Outcomes of open versus closed treatment of mandibular subcondylar fractures.
OBJECTIVE
The purpose of this study was to compare the long-term treatment results of open reduction and rigid internal fixation (ORIF) with closed reduction and maxillomandibular fixation (CRMMF) for subcondylar fractures when guided by specific indications and contraindications.


METHODS
A protocol for the treatment of condylar process fractures was developed that included absolute and relative indications and contraindications as well as a technique regimen. To evaluate the results of this protocol, 10 patients treated with CRMMF and 10 treated by ORIF were recalled after a minimum of 6 months and examined for gender, race, diagnosis, age at injury, time since operation, and cause of the fracture. Each group was assessed by 2 blinded investigators for maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, deviation on opening, scar perception, motor function, sensory perception, contour perception, occlusion, and perception of pain. Nonparametric data were compared for statistical significance with a chi-square analysis and parametric data with an independent samples t-test (P < .05).


RESULTS
No statistically significant differences existed between the ORIF and CRMMF groups for gender, race, diagnosis, or cause. Moreover, no differences existed for age at injury, maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, deviation on opening, or occlusion. Differences were noted between groups for time since operation, scar perception, and perception of pain. Using the protocol outlined, there were no differences between the ORIF and CRMMF groups for ranges of motion, occlusion, contour, and motor or sensory function. The ORIF group was associated with perceptible scars. The CRMMF group was associated with chronic pain.


CONCLUSIONS
Using a treatment protocol, there were few differences in outcomes between patients treated with CRMMF and ORIF for subcondylar fractures.
Haug
R H
RH
The University of Kentucky, Division of Oral and Maxillofacial Surgery, Lexington, USA.
Assael
L A
LA
D000328:Adult; D016009:Chi-Square Distribution; D002908:Chronic Disease; D002921:Cicatrix / Q000503:physiopathology; D002985:Clinical Protocols; D016001:Confidence Intervals; D000075202:Contraindications; D003766:Dental Occlusion; D005157:Facial Pain / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006801:Humans; D019248:Jaw Fixation Techniques; D008137:Longitudinal Studies; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery*; D009046:Motor Neurons / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012677:Sensation / Q000502:physiology; D016037:Single-Blind Method; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D016896:Treatment Outcome