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Closed treatment is indicated for children less than 12 years of age and this is best understood in relation to the regenerative and remodeling capacity of the condyle.
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Vascular supply affects the remodeling capacity of the condyle.
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Immediate mobilization and physical therapy are important to the outcomes in closed and open treatment by affecting remodeling with local cytokines; intermaxillary fixation is not supported.
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Complex neuromuscular, skeletal, and occlusal adaptations affect functional
The Biology of Open Versus Closed Treatment of Condylar Fractures
Section snippets
Key points
Temporomandibular joint
The TMJ is supplied by many named vessels that branch and contribute to the articular capsule. These vessels are primarily branches of the superficial temporal artery and maxillary artery1, 2 (Fig. 1). This plexus of vessels is richest to the posterior zone of retrodiscal tissue.
Condylar head
Condylar head blood flow is primarily through the TMJ capsule, with some endosteal and muscular contributions.
Condylar process
It has not been conclusively established what the nutrient artery to the condylar process is. Contributions
Injuries
Repair of soft tissue injury to the TMJ capsule, disc, and retrodiscal tissues plays an important role in rehabilitation and function of the TMJ. Endoscopic and MRI studies show that hemarthrosis and vascular hyperemia are common in the injured capsule when the joint is traumatized by condylar fractures (Fig. 8). Hemarthrosis resolves with functional rehabilitation and has little long-term consequence.11, 12, 13, 14, 15, 16
Other injuries to the disc and capsule have more significant
Summary
Fixation is not necessary for healing. Unlike other parts of the mandible, fractures of the condyle rarely result in malunion even without treatment.6 There is a wide variety of treatment recommendations, including immediate mobilization with soft diet, MMF for 2 to 6Â weeks, and immediate mobilization with soft diet. Biology seems to support early mobilization in both closed and open treatments. Early mobilization has equal occlusal results to those with periods of MMF37 and helps patients to
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Cited by (8)
Which Factors Affect the Reduction Quality of Open Reduction Internal Fixation of Mandibular Subcondylar Fractures?
2023, Journal of Oral and Maxillofacial SurgeryMandibular Condylar Fractures
2022, Facial Plastic Surgery Clinics of North AmericaCitation Excerpt :Dental adaptations with closed treatment result in intrusion, or apical displacement of the molars into alveolar bone on the fractured side to help compensate for this. Closed treatment also frequently results in reestablishing articulation further down the articular eminence.23,42 A course of physiotherapy including exercises to prevent the negative impact of scar tissue formation, to restore muscle strength, and prevent the development of chronic pain has a significant role to play in full recovery.13,26
Central Giant Cell Granuloma of the mandibular condyle – Endoscopic treatment and 5-year follow-up
2021, Advances in Oral and Maxillofacial SurgeryChanges in mandibular and articular dynamics associated with surgical versus nonsurgical treatment of mandibular condylar fractures: a systematic review with meta-analysis
2020, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :Because the lateral pterygoid function is diminished on the injured side as a result of malpositioning of the condyle, the lateral pterygoid on the contralateral side pulls the condylar head anteriorly more vigorously, thus compensating for the injured side. This imbalance causes the chin to deflect to the injured side on mouth opening.30,34,40 With regard to the complications associated with ORIF, facial nerve injury was reported in 22% (2 of 8) of the studies.32,34
Unilateral condylar fracture with review of treatment modalities in 30 cases - An evaluative study
2021, Annals of Maxillofacial SurgeryEstablishing a Protocol for Closed Treatment of Mandibular Condyle Fractures with Dynamic Elastic Therapy
2019, Plastic and Reconstructive Surgery - Global Open