title: Endoscope-assisted transoral reduction and internal fixation versus closed treatment of mandibular condylar process fractures--a prospective double-center study.
abstract: OBJECTIVE
  The aim of this international AO-study was to compare the functional outcome after open versus closed treatment of mandibular condylar neck fractures.
  
  
  METHODS
  A prospective comparative study with two follow-ups (FU) at 8-12 weeks and 1 year was undertaken in two clinics, which exclusively privileged either surgical or conservative treatment due to different therapeutic agendas. Patients from clinic 1 (ENDO group) received endoscope-assisted transoral open reduction and internal fixation, whereas patients from clinic 2 (CONS group) were treated conservatively without surgery. Patients with unilateral condylar neck fractures showing one or more of the following conditions were included: displacement of the condyle with an inclination >30° and/or severe functional impairment such as malocclusion or open bite, with or without dislocation of the condylar fragment; severe pain upon palpation or movement, and/or vertical shortening of the ascending ramus. High or intracapsular condylar neck fractures were excluded.
  
  
  RESULTS
  75 patients (44 CONS and 31 ENDO patients) with condylar neck fractures were included in this study. The Asymmetric Helkimo Dysfunction Score (A-HDS) was slightly lower in the CONS group than in the ENDO group at the 8-12-week FU, corresponding to better function on the short-term. At the 1-year FU, however, there were slightly better values in the ENDO group. For the Clinical Dysfunction Index (Di) and the Anamnestic Dysfunction Index (Ai), CONS patients had a better outcome than ENDO patients at the 8-12 week FU, ie, a higher proportion of ENDO patients had severe symptoms due to the operative trauma. Yet these symptoms improved by one year, finishing with a significant higher proportion of symptom-free patients in the ENDO group. In addition, these patients had better values for the Index for Occlusion and Articulation Disturbance (Oi) at both FU examinations, ie, the proportion of patients without any occlusal disturbances was significantly higher in the ENDO group. On average, the duration of postoperative maxillo-mandibular fixation (MMF) was 3 times longer for the CONS group than for the ENDO group (33 vs. 11 days).
  
  
  CONCLUSIONS
  Both treatment options may yield acceptable results for displaced condylar neck fractures. Especially in patients with severe malocclusion directly after trauma, however, endoscope-assisted transoral open reduction and fixation seems to be the appropriate treatment for prevention of occlusal disturbances during FU.
authors.affiliation: Department for Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany. kokemueller.horst@mh-hannover.de
authors.forename: Horst
authors.initials: H
authors.lastname: Kokemueller
authors.forename: Vitomir S
authors.initials: VS
authors.lastname: Konstantinovic
authors.forename: Enno-Ludwig
authors.initials: EL
authors.lastname: Barth
authors.forename: Sabine
authors.initials: S
authors.lastname: Goldhahn
authors.forename: Constantin
authors.initials: C
authors.lastname: von See
authors.forename: Frank
authors.initials: F
authors.lastname: Tavassol
authors.forename: Harald
authors.initials: H
authors.lastname: Essig
authors.forename: Nils-Claudius
authors.initials: NC
authors.lastname: Gellrich
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D004954:Esthetics; D005081:Exercise Therapy; D005157:Facial Pain / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006261:Headache / Q000209:etiology; D006406:Hematoma / Q000209:etiology; D006801:Humans; D019248:Jaw Fixation Techniques; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy; D008297:Male; D008310:Malocclusion / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery* / Q000628:therapy; D008410:Masticatory Muscles / Q000503:physiopathology; D017060:Patient Satisfaction; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D013704:Temporomandibular Joint / Q000503:physiopathology; D016896:Treatment Outcome