J Korean Assoc Oral Maxillofac Surg.  2022 Oct;48(5):303-308. 10.5125/jkaoms.2022.48.5.303.

Open versus closed treatment for extracapsular fracture of the mandibular condyle

• Lee J
• Jung HY
• Ryu J
• Jung S
• Kook MS
• Park HJ
• Oh HK

• KMID: 2534811
• DOI: http://doi.org/10.5125/jkaoms.2022.48.5.303

Abstract

Objectives
Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction.
Patients and Methods
Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography.
Results
A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment.
Conclusion
No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

Keyword

Mandibular fracture; Open fracture reduction; Closed fracture reduction

Figure

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  Fig. 1 Coronal computed tomography views of a patient showing displacement (A) and no displacement (B) of the condylar fracture.

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  Fig. 2 Measurements in panoramic radiographs before treatment (A) and after treatment (B). (T0: before treatment, T1: after treatment, RH: ramal height, fx: fracture site, non-fx: non-fracture site)

Reference

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