Comparison of Surgical and Nonsurgical Treatment of Bilateral Condylar Fractures Based on Maximal Mouth Opening (Maxillofacial Surgery) (Clinical Report)
By CRANIO: The Journal of Craniomandibular Practice
- Release Date: 2007-01-01
- Genre: Engineering
Description
ABSTRACT: This study presents a comparative analysis of the open surgical and nonsurgical treatment of patients with bilateral condylar fractures. Sixty-seven (67) patients were treated, and the completed data on 55 patients were reviewed to compare both therapeutic modalities, which consisted of nonsurgical and surgical treatment in 37 and 18 patients, respectively. In the nonsurgical group, 23 patients (23/37, 62%) had normal mouth opening. Functional success rate was 79% (15/19) and 44% (8/18) in young adult patients (-29yrs) and older patients (30+yrs), respectively, and there was a significant difference of outcome between the two groups. In nonsurgically treated young patients with disorders, bilateral dislocation and existence of concomitant mandibular fractures were commonly observed. In the open surgical group, seven (7/11, 64%) young adult and three (3/7, 43%) older patients gained normal mouth opening, and no significant difference was observed. Additionally, there was no difference between non-surgical and surgical treatment in any category. Patients undergoing rigid fixation benefited from restoring maximum mouth opening, although there was no significant difference between the rigid and non-rigid fixation groups. Based on these findings, nonrigid fixation should be avoided, and rigid fixation might improve outcome in young adult patients with severe fracture pattern, such as bilateral dislocation and concomitant mandibular fracture. Mandibular fractures are common in facial trauma, with 26-57% involving the condyle (1) and with 24-33% (1-5) of all condylar fractures presenting as bilateral condylar fractures. Multivariate analysis reveals that bilateral condylar fractures result from an extremely strong impact and are more often the cause of physical complaints than unilateral ones. They are also a predictive factor for poor outcomes. (6-8) Nevertheless, there is a paucity of information on the optimal treatment of bilateral condylar fractures.
