Open Reduction and Internal Fixation Versus Closed Reduction and Maxillomandibular Fixation of Condylar Fractures of the Mandible: A Prospective Study

Prakash, Rathod; Ramesh, KV; Alwala, Aditya Mohan; Porika, Rachana; Manjusha, .; Katkuri, Saideep

doi:10.7759/cureus.21186

Cited by 6 publications

(10 citation statements)

References 27 publications

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“…Our clinical findings show significant improvements in TMJ function and pain between T1 and T2, with no severe TMJ disorders or medium-term complications at T2. Despite the anesthesiologic risk, additional expenses, and necessary surgeon training, our study findings support the open treatment of CHF and the findings of previous studies with low resorption and good clinical patient outcomes [ 14 , 16 , 19 , 20 , 29 ]. Therefore, we strongly recommend the open treatment for displaced condylar head fractures, as it is still not widely performed.…”

Section: Discussionsupporting

confidence: 89%

“…A latest clinical trial showed that open treatment seems to be clearly superior to conservative treatment in terms of clinical function [ 29 ]. The information on clinical function and outcome in our study is limited due to its medium-term follow-up of 15 months.…”

Section: Discussionmentioning

confidence: 99%

“…The information on clinical function and outcome in our study is limited due to its medium-term follow-up of 15 months. This challenge could be clearly observed throughout the literature as the rate of patients lost to follow-up increases over time, with common follow-up periods of 5 to 6 months [ 19 , 20 , 29 ]. Xie et al [ 18 ] were able to observe their patients over a period of 24 months.…”

Section: Discussionmentioning

confidence: 99%

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No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term

Neuhaus

Gellrich

Sander

et al. 2022

JCM

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Open treatment of condylar head fractures (CHF) is considered controversial. In this retrospective cohort study our primary objective was therefore to assess bone resorption and remodeling as well as patients function after open treatment of CHF in a medium-term follow-up (15.1 ± 2.2 months). We included 18 patients with 25 CHF who underwent open reduction and internal fixation, between 2016 and 2021, in our analysis. The clinical data and cone-beam computed tomography (CBCT) datasets were analyzed. The condylar processes were segmented in the postoperative (T1) and follow-up (T2) CBCT scans. Volumetric and linear bone changes were the primary outcome variables, measured by using a sophisticated 3D-algorithm. The mean condylar head volume decreased non-significantly from 3022.01 ± 825.77 mm3 (T1) to 2878.8 ± 735.60 mm3 (T2; p = 0.52). Morphological alterations indicated remodeling and resorption. The pre-operative maximal interincisal opening (MIO) was 19.75 ± 3.07 mm and significantly improved to 40.47 ± 1.7 mm during follow-up (p = 0.0005). Low rates of postoperative complications were observed. Open reduction of CHF leads to good clinical outcomes and low rates of medium-term complications. This study underlines the feasibility and importance of open treatment of CHF and may help to spread its acceptance as the preferred treatment option.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term

Neuhaus

Gellrich

Sander

et al. 2022

JCM

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“…The P value is < 0.001 which indicated highly significant difference between both the groups. In open reduction group Similar results were achieved by Prakash R Sr et al 24 over 6 months after the surgery (37.36mm). Thus, major concern after conservative treatment is restricted mouth opening.…”

Section: Stability Of Fractured Fragment and Osteosynthesis Devicesupporting

confidence: 83%

Comparative evaluation of open reduction and internal fixation using delta plate versus conservative treatment in management of mandibular subcondylar fractures in adults

Bhavsar

Patel²,

Pandya³

et al. 2023

JOOO

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The aim of the evaluative study was to compare the efficacy of standard conservative treatment and the open reduction internal fixation (ORIF) using the delta titanium plates in the mandibular subcondylar fractures in adults. Patients who diagnosed with mandibular subcondylar fracture in the department from January 2018 up to September 2019 were recruited into the study. The patients satisfying the inclusion criteria were randomly assigned to two groups in a 1:1 ratio (10 in each group). Group A comprised patients treated using delta titanium plates through open reduction and internal fixation and Group B comprised patients treated with closed reduction. Informed consent was taken for all the patients. All the patients of Group A underwent ORIF under GA via retromandibular approach. Pain was significantly higher in 1 and 3 month follow up in group B compared to group A. Comparison of mouth opening in both the groups show statistically significant difference at 3 and 6 month compared to baseline mouth opening. Deviation was more prevalent at 1 and 3 month follow up in group B compared to group A. Presence of mandibular deviation at 1, 3 and 6 month was statistically insignificant for both the groups.Our experience with 3D stable delta plate provides better treatment outcomes in terms of easy adaptation to the anatomy of the fracture site, better 3D stability and functional osteosynthesis.

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“…In general, ORIF is suggested to lead to better occlusal results, anatomic restoration and faster recovery rates than non‐surgical techniques 1 . Other studies suggest that open surgical treatment should be indicated in cases of displaced and dislocated condylar fractures 5 . Nevertheless, potential surgical complications such as facial nerve palsy, salivary fistula and deranged occlusion cannot be denied 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases

Maurer,

Klaes,

Meier

et al. 2023

Dental Traumatology

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Background/AimMandibular condylar fractures represent 25%–35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF).The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post‐treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications.MethodsA retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre‐ and postoperative documentation. Follow‐up period was 12 months. Pearsons' chi‐square‐test, correlations, Kruskal–Wallis test and t‐test were carried out for statistical analysis.ResultsThe dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post‐treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post‐treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009).ConclusionMalocclusion seems to be the most frequent long‐term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

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Open Reduction and Internal Fixation Versus Closed Reduction and Maxillomandibular Fixation of Condylar Fractures of the Mandible: A Prospective Study

Cited by 6 publications

References 27 publications

No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term

No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term

Comparative evaluation of open reduction and internal fixation using delta plate versus conservative treatment in management of mandibular subcondylar fractures in adults

Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases

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