Outcomes of open versus closed treatment of mandibular subcondylar fractures

Objectives: The purpose of this study was to compare the long-term treatmen t results of open reduction and rigid internal fixation (ORIF) with closed reduction and maxillomandibular fixation (CRMMF) for subcondylar fractures when guided by specific indications and contraindications. Patients and Methods: A protocol for the treatment of condylar process frac tures was developed that included absolute and relative indications and con traindications as well as a technique regimen. To evaluate the results of t his protocol, 10 patients treated with CRMMF and 10 treated by ORIF were re called after a minimum of 6 months and examined for gender, race, diagnosis , age at injury, time since operation, and cause of the fracture. Each grou p was assessed by 2 blinded investigators for maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, devi ation on opening, scar perception, motor function, sensory perception, cont our perception, occlusion, and perception of pain. Nonparametric data were compared for statistical significance with a chi-square analysis and parame tric data with an independent samples t-test (P < .05). Results: No statistically significant differences existed between the ORIF and CRMMF groups for gender, race, diagnosis, or cause. Moreover, no differ ences existed for age at injury, maximum interincisal opening, right latera l excursion, left lateral excursion. protrusive movement, deviation on open ing, or occlusion. Differences were noted between groups for time since ope ration, scar perception, and perception of pain. Using the protocol outline d, there were no differences between the ORIF and CRMMF groups for ranges o f motion, occlusion, contour, and motor or sensory function. The ORIF group was associated with perceptible scars. The CRMMF group a-as associated wit h chronic pain. Conclusions: Using a treatment protocol, there were few differences in outc omes between patients treated with CRMMF and ORIF for subcondylar fractures . <(c)> 2001 American Association of Oral and Maxillofacial Surgeons.