Closed versus open reduction of mandibular condylar fractures in adults: a meta-analysis

A review of the literature shows a difference of opinion regarding whether open or closed reduction of condylar fractures produces the best results. It would be beneficial, therefore, to critically analyze past studies that have directly compared the 2 methods in an attempt to answer this question.

A Medline search for articles using the key words "mandibular condyle fractures" and "mandibular condyle fracture surgery" was performed. Articles that compared open and closed reduction were selected for further evaluation. Additional articles were obtained from reference lists in the Medline-selected articles. Of the 32 articles identified, 13 met the final selection criteria. These contained data on at least one of the following: postoperative maximum mouth opening, deviation on opening, lateral excursion, protrusion, asymmetry, and joint or muscle pain.

Numerous problems were found with the information presented in the various articles. These included lack of patient randomization, failure to classify the type of condylar fracture, variability within the surgical protocols, and inconsistencies in choice of variables and how they were reported. However, the results from the meta-analyses were explored in a general sense.

Because of the great variation in the manner in which the various study parameters were reported, it was not possible to perform a reliable meta-analysis. There is a need for better standardization of data collection as well as randomization of the patients treated in future studies to accurately compare the 2 methods.