Open versus closed treatment of fractures of the mandibular condylar process - a prospective randomized multi-centre study

Aim: The aim of this international prospective randomized multi-centre study was to compare operative and conservative treatment of displaced condylar fractures of the mandible. Methods and patients: Out of a total of 88 randomized patients from 7 centres, 66 patients with 79 fractures of the mandibular condylar process completed the study and were evaluated. All fractures were displaced, being either angulated between 10 degrees and 45 degrees or the ascending ramus was shortened by more than 2 mm. The follow-up examinations 6 weeks and 6 months following treatment included evaluation of radiographic measurements, clinical, functional and subjective parameters including visual analogue scale for pain and the Mandibular Function Impairment Questionnaire index for dysfunction. Results: Correct anatomical position of the fragments was achieved significantly more often in the operative group in contrast to the closed treatment group. Regarding mouth opening/lateral excursion/protrusion, significant (p = 0.01) differences were observed between both groups (open 47/16/7 mm versus closed 41/13/5 mm). The visual analogue scoring revealed significant (p = 0.03) differences with less pain in the operative treatment group (2.9 open versus 13.5 closed). The Mandibular Function Impairment Questionnaire index recorded a significant (p = 0.001) difference with less pain and discomfort in the open treatment group (10.5 versus 2.4 points). Conclusion: Both treatment options for condylar fractures of the mandible yielded acceptable results. However, operative treatment, irrespective of the method of internal fixation used, was superior in all objective and subjective functional parameters. (C) 2006 European Association for Cranio-Maxillofacial Surgery.