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.

Keywords: Jaw fixation techniques; Mandibular condyle; Mandibular fractures; Motion therapy, continuous passive.

Fig. 1

An 18-year-old man with condyle head fracture due to traffic accident (A) Preoperative coronal view of 3D head computed tomography (CT). (B) Coronal view of 3D head CT after functional treatment for 4 weeks.

Fig. 2

An 8-year-old girl with condyle head fracture due to slip down Serial 3D head computed tomography (CT) was checked during closed reduction and functional therapy. (A) Preoperative axial view of 3D head CT. (B) Axial view of 3D head CT after functional treatment for 2 months. (C) Axial view of 3D head CT after functional treatment for 4 months. (D) Preoperative Coronal view of 3D head CT. (E) Coronal view of 3D head CT after functional treatment for 2 months. (F) Coronal view of 3D head CT after functional treatment for 4 months.

Fig. 3

A 39 years old woman with both condyle fracture due to traffic accident (A) Intermaxillary fixation (IMF) with arch bar apply. (B) IMF and arch bar removal was done at postoperative 1 month. (C) After 2 years, the panorama plain film was checked. Functional treatment was applied initially for 2 months.

Fig. 4

A 70 years old woman with subcondylar fracture due to slip down (A) Preoperative intermaxillary fixation with arch bar apply. (B) Intraoperative finding. (C) Panorama plain film was checked at postoperative 6 months. The subcondylar fracture was corrected by open reductionand internal fixation using pre-auricular approach.

Fig. 5

Authors's algorithm for open reduction (2012) IMF, intermaxillary fixation.