Close Treatment Versus Open Rduction & Internal Fixation with Ultrasound Activated Resorbable Pins for Mandible Condylar Head Fractures

OBJECTIVE- To evaluate the outcome of reduction and fixation achieved with ultrasound activated resorbable pins (Sonicweld, KLS Martin) and compare it with closed treatment of mandible condylar head fracture in terms of clinical parameters like pain, occlusion, facial nerve function, presence or absence of infection, maximal incisal opening, excursive movements and radiographic parameters - ramus height and morphological changes.

METHODS- Nineteen patients with fractured condylar head were divided two groups- open (N=9)and closed (N=10). In closed group patients were managed with arch bar and elastic guidance. In open group ultrasound activated resorbable pins were used for fixation after reduction of fractured condylar head. Ramal height was measured in MIMICS software preoperatively and post operatively (>3 months) and morphological changes were seen on CBCT.

RESULT- Radiographic parameters- In open group 4 patient had redislocation of segment, 2 showed resorption while 3 patient had good anatomical reduction and in closed group displaced fragment fused with mandible at displaced position (9/10), ramal height was almost same in closed and open group pre operatively and post operatively. There was appreciable resorption of condyle in open group.

Clinical parameter- Occlusion was deranged in 3 patients in open group and 1 patient in closed group, temporary facial nerve paralysis occured in 4 patients in open group, 2 patient showed infection in open group while none in closed group. There was same almost same mouth opening (31 mm) at 3 month follow up in both groups.

CONCLUSION- Closed treatment group had better outcome in comparison to open group fixed with ultrasound activated resorbable pins.