Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment
Subcondylar fractures represent 25 to 35 percent of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery, whereas open treatment is challenging and risks facial nerve injury. Perioperative, func...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2021-09, Vol.148 (3), p.398e-406e |
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| creator | Gibstein, Alexander R. Chen, Kevin Nakfoor, Bruce Gargano, Francesco Bradley, James P. |
| description | Subcondylar fractures represent 25 to 35 percent of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery, whereas open treatment is challenging and risks facial nerve injury. Perioperative, functional, and patient-reported outcomes were measured to compare methods of open versus closed treatment of subcondylar fractures.
Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded.
Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases.
For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters.
Therapeutic, II. |
| doi_str_mv | 10.1097/PRS.0000000000008294 |
| format | Article |
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Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded.
Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases.
For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters.
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Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded.
Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases.
For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters.
Therapeutic, II.</description><subject>Adult</subject><subject>Bone Plates</subject><subject>Endoscopy - instrumentation</subject><subject>Endoscopy - methods</subject><subject>Endoscopy - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Fracture Fixation, Internal - instrumentation</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fracture Fixation, Internal - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Mandibular Condyle - diagnostic imaging</subject><subject>Mandibular Condyle - injuries</subject><subject>Mandibular Condyle - surgery</subject><subject>Mandibular Fractures - surgery</subject><subject>Middle Aged</subject><subject>Open Fracture Reduction - adverse effects</subject><subject>Open Fracture Reduction - instrumentation</subject><subject>Open Fracture Reduction - methods</subject><subject>Open Fracture Reduction - statistics & numerical data</subject><subject>Patient Reported Outcome Measures</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Prospective Studies</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkNtOwzAMhiMEgnF4A4RyyU0hp2YtdwgxQAINMbiuktTVCmk7cmDa25NxFpGs2LH9O_4QOqTkhJJyfHr_MDshf07BSrGBRjRnZSaYYJtoRAhnGSU520G73j8TQsdc5ttohwvBmSzZCDV3qq9bHa1yeBa1Gfp6tfYnTpkQHZzhm27hhjeo8ST2JrRDryyexmCGDjxuezwDCyak_L0KLfTB42Ub5ni6gB4_OlChS4_7aKtR1sPB172HniaXjxfX2e306ubi_DYzPGc0M42GZsx0LYFxXkutJBTJKNNFblRhmrRdUZAUwjqZVpOyKCnVGqisJd9Dx5-66c-vEXyoutYbsFb1MERfsVyKMk-0RCoVn6XGDd47aKqFazvlVhUl1ZpwlQhX_wmntqOvCVF3UP80fSP91V0ONoDzLzYuwVVzUDbMP_RkzkXGCEtDUpQlY5S_AzVxh1A</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Gibstein, Alexander R.</creator><creator>Chen, Kevin</creator><creator>Nakfoor, Bruce</creator><creator>Gargano, Francesco</creator><creator>Bradley, James P.</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210901</creationdate><title>Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment</title><author>Gibstein, Alexander R. ; Chen, Kevin ; Nakfoor, Bruce ; Gargano, Francesco ; Bradley, James P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3521-cfbef72bd6e233d6ba6e8a6e12b85ca8cf5298802b8e6ba6052668911bbe16d63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Bone Plates</topic><topic>Endoscopy - instrumentation</topic><topic>Endoscopy - methods</topic><topic>Endoscopy - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Fracture Fixation, Internal - instrumentation</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fracture Fixation, Internal - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Mandibular Condyle - diagnostic imaging</topic><topic>Mandibular Condyle - injuries</topic><topic>Mandibular Condyle - surgery</topic><topic>Mandibular Fractures - surgery</topic><topic>Middle Aged</topic><topic>Open Fracture Reduction - adverse effects</topic><topic>Open Fracture Reduction - instrumentation</topic><topic>Open Fracture Reduction - methods</topic><topic>Open Fracture Reduction - statistics & numerical data</topic><topic>Patient Reported Outcome Measures</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Prospective Studies</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gibstein, Alexander R.</creatorcontrib><creatorcontrib>Chen, Kevin</creatorcontrib><creatorcontrib>Nakfoor, Bruce</creatorcontrib><creatorcontrib>Gargano, Francesco</creatorcontrib><creatorcontrib>Bradley, James P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gibstein, Alexander R.</au><au>Chen, Kevin</au><au>Nakfoor, Bruce</au><au>Gargano, Francesco</au><au>Bradley, James P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>148</volume><issue>3</issue><spage>398e</spage><epage>406e</epage><pages>398e-406e</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>Subcondylar fractures represent 25 to 35 percent of all mandibular fractures, yet the treatment paradigm has remained controversial. Closed treatment relies on the plasticity of the condyle head during recovery, whereas open treatment is challenging and risks facial nerve injury. Perioperative, functional, and patient-reported outcomes were measured to compare methods of open versus closed treatment of subcondylar fractures.
Selected displaced subcondylar fracture cases with open (open reduction and internal fixation of subcondylar fracture with maxillomandibular fixation) versus closed (maxillomandibular fixation) treatment were compared (n = 60). Demographics, perioperative data, complications, persistent symptoms, chin deviation, malocclusion, change in mouth opening, functional scores, and FACE-Q patient satisfaction were recorded.
Open versus closed groups had similar demographics and perioperative data, except the open group had longer operating room time (76.39 minutes versus 56.15 minutes). In long-term follow-up, open-treated patients had fewer symptoms (9 percent versus 67 percent), less chin deviation (0 percent versus 40 percent), a less restricted mouth opening (3mm versus 5mm), and better functional scores (1.92 versus 0.861). Transient facial nerve weakness was seen in 6 percent of open cases.
For selected subcondylar fracture patients, open treatment with endoscopic assistance, nerve monitoring, and specialized plates provides superior long-term results compared to closed treatment when considering symptoms and functional parameters.
Therapeutic, II.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>34432692</pmid><doi>10.1097/PRS.0000000000008294</doi></addata></record> |
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| subjects | Adult Bone Plates Endoscopy - instrumentation Endoscopy - methods Endoscopy - statistics & numerical data Female Follow-Up Studies Fracture Fixation, Internal - adverse effects Fracture Fixation, Internal - instrumentation Fracture Fixation, Internal - methods Fracture Fixation, Internal - statistics & numerical data Humans Male Mandibular Condyle - diagnostic imaging Mandibular Condyle - injuries Mandibular Condyle - surgery Mandibular Fractures - surgery Middle Aged Open Fracture Reduction - adverse effects Open Fracture Reduction - instrumentation Open Fracture Reduction - methods Open Fracture Reduction - statistics & numerical data Patient Reported Outcome Measures Postoperative Complications - epidemiology Postoperative Complications - etiology Prospective Studies Tomography, X-Ray Computed Treatment Outcome Young Adult |
| title | Mandibular Subcondylar Fracture: Improved Functional Outcomes in Selected Patients with Open Treatment |
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