Comparing open and closed treatment strategy in adult patients with condylar head fractures. What is associated with a better functional outcome?

Abstract

Introduction: Intracapsular condylar fractures are an important component of craniofacial trauma. The indication for open repair has been historically controversial. A review of the literature was performed to compare functional outcomes of open vs closed treatment strategies of condylar head fractures, as well as to identify indications for operative management.Few systematic reviews have been conducted specifically addressing condylar fractures, however none to our awareness specifically address the condylar head fracture. Method: A literature review was designed and implemented to evaluate the functional outcomes and indications for open reduction of condylar head fractures versus closed treatment. A comprehensive electronic search of studies published between 2001 and 2021 of adult patients with condylar head fractures was conducted. Results: The literature review identified 18 articles that met the inclusion criteria. The majority of studies showed improved functional outcomes in the open reduction group with regards to maximal interincisal opening, excursive movements, deviation of midline, malocclusion, ankylosis, and chronic pain. Indications for operative management of condylar head fractures vary, however ramus shortening with loss of vertical height seems to be the prevalent indication. Conclusion: There is not yet one overriding consensus dictating management of condylar head fractures. It appears more and more studies are supporting the idea that better functional outcomes (and quicker return to function) are achievable using an open reduction strategy. However, closed treatment remains a valid option in some cases. Therefore, the most appropriate treatment must still be personalised to the individual patient.