General considerations
The decision to perform closed versus open treatment is based on thorough clinical and radiographic (CT) evaluation.
The challenge of closed reduction is that it is difficult to ensure that stable reduction has been achieved.
| Closed treatment | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Displaced fracture amenable for minimally invasive reduction techniques. |  |
 |
The challenge of closed reduction is that it is difficult to ensure that stable reduction has been achieved.
Further indications
- the fracture segments impinge on the coronoid process of the mandible
- to correct facial deformity (depression)
Advantage
- Closed treatment is the least invasive form of operative management
Disadvantages
- No direct visualization of fracture site and the reduction
- Risk of injury to soft tissues, due to poor placement of bone hook
| Open reduction without fixation | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Displaced fractures resulting in impingement of the coronoid process and/or facial deformities. | |
 |
Contraindication
- Unstable reduction
Advantages
- Simple and fast operation
- No external scar
- Allows for direct digital palpation of the reduction
Disadvantages
- Blind reduction
- Limited stability of the reduction
| Open reduction with fixation | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Displaced unstable fractures resulting in impingement of the coronoid process and/or facial deformities requiring reduction and fixation. | |
|
Advantage
- Allows reduction and fixation under direct visualization
Disadvantages
- Visible scar
- Time consuming
- Risk of temporal hollowing
- Risk of injury to temporal branch of the facial nerve
| CAS: Intraoperative imaging in closed treatment | ||
| Main indication | Skill | Equipment |
|---|---|---|
| Whenever post reduction control imaging is available. | |
 |
Whenever an intraoperative CT scanner is available, an intraoperative scan should be obtained for intraoperative evaluation of the reduction.
| *Skill | |
|---|---|
 |
Basic surgical experience, no specialized skills |
|
Some specialized surgical experience |
 |
Highly experienced and skilled surgeon |
| *Equipment | |
|---|---|
|
Basic equipment only |
|
Simple surgical and imaging resources |
|
Full specialized surgical and imaging resources |