2017-18 HSC Section 3 Green Book

ORIGINAL ARTICLE

Kotrashetti, Lingaraj and Khurana e11

Volume 115, Number 4

CONCLUSION This prospective study of patients treated for condylar fractures at KLE’s Hospital and Medical Research Cen- tre, Belgaum, India, revealed that: ● Pain in the temporomandibular joint was more com- mon in patients treated conservatively compared with patients treated by ORIF. ● Similarly, occlusion also was found to be deranged more frequently in patients treated by closed reduction. ● On clinical observation, the incidences of mandibular deviation toward the fractured side was more com- mon in patients treated conservatively. In contrast, it occurred less often in the patients treated with ORIF. ● Reduced mouth opening was noted more commonly in patients treated conservatively than in those treated by open reduction and rigid fixation. ● Pain with restriction was noted on lateral excursive movements more commonly in patients treated con- servatively than in those treated by open reduction. ● Facial nerve weakness, salivary fistula, and infection were noted in 1 patient treated by open reduction, for which fistula excision followed by a course of intra- venous antibiotics was given and no reinfection was seen. Facial nerve function was assessed at regular intervals and aggressive physiotherapy given. Recov- ery was significant after 6 months. ● Reduced ramal height was observed on radiography more commonly in patients treated by closed reduc- tion. Despite fractured condyle not being in its ana- tomic position as observed on a radiograph, the jaw functions were normal. Considering these findings, we conclude that conserva- tive management gives good results clinically, although radiographically the condylar position is not normal but with reduced ramal height. This was achieved by early mobilization and aggressive physiotherapy. Open re- duction of displaced low-level subcondylar fractures led to excellent results. Therefore, this study concludes that open reduction is indicated in cases with displaced low-level subcondylar fractures both clinically and ra- diographically, compared with closed reduction, which gives inferior results in such cases. Also, the retroman- dibular approach used in this study provides good ac- cessibility, lower risk of facial nerve injury, and good esthetic outcome. REFERENCES 1. Rowe NL, Killey HC. Fractures of the facial skeleton. London: Churchill Livingstone; 1968: pp 173-179. 2. Alexander R, Su JY, Stark MM. An accurate method of open reduction and internal fixation of high and low condylar process fractures. J Oral Maxillofac Surg 1994;52:808-12. 3. Widmark G, Bågenholm T, Kahnberg KE, Lindahl L. Open reduction of subcondylar fractures. A study of functional reha- bilitation. Int J Oral Maxillofac Surg 1996;25:107-11.

4. Takenoshita Y, Ishibashi H, Oka M. Comparison of functional recovery after nonsurgical and surgical treatment of unilateral dislocated low subcondylar fractures. J Oral Maxillofac Surg 1990;48:1191-5. 5. Ellis E, 3rd, Simon P, Throckmorton GS. Occlusal results after closed and open treatment of unilateral mandibular condylar process fractures. JOMFS 2000;58:260-8. 6. Haug RH, Assael LA. Outcomes of open versus closed treatment of mandibular subcondylar fractures. J Oral Maxillofac Surg 2001;59:370-5; discussion 375-6. 7. Ellis E, et al. Open treatment of condylar process fractures: assessment of adequacy of repositioning and maintenance of stability. J Oral Maxillofac Surg 2000;58:27-34. 8. Silverman SL. New operation for displaced fractures at the neck of the condyle. Int J Orthod 1925;67:876. 9. Koberg WR, Momma WG. Treatment of fractures of the articular process by functional stable osteosynthesis using miniaturized dynamic compression plates. Int J Oral Surg 1978;7:256-62. 10. Kitayama S. A new method of intra-oral open reduction using a screw applied through the mandibular crest of condylar fractures. J Craniomaxillofac Surg 1989;17:16-23. 11. Biglioli, Colletti G. Mini-retromandibular approach to condylar fractures. J Craniomaxillofac Surg 2008;36:378-83. 12. Spiessl B, Schroll K. Gesichtsschädel: Gelenkfortsatz und Ge- lenkköpfchenfrakturen. In: Stuttgart; Georg Thieme Verlag; 1972:p. 58–59136-152. 13. Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota RA, Rasse M, et al. Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multi- center study with special evaluation of fracture level. J Oral Maxillofac Surg 2008;66:2537-44. 14. Eckelt U, Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota R, et al. Open versus closed treatment of fractures of the mandibular condylar process—a prospective randomized multi-centre study. J Craniomaxillofac Surg 2006;34:306-14. 15. Hyde M, Manisali M, Aghabeigi B, Sneddon K, Newman L. The role of open reduction and internal fixation in unilateral fractures of the mandibular condyle: a prospective study. Br J Oral Max- illofac Surg 2002;40:19-22. 16. Zide MF, Kent JN. Indications for open reduction of mandibular condylar fractures. J Oral Maxillofac Surg 1983;41:89-98. 17. Vesnaver A, Gorjanc M, Eberlinc A, Dovsak DA, Kansky AA. The periauricular transparotid approach for open reduction and internal fixation of condylar fractures. J Craniomaxillofac Surg 2005;33:169-79. 18. Choi BH, Yoo JH. Open reduction of condylar neck fractures with exposure of the facial nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:292-96. 19. Nogueira RVB, Vasconcelos B. Facial nerve injury following surgery for the treatment of ankylosis of the temporomandibular joint. Med Oral Patol Oral Cir Bucal 2007;12:E160-65. 20. Yang WG, Chen CT, Tsay PK, Chen YR. Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma 2002;52:498-503.

Reprint requests: Dr. Vishal Khurana Postgraduate Student Department of Oral and Maxillofacial Surgery KLE’s VK Institute of Dental Sciences Belgaum, Karnataka India vishalkhurana12@gmail.com

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