Jc open vs closed reductionPresentation Transcript
Prospective evaluation of a pragmatic treatment rationale: ORIF of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures Part I: condyle and subcondylar fractures . C. A. Landes, R. Lipphardt Moderator: Dr. Shireen Fatima Presented by: Dr. Shahid Khan ypagk
Traditionally, Condylar fractures were treated by closed reduction (CR) with varying degrees of mandibulo-maxillary fixation(MMF) or guided occlusion.
Survey of the IAOMS surgeons published in 1998 shows the increasing popularity of ORIF: in general,57% of surgeons prefer ORIF compared to 40% in favor of closed reduction.
Non-dislocated, non-displaced condyle fractures,
incomplete fracture lines, unchanged occlusion,
normal vertical mouth opening were reported to heal without any immobilization.
,but were treated with soft diet and vertical mouth opening exercises.
Displaced, dislocated and 3-week-old fractures had better outcomes with ORIF.
Conservative treatment is generally recommended in children up to 12 years due to high local restitution capacity.
However, increasing dysfunction Index proportional with age and incomplete remodeling in dislocated fractures in children are reported. Therefore, recent reports favor ORIF even in patients under 12 years of age.
To evaluate outcomes of closed reduction (CR) in nondisplaced, non-dislocated condyle and subcondylar fractures.
& open reduction and internal fixation (ORIF) of displaced & dislocated condyle fractures.
Pt’s with malocclusion, locking, or a displaced or dislocated condyle were operated on.
Non-displaced fractures with normal occlusion and moderate joint tenderness were treated with CR. The results were evaluated separately.
MATERIALS AND METHODS:
Unilateral or bilateral condyle fractures, located at the sigmoid notch or subcondylar region.
Pt’s with a H/O TMJ dysfunction and insufficient dentition to reproduce occlusal relationships & severe pre-traumatic dysgnathia.
The mean age in the operated group was 36 (9–79) yrs.& in non-operated group 30yrs (15–60)yrs.
45pt’s with 51 fractures [6(13%) with bilateral fractures].
11 pt’s (25%) CR. 34 pt’s (75%) ORIF (includes all bilateral fracture)were enrolled in a 1-year follow up that 20 pt’s with 25 fractures completed.
Diagnostic imaging: This was performed with mandibular tomograms and Towne views.
Fracture classification was performed radiologically to separate condyle/subcondylar from high condylar/condylar head fractures.
OPEN Vs CLOSED TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLAR PROCESS-A Prospective Randomized Multicenter Study:
ECKELT & SCHNEIDER [Journal of Cranio-Maxillofacial Surgery 2006]
To compare operative and conservative treatment of displaced condylar fracture of mandible 66 patients with 79 fractures were evaluated.
Both treatment options for condylar fractures of the mandible provides acceptable result ,
However ORIF, irrespective of the method of internal fixation used, was superior in all objective and subjective functional parameters.
FRACTURES OF THE CONDYLAR PROCESS: SURGICAL VS NONSURGICAL TREATMENT
SANTLER, KIIRCHER [JOMS 1999]
To compare outcomes from surgical and nonsurgical T/t of condylar fractures,234 pt’s with fractures of the condylar process were treated by open or closed methods.
150 patients with a mean follow-up time of 2.5 years were analyzed.
Open surgery is only indicated in pt’s with severely dislocated condylar process fractures.
OPEN TREATMENT OF CONDYLAR PROCESS FRACTURES:ASSESMENT OF ADEQUACY OF REPOSITIONING AND MAINTAINANCE OF STABILITY
Edward ellis [JOMS-2000]
To determine how fractured condyle were reduced and the stability of the internal fixation in a group of pt’s who’s fractures were treated by open reduction.
61 patients treated by ORIF for unilateral condylar fractures were studied.
This study showed that it is possible to anatomically reduce the fractured condylar process, but changes in position of the condylar fragment may then result from a loss of fixation.
CONCLUSION: Major risk in displaced and dislocated cases can safely be avoided through ORIF, with acceptable complication rates. Bilateral fractures can be treated with the identical approach of ORIF on the displaced and dislocated side, and CR on the non-displaced sides for comparable results.
This Treatment Rationale Conforms To The General Rule Of Traumatology: ORIF For Dislocated Fractures And Conservative Treatment For Non-dislocated Fractures & Gave Successful Results.