FUNCTIONAL OUTCOMES OF OPEN VERSUS CLOSED TREATMENT OF UNILATERAL MANDIBULAR CONDYLAR FRACTURES

Authors

  • Muhammad Adil Asim Rawal Institute of Health Sciences Islamabad
  • Muhammad Wasim Ibrahim CMH Institute of Medical Sciences
  • Muhammad umer Javed Khyber Medical University, Institute of Dental Sciences, Kohat
  • Rubbab Zahra Bakhtawar Amin Medical and Dental College Multan
  • Muhammad Umar Qayyum Combined Military Hospital Multan

Abstract

Background: Although mandibular condylar fractures are among the most common fractures of maxillofacial region, the ideal method for treatment of these fractures is still a controversy. The objective of this study was to compare functional outcomes of open vs closed treatment of unilateral mandibular condylar fractures. Methods: This study was carried out at Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi. All patients, included in our study, were randomly put in open and closed treatment groups. Patients were assessed for maximal mouth opening, deviation of mandible on opening and occlusal status six months postoperatively. Maximal mouth opening was assessed by maximal interincisal distance, deviation of mandible on opening by calculating the midline discrepancy during mouth opening and occlusion was assessed by clinical examination according the modified criteria described by Singh V et al.Independent samples t-test was used to compare means of variables in open and closed treatment groups. Results: After six months of follow up the mean mouth opening was 36.39±4.72 mm in open treatment group while it was 33.74±4.72 mm in closed treatment group and difference was statistically significant. While deviation of mandible on opening was found to be 0.48±0.99 mm in open treatment group and 1.09±1.60 mm in closed treatment group. The mean occlusal disturbance was found to be 1.17±0.38 in closed treatment group while it was 1.10±0.30 in open treatment group. Conclusion: Open treatment of unilateral mandibular condylar fractures results in better functional outcomes particularly in terms of mobility of mandible (mouth opening).Keywords: Mandibular condyle; Temporomandibular joint; Maxillomandibular fixation; Open reduction; Internal fixation

Author Biographies

Muhammad Adil Asim, Rawal Institute of Health Sciences Islamabad

Oral and Maxillofacial Surgery DepartmentAssistant Professor 

Muhammad Wasim Ibrahim, CMH Institute of Medical Sciences

Oral and Maxillofacial Surgery DepartmentAssociate Professor

Muhammad umer Javed, Khyber Medical University, Institute of Dental Sciences, Kohat

Khyber Medical University, Institute of Dental SciencesAssistant Professor

Rubbab Zahra, Bakhtawar Amin Medical and Dental College Multan

Department of Oral MedicineSenior Registrar 

Muhammad Umar Qayyum, Combined Military Hospital Multan

Consultant Oral and Maxillofacial Surgeon

References

Singh V, Bhagol A, Goel M, Kumar I, Verma A. Outcomes of open versus closed treatment of mandibular subcondylar fractures: A prospective randomized study. J Oral Maxillofac Surg 2010;68(6):1304–9.

Shah A, Shah AA, Salam A. Pattern and management of mandibular fractures: a study conducted on 264 patients. Pak Oral Dental J 2007;27(1):103–6.

Laskin DM. Management of condylar process fractures. Oral Maxillofac Surg Clin North Am 2009;21(2):193–6.

Khelemsky R, Moubayed SP, Buchbinder D. What is the evidence for open vs closed treatment of mandibular condylar fractures in adults? Laryngoscope 2016;126(11):2423–5.

Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukata RA, Rasse M, et al. Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: A randomized, prospective, multicenter study with special evaluation of fracture level. Int J Oral Maxillofac Surg 2008;66(12):2537–44.

Cenzi R, Burlini D, Arduin L, Zollino I, Guidi R, Carinci F, et al. Mandibular condyle fractures: Evaluation of the Strasbourg Osteosynthesis Research Group Classification. J Craniofac Surg 2009;20(1):24–8.

Liu Y , Bai N, Song G, Zhang X, Hu J, Zhu S, et al. Open versus closed treatment of unilateral moderately displaced mandibular condylar fractures: a meta-analysis of randomized control trials. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;116(2):169–73.

Rutges JP, Kruizinga EH, Rosenberg A, Koole R. Functional result after conservative treatment of mandibular condyle. British J Oral Maxillofac Surg 2007;45(1):30–4.

Back CPN, McLean NR, Anderson PJ, David DJ. The conservative management of facial fractures: indications and outcomes. J Plast Reconstr Aesth Surg 2007;60(2):146–51.

Santler G, Kärcher H, Ruda C, Kole E. Fractures of the condylar process: surgical versus non-surgical treatment. J Oral Maxillofac Surg 1999;57(4):397–8.

Haug RH, Assael LA. Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 2001;59(4):370–5.

Shiju M, Rastogi S, Gupta P, Kukreja S, Thomas R, Bhugra AK, et al. Fractures of the mandibular condyle – open versus closed – a treatment dilemma. J Craniomaxillofac Surg 2015;43(4):448–51.

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(3):498–503.

Niezen ET, Stuive I, Post WJ, Bos RR, Dijkstra PU. Recovery of mouth-opening after closed treatment of a fracture of the mandibular condyle: a longitudinal study. Br J Oral Maxillofac Surg 2015;53(2):170–5.

Eckelt U, Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukata R, et al. Open versus closed treatment of fractures of the mandibular condylar process-a prospective randomized multi-centre study. J Craniomaxillofac Surg 2006;34(5):306–14.

Ellis E 3rd, Throckmorton G. Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg 2000;58(7):719–28.

Worsaae N, Thorn JJ. Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: A clinical study of 52 cases. J Oral Maxillofac Surg 1994;52(4):353–60.

Al-Moraissi EA, Ellis E 3rd. Surgical Treatment of Adult Mandibular Condylar Fractures Provides Better outcomes than Closed Treatment: A Systematic Review And Meta-Analysis. J Oral Maxillofac Surg 2015;73(3):482–93.

Abdel-Galil A, Loukota R. Fractures of the mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg 2010;48(7):520–6.

García-Guerrero I, Ramirez JM, Gomez de Diego R, Martinez-Gonzalez JM, Poblador MS, Lancho JL. Complications in the treatment of mandibular condylar fractures: Surgical versus conservative treatment. Ann Anat 2018;216:60–8.

Yao S, Zhou J, Li Z. Contrast Analysis of Open Reduction and Internal Fixation and Non–Surgical Treatment of Condylar Fracture: A Meta-Analysis. J Craniofac Surg 2014;25(6):2077–80.

Berner T, Essig H, Schumann P, Blumer M, Lanzer M, Rücker M, et al. Closed versus open treatment of mandibular condylar process fractures: a meta-analysis of retrospective and prospective studies. J Craniomaxillofac Surg 2015;43(8):1404–8.

Snyder SK, Cunningham LL Jr. The biology of open versus closed treatment of condylar fratures. Atlas Oral Maxillofac Surg Clin North Am 2017;25(1):35–46.

Tabrizi R, Bahramnejad E, Mohaghegh M, Alipour S. Is the frequency of temporomandibular dysfunction different in various mandibular fractures? J Oral Maxillofac Surg 2014;72(4):755–61.

Lee JS, Jeon EG, Seol GJ, Choi SY, Kim JW, Kwon TG, et al. Anatomical and functional recovery of intracapsular fractures of the mandibular condyle: analysis of 124 cases after closed treatment. Maxillofac Plast Reconstr Surg 2014;36(6):259–65.

Published

2018-12-09