Open versus closed reduction: diacapitular fractures of the mandibular condyle

Abstract

The current indications for open reduction and internal fixation (ORIF) of DFs described in the literature are: (a) fractures affecting the lateral condyle with reduction of mandibular height; (b) fractures in which the proximal fragment dislocates laterally out of the glenoid fossa, which cannot be reduced by closed or open treatment of another part of the mandibular fracture. The indications for conservative treatment are: (a) fractures that do not shorten the condylar height (a fracture with displacement of the medial parts of the condyle); (b) undisplaced fractures; (c) comminution of the condylar head, when the bony fragments are too small for stable fixation; and (d) fractures in children. As the temporomandibular joint disk plays an important role as a barrier preventing ankylosis, it is important to reposition the disk (if displaced/dislocated) during the surgical treatment of DFs. The lateral pterygoid muscle should never be stripped from the medially displaced fragment because its desinsertion disrupts circulation to the medial bony fragment, and also because this muscle helps to restore the muscle function after surgery. ORIF of selected DFs improves prognosis by anatomical bone and soft tissue recovery when combined with physical therapy. If conducted properly, surgical treatment of DFs is a safe and predictable procedure and yields good results.

The influence of the condylar fracture treatment method on mandible dynamics

“…17 What is more, some authors even prefer the conservative me thod of treating condylar fractures in children. There have been studies recently proving a well-tolerated removal splint therapy which enabled good occlusion in all the patients, along with unimpaired function and good development of the mandible in those patients.…”

“…Chrcanovic, on the other hand, states that each time the articular disc, which acts as a barrier preventing ankylosis of TMJ, should be repositioned intraoperatively. 17 The lateral pterygoid muscle should not be delaminated from a chipped fragment because it impairs the vascularization of the bone and delays the regeneration of the masticatory muscles, which may have an impact on mandibular mobility. He et al, examining patients with condylar fractures (intra-articular), came to the conclusion that stable miniplate osteosynthesis is the best method of treating such fractures.…”

Bilateral condylar fracture mimicking bifid condyle - A case report

“…Recovery of mastication, on the basis of adaptive processes of TMJ is achieved by closed functional therapeutic regimen (CTR) as done in our case (10). Conservatively treated patients show an increased incidence of restriction in translation movement (10). Physiotherapy should be focused on rotational movement components and mouth opening exercises in the immediate post-operative phase (10).…”

“…However conservative management is preferred as surgery is technically demanding and risks the damage to facial nerve and development of unsightly scars (9). Recovery of mastication, on the basis of adaptive processes of TMJ is achieved by closed functional therapeutic regimen (CTR) as done in our case (10). Conservatively treated patients show an increased incidence of restriction in translation movement (10).…”

“…Conservatively treated patients show an increased incidence of restriction in translation movement (10). Physiotherapy should be focused on rotational movement components and mouth opening exercises in the immediate post-operative phase (10). Current literature does not give an unequivocal answer to the method of management of mandibular condylar fractures.…”