Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Maxillofacial and Oral Surgery

17-03-2024 | REVIEW PAPER

Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis

Authors: E. S. Shobha, Neha Nainoor, N. T. Prashanth, Vinod Rangan, Rayan Malick, Shavari Shetty

Published in: Journal of Maxillofacial and Oral Surgery

Login to get access

Abstract

Background

Mandibular fractures are frequent in facial trauma. Management of mandibular condylar fractures (MCF) remains an ongoing matter of controversy in maxillofacial injury. A number of techniques, from closed reduction (CR) to open reduction and internal fixation (ORIF), can be effectively used to manage these fractures. The best treatment strategy, that is, closed reduction or open reduction with internal fixation, remains controversial.

Aim

The aim of this study is to systematically review the existing scientific literature to determine whether open reduction with internal fixation or closed reduction is a better treatment alternative for the patients with condylar fractures through a meta-analysis.

Methods

A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases like PubMed, google scholar and Ebsco Host were searched from 2000 to December 2021 for studies reporting management of condylar fractures through open reduction with internal fixation against closed reduction and reporting the outcome in terms of mean and standard deviation (SD). Quality assessment of included case control and cohort studies was performed using Newcastle–Ottawa Scale, and randomized studies were evaluated using Cochrane risk-of-bias (ROB)-2 tool through its domains. The risk of bias summary graph and risk of bias summary applicability concern was plotted using RevMan software version 5.3. The standardized mean difference (SDM) was used as summary statistic measure with random effect model and p value <0.05 as statistically significant.

Results

Seventeen studies fulfilled the eligibility criteria and were included in qualitative synthesis, of which only nine studies were suitable for meta-analysis. The pooled estimate through the Standardized Mean Difference (SMD) of 0.80, 0.36 and 0.42 for maximum inter incisal opening, laterotrusion and protrusion favours CR compared to ORIF for condylar fracture management. Also, most results of heterogeneity tests were poor and most of the funnel plots showed asymmetry, indicating the presence of possible publication bias.

Conclusion

The results of our meta-analysis suggest that CR provides superior outcomes in terms of maximum inter incisal opening, laterotrusion and protrusion compared to ORIF in condylar fractures management. It is necessary to conduct more prospective randomized studies and properly control confounding factors to achieve effective results and gradually unify clinical guidelines.
Literature
1.
Marker P, Nielsen A, Bastian HL (2000) Fractures of the mandibular condyle. Part 1: patterns of distribution of types and causes of fractures in 348 patients. Br J Oral Maxillofac Surg 38(5):417–421CrossRefPubMed
2.
Yang WG, Chen CT, Tsay PK, Chen YR (2002) Functional results of unilateral mandibular condylar process fractures after open and closed treatment. J Trauma Acute Care Surg 52(3):498–503CrossRef
3.
Santler G, Kärcher H, Ruda C, Köle E (1999) Fractures of the condylar process: surgical versus nonsurgical treatment. J Oral Maxillofac Surg 57(4):392–397CrossRefPubMed
4.
Suzuki T, Kawamura H, Kasahara T, Nagasaka H (2004) Resorbable poly-l-lactide plates and screws for the treatment of mandibular condylar process fractures: a clinical and radiologic follow-up study. J Oral Maxillofac Surg 62(8):919–924CrossRefPubMed
5.
Manisali M, Amin M, Aghabeigi B, Newman L (2003) Retromandibular approach to the mandibular condyle: a clinical and cadaveric study. Int J Oral Maxillofac Surg 32(3):253–256CrossRefPubMed
6.
7.
Bhagol A, Singh V, Kumar I, Verma A (2011) Prospective evaluation of a new classification system for the management of mandibular subcondylar fractures. J Oral Maxillofac Surg 69(4):1159–1165CrossRefPubMed
8.
Singh V, Bhagol A, Goel M, Kumar I, Verma A (2010) Outcomes of open versus closed treatment of mandibular subcondylar fractures: a prospective randomized study. J Oral Maxillofac Surg 68(6):1304–1309CrossRefPubMed
9.
Luchini C, Stubbs B, Solmi M, Veronese N (2017) Assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa scale. World J Meta-Anal 5(4):80–84CrossRef
10.
Corbett MS, Higgins JP, Woolacott NF (2014) Assessing baseline imbalance in randomised trials: implications for the cochrane risk of bias tool. Res Synth Methods 5(1):79–85CrossRefPubMed
11.
DerSimonian R, Laird N (2015) Meta-analysis in clinical trials revisited. Contemp Clin Trials 1(45):139–145CrossRef
12.
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558CrossRefPubMed
13.
Sterne JA, Becker BJ, Egger M (2005) The funnel plot. Publication bias in meta-analysis: prevention, assessment and adjustments. 75–98
14.
15.
Stypulkowski RP, Santos AG, Paula Silva E, Costa Moraes CA, Rosa EL (2019) Unilateral mandibular condylar process fractures: a retrospective clinical comparison of open versus closed treatment. Oral Maxillofac Surg 1(23):209–214CrossRef
16.
Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS (2021) Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Cranio-Maxillofac Surg 49(3):196–205CrossRef
17.
Throckmorton GS, Ellis IE (2000) Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. Int J Oral Maxillofac Surg 29(6):421–427CrossRefPubMed
18.
Landes CA, Lipphardt R (2005) Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures: part I: condyle and subcondylar fractures. Int J Oral Maxillofac Surg 34(8):859–870CrossRefPubMed
19.
Jensen T, Jensen J, Nørholt SE, Dahl M, Lenk-Hansen L, Svensson P (2006) Open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach: a long-term follow-up study of 15 patients. J Oral Maxillofac Surg 64(12):1771–1779CrossRefPubMed
20.
Kokemueller H, Konstantinovic VS, Barth EL, Goldhahn S, von See C, Tavassol F, Essig H, Gellrich NC (2012) Endoscope-assisted transoral reduction and internal fixation versus closed treatment of mandibular condylar process fractures—a prospective double-center study. J Oral Maxillofac Surg 70(2):384–395CrossRefPubMed
21.
Kotrashetti SM, Lingaraj JB, Khurana V (2013) A comparative study of closed versus open reduction and internal fixation (using retromandibular approach) in the management of subcondylar fracture. Oral Surg Oral Med Oral Pathol Oral Radiol 115(4):e7-11CrossRefPubMed
22.
Gareikpatii N (2021) Study of open versus closed reduction of mandibular condyle fractures. Int Surg J 8(11):3402–3406CrossRef
23.
24.
Karan A, Kedarnath NS, Reddy GS, Kumar TH, Neelima C, Bhavani M, Nayyar AS (2019) Condylar fractures: surgical versus conservative management. Ann Maxillofac Surg 9(1):15CrossRefPubMedPubMedCentral
25.
Khiabani KS, Raisian S, Khanian MM (2015) Comparison between two techniques for the treatment of mandibular subcondylar fractures: closed treatment technique and transoral endoscopic-assisted open reduction. J Maxillofac Oral Surg 14(2):363–369CrossRefPubMed
26.
Rashid A, Mumtaz M, Asif J, Azeem M (2014) Mandibular Condyle Fracture-Effect of Treatment on Occlusal Relationship. Pak Oral Dent J 34(1)
27.
Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota RA, Rasse M, Schubert J, Terheyden H, Eckelt U (2008) Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level. J Oral Maxillofac Surg 66(12):2537–2544CrossRefPubMed
28.
Singh V, Kumar N, Bhagol A, Jajodia N (2018) A comparative evaluation of closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures: a prospective randomized study. Craniomaxillofac Trauma Reconstr 11(3):205–210CrossRefPubMed
29.
Vesnaver A, Ahčan U, Rozman J (2012) Evaluation of surgical treatment in mandibular condyle fractures. J Cranio-Maxillofac Surg 40(8):647–653CrossRef
30.
Khelemsky R, Moubayed SP, Buchbinder D (2016) What is the evidence for open versus closed treatment of mandibular condylar fractures in adults? Laryngoscope 126(11):2423–2425CrossRefPubMed
31.
Kozakiewicz M (2019) Classification proposal for fractures of the processus condylaris mandibulae. Clin Oral Invest 23(1):485–491CrossRef
32.
Eckelt U, Schneider M, Erasmus F, Gerlach KL, Kuhlisch E, Loukota R, Rasse M, Schubert J, Terheyden H (2006) Open versus closed treatment of fractures of the mandibular condylar process–a prospective randomized multi-centre study. J Cranio-Maxillofac Surg 34(5):306–314CrossRef
33.
Haug RH, Brandt MT (2007) Closed reduction, open reduction, and endoscopic assistance: current thoughts on the management of mandibular condyle fractures. Plast Reconstr Surg 120(7):90–102CrossRef
34.
Assael LA (2003) Open versus closed reduction of adult mandibular condyle fractures: an alternative interpretation of the evidence. J Oral Maxillofac Surg 61(11):1333–1339CrossRefPubMed
35.
Al-Moraissi EA, Ellis E III (2015) Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis. J Oral Maxillofac Surg 73(3):482–493CrossRefPubMed
Metadata
Title
Comparative Evaluation of Open Reduction with Internal Fixation Against Closed Reduction Methods for Condylar Fracture Management: A Systematic Review and Meta- analysis
Authors
E. S. Shobha
Neha Nainoor
N. T. Prashanth
Vinod Rangan
Rayan Malick
Shavari Shetty
Publication date
17-03-2024
Publisher
Springer India
Published in
Journal of Maxillofacial and Oral Surgery
Print ISSN: 0972-8279
Electronic ISSN: 0974-942X
DOI
https://doi.org/10.1007/s12663-024-02125-4