For conservative methods using closed reduction, early mouth mobilization is essential to prevent adhesion or ankylosis of the temporomandibular joint (TMJ). Like other mandibular fractures, the treatment of condylar fractures is controversial 12. In the treatment of condylar fractures, there are conservative methods such as closed reduction with concomitant physical therapy, and surgical methods using open reduction and internal fixation. Concomitant fractures of the mandibular body often accompany subcondylar fractures and are more frequently bilateral than unilateral 11. Teeth injuries such as fractures and luxations are frequently accompanied with condylar head or neck fractures. Condylar fractures are usually caused by traffic accidents, falls, and violence 8. There are two types of condylar fractures, intracapsular and extracapsular, but for practical purposes, the anatomical level of the fracture is divided into three sites: the condylar head (intracapsular), the condylar neck (extracapsular), and the subcondylar region 8, 9, 10. Closed reductions with long-term limitation of mouth opening are beneficial for comminuted fracture, but are harmful for condylar fractures. The decision for the proper treatment can be complicated when condylar fractures accompany the comminuted mandibular fracture. However, it is still controversial whether closed reduction is the optimal treatment for comminuted fractures as compared to open reduction and internal fixation. Some reports 3, 5, 6, 7 insist that open reduction and internal fixation is a better treatment option and causes lower complication rates than closed reduction in some comminuted mandibular fractures. In the last 30 years, however, there has been a change in the treatment perspective of such injuries driven by advancements in rigid fixation techniques 2. Traditionally, extensive comminuted mandibular fractures have been considered to be indications for closed reduction in order to avoid periosteal stripping and devascularization of the comminuted bone segments 5. The high-energy impact seen in gun shots, traffic accidents, and falls can lead to enough concentrated force on the mandible to cause multiple sites of comminuted fractures 3, 4. Extensive comminuted mandibular fractures occur when a high-energy impact is applied onto a region of the mandible. In extensive communited fractures, multiple sites (exceeding one region and involving the neighbouring region) of the mandible are splintered, crushed, pulverized, or broken into several pieces 1, 2. Comminuted fracture is defined as the presence of multiple fracture lines resulting in many small pieces within the same area of the mandible (e.g., angle, body, ramus, or symphysis) 1.
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