Functional Recovery Trajectory of Temporomandibular Joint Following Condylar Fracture Treated by Closed Reduction and Intermittent Jaw Mobilization: A Longitudinal Assessment Using Helkimo’s Clinical Dysfunction Index

BackgroundThe optimal treatment of mandibular condylar fractures remains controversial, as comparative studies have demonstrated variable outcomes following open reduction and internal fixation and closed treatment, with the available evidence not establishing a universally superior treatment modality.Closed reduction of condylar fractures aims to allow fracture healing, taking the patient's occlusion as a reference for fracture management.Early functional mobilization has been advocated following condylar fractures because prolonged immobilization may contribute to joint stiffness, fibrous adhesions, and restricted mandibular movement, potentially increasing the risk of post-traumatic ankylosis.Hence, intermittent jaw mobilization has been instituted to maintain functional mandibular movement during the healing period and to minimize prolonged immobilization of the temporomandibular joint (TMJ).However, the functional recovery trajectory of the joint after fracture of the condyle follows a unique trend, and this study aims to map this trajectory of fracture healing to functional healing of the joint following condylar fractures. MethodsA prospective longitudinal observational study was conducted among 63 patients presenting with mandibular condylar fractures and managed conservatively by closed treatment with an intermittent jaw mobilization protocol.The mapping of functional recovery of the TMJ was assessed at the first visit, at six weeks, and at three months, and the assessment was done using Helkimo's Clinical Dysfunction Index. ResultsThe longitudinal assessment in the present study provides a more meaningful representation of functional recovery than a single postoperative assessment.The observed trajectory highlights that clinical functional recovery may evolve progressively over time; however, structural healing or morphological changes of the condyle were not directly assessed radiographically in the present study.Therefore, the observed data demonstrate temporal improvement in TMJ function following conservative treatment with intermittent mobilization, but due to the observational design and absence of a comparison group, the observed improvement in functional parameters cannot be interpreted as evidence of treatment effectiveness or causality.