Comparison occlusion between closed and open reduction of unilateral condylar fractures: a randomized controlled trial
Keywords:
unilateral mandibular condylar fracture, mandibular fractureAbstract
Objective To compare occlusion, outcome and complications with the closed method versus the open method of treatment for unilateral mandibular condylar fracture.
Methods Twenty patients with unilateral mandibular condylar fractures (neck or subcondyle) of the mandible were evaluated. The patients were randomly divided into two groups, with group 1 receiving closed reduction and group 2 receiving open reduction and internal fixation. Patients were followed up for a period of 3 months.
Results No statistically significant differences between the open and closed treatment methods were found in terms of occlusion, interincisive distance, temporomandibular joint (TMJ) pain, TMJ clicking and period of hospital stay. Statistically significant improvement was seen in group 2 compared with group 1 in terms of chin deviation on mouth opening. Group 1 had shorter operation times and less postoperative pain scores than group 2. None of the Group 2 patients developed permanent facial nerve damage or unsightly scarring.
Conclusions There is no statistically significant difference between the two methods in terms of occlusion. A statistically significant difference was seen in the patients treated with the open method, with improved chin swaying compared with those treated with the closed method.
References
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15. Haug RH, Peterson GP, Goltz M, et al. A biomechanical evaluation of mandibular condyle fracture plating techniques. J Oral Maxillofac Surg. 2002;60:73-80; discussion 80-1.
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17. Brandt MT, Haug R. Open versus closed reduction of mandibular fractures: a review of the literature regarding the evolution of current thoughts on management. J Oral Maxillofac Surg. 2003;61:1324-32.
18. Landes CA, Lipphardt R. Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced nondislocated fractures. J Oral Maxillofac Surg. 2006;35:115-26.
19. Lee JW, Lee YC, Kuo YL. Reappraisal of the surgical strategy in treatment of mandibular condylar fractures. Plast Reconstr Surg. 2010;125:609-19
20. Raveh J, Vuillemin T, Ladrach K. Open reduction of the dislocated fractured condylar process: indications and surgical procedures. J Oral Maxillofac Surg. 1989;47:120-7.
21. Raveh J, Ladrach K, Vuillemin T. Indication for open reduction of the dislocated fractured condylar process. J Oral Maxillofac Surg. 1989;47:120-7.
22. Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg.J Oral Maxillofac Surg. 1983;41:89-98.
23. Konstantinovic VS, Dimitrijevic B. Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients. J Oral Maxillofac Surg.J Oral Maxillofac Surg. 1992;50:349-52.
24. Takenoshita Y, Oka M, Tashiro H. Surgical treatment of fractures of the mandibular condylar neck. J Craniomaxillofac Surg. J Craniomaxillofac Surg. 1989;17:119-24.
25. Patil RS, Gudi SS.Management of Subcondylar Fracture through Intraoral Approach with Rigid Internal Fixation.J Maxillofac Oral Surg. 2011;10: 209-15.
26. Choi BH1, Kim KN, Kim HJ, Kim MK. Evaluation of condylar neck fracture plating techniques. J Craniomaxillofac Surg.J Craniomaxillofac Surg. 1999;27:109-12.
27. Choi BH, Yi CK, Yoo JH. Clinical evaluation of 3 types of plate osteosynthesis for fi xation of condylar neck fractures. J Oral Maxillofac Surg. J Oral Maxillofac Surg. 2001;59:734-7.
28. Rao JK1, Gehlot N1, Siwach V1.Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study.J Maxillofac Oral Surg. 2014;13:488-94.
29. Zide MF. Open reduction of mandibular condyle fractures. Clin Plast Surg. 1989;16:69-76.
30. Choi BH, Yoo JH. Open reduction of condylar neck fractures with exposure of the facial nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:292-6.
31. Iizuka T, Lindqvist C, Hallikainen D, Mikkonen P, Paukku P. Severe bone resorption and osteoarthritis after miniplate fixation of high condylar fractures: a clinical and radiologic study of thirteen patients. Oral Surg Oral Med Oral Pathol. 1991;72: 400-7.
32. Yang WG, Chen CT, Tsay PK, Chen YR. Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma. 2002;52:498-503.
33. Palmieri C, Ellis E, 3rd, Throckmorton G. Mandibular motion after closed treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg. 1999;57:764-75.
34. Silvennoinen U, Iizuka T, Oikarinen K, Lindqvist C. Analysis of possible factors leading to problems after nonsurgical treatment of condylar fractures. J Oral Maxillofac Surg. 1994;52:793-9.
2. Baker AW, McMahon J, Moos KF. Current consensus on the management of fractures of the mandibular condyle. A method by questionnaire. Int J Maxillofac Surg. 1998;27:258-66.
3. Eduardo D. Facial fractures. In: Neligan PC, editor. Plastic Surgery. 3rd ed. New York: Elsevier & Saunders; 2013. p. 49-88.
4. Haug RH, Assael L. Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg. 2001;59:370-5.
5. Ellis E 3rd, Palmieri C, Throckmorton G. Further displacement of condylar process fractures after closed treatment. J Oral Maxillofac Surg. 1999;57: 1307-16; discussion 16-7.
6. Ellis E 3rd, Throckmorton GS. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg. 2000;58:719.
7. Ellis E 3rd, McFadden D, Simon P, Throckmorton G. Surgical complications with open treatment of mandibular condylar process fractures. J Oral Maxillofac Surg. 2000;58:950-8.
8. Worsaae N, Thorn JJ. Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar process fractures:a clinical study of 52 cases. J Oral Maxillofac Surg. 1994;52:353-60; discussion 60-1.
9. Worsaae N, Thorn JJ. Surgical versus conservative treatment of the unilateral condylar process fracture. J Oral Maxillofac Surg. 1992;50:349-52; discussion 352-3.
10. Takenoshita Y, Ishibashi H, Oka M. Comparison of functional recovery after nonsurgical and surgical treatment of condylar fractures. J Oral Maxillofac Surg. 1990;48:1191-24.
11. Ellis E, Simon P, Throckmorton GS. Occlusal results after open or closed treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg. 2000;58:260-8.
12. Sirimaharaj W, Pyungtanasup K. The epidemiology of mandibular fractures treated at Chiang Mai University Hospital. J Med Assoc Thai. 2008;91: 868-74.
13. Taub DI. Anthropometry cephalometry and ortho-gnathic surgery. In: Neligan PC, editor. Plastic Surgery. 3rd ed. New York: Elsevier & Saunders; 2013. p. 354-72.
14. Assael LA. Open versus closed reduction of adult mandibular condyle fractures: an alternative interpretation of the evidence. J Oral Maxillofac Surg. 2003;61:1333-9.
15. Haug RH, Peterson GP, Goltz M, et al. A biomechanical evaluation of mandibular condyle fracture plating techniques. J Oral Maxillofac Surg. 2002;60:73-80; discussion 80-1.
16. Zide MF. Outcomes of open versus closed treatment of mandibular subcondylar fractures [discussion]. J Oral Maxillofac Surg. 2001;59:370-5; discussion 375-6.
17. Brandt MT, Haug R. Open versus closed reduction of mandibular fractures: a review of the literature regarding the evolution of current thoughts on management. J Oral Maxillofac Surg. 2003;61:1324-32.
18. Landes CA, Lipphardt R. Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced nondislocated fractures. J Oral Maxillofac Surg. 2006;35:115-26.
19. Lee JW, Lee YC, Kuo YL. Reappraisal of the surgical strategy in treatment of mandibular condylar fractures. Plast Reconstr Surg. 2010;125:609-19
20. Raveh J, Vuillemin T, Ladrach K. Open reduction of the dislocated fractured condylar process: indications and surgical procedures. J Oral Maxillofac Surg. 1989;47:120-7.
21. Raveh J, Ladrach K, Vuillemin T. Indication for open reduction of the dislocated fractured condylar process. J Oral Maxillofac Surg. 1989;47:120-7.
22. Zide MF, Kent JN. Indications for open reduction of mandibular condyle fractures. J Oral Maxillofac Surg.J Oral Maxillofac Surg. 1983;41:89-98.
23. Konstantinovic VS, Dimitrijevic B. Surgical versus conservative treatment of unilateral condylar process fractures: clinical and radiographic evaluation of 80 patients. J Oral Maxillofac Surg.J Oral Maxillofac Surg. 1992;50:349-52.
24. Takenoshita Y, Oka M, Tashiro H. Surgical treatment of fractures of the mandibular condylar neck. J Craniomaxillofac Surg. J Craniomaxillofac Surg. 1989;17:119-24.
25. Patil RS, Gudi SS.Management of Subcondylar Fracture through Intraoral Approach with Rigid Internal Fixation.J Maxillofac Oral Surg. 2011;10: 209-15.
26. Choi BH1, Kim KN, Kim HJ, Kim MK. Evaluation of condylar neck fracture plating techniques. J Craniomaxillofac Surg.J Craniomaxillofac Surg. 1999;27:109-12.
27. Choi BH, Yi CK, Yoo JH. Clinical evaluation of 3 types of plate osteosynthesis for fi xation of condylar neck fractures. J Oral Maxillofac Surg. J Oral Maxillofac Surg. 2001;59:734-7.
28. Rao JK1, Gehlot N1, Siwach V1.Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study.J Maxillofac Oral Surg. 2014;13:488-94.
29. Zide MF. Open reduction of mandibular condyle fractures. Clin Plast Surg. 1989;16:69-76.
30. Choi BH, Yoo JH. Open reduction of condylar neck fractures with exposure of the facial nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:292-6.
31. Iizuka T, Lindqvist C, Hallikainen D, Mikkonen P, Paukku P. Severe bone resorption and osteoarthritis after miniplate fixation of high condylar fractures: a clinical and radiologic study of thirteen patients. Oral Surg Oral Med Oral Pathol. 1991;72: 400-7.
32. Yang WG, Chen CT, Tsay PK, Chen YR. Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma. 2002;52:498-503.
33. Palmieri C, Ellis E, 3rd, Throckmorton G. Mandibular motion after closed treatment of unilateral mandibular condylar process fractures. J Oral Maxillofac Surg. 1999;57:764-75.
34. Silvennoinen U, Iizuka T, Oikarinen K, Lindqvist C. Analysis of possible factors leading to problems after nonsurgical treatment of condylar fractures. J Oral Maxillofac Surg. 1994;52:793-9.
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2017-10-01
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Sirimaharaj W, Kwan-ngern K, Boonyawong P. Comparison occlusion between closed and open reduction of unilateral condylar fractures: a randomized controlled trial. BSCM [Internet]. 2017 Oct. 1 [cited 2024 Nov. 15];56(4):203-11. Available from: https://he01.tci-thaijo.org/index.php/CMMJ-MedCMJ/article/view/89125
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