Fractures of mandible: is spontaneous healing possible? Why? When?

Closed and open reduction of fractures of the mandible constitutes an endless debate, and it is interesting that modern times have not brought a conclusion to this controversy. From 1995 to 1997 in the Plastic Surgery Department of Argerich Hospital in Buenos Aires, Argentina, 23 patients were evaluated with different fractures of the mandible in which neither closed nor open reduction was performed. Seventeen patients (74%) presented associated fractures in different areas of the mandible and 6 (26%) only had one fracture; 2 of them (9%) were edentulous. Three (13%) of the 23 patients had more than two fractures in different areas. Condylar fractures were the only lesion in 8 patients (35%), and they were associated with body fractures in another 6 patients (26%). Spontaneous healing of the fractures occurred in all 23 patients. No complications were found in any of them. All fractures presented the following characteristics: 1) Fractured fragments were aligned without displacement (or light displacement), 2) Occlusion was normal (or pretraumatic occlusion), 3) Facial symmetry was maintained, 4) Radiography demonstrated fractures without displacement, 5) Minor edema and hematoma were present in the area of the fracture, and 6) There was only pain during masticatory movements. The treatment was as follows: 1) Soft food and liquid diet (solid food was avoided 30 days after trauma), 2) Opening of the mouth was not permitted, 3) Oral antibacterial cleaning, and 4) Analgesic therapy. Spontaneous healing was produced by secondary bone repair mechanism as a "natural" process.