Page 9 - Open versus closed Mandibular condyle fractures

Condylar fractures 1
Optimal treatment of a fracture of the mandibular condyle is one of the most challenging controversies in maxillofacial trauma care. The mandible is prone to external forces because of its exposed position in the maxillofacial skeleton, so mandibular fractures are particularly common (42%–66%),1–3 as is involvement of the condyle (25%–35%).4–6
From an anatomic perspective, the fractures of the condyle can be divided in several types. Numerous classification systems for these fractures have been published in the recent literature.7–11 However, for practical purposes, a distinction needs to be made between fractures of the condylar head (intracapsular), condylar neck (extracapsular), and condylar base (subcondylar).7,12
Treatment modalities
Treatment options for fractures of the mandibular condyle consist of either closed treatment, i.e., expectative or conservative treatment with or without maxillomandibular fixation, or open treatment, i.e., open reduction with internal fixation.13,14
Several studies have reported favorable clinical results with closed treatment of condylar fractures. Some of these studies have even concluded that the closed approach should be regarded as the first choice of treatment for condylar fractures,15–18 based on the assumption that closed treatment methods are favorable in terms of preventing potential complications arising from surgical treatment.
Historically, closed treatment was the treatment option of choice and has had satisfactory outcomes in the majority of cases.20 Open treatment, on the other hand, has always been considered to be a more challenging procedure, mainly because of the complex anatomy, e.g. the facial nerve. Furthermore, before the development of modern osteosynthesis material, i.e., for plate and screw fixation, open treatment consisted of an interosseous wire for stabilizing the fracture and a period of maxillomandibular fixation for achieving an osseous union.
General Introduction and Outline
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