Available evidence for best treatment approach for fractured mandibular condyles is of poor quality

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Fractured mandibular condyles are common representing 25-35% of all mandibular fractures.  They are treated by conservative management (CM) or open reduction/internal fixation (ORIF) but the evidence to support superiority of one method over the other has not been assessed. The aim of this review is to evaluate the current evidence regarding the interventions that can be used for the treatment of mandibular condylar fractures.

What did they do

The  Medline, Embase, and the Cochrane Library databases were searched with no language restrictions. Randomized controlled trials (RCTs) and non-experimental studies (i.e. case series) were eligible for inclusion.  A quantitative synthesis was planned but only a qualitative summary was presented owing to heterogeneity between the included studies. The primary outcome of interest was post treatment function i.e  post treatment occlusion, mouth opening, protrusion, facial height, pain and the presence of postoperative ankylosis. In studies evaluating ORIF, adverse effects such as facial nerve weakness and scarring, were also recorded

What did they find

  • Twenty studies (1596 patients)  were included in four RCTs and 16 non-randomized case series.
  • In nine studies the superiority of ORIF over CM reached statistical significance.
  • The incidence of facial nerve weakness following ORIF averaged 6% and it was temporary for the majority of the patients.
  • The identified RCTs were small (160 patients) and suffered from a number of methodological shortcomings.
  • All the RCTs reached statistically significant conclusions favouring ORIF over CM.

What were their conclusions

 The current meta-analysis suggests that ORIF for condylar fractures may be as good or better than CM. The morbidity associated with the operation is low. However, the available evidence is of poor quality and not strong enough to change clinical practice.

Kyzas PA, Saeed A, Tabbenor O. The treatment of mandibular condyle fractures: A meta-analysis. J Craniomaxillofac Surg. 2012 Apr 12. [Epub ahead of print]PubMed PMID: 22503083.