Open and closed treatment approaches for mandibular condyle fractures: a systemati̇c review and meta-analysi̇s

Condyle fractures are common fractures of the mandible. Condyle fractures are treated with open reduction internal fixation or closed-conservative approaches. In this study, a meta-analysis were planned to compare the effect of open and closed approaches on maximum mouth opening, laterotrusion and protrusion after treatment. Using Pubmed, the online biomedical database of the National Library of Medicine of the United States of America, following keywords, "Surgical versus nonsurgical treatment in mandibular condylar fractures" , "Open versus closed reduction in treatment of unilateral mandibular condylar process fractures" , "Surgical versus conservative treatment of mandibular condylar fractures" , "Surgical versus conservative treatment of mandibular subcondylar fractures" , "Surgical complication and mandibular condylar fractures" , "Outcomes of open versus closed treatment of mandibular subcondylar fractures" , "Open and closed treatment of condylar fractures" were scanned in English. 652 articles were identified. Data from 10 publications that met our inclusion criteria was systematically collected. Data from 10 publications that met our inclusion criteria was systematically collected. 4 studies were controlled clinical trials, 2 studies were retrospective, and 4 studies were randomized controlled trials. From the publications, the design of the studies, the technique used, maximum mouth opening after treatment (MAA), laterotrusion, protrusion, age, duration of follow up, facial nerve damage, pain, malocclusion information were recorded. 9 studies were included in the maximum mouth opening meta-analysis. As a result of statistical analysis, MAA was determined as 0,244 (%95 GA [-0,317 0,804] , p=0,393, t=0,855 according to the random effect model. The P value was seen to be greater than 0.05. According to the Meta analysis conducted according to these results, no statistically significant difference was observed between the mean values of the MMA parameter between open and closed treatments in the publications that were included in the criterion. 7 studies were included in the laterotrusion meta-analysis. As a result of the statistical analysis, it was determined as 0.350 (95% GA = -0.090 0.791, p=0.117, t=1,416) according to the random effect model. The P value was seen to be greater than 0.05. According to the Meta-analysis conducted according to these results, no statistically significant difference was observed between the averages of the laterotrusion parameter values in the publications included in the criterion. 6 studies were included in the protrusion meta-analysis. As a result of the statistical analysis, it was determined as 0.417 (95% GA= -0.157 0.994, p=0.155, t=1,424) according to the random effect X model. The P value was seen to be greater than 0.05. According to the Meta-analysis conducted according to these results, no statistically significant difference was observed between the averages of the protrusion parameter values in the publications included in the criterion. As a result, in the meta-analysis, no statistically significant difference was observed between the effects of open and closed technique approaches in adult mandible condyle fractures on maximum mouth opening, laterotrusion and protrusion in the post-treatment period.