duration of follow-up ranged from 1 month to 66 months.
Overview of the treatment modalities applied in the included studies
Table 2 shows an overview of the approaches used in the included studies. Based on the literature, the most frequently used skin incision was retromandibular (36.4%), followed by pre-auricular (25.0%), submandibular (13.6%) and peri-angular (6.8%). In some studies, other skin incisions were used or the skin incision was not described (18.2%).
The subcutaneous dissection was transparotid in 35.2% of the studies, non- transparotid in 21.5%, and both transparotid and non-transparotid in 4.5%. It was not specified whether the approach was transparotid in 38.6% of the studies. Focusing on the individual approaches, 59.4% of the retromandibular approaches were transparotid, 12.5% were non-transparotid, 12.5% described both transparotid and non-transparotid approaches, while in 15.6% it was not described whether the approach involved the parotid gland. When the pre-auricular approach was used, 13.6% of the studies reported involvement of the parotid gland, 22.7% did not involve the parotid gland, and involvement of the parotid gland was not defined in 63.6%. In the submandibular and periangular approaches, logically no transparotid procedures were described.
Overall, the data showed a tendency toward an increase in the use of the transparotid approach in recent years. Among the 35.2% of the studies that used a transparotid approach, 96.8% were published after the year 2000.
In most studies, osteosynthesis plates were 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.
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