2017-18 HSC Section 3 Green Book

Reprinted by permission of Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115(4):e7-e11.

Vol. 115 No. 4 April 2013

A comparative study of closed versus open reduction and internal fixation (using retromandibular approach) in the management of subcondylar fracture S. M. Kotrashetti, MDS, J. B. Lingaraj, MDS, and Vishal Khurana, MDS Objective. The aim of this study was to evaluate the clinical and radiologic outcomes of open reduction and internal fixation compared with closed reduction approach for fractures occurring at the subcondylar level. Study Design. Twenty-two patients with subcondylar fractures were included in the study; 12 patients were treated by closed reduction and 10 patients underent open reduction and rigid internal fixation, with follow-up at 3 and 6 months. Selection of patients for open and closed procedures was done on a random basis. Results and conclusions. The results showed that open reduction and internal fixation of displaced subcondylar fractures showed better results clinically as well as radiographically compared with similar fractures treated by closed reduction. (Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e7-e11)

According to Wildmark et al. 3 and Takenoshita et al., 4 satisfactory post operative function and occlusion were present in both surgical and conservative groups. Al- though there are equal numbers of studies supporting open and closed reductions, there has been a considerable in- crease in the incidence of long-term complications asso- ciated with closed form of treatment. Ellis et al. 5 had greater incidence (27.3%) of malocclu- sion, 39% of patients had deviation of jaw during mouth opening, and 22% of patients had joint clicking among those treated with closed reduction. It is still controversial regarding clear guidelines for treatment and precise func- tional evaluation of surgical treatment of condylar fractures. The present study was aimed at comparing outcomes of closed and open reduction of condylar fractures. MATERIALS AND METHODS Twenty-two patients with displaced mandibular condy- lar process fractures reporting to KLE’s Hospital and Medical Research Centres, Belgaum, India, were cho- sen for this study. Group I included 12 patients treated with closed reduction. Group II included 10 patients treated with open reduction and internal fixation (ORIF). Patients 20-40 years old were included, and patients with undisplaced subcondylar fractures or pan- facial trauma were excluded from the study. Selection of patients for open and closed procedures was done on a simple random basis with toss of coin. Patients were Statement of Clinical Relevance Treatment of condylar fractures is still a major controversy in maxillofacial trauma. This study has been conducted to improve the clinical outcome of such cases with early return to function.

Mandibular fractures are common in maxillofacial inju- ries. Among mandibular fractures, the condylar region is the most frequent site, accounting for 25%-35% of cases. 1 Condylar fractures arise mainly through indirect injury from a traumatic impact on the chin and seldom arise from direct trauma unless accompanied by fracture of zygoma. Injury to the condylar region deserves special consider- ation apart from rest of the mandible, owing to anatomic differences and healing potential. Condylar fractures are classified according to the anatomic location and the degree of dislocation of the articular head. There are 2 methods of principal thera- peutic modalities to these fractures: functional and sur- gical. There has been considerable controversy regard- ing the treatment of condylar fractures, either they should be treated conservatively or surgically. There are complications associated with both types of treat- ment. Many authors prefer open reduction, because there is early recovery of function, less incidence of malocclusion, and adequate interincisal mouth opening compared with treatment by closed reduction. According to Alexander et al. 2 displaced low sub- condylar fractures should be treated by open reduction, because there are no malocclusion, wound infection, and neurosensory deficits. Those preferring closed re- duction claim that functional recovery is the same after open or closed reduction, and morbidities associated with surgical treatment could be avoided.

Department of Oral and Maxillofacial Surgery, KLE’s VK Institute of Dental Sciences, Belgaum, Karnataka, India. Received for publication Feb 19, 2011; returned for revision Oct 4,

2011; accepted for publication Oct 13, 2011. © 2013 Elsevier Inc. All rights reserved. 2212-4403/$ - see front matter http://dx.doi.org/10.1016/j.oooo.2011.10.027

16