Open treatment of unilateral mandibular condyle fractures in adults: a systematic review

Abstract

Since the introduction of rigid internal fixation devices, more and more surgeons favour an open approach to treating condylar fractures of the mandible in adult patients. Different indications for open treatment have been published. Open treatment is associated with surgical complications because of the technique employed. The aim of this systematic review was to provide an overview of the studies published exclusively on open treatment, and to summarize the existing open treatment modalities and their clinical outcomes. A total of seventy studies were selected for detailed analysis. Most studies reported good results with regard to the outcome measures of open treatment. Surgical complications including hematoma, wound infection, weakness of the facial nerve, sialocele, salivary fistula, sensory disturbance of the great auricular nerve, unsatisfactory scarring, and fixation failure were reported in the studies. This review suggests that because of the high level of methodological variance in the relevant studies published to date, among other factors, there are currently no evidence-based conclusions or guidelines that can be formulated with regard to the most appropriate open treatment. Establishment of such standards could potentially improve treatment outcomes.

Frequency and approaches in treatment of fractured condylar processes in population of South East Serbia for the period from 2011 to 2017

“…Većina autora se slaže po pitanju indikacija za primenu konzervativnog i hirurškog lečenja preloma kondilarnog nastavka. Handšel, Borman, Rozebom (Rozeboom), Elis, Šiju (Shiju), Ekelt (Eckelt) i Konstantinović u svojim studijama daju prednost hiruškom lečenju ovog preloma, dok Suhas, Santler i Nalić favorizuju konzervativno lečenje (1,8,12,19,26,28,29,30,31,32,33). Studija sprovedena nad dve grupe pacijenata, od kojih je prva lečena konzervativno, a druga hirurški (endoskopski vođenim intraoralnim pristupom), pokazuje da su obe vrste lečenja dale zadovoljavajuće rezultate u terapiji preloma kondilarnog nastavka sa dislokacijom.…”

Algorithm for Management of Mandibular Condylar Base Fractures

“… 13 , 15 , 16 , 20 , 22 – 24 Supporters commonly state that ORIF is a safe alternative that improves ramus height with quicker return of jaw function. 3 , 7 , 20 , 24 A recent meta-analysis, including 23 studies, looked at clinical outcomes comparing ORIF with closed treatment for condylar fractures and showed improved outcomes with open treatment in regards to interincisal opening, jaw movement, pain, and malocclusion. 1 Similar findings were noted in a multicenter randomized controlled trial by Eckelt et al 9 showing improved functional outcomes of moderately displaced condylar base, neck, and head fractures.…”

“…However, facial nerve injury (temporary or permanent), infection, hematoma, sialocele, Frey’s syndrome, salivary fistula, and visible scar are reported complications of open treatment. 3 , 5 , 11 , 24 – 26 …”

“…Suggested indications for ORIF of condylar base fractures in the literature vary and often include loss of ramus height, inability to restore occlusion through closed management, foreign body in the mandible, dislocation, severe displacement, and edentulous patients. 1 , 2 , 15 , 16 , 21 , 24 ORIF for condylar fractures encompasses a wide range of operative incisions, techniques, and plating options. Common approaches include retromandibular, submandibular, preauricular, and transoral.…”

Experiência de tratamento cirúrgico de fraturas de côndilo mandibular extracapsular do Hospital do Trabalhador - Curitiba

“…Após a introdução de dispositivos rígidos de fixação interna, a maioria dos cirurgiões opta por uma abordagem aberta em pacientes adultos 4 . Um número crescente de publicações apresentou resultados ruins em relação ao tratamento conservador das fraturas condilares extracapsulares, o que leva a uma maior proporção de distúrbios funcionais 1 .…”