Open versus closed treatment for unilateral mandibular extra-capsular condylar fractures: A meta-analysis

Purpose: To compare the functional outcomes between open reduction and internal fixation (ORIF) and closed reduction (CR) for unilateral mandibular extra-capsular condylar fractures in patients over 12 years old. Materials and methods: A comprehensive electronic search of PubMed, Embase and the Cochrane Library databases was conducted up to October 31, 2018. The evaluated functional outcomes included malocclusion, temporomandibular joint (TMJ) pain, protrusion, laterotrusion, maximum inter-incisal opening and lateral deviation during maximum inter-incisal opening. Results: Fourteen studies appeared to meet the inclusion criteria. Statistically significant differences between ORIF and CR treatment were observed for the outcomes of malocclusion (P = 0.001), maximum inter-incisal opening (P = 0.0008), lateral deviation during maximum inter-incisal opening (P = 0.007) and laterotrusion (P < 0.0001), but not for the outcomes of protrusion (P = 0.33) and TMJ pain (P = 0.29). Conclusions: ORIF treatment of unilateral mandibular extra-capsular condylar fractures provides better functional outcomes in comparison to CR treatment with regard to occlusion, maximum inter-incisal opening, lateral deviation during maximum inter-incisal opening and laterotrusion, whereas there was no statistically significant difference between ORIF and CR group with regard to protrusion and TMJ pain. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.