Closed Reduction, Open Reduction, and Endoscopic Assistance: Current Thoughts on the Management of Mandibular Condyle Fractures

Abstract

The management of fractures of the mandibular condyle continues to be controversial. This is in part attributable to a misinterpretation of the literature from decades prior, a lack of uniformity of classification of the various anatomical components of the mandibular condyle, and a perceived potential to cause harm through the open approach based in part on the surgeon's lack of a critical examination of the literature. This review explores the key historical articles that deal with the management of mandibular condyle fractures, and those modern-day contributions that represent the state of the art. The authors' intention was to provide the reader with an objective summary of the management of this form of injury, to place its management into a modern-day perspective, and perhaps to minimize the perception of controversy.

Complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle

“…An endoscopically assisted intraoral approach with open reduction and internal fixation is becoming popular and these procedures show promising results 11,26 .…”

Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study

“…Many studies have reported that surgical treatment with open reduction and rigid fixation leads to significantly better results than conservative management of condylar fractures [6][7][8][9][10][11][12][13]. With the exception of undisplaced, intracapsular fractures and fractures in pediatric patients younger than 12 years of age [14][15], most mandibular condylar fractures should be treated with open reduction and rigid fixation.…”

“…With the exception of undisplaced, intracapsular fractures and fractures in pediatric patients younger than 12 years of age [14][15], most mandibular condylar fractures should be treated with open reduction and rigid fixation. Points to be clarified regarding surgical treatment, is how many fixation devices should be used [6], and the choice of approach for treating condylar fractures. The ideal surgical approach should be the least invasive method available, allow comfortable and easy solution to the surgical problem, be versatile, allow satisfactory vision, have the lowest rate of surgical complications, and be easily performed.…”

“…Undiagnosed or incorrectly treated condylar fractures can lead to severe functional impairment, including malocclusion, reduced mouth opening associated with deviation of jaw and limited lateral mandibular movements [2,3]. A number of reports have suggested that the treatment of condylar fractures by open reduction and rigid fixation offers much better anatomic results [6][7][8][9][10][11][12][13]. Conservative treatment is still the choice of treatment for intracapsular or comminuted fractures and fractures in pediatric patients [14,15].…”

Diagnostic accuracy of cone beam computed tomography and conventional multislice spiral tomography in sheep mandibular condyle fractures

“…Following two consensus meetings 1,2 in which researchers have had only limited agreement on an optimal treatment strategy in adults 3 subject to more than six classification proposals in the past 80 years, 4 the treatment of mandibular condyle fractures still remains a controversial topic in maxillofacial traumatology. 5 Mandibular condyle fractures account for 17.5 -52% of all mandibular fractures.…”