Open Reduction and Internal Fixation Versus Closed Reduction and Maxillomandibular Fixation of Condylar Fractures of the Mandible: A Prospective Study

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

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.

[Morphometric features of the condylar process of the mandible]

OBJECTIVE

The aim of the study is to determine the X-ray morphometric parameters of the neck of the mandible for the rational choice of fixing elements during osteosynthesis.

MATERIAL AND METHODS

Based on 145 computed tomography scans of the mandible, the parameters of the upper and lower borders, the area and thickness of the neck of the mandible were studied. The anatomical boundaries of the neck were determined using the classification of A. Neff (2014). The parameters of the neck of the mandible were studied depending on the shape of the mandible ramus, gender, age and preservation of dentition.

RESULTS

The sizes of morphometric parameters of the neck of the mandible prevail in men. Statistically significant differences were found between the sizes of the neck of the mandible in men and women in the width of the lower border, area, and thickness of bone tissue. It was revealed that there are statically significant differences between hypsiramimandibular, orthoramimandibular and platyramimandibular forms in the following parameters: the width of the lower and upper borders, the middle of the neck, the area of bone tissue. When comparing the morphometric parameters of the neck of the articular process, there were no statistically significant differences between the age groups (p>0.05), and no differences were found between the groups identified by the degree of preservation of the dentition (p>0.05).

CONCLUSION

Morphometric parameters of the neck of the mandible have individual variability, statically significant differences depending on the sex and shape of the mandibular ramus. The obtained results on the width, thickness, and area of the bone tissue of the neck of the mandible will help in clinical practice to rationally choose the length of screws; the size, number, and shape of titanium mini-plates to achieve the requirements of stable functional osteosynthesis.

No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term

Open treatment of condylar head fractures (CHF) is considered controversial. In this retrospective cohort study our primary objective was therefore to assess bone resorption and remodeling as well as patients function after open treatment of CHF in a medium-term follow-up (15.1 ± 2.2 months). We included 18 patients with 25 CHF who underwent open reduction and internal fixation, between 2016 and 2021, in our analysis. The clinical data and cone-beam computed tomography (CBCT) datasets were analyzed. The condylar processes were segmented in the postoperative (T1) and follow-up (T2) CBCT scans. Volumetric and linear bone changes were the primary outcome variables, measured by using a sophisticated 3D-algorithm. The mean condylar head volume decreased non-significantly from 3022.01 ± 825.77 mm3 (T1) to 2878.8 ± 735.60 mm3 (T2; p = 0.52). Morphological alterations indicated remodeling and resorption. The pre-operative maximal interincisal opening (MIO) was 19.75 ± 3.07 mm and significantly improved to 40.47 ± 1.7 mm during follow-up (p = 0.0005). Low rates of postoperative complications were observed. Open reduction of CHF leads to good clinical outcomes and low rates of medium-term complications. This study underlines the feasibility and importance of open treatment of CHF and may help to spread its acceptance as the preferred treatment option.