Schneider M., Erasmus F., Gerlach K.L., Kuhlisch E., Loukota R.A., Rasse M., Schubert J., Terheyden H., Eckelt U.
Department of Oral and Maxillofacial Surgery, Technical University of Dresden, Dresden, Germany; Department of Oral and Maxillofacial Surgery, Klerksdorp, North West Province, Flamwood, South Africa; Department of Oral and Maxillofacial Surgery, University of Magdeburg, Magdeburg, Germany; Employee, Institute for Medical Informatics and Biometry, Dresden, Germany; Department of Maxillofacial Surgery, University of Leeds, Leeds, England, United Kingdom; Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria; Department of Oral and Maxillofacial Surgery, University of Halle, Halle, Germany; Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Kassel, Germany; Department of Oral and Maxillofacial Surgery, Technical University of Dresden, Dresden, Germany
Schneider, M., Department of Oral and Maxillofacial Surgery, Technical University of Dresden, Dresden, Germany; Erasmus, F., Department of Oral and Maxillofacial Surgery, Klerksdorp, North West Province, Flamwood, South Africa; Gerlach, K.L., Department of Oral and Maxillofacial Surgery, University of Magdeburg, Magdeburg, Germany; Kuhlisch, E., Employee, Institute for Medical Informatics and Biometry, Dresden, Germany; Loukota, R.A., Department of Maxillofacial Surgery, University of Leeds, Leeds, England, United Kingdom; Rasse, M., Department of Oral and Maxillofacial Surgery, University of Innsbruck, Innsbruck, Austria; Schubert, J., Department of Oral and Maxillofacial Surgery, University of Halle, Halle, Germany; Terheyden, H., Department of Oral and Maxillofacial Surgery, Red Cross Hospital, Kassel, Germany; Eckelt, U., Department of Oral and Maxillofacial Surgery, Technical University of Dresden, Dresden, Germany
Purpose: This randomized, clinical multicenter trial investigated the treatment outcomes of displaced condylar fractures, and whether radiographic fracture level was a prognostic factor in therapeutic decision-making between open reduction and internal fixation (ORIF) versus closed reduction and mandibulomaxillary fixation (CRMMF). Patients and Methods: Sixty-six patients with 79 displaced fractures (deviation of 10° to 45°, or shortening of the ascending ramus ≥2 mm) of the condylar process of the mandible at 7 clinical centers were enrolled. Patients were randomly allocated to CRMMF (n = 30 patients) or ORIF (n = 36 patients) treatment. The following parameters were measured 6 months after the trauma. Clinical parameters included mouth opening, protrusion, and laterotrusion. 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 analogue scale), discomfort, and subjective functional impairment with a mandibular functional impairment questionnaire. Results: The difference in average mouth opening was 12 mm (P ≤ .001) between both treatment groups. The average pain level (visual analogue scale from 0 to 100) was 25 after CRMMF, and 1 after ORIF (P ≤ .001). In 53 unilateral fractures, better functional results were observed for ORIF compared with CRMMF, irrespective of fracture level (condylar base, neck, or intracapsular head). Unexpectedly, the subjective discomfort level decreased with ascending level of the fracture. In patients with bilateral condylar fractures, ORIF was especially advantageous. Conclusion: Fractures with a deviation of 10° to 45°, or a shortening of the ascending ramus ≥2 mm, should be treated with ORIF, irrespective of level of the fracture. © 2008 American Association of Oral and Maxillofacial Surgeons.
adult; article; bone pain; bone radiography; bone screw; clinical evaluation; clinical trial; controlled clinical trial; controlled study; follow up; fracture reduction; human; intermethod comparison; major clinical study; mandible condyle; mandible fracture; maxilla fracture; multicenter study; open reduction; osteosynthesis; prospective study; questionnaire; randomized controlled trial; treatment duration; treatment outcome; visual analog scale; Decision Making; Fracture Fixation; Fracture Fixation, Internal; Humans; Jaw Fixation Techniques; Mandibular Condyle; Mandibular Fractures; Pain, Postoperative; Prospective Studies; Range of Motion, Articular; Temporomandibular Joint; Treatment Outcome