Comparing Surgical Approaches for Mandibular Condylar Fractures: Implications for Masticatory Function, Pain, and Quality of Life

Abstract

Atef Eid Madkour Elsayed*, Alhaitham W. Almohawis, Abdulaziz Abdrabuh Alsulami, Amer H Q D Alazmi, Fahad melfi aldhafeeri, Saleh Saeed Mohammed Alqahtani, Mohamed Mohamed Aboshetaih, Zenab Samir Abdelfattah, Sundees Sultan Abdulrahman Alabdulrazzaq, Njood Khalid Ali Bin Jahlan, Fatimah Meqbil Almehmadi, Shahad Mohammed Baheydrah and Ali Ayed Alkhmmash

Background: Mandibular condylar fractures represent a significant proportion of facial trauma cases and pose therapeutic challenges due to their anatomical complexity and functional implications. This systematic review aimed to evaluate and compare the outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) in the management of unilateral condylar fractures.

Methods: This study followed PRISMA 2020 guidelines and included 15 comparative studies published between 2000 and 2024. Eligible studies were randomized controlled trials, cohort, or case-control studies evaluating ORIF and CR techniques for unilateral mandibular condylar fractures. Data were extracted regarding functional recovery, complications, and occlusal outcomes.

Results: Meta-analytic synthesis revealed that closed reduction offered statistically superior outcomes in maximum interincisal opening (SMD = 0.80, p = 0.008), with mild, non-significant improvements in laterotrusion and protrusion. ORIF was superior in anatomical realignment and was favoured in significantly displaced fractures. Pediatric populations benefited more from CR, while adult and complex cases leaned toward ORIF or hybrid endoscopic-assisted approaches.

Conclusion: While both modalities are effective, treatment choice should be individualized based on patient age, fracture complexity, and surgical accessibility. Closed reduction remains reliable for Pediatric and minimally displaced fractures, while ORIF is preferable in cases requiring anatomical correction.