Is Open Reduction and Internal Fixation Sacrosanct in the Management of Subcondylar Fractures: A Comparative Study

Overview

Journal J Pharm Bioallied Sci

Specialty Pharmacology

Date 2022 Jan 12

PMID 35018044

Authors

Nandini Dayalan

Bhawna Kumari

Shilpa Sunil Khanna

Faisal Mohiuddin Ansari

Ramandeep Grewal

Sanket Kumar

Rahul V C Tiwari

Affiliations

Soon will be listed here.

Abstract

Purpose: This paper is intended to compare and evaluate the better treatment option in the management of subcondylar fractures of the mandible.

Materials And Methods: This study included 20 patients who were diagnosed clinically and radiologically to have sustained an isolated subcondylar fracture of the mandible. They were divided into two groups randomly. Group I included 10 patients who underwent treatment by intermaxillary fixation alone followed by active physiotherapy in the form of conservative management. Group II included 10 patients who underwent treatment by surgical intervention for open reduction and internal fixation under general anesthesia following elastic guidance. Factors such as maximal mouth opening, pain scores, and deviation of mandible on mouth opening were taken into consideration and evaluated.

Results: It is observed that the patients in Group I had weight loss and restrictions in their social well-being in the early recovery phase, in addition to delay in return to function. In spite of the early return to function, patients in Group II were subjected to all kinds of surgical complications such as transient facial nerve injury, infection, and unesthetic scar. The maximal mouth opening and deviation of the mandible on mouth opening remained almost the same in both groups.

Conclusion: A regular follow up of operated patients post trauma is essential to obtain morphological and functional recovery. When the respective advantages and disadvantages of both treatment options were compared and evaluated, it was observed that patients treated by closed reduction had a better clinical and psychological outcome.

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References

Singh V, Bhagol A, Goel M, Kumar I, Verma A . Outcomes of open versus closed treatment of mandibular subcondylar fractures: a prospective randomized study. J Oral Maxillofac Surg. 2010; 68(6):1304-9. DOI: 10.1016/j.joms.2010.01.001. View

Worsaae N, Thorn J . Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: a clinical study of 52 cases. J Oral Maxillofac Surg. 1994; 52(4):353-60; discussion 360-1. DOI: 10.1016/0278-2391(94)90436-7. View

Uppada U, Sinha R, Susmitha M, Praseedha B, Kiran B . Mandibular Fracture Patterns in a Rural Setup: A 7-Year Retrospective Study. J Maxillofac Oral Surg. 2023; 21(4):1349-1354. PMC: 9989092. DOI: 10.1007/s12663-020-01358-3. View

Santler G, Karcher H, Ruda C, Kole E . Fractures of the condylar process: surgical versus nonsurgical treatment. J Oral Maxillofac Surg. 1999; 57(4):392-7; discussion 397-8. DOI: 10.1016/s0278-2391(99)90276-8. View

Simsek S, Simsek B, Abubaker A, Laskin D . A comparative study of mandibular fractures in the United States and Turkey. Int J Oral Maxillofac Surg. 2007; 36(5):395-7. DOI: 10.1016/j.ijom.2006.11.010. View

Talwar R, Ellis 3rd E, Throckmorton G . Adaptations of the masticatory system after bilateral fractures of the mandibular condylar process. J Oral Maxillofac Surg. 1998; 56(4):430-9. DOI: 10.1016/s0278-2391(98)90707-8. View

Ellis 3rd E, Throckmorton G . Facial symmetry after closed and open treatment of fractures of the mandibular condylar process. J Oral Maxillofac Surg. 2000; 58(7):719-28; discussion 729-30. DOI: 10.1053/joms.2000.7253. View

De Riu G, Gamba U, Anghinoni M, Sesenna E . A comparison of open and closed treatment of condylar fractures: a change in philosophy. Int J Oral Maxillofac Surg. 2001; 30(5):384-9. DOI: 10.1054/ijom.2001.0103. View

Newman L . A clinical evaluation of the long-term outcome of patients treated for bilateral fracture of the mandibular condyles. Br J Oral Maxillofac Surg. 1998; 36(3):176-9. DOI: 10.1016/s0266-4356(98)90492-2. View

10.

Yang W, Chen C, Tsay P, Chen Y . Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma. 2002; 52(3):498-503. DOI: 10.1097/00005373-200203000-00014. View

11.

Shiju M, Rastogi S, Gupta P, Kukreja S, Thomas R, Bhugra A . Fractures of the mandibular condyle--Open versus closed--A treatment dilemma. J Craniomaxillofac Surg. 2015; 43(4):448-51. DOI: 10.1016/j.jcms.2015.01.012. View

12.

Terai H, Shimahara M . Closed treatment of condylar fractures by intermaxillary fixation with thermoforming plates. Br J Oral Maxillofac Surg. 2004; 42(1):61-3. DOI: 10.1016/s0266-4356(03)00205-5. View

13.

Asim M, Ibrahim M, Javed M, Zahra R, Qayyum M . Functional Outcomes Of Open Versus Closed Treatment Of Unilateral Mandibular Condylar Fractures. J Ayub Med Coll Abbottabad. 2019; 31(1):67-71. View

14.

Revanth Kumar S, Sinha R, Uppada U, Ramakrishna Reddy B, Paul D . Mandibular Third Molar Position Influencing the Condylar and Angular Fracture Patterns. J Maxillofac Oral Surg. 2015; 14(4):956-61. PMC: 4648771. DOI: 10.1007/s12663-015-0777-2. View

15.

Valiati R, Ibrahim D, Abreu M, Heitz C, Oliveira R, Pagnoncelli R . The treatment of condylar fractures: to open or not to open? A critical review of this controversy. Int J Med Sci. 2008; 5(6):313-8. PMC: 2574020. DOI: 10.7150/ijms.5.313. View

16.

Liu Y, Bai N, Song G, Zhang X, Hu J, Zhu S . Open versus closed treatment of unilateral moderately displaced mandibular condylar fractures: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116(2):169-73. DOI: 10.1016/j.oooo.2013.02.023. View

17.

Ellis E, Throckmorton G . Treatment of mandibular condylar process fractures: biological considerations. J Oral Maxillofac Surg. 2005; 63(1):115-34. DOI: 10.1016/j.joms.2004.02.019. View

18.

Haug R, Assael L . Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg. 2001; 59(4):370-5; discussion 375-6. DOI: 10.1053/joms.2001.21868. View

19.

Long X, Goss A . A sheep model of intracapsular condylar fracture. J Oral Maxillofac Surg. 2007; 65(6):1102-8. DOI: 10.1016/j.joms.2006.06.307. View