Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

Abstract

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.

Review article: Maxillofacial emergencies: Dentoalveolar and temporomandibular joint trauma

“…It is not uncommon to see the condylar fragment angulated and displaced anteromedially because of the pull of the lateral pterygoid muscle attached to the condylar neck . This is not itself an indication for treatment and isolated injuries of this sort are often managed conservatively …”

“…Patients with an isolated unilateral condylar fracture with no new malocclusion or displacement superiorly or laterally are suitable for conservative management . All other injuries should be assessed by a maxillofacial surgeon and/or neurosurgeon if the condyle is displaced intracranially…”

Giant life-threatening external carotid artery pseudoaneurysm caused by a mandibular condylar fracture

“…Well-known complications of condylar fractures include pain, infection, nerve damage, temporomandibular joint ankylosis, limitation of mouth opening, temporomandibular joint disorders, malocclusion, and skin scars. [5][6][7] Vascular lesions associated with condylar fractures are poorly described, and their role in maxillofacial trauma are still underestimated.…”

Treatment of extensive comminuted mandibular fracture between both mandibular angles with bilateral condylar fractures using a reconstruction plate: a case report

“…Like other mandibular fractures, the treatment of condylar fractures is controversial12. For conservative methods using closed reduction, early mouth mobilization is essential to prevent adhesion or ankylosis of the temporomandibular joint (TMJ).…”