Background: To take surgical treatment or non-surgical treatment on condylar fracture, clinicians are faced with a difficult choice. Traditional treatment on condylar fracture advocated non-surgical treatment, including intermaxillary traction and intermaxillary fixation, which relies mainly on condylar rebuilt. In recent years, with the development of rigid internal fixation, open reduction and internal fixation technique has been well applied in the treatment of condylar fracture and has obtained an optimistic therapeutic effect. More and more of patients with condylar fracture are advised to undergo surgical treatment. However, surgical treatment sometimes causes some discomforts and complications to patients. Is surgery treatment inevitable for condylar fracture? We, in this study, adopted a meta-analysis to compare the efficacy of open reduction and fixation surgical treatment with that of the non-surgical treatment on condylar fracture to give a reference to clinic.
Methods: Computer retrieval of PubMed, Cochrane Library, and EMbase was used to identify literatures that reported the efficacy of open reduction and fixation surgical treatment compared with that of the non-surgical treatment on condylar fracture. Retrieval time began from the establishment of database to January 2012. Two reviewers assessed the quality of each trial and extracted data independently. RevMan 5.0 software was used for statistical analysis.
Results: Thirteen literatures including 859 patients were included. A total of 409 patients underwent surgical treatment and 450 patients underwent non-surgical treatment. The results of the meta-analysis showed that the indicator of maximal mouth opening of the surgical treatment group was higher than that in the non-surgical treatment group (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.21-0.50; P < 0.00001). After 1 year of follow-up, the malocclusion incidence in the surgical group was less than that in the non-surgical treatment group (OR, 0.29; 95% CI, 0.13-0.66; P = 0.003). The incidence of temporomandibular joint pain has no significant statistical difference in the 2 groups (OR, 0.76; 95% CI, 0.25-2.29; P = 0.63). No significant statistical difference in the indicators of facial symmetry (OR, 1.27; 95% CI, 0.34-4.79; P = 0.73) and mandibular activity status (OR, 0.94; 95% CI, 0.43-2.07; P = 0.88) has been found in the 2 groups.
Conclusions: Surgical treatment has significant advantages in improving the maximal mouth opening as well as the occlusional relationship and has no significant statistical difference in the occurrence of joint pain after treatment, facial symmetry, and mandibular activity status in the 2 groups. Surgical treatment is suggested for patients older than 16 years with low position of condylar fracture, severe displacement, dislocation, and malocclusion. Joint pain, mandibular activity, facial symmetry after treatment, and jaw development impact should not be used as the influencing factors for treatment methods selection.