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Does Open Reduction and Internal Fixation Yield Better Outcomes Over Closed Reduction of Mandibular Condylar
Risimati Ephraim Rikhotso1, Johan P Reyneke2, Marietha Nel3
1Department Head, Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Summary
Closed reduction (CR) and open reduction internal fixation (ORIF) for mandibular condylar fractures (MCFs) yield acceptable outcomes. However, CR resulted in more complications, particularly with severe fractures.
Area of Science:
- Oral and Maxillofacial Surgery
- Traumatology
- Orthodontics
Background:
- Therapeutic approaches for mandibular condylar fractures (MCFs) lack a definitive consensus.
- The choice between invasive (open reduction and internal fixation - ORIF) and noninvasive (closed reduction - CR) treatment remains debated.
Purpose of the Study:
- To compare the functional and aesthetic outcomes of MCFs treated with CR versus ORIF.
- To evaluate temporomandibular joint function, occlusion, and complication rates between the two treatment groups.
Main Methods:
- A randomized controlled trial involving 116 patients with unilateral or bilateral MCFs.
- Patients were randomized to either CR or ORIF groups.
- Outcomes including pain, range of motion, occlusion, and complications were assessed over 12 months.
Main Results:
- No significant differences were found in mouth opening, protrusion, or lateral movements between CR and ORIF groups.
- Statistically significant differences favored ORIF for malocclusion (P=0.040) and deviation (P<0.0001).
- Ramus height loss and fracture displacement angle were associated with complications in the CR group.
Conclusions:
- Both CR and ORIF are acceptable treatment options for mandibular condylar fractures.
- CR is associated with a higher complication rate, especially in cases of bilateral fractures, significant ramus height loss (>5mm), or large displacement angles (>15°).
