Outcomes of open versus closed treatment of mandibular subcondylar fractures: a prospective randomized study.
OBJECTIVE
To compare open reduction and internal fixation with closed treatment and maxillomandibular fixation for the management of subcondylar fractures of the mandible.


METHODS
Forty patients with subcondylar fractures of the mandible were evaluated. All fractures were displaced; either angulated between 10 degrees and 35 degrees or the ascending ramus was shortened by more than 2 mm. Clinical and radiographic evaluation was performed 6 months after the trauma. Clinical parameters included mouth opening, protrusion, laterotrusion, deviation on mouth opening, and occlusion. Radiographic parameters included level of the fracture, deviation of the fragment, and shortening of the ascending ramus. Subjective parameters included pain according to a visual analog scale. Nonparametric data were compared for statistical significance with a chi(2) analysis and parametric data with an independent samples t test (P < .05).


RESULTS
Correct anatomical position of the fragments was achieved significantly more accurately in the operative group in contrast to the closed treatment group. Regarding mouth opening/lateral excursion/protrusion, significant (P = .00) differences were observed between both groups (open 39.6/12.5/5.9 mm vs closed 33.5/9.8/4.1 mm). The visual analog scoring revealed significant (P = .00) difference with less pain in the operative treatment group (1.1 open vs 5.2 closed). No statistically significant difference was found between the 2 groups for occlusion (P = .86).


CONCLUSIONS
Both treatment options for condylar fractures of the mandible yielded acceptable results. However, operative treatment was superior in all objective and subjective functional parameters except occlusion.
Singh
Virendra
V
Department of Oral and Maxillofacial Surgery, Government Dental College, Pt. B.D. Sharma University of Health Sciences, Haryana, India.
Bhagol
Amrish
A
Goel
Mahesh
M
Kumar
Ish
I
Verma
Ajay
A
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D016009:Chi-Square Distribution; D003766:Dental Occlusion; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D019248:Jaw Fixation Techniques; D008297:Male; D008334:Mandible / Q000502:physiology; D008335:Mandibular Condyle / Q000000981:diagnostic imaging / Q000293:injuries*; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D009046:Motor Neurons / Q000502:physiology; D009460:Neurologic Examination; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D011984:Sensory Receptor Cells / Q000502:physiology; D016037:Single-Blind Method; D016896:Treatment Outcome