Management Of Condylar Fractures Research Articles

The Role of Orthodontics in the Management of Maxillofacial Fractures in Children: A Review on Contemporary Approaches.

Maxillofacial fractures present complex challenges requiring effective orthodontic management to restore function and aesthetics. This review explores various orthodontic techniques, including fixed braces, maxillomandibular fixation (MMF), functional orthodontic therapy (FOT), and acrylic splints, emphasizing their roles in stabilizing fractures and promoting healing. The management of condylar fractures is discussed, highlighting the benefits of early intervention with functional appliances to facilitate condylar remodeling in children and adolescents. Additionally, the review covers splinting methods for dental and dentoalveolar fractures and the use of open reduction internal fixation (ORIF) for maxillary fractures. It addresses the complications and challenges of fracture management, the need for a multidisciplinary approach, and the limitations of current studies. Future directions include the use of advanced technologies such as virtual surgical planning (VSP) and 3D printing to enhance treatment precision and outcomes. This review provides a comprehensive overview of orthodontic strategies for maxillofacial fractures, offering insights into clinical applications and future advancements.

Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis.

Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial. The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle-Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant. Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias. The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.

Comparison between endoscopically assisted transoral and high perimandibular approaches for the surgical management of condylar fractures: A retrospective study

ObjectiveThis study aimed to compare the endoscopically assisted transoral approach (EATA) and high perimandibular approach (HPMA) for mandibular condylar fractures. MethodsWe conducted a retrospective study on patients who underwent open reduction and internal fixation using the EATA or HPMA between March 2013 and February 2023 and were followed up for > 6 months. The primary predictor variables were the surgical approach, including the EATA and HPMA. The outcome variables were postoperative mandibular condition, including maximum interincisal opening, occlusion and condylar pain, anatomical reduction, and complications. Other predictive variables were patient characteristics and perioperative fracture conditions. Statistical analyses were performed by comparing patients treated with the EATA and HPMA. ResultsSeventeen and 14 patients who were treated with the EATA and HPMA, respectively, were eligible for this study. Radiological assessments showed that the anatomical reduction in patients treated with the HPMA was significantly better than in those treated with the EATA. Notably, four patients experienced trismus after the EATA and none after the HPMA. One patient experienced malocclusion after the EATA; however, none experienced malocclusion after the HPMA. However, the differences in these mandibular condition between the EATA and HPMA groups were not significant. None of the patients experienced transient or permanent facial nerve palsy. ConclusionsSignificant differences in anatomical reduction between patients treated with the EATA and HPMA are observed; however, the difference in postoperative mandibular condition is not significant between the two approaches. It is essential to choose the appropriate approach based on a thorough preoperative evaluation.

Retromandibular Approach and its Different Variations in the Management of Fracture Condyle: Surgical Experience.

The management of condylar fractures is a controversial topic in maxillofacial surgery. Surgical treatment is the preferred treatment choice nowadays and the article aims to describe different variations of the retromandibular approach with their surgical outcome based on experience. A total of 15 cases were managed with the retromandibular approach and its different variations. We advocate retromandibular approach for the management of condyle fractures, and among which retromandibular retroparotid and retromandibular anteroparotid provide best accessiblity with less bleeding and minimal risk of injury to the facial nerve.

Treatment Outcome Following Closed and Open Reduction of Condylar Fractures – A 3 Year Clinical Prospective Study

In maxillofacial trauma patients mandibular fractures are more common, among which condylar region is the most frequent site of fracture accounting for 25-30%. Management of Condylar fracture is most controversial topic in maxillofacial trauma. This study is aimed at comparing the outcome of closed and open reduction of condylar fractures.

Surgical approaches of condylar fracture management - A Mini Review

Mandibular condylar neck and subcondylar fractures are common in maxillofacial surgery. The justification for surgical treatment of these fractures has varied over time, to avoid the most concerning side event, namely facial nerve injury. We offer a new approach that combines intraoral and cutaneous pre-auricular access, allowing for quick and safe access to the surgical site while avoiding facial nerve injury and surgical scars in high-impact aesthetic areas of the neck. Five patients with condylar neck or subcondylar fractures were treated at the same hospital using a combined intraoral and pre-auricular approach. Three months following surgery, the results were assessed in terms of mandibular mobility, complications, and patient satisfaction All five patients had a positive outcome, with complete fracture healing and no sequelae, including no facial nerve palsy. The safe reduction of the two mandibular pieces achieved by a combined intraoral and cutaneous pre-auricular surgical access is a major element of the approach. The periosteal plan of the ramus can be broadly and safely elevated using the intraoral approach and connected to the condylar bone plane with the pre-auricular cutaneous approach, avoiding facial nerve damage. The wide ramus periosteum elevation generates an "optical space" that allows fragment reduction and fixation in direct oblique view without the requirement for endoscopic intervention. Our findings strongly imply that with our technique, it is possible to treat sub-condyle and condylar neck fractures safely while avoiding facial nerve injury, which is an undesirable consequence due to its severe impact on quality of life.

Management and Complications of Condylar Fractures

Mandibular condylar fractures are frequently encountered maxillofacial traumatic injuries, representing a significant proportion of all fractures of the lower jaw. They are more common in young males and are typically caused by trauma to the face or jaw. The diagnosis begins with a thorough medical and dental history, followed by a clinical examination and radiographic imaging. With both surgical and nonsurgical methods available, there are differences in opinion regarding condylar fracture repair. Surgical options include open reduction and internal fixation (ORIF), closed reduction and internal fixation (CRIF), percutaneous reduction and internal fixation (PRIF), arthroscopy-assisted reduction and internal fixation (ARIF), and endoscopic-assisted reduction and internal fixation (ERIF). Non-surgical options include closed reduction, immobilization, and functional therapy. Complications can occur with both surgical and non-surgical approaches, and the timing of treatment should be based on the severity and complexity of the fracture, as well as the patient's overall health and individual circumstances. The longterm outcomes of mandibular condylar fracture management are generally favorable, but certain factors can influence the prognosis. Further research is needed to better understand how to optimally manage these injuries and improve clinical and surgical outcomes.

Open vs Closed Management of Condylar Fracture Our Experience of 100 Cases in a Suburban Tertiary Care Hospital.

Retrospective Observational Study. Mandibular condyle fractures are distinctive among maxillofacial injuries in which they disrupt mandibular function in a way that other traumatic injuries do not. Condylar fractures can be treated using either the conservative (closed reduction and immobilisation) or surgical (open reduction and internal fixation) approaches. Both of these modalities of treatment have advantages and disadvantages, as well as indications and contraindications. The purpose of this study is to compile and compare our experience in the management of condylar fractures through open and closed reduction. The present retrospective analysis included a total 100 patients of condylar fractures in patients > 18years of age who were randomly divided into nonsurgical and surgical group based on Edward Ellies criteria. In the present study, the outcomes of conservative vs surgical management of condylar fractures were discussed in terms of seven parameters, including the maximal inter-incisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, temporo-mandibular disorders and facial nerve paralysis which were measured and evaluated pre- and post-operatively at different intervals of time. Follow-up period was for 6months. It was noted that the main cause of condylar fracture was trauma with a male predilection with an average age of 32.6 ± 1.2years. Subcondylar fracture was the commonest type of condylar fracture that we encountered. 33.3% of the patients had restricted mouth opening and 57% of the patients had deranged occlusion. 37% of the patients were treated surgically and 48.6% of these fractures were approached using peri-angular approach. More patients had an increased mouth opening and a stable occlusion at the 6months follow-up when compared to that of the 2month follow up. From the above study we can conclude that the treatment plan should be patient specific and follow the algorithm for a particular type of fracture. We endorse the same based on our experience in treating condylar fractures over the last 5years. The art of decision making solely depends on the surgeon's expertise in managing condylar fractures.

191. Management of condylar fractures: a national survey of senior clinicians

As open reduction and internal fixation (ORIF) of condyle fractures is now an index procedure, the aim of this study was to survey volume and practice of senior clinicians with regards to condylar trauma.

Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review.

PRISMA-SWiM guided systematic review. 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts. A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and non-human studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence. Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation. There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures.

Management of Condylar Fractures; Comparative Outcomes of Conservative Closed Versus Open Reduction

Objective: To compare the frequency of complications after closed and open reduction managementof condylar fractures.Methods: This is a casual-comparative study conducted in the Out-patient &amp; ward, Department of Oral &amp; Maxillofacial Surgery, Nishter Institute of Dentistry, Multan, over a period of six months. Through nonprobability consecutive sampling, 178 patients were recruited and randomly allotted to two groups,Group 1 for closed reduction and Group 2 for open reduction. A non-rigid mandibular splint was appliedfor one month in Group 1 whereas, a pre-auricular incision was given and the fracture was reduced and fixed by mini-plates in Group 2. Patients of both groups were given antibiotics intravenously and were followed up clinically for complications such as pain and mandibular deviation after one month by employing “The Visual Analog Scale”. Data were analyzed using SPSS version (21) employing descriptive statistics and Chi-square test.Results: Mean age was found to be 26.48 ± 4.62 years in Group 1 and 24.85 ± 6.05 years in Group 2. Male to-female ratio, mean weight, height and BMI were almost similar in both groups. The mean duration of fracture was 7.101 ± 2.24 days in Group 1 and 6.898 ± 2.21 days in Group 2. The mandibular deviation was seen in 33.7% and 16.9% of patients (p=0.009) respectively in Groups 1 &amp; 2. The pain was seen in 41.6% of patients in Group 1 and 24.7% in Group 2 (p=0.016).Conclusion: Considering the complications encountered, patients treated by open reduction gave betterclinical results in comparison to close reduction management of condylar fractures.

Manejo de fractura de cóndilo mandibular diacapitular mediante fijación con tornillo de tracción único: Reporte de caso

Introduction: Mandibular fractures are the most common facial fractures affecting various anatomical sites of the mandible. Among the various mandibular fractures, management of condylar fractures remains a challenging task for surgeons. Case Report: We report the case of a 28 year old male patient who presented with pain in the chin and restricted mouth opening. Computed tomography revealed a sagittal fracture of the right condylar head with medial displacement of the fractured fragments. Management of diacapitular fractures includes open reduction and internal fixation of the right condyle using a single lag-screw. Results: The postoperative outcomes were favorable, where normal mandibular movements, desired dental occlusion and exact positioning of the condyle with rigid fixation were established thereby maintaining the shape of the condyle. Conclusion: Use of single lag screw fixation is highly recommended as it greatly supports the stabilized fracture fragments and also aid in prevention of fracture fragment rotation medially.

Risk of complications with retromandibular transparotid vs. anteroparotid approach for condylar fractures: a systematic review and meta-analysis.

Retromandibular approaches have been known to reduce the risk of facial nerve palsy and improve the management of condylar fractures. As such, it is necessary to identify the best approach with the least complications. This review was conducted to obtain a comprehensive estimate for the risk of complications following both the transparotid and the anteroparotid approach for patients with mandibular condylar fractures. A comprehensive search was conducted using PubMed Central, EMBASE, MEDLINE, and Cochrane library, ScienceDirect and Google Scholar from January 1964 until October 2021. The Newcastle Ottawa scale and Cochrane risk of bias tool were used to assess the quality of the included studies. A meta-analysis was carried out using a random-effects model and reported pooled incidence with 95% confidence intervals (CIs). A funnel plot was used to assess possible publication biases. In total, 40 studies with 2,096 participants were assessed and the majority of the included studies (29 out of 40 studies) had a high risk of bias. The pooled incidence of facial nerve palsy following the transparotid approach was 13% (95% CI: 10%-17%; I2=66.8%), and 2% (95% CI: 1%-5%; I2=57.8%) following the anteroparotid approach. The pooled incidence of sialocele following the transparotid approach was 2% (95% CI: 0%-4%; I2=45.8%), and 2% (95% CI: 1%-5%; I2=67.2%) following the anteroparotid approach. The pooled incidence of postoperative infection following the transparotid approach was 1% (95% CI: 0%-4%; I2=63.1%), and 1% (95% CI: 0%-3%; I2=0%) following the anteroparotid approach. The incidence of facial nerve palsy was higher among patients undergoing the transparotid approach when compared to patients undergoing the anteroparotid approach. Further trials comparing both of these approaches are required to identify the best methodology with the lowest complication rate.

Open Reduction and Internal Fixation Versus Closed Reduction and Maxillomandibular Fixation of Condylar Fractures of the Mandible: A Prospective Study.

BackgroundThe choice of surgical versus nonsurgical treatment for fractures of the condylar process has its own limitations and remains a controversial issue. Improved knowledge of anatomy, technique, and technology combined with adequate experience with careful planning of surgical technique can avoid all the possible complications.AimTo compare open reduction and internal fixation with closed reduction and maxillomandibular fixation in the management of condylar fractures.Materials and methodA prospective study was carried out among 22 patients who had minimally displaced or displaced condylar fractures. The patients were divided into two groups of 11 each: group A patients treated with open reduction and rigid internal fixation and group B patients treated with closed reduction and maxillomandibular fixation. Follow-up examinations were performed at one week, one month, three months, and six months postoperatively.ResultsPreauricular pain was significantly decreased (p < 0.001) in both groups postoperatively but more significantly decreased in the open reduction group. There was a significant improvement in the mouth opening at every follow-up to a maximum mean of 37.36 mm in group A and a mean of 33.64 mm in group B. Significantly more improvement in protrusive and lateral movements and reduced deviation on mouth opening at every follow up was observed in the open reduction group.ConclusionBoth the treatment options for condylar fractures of the mandible yielded acceptable results with significant clinical differences in terms of occlusion, mouth opening, functional movements, and pain among patients with open reduction.

New protocol for simplified reduction and fixation of subcondylar fractures of the mandible: a technical note.

The dilemma regarding the management of condylar fractures generally revolves around the surgical approach, implant design, and the surgeon’s experience. Zide and Kent’s guidelines streamlined the decision making process for condylar fractures. However, there exists no standardized protocol for reduction and fixation of condylar fractures. Here, we have described a detailed and stepwise protocol, common to any surgical approach, that would lead to predictable, reproducible, and repeatable results in every surgeon’s hands.

Open Reduction Internal Fixation of Mandibular Condylar Fractures: Factors Influencing Radiographic Anatomical Reduction

Mandible fractures occur frequently, accounting for approximately 70% of all facial fractures. Of those, fractures of the mandibular condyle account for 25-35%.1,2 Over several decades, there has been much controversy over the standard treatment method for condylar fractures, with increasing support for open reduction internal fixation (ORIF). The aim of this study is to determine negative and positive factors that may influence radiographic reduction outcomes after ORIF of mandibular condylar fractures.This retrospective study assessed the influence of several clinical factors on the quality of reduction. Records from patients treated with ORIF for condylar fractures between 2013 and 2021 at a single institution were reviewed. The predictor variables were condylar fracture level, type of fracture, amount and direction of displacement, vertical segment overlap, height of fracture, amount of soft-tissue envelope thickness, surgical approach, time to surgery, type of plate utilized, and surgeon experience. The primary outcome variable was the radiographic postoperative outcome of reduction and fixation as rated by 2 blinded observers in a 1-5 ordinal scale, with a score of 5 indicating adequate anatomical alignment of the posterior border of the mandibular-condylar border without displacement or deviation of the condylar process after ORIF.The data were analyzed statistically using ANOVA and Pearson's Correlation Coefficient tests using IBM SPSS Statistics to determine the significance between factors that may affect anatomical reduction and fixation of the mandibular condyle.The sample was composed of 21 subjects with 22 subcondylar fractures; 1 subject with bilateral subcondylar fractures was treated with ORIF with the majority being left subcondylar fractures (68%) with a concurrent fracture (86%). The study composed of nondisplaced (7), displaced (11), and dislocated (4) subcondylar fractures. The majority of subcondylar fractures treated with ORIF utilized 2 single miniplates (55%) via the retromandibular transparotid approach (90%). The mean adequacy of ORIF of subcondylar fracture score was 4.16 with the interclass correlation coefficient being 0.75, indicating good agreement between the 2 blinded observers. The plate utilized (P = .042), surgeon experience (P = .000), time to surgery (P =.000), and a concurrent mandible fracture (P = .000) were all shown to be significant in the adequacy of open reduction internal fixation of subcondylar fractures. A single plate along with a concurrent mandible fracture were shown to be negative factors influencing the ORIF of subcondylar fractures, whereas increased duration from the time of injury to ORIF was shown to be a positive factor.The management of condylar fractures is a subject of much debate and controversy within the field of oral and maxillofacial surgery. This study assessed multiple factors that may influence the objective radiographic outcome of ORIF of subcondylar fractures. Perhaps this study will further provide the oral and maxillofacial surgeon with an objective assessment based on radiographic interpretation for achieving anatomical reduction of the fractured condylar segment prior to taking the patient to the operative room.

Assessment of Clinical Outcomes in Open Reduction and Internal Fixation of Mandibular Condyle Fractures Compared to Closed Treatment

Statement of the problemThe clinical decision to pursue open reduction and internal fixation (ORIF) vs. closed treatment (CT) to treat mandibular condyle fractures has been long contested but predicated on understanding of absolute and relative indications and contraindications. This meta-analysis critically appraised the literature to compare and contrast clinical outcomes following these interventions. Materials and methodsA systematic review and meta-analysis were performed to test the null hypothesis of no difference in clinical outcomes in ORIF vs. CT of mandibular condyle fractures. ORIF also was compared to endoscopically assisted open treatment. The PubMed, EMBASE, Cochrane Library, Elsevier text mining tool database and ClinicalTrials.gov trial registries were accessed from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development and Evaluation methodology. No pediatric studies were included. The quality of evidence was downgraded due to risk of bias and imprecision in specific outcomes in observational studies. Data analysisTwo authors extracted the following data from included studies: country of origin, study design, study period, number of patients, patient characteristics (i.e., age range, gender, ethnicity), fracture laterality (unilateral vs. bilateral), treatment used (CT vs. ORIF), and clinical outcomes. The study analyzed the data separately according to fracture location and study design (e.g., RCTs and observational studies). An experienced medical librarian was consulted on methodology and ran a medical subject heading (MeSH) analysis of known key articles provided by the research team to ensure complete capture of all articles pertaining to management of condylar fractures. In each database, the study ran scoping searches and used an iterative process to translate and refine the searches. Results and outcomes dataOf 1507 screened articles, 14 met the inclusion criteria. There were 4 meta-analyses that were included, examining 7 randomized controlled (RCTs) trials and 31 non-randomized studies. Primary studies enrolled adults with displaced uni- or bilateral condylar fractures and did not report the results by fracture location (e.g., subcondylar or condylar) except with 2 RCTs that included all adults with subcondylar fractures. Primary studies compared the outcomes after open surgical procedure with those of fixation using 1 or 2 miniplates with various diameters. Open reduction and internal fixation were favored significantly when evaluating temporomandibular joint pain (RR 0.3; 95% CI 0.1-0.7) (NNTp 3; 2-6), laterotrusive movements of the mandible (MD 2.3; 1.7-3.0) (SMD 0.9; 0.4-1.3), and malocclusion (RR 0.5; 0.4-0.7) (NNTp 19; 10-200). However, open treatment yielded higher incidence of postoperative infection (RR 3.6; 95% CI 0.9-13.8). With respect to ORIF versus endoscopically assisted open treatment, no difference was seen in overall patient satisfaction with postoperative mandibular movement, disturbance to articulation, or occlusion. ConclusionMeta-analysis of high-level evidence in randomized controlled trial data suggests ORIF yields significantly superior clinical outcomes when evaluating restoration of translational and rotational mandibular movement, alleviation of pain, and restoration of occlusion and symmetry, although it is associated with higher risk of postoperative infection and facial nerve injury. These long-term benefits must be weighed against the increased risk of postoperative infection in ORIF; thus, treatment should be patient-specific. Future investigations with high-level evidence may further elucidate the relative effectiveness and safety of various open, endoscopic, and closed techniques in patients with facial trauma.

Frey's Syndrome

The incidence of Frey's syndrome after parotidectomy greatly varies in the literature. It is a sequelae of any surgery near the pretragal region like parotidectomy or condylar surgeries which might cause embarrassment and considerable social discomfort and may further result in disruptions and disturbances in daily life. Hence, frequent follow-ups after the surgeries, early diagnosis, and proper management of Frey's syndrome may help to alleviate symptoms and improve quality of life for the patient. This case report highlights a case of Frey's syndrome followed by the surgical management of condylar fracture and also highlights the management of the syndrome.

How far we have come with the Management of Condylar Fractures? A Meta-Analysis of Closed Versus Open Versus Endoscopic Management.

The treatment approaches for condylar fractures of the mandible include functional, closed reduction and open reduction-internal fixation. Recently endoscopic management of condylar fractures has been emphasized in the literature. We systematically review the studies comparing closed versus open versus endoscopic-assisted condyle fracture management with regard to the indications, effectiveness and complications of each modality. A total of 11 articles were selected based on the inclusion and exclusion criteria from PubMed, Cochrane and clinical trials.gov. Differences in means and risk ratios were used as principal summary measures with p value < 0.05 as significant. For detection of any possible biases in sample sizes, the OR and its 95% CI for each study were plotted against the number of participants. Chi-square test, I2 test and the Cochrane bias tool were used to assess the bias in and across studies. Except for deviation on opening there was no significant difference between open versus closed treatment of condylar fractures. Endoscopic approach and open surgical approaches differed only in terms of operating time and TMJ pain. There was no significant difference in facial nerve injury among the two groups. Closed reduction is particularly indicated for minimally displaced fractures; for moderate to severe displacement, open reduction is preferred. Open reduction can also be preferred over endoscopic approaches as there is no significant advantage of using latter. Limitations of the study included specific treatment according to the site of fracture not addressed, limited data regarding pediatric condylar fracture, lack of homogenous classification schemes, etc.

Can Condylar Fracture Still Be Treated with Conservative Approach?? – A Retrospective Study

Background: Ideal management of mandibular condylar fractures remains controversial in maxillofacial trauma. Traditionally, conservative approach was implemented but recently ORIF (Open Reduction with Internal Fixation) has become prevalent. A difference of opinion has been acknowledged in the review of literature concerning the results achieved by open/closed reduction of fractures of the condyle in mandible. Research Objectives: To assess the preference of treatment for fractures of condyle and their indications, advantages, disadvantages and complications for open/closed reduction of fractures of condyle. Methodology: A 13-year retrospective study involving 56 patients who reported with fractures of condylar region were selected from 264 patients who experienced maxillofacial fractures. Out of them, seven were treated with ORIF, while 49 underwent closed reduction. Every patient was critically evaluated for identifying their indications, advantages, disadvantages, their effectiveness and complications of chosen interventions used in the management of condylar fractures. Findings: A male predominance was observed. Closed reduction with concomitant active physical therapy after inter-maxillary fixation gave similar results to that of open method. Conclusion: This study manifested that an appropriately followed conservative treatment provided similar clinical results when compared to ORIF for the management of condylar fractures. In cases with severe loss of height of mandible, surgical intervention is to be preferred to restore it. Further prospective randomized controlled trials with larger sample size are required to come to a decisive conclusion.