Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

The purpose of this study was to determine the rate of recovery of mandibul ar motion in patients treated for fractures of the mandibular condylar proc ess. One hundred and thirty-six patients(lll men, 25 women), 74 treated by closed and 62 by open methods, were included. They underwent testing of man dibular and condyle mobility at 6 weeks, 6 months, and 1, 2, and 3 years po st surgery. Their ranges of motion were compared to those of 52 controls (2 6 men and 26 women). A jaw-tracking device was used to assess mandibular mo tion. Multilevel statistical models were used to assess differences between groups, and to estimate rate of recovery in the fracture patients. In gene ral, patients with unilateral fractures of the condylar process had maximum excursions that returned to normal values within 3 years after fracture, r egardless of treatment. Patients treated open exhibited a faster rate of im provement in maximum interincisal opening than patients treated closed (0.4 3 mm/month vs 0.15 mm/month, respectively), but part of the difference was due to a significantly smaller opening after 6 weeks for the patients treat ed open (38 mm vs 42 mm, respectively). Patients treated open also exhibite d a faster rate of improvement in maximum excursion toward the fracture sid e than patients treated closed (0.10 mm/month vs 0.04 mm/month, respectivel y). Based upon this study, patients with unilateral fractures of the condyl ar process, who are treated closed and not put into maxillomandibular fixat ion but are instructed in physical therapy, can be expected to achieve norm al maximum excursions within 3 years after treatment. Patients treated open will have reduced maximum opening initially, but may reach normal levels o f opening sooner than patients treated without surgery. Patients treated wi thout surgery may have smaller than normal excursion toward the non-fractur e side for at least 3 years after fracture, especially if their fracture wa s at or above the condylar neck. Improvement rates for other maximum excurs ions are similar for patients treated with or without surgery.