Page 98 - Open versus closed Mandibular condyle fractures

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Chapter 3.2 Open
DISCUSSION
The debate on which is the best way to treat condylar fractures is an ongoing one. Outcomes of both open and closed treatment have been critically reviewed.5,6 The major drawback of open treatment remains the surgery-related complications. A better definition of the most appropriate approach and knowledge of the exact risks for specific complications are essential in the decision-making process.
The most serious complication is probably damage to the facial nerve. Fortunately, this is transient in most cases, with a reported incidence of between 12% and 48%,14-16, 26,34 when the most commonly used incision (the retromandibular transparotid approach) is used. In the studies included in this review, the incidence of temporary weakness was higher with transparotid dissection than with non- transparotid dissection. The recovery rate was significantly higher with the transparotid approach compared with anterior or posterior parotid approach. A possible explanation might be, as mentioned earlier, the necessity for less traction of the nerve. Taking this into account, the incidence of permanent facial nerve damage was 0.4% with a non-transparotid approach and 0.07% with the transparotid approach. Differences in the subcutaneous approaches, i.e., with or without retrograde nerve dissection with identification of the nerve, could have biased these outcomes.
Recently a comprehensive systematic review and meta-analysis were published on facial nerve injuries related to surgical approaches for treating mandibular condyle fractures.87 With respect to the condylar neck and base fractures, no differences between the non-transparotid and transparotid approach were found. In our study, there seems to be a preference for the transparotid approach. This difference could be a result of the different inclusion criteria used in the two studies, and therefore the use of non-identical literature.
Though Al-Moraissi et al. did emphasize the importance of traction on the nerve and the risk of damaging the nerve by either approach, it was stated that the choice of approach was highly related to the level of the fracture and therefore different approaches were recommended for different condyle fractures.