PubMed · 6588609
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J K Petersen. 1984. [Maxillo-mandibular fixation].. https://pubmed.ncbi.nlm.nih.gov/6588609/
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BACKGROUND AND AIM: The aim of this study was to assess whether the duration of intermaxillary block in patients with non-condylar mandibular fractures can interfere with restored mandibular function and whether there is a statistically significant correlation between the duration of joint immobilisation and the onset of temporo-mandibular joint pathologies. METHODS: A clinical evaluation was made of 40 patients treated for non-condylar mandibular fractures during the period 1991-1992. The patients were subdivided into two groups depending on the type of treatment and the duration of the intermaxillary block. Group A included patients treated with intermaxillary block alone lasting more than 25 days. Group B included patients treated surgically with intrafocal osteosynthesis with immobilisation lasting less than 15 days. RESULTS: The follow-up of results (3.7 years) showed a maximum mean aperture in Group A of 45.1 mm compared to 50.1 mm in Group B. The mean score for mandibular clinical dysfunction in patients in Group A was 5.0 points (SD +/- 4.75), whereas it was 0.7 points (SD +/- 1.45) in patients in Group B. This difference between the two groups was statistically significant (p < 0.01). CONCLUSIONS: The results of this study suggest that jaw immobilisation in mandibular fractures may be potentially damaging for the temporo-mandibular joint, sometimes leading to painful dysfunctional syndromes. For this reason, even in the case of mandibular fractures without decomposition, the authors feel that it is advisable to avoid long periods of immobilisation in patients with a positive history of mandibular dysfunction.
The treatment of fractures was originally conservative. Improvements in materials and surgical techniques and new insights into the biological aspects of fracture healing led to an increase of surgical treatment of fractures. The main breakthrough of osteosynthesis took place with the foundation of the Arbeitsgemeinschaft für Osteosynthesefragen (Study Group for Problems in Osteosynthesis) which had as its basic principles anatomical repositioning, stable internal fixation, atraumatic surgical technique and early mobilization. In general, surgical treatment is indicated for periarticular fractures, open fractures, fractures complicated by nervous or vascular lesions, pathological fractures and fractures in multiple injury patients. The question who should practise traumatology, the general or the orthopaedic surgeon, was initially a point of controversy; by now, cooperative teams have been formed based on appreciation of one another's qualities. The trend for the near future appears to be minimally invasive surgery, with indirect repositioning and fixation techniques and biological methods of stimulating fracture healing.