Around a third of mandibular fractures involve the mandibular condyle. Treatment approaches involve either an open or closed approach and there is no general agreement of which method should be used.    The aim of this review was to compare open and closed treatment of moderately displaced condylar fractures.

The authors searched 3 databases PubMed, Cochrane Controlled Trials Register, and Embase for randomised controlled trials (RCTs) evaluating the effect of open and closed treatment of unilateral displaced condylar fractures. The studies had to contain sufficient raw data for weighed mean difference (WMD) with 95% confidence intervals. Data abstraction was conducted independently by two reviewers with quality being assessed using the Jadad score. Meta-analysis was conducted using RevMan.

• Four RCTs, involving 177 cases in total were included. The trials were from Denmark, India (2), and Germany . All four studies had a Jadad score of more than 3 and a follow-up period of 6 months or more.
• No significant difference was found between the 2 groups in the maximal inter incisal opening (P 1⁄4 .32).
• a statistically significant difference was seen that operative treatment statistically got better efficacy in lateral excursion movement, protrusion, malocclusion, and temporomandibular joint pain (P < .05).

The authors concluded

This meta-analysis confirms that both treatment options for unilateral displaced condylar fractures of the mandible yielded acceptable results. However, operative treatment was superior in most objective and subjective functional parameters

Comment

The have been two previous systematic reviews of this topic ( Kyzas et al 2012 – see Dental Elf 20^th April 2012)  and Nussbaum et al  2008.  Both of those reviews included non-randomised studies.  All except one of the RCTs was published after the 2008 review.  The Kyzas review also concluded that the evidence suggests that the open approach may be better.  Neither of the two previous reviews are mentioned in this current review.

Links

Liu Y, Bai N, Song G, Zhang X, Hu J, Zhu S, Luo E. Open versus closed treatment of unilateral moderately displaced mandibular condylar fractures: a meta-analysis of randomized controlled trials. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 May 7. doi:pii: S2212-4403(13)00116-8. 10.1016/j.oooo.2013.02.023. [Epub ahead of print] PubMed PMID: 23663989.

Dental Elf Apr 20^th  2012    – Available evidence for best treatment approach for fractured mandibular condyles is of poor quality.

Nussbaum ML, Laskin DM, Best AM. Closed versus open reduction of mandibular condylar fractures in adults: a meta-analysis. J Oral Maxillofac Surg. 2008 Jun;66(6):1087-92. doi: 10.1016/j.joms.2008.01.025. Review. PubMed PMID: 18486771.