Open versus closed treatment of fractures of the mandibular condyle:
A prospective, randomized, multicentre study

Fractures of the mandibular condyle are common injuries that account for
between 25% and 35% of all mandibular fractures. Treatment options for
fractures of the mandibular condyle consist of either closed reduction or open
reduction with internal fixation (ORIF).

Several studies have demonstrated advantageous clinical results with closed
treatment of condylar fractures. Some studies however have shown complications
of the closed reduction; including malocclusion, particularly open bites,
reduced posterior facial height and facial asymmetry, chronic pain and reduced
mobility.
Open reduction of the condylar fractures has been recommended in selected cases
and different indications have been proposed. As well as the closed reduction,
the open approach has not infrequently been associated with complications; a
cutaneous scar and temporary paralysis of the facial nerve.
At present a consensus regarding the most appropriate method for the management
of fractures of the mandibular condyle is missing. There is a lack of high
quality evidence for the effectiveness of either approach. Most of the studies
on this subject have been retrospective case series using a single approach
rather than a comparison of the two techniques. Further research, comparing the
two treatmen options is required to be able to make an informed choice between
the open and closed reduction.

The aim of this prospective study was to compare open and closed treatment of
fractures of the manibular condyle. With special attention to the subjective
experience of temporomandibular joint dysfunction in patients.

To compare open and closed treatment of fractures of the manibular condyle.
With special attention to the subjective experience of temporomandibular joint
dysfunction in patients.

Randomised clinical trial with follow up examinations at 2 weeks, 6 weeks, 6
months and 12 months.

Open reduction

- Internal fixation (ORIF = titanium plates)
- Decisions about individual surgical procedures and surgical approaches are
left to the surgeon
- No maxillomandibular fixation
- Physiotherapy is allowed

Closed reduction

- Maxillomandibular fixation (with steel wires or firm elastics for a maximum
of 14 days)
- Physiotherapy is allowed

Postoperative instructions regarding mouth opening, no rinsing in the first 24
hours and a full liquid diet, are given to all patients.

Number of visits
- Follow up examinations at 2 weeks, 6 weeks, 6 months and 12 months.


Physical examination
a. Functional assessment: temporomandibular joint
b. Neurological assessment

Questionnaires
1. Mandibular Function Impairment Questionnaire (MFIQ)

2. Remaining:

a. General health questionnaire
b. Research Diagnostic Criteria for Temporomandibular Disorders: RDC/TMD
c. Oral Health Impact Profile: OHIP-14
d. Symptom Checklist: SCL-90 (somatisation, sleep, depression, anxiety)

Possible complications

Closed reduction:
Malocclusion, particularly open bites, reduced posterior facial height and
facial asymmetry, chronic pain and reduced mobility.

Open reduction:
Bleeding, infection, cutaneous scar and temporary paralysis of the facial
nerve.