Open Versus Closed Treatment of Mandibular Condylar Fractures

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Mariam El Hadi Ahmed,El Sheikh
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Closed treatment may include a period of maxillomandibular fixation (MMF) followed by functional therapy, while the surgical approach involves open reduction and internal fixation; mandibular condylar fracture management is a matter of controversy despite numerous consensus meetings on open reduction and internal fixation (ORIF) Design: Controlled clinical trial conducted at Khartoum Teaching Dental Hospital Objective: This study aims to compare the treatment outcomes of open versus closed reduction of mandibular condylar process fractures. This study also closely examines the risks and complications which may accompany the surgical procedure. Methodology: A total of 26 patients were enrolled, with 13 patients assigned to each group. This convenient sample was drawn from all patients presenting at the hospital over one year, who matched the study criteria and fulfilled the treatment and follow up requirements. The variables under study were differences in the condylar process sagittal displacement, ramus height shortening, and deviation on mouth opening, malocclusion and pain perception measures on the visual analogue scale (VAS). The two groups were matched for age, gender, site and mechanism of injury and controlled for preexisting differences in the outcome measures. Results: The majority of patient enrolled were males constituting 84.6% % of the sample. The mean patient age was 28.31±7.56 years in the surgical treatment group and 30.08±15.41 years in the closed treatment group. Pre-treatment, the mean sagital displacement and mean ramus height shortening in the surgical group were 15.62±3.097° and 2.38±2.022 mm respectively. In the closed treatment group the mean displacement was 14.23±3.81° and the mean value for ramus height shortening was 4.23±2.55 mm. Three months post-treatment, the mean maximal mouth opening among the surgical treatment group was 4.3 ± 0.77 mm, and for the closed treatment group was 3.8 ± 0.96 mm. Post-operative absolute deviation at maximal mouth opening was significantly higher among the closed treatment group, affecting 10 (76.9%) patients (P 0.000). No significant differences were observed in the prevalence of post-operative occlusal disturbances or in the degree of pain perception. Following the surgical treatment, one patient developed infection at the surgical site and two patients developed transient facial nerve palsy. None developed permanent nerve damage, salivary fistula or Frey’s syndrome. Conclusion: There was no significant difference in the mandibular functional capacity between the two groups; deviation on mouth opening was significantly higher among patients treated conservatively. On the other hand, surgical treatment does involve the risk of transient facial palsy and, rarely, post-operative infection. There were no significant differences in the prevalence of post-operative occlusal disturbances, changes in mouth opening (inter-incisial distance) or in the degree of pain perception
Open Versus Closed Treatment of Mandibular Condylar Fractures