Study to Compare Different Modalities in the Management of Paediatric Mandibular Condylar Fractures: A Meta-Analysis

Abstract

Background: Mandibular condylar and subcondylar fractures are common among pediatrics. They are important to be appropriately managed for their effect on the normal growth of the mandible and the associated complications. Given these concerns, it is unsurprising to note the variety of treatment approaches including; conservative, closed reduction with arch bar application, and open reduction with internal fixation by plates & screws. This reflects the need to appropriately select the convenient modality according to age, displacement of the fractured segments, and presence of malocclusion.Objective: To compare the functional outcomes of different modalities in the management of pediatric condylar and subcondylar fractures.Patients and Methods: This systematic review was done on ten retrospective and cohort studies published in the English language, from any geographical location, between 2010 and 2021. A total of 626 patients aged less than 15-year-old with condylar and sub-condylar fractures, associated with or without other mandibular fractures, managed with conservative management, closed reduction with application of arch bar or MMF, and open reduction with internal fixation by plates & screws.Results: Pediatric patients managed by conservative management and physiotherapy yielded a significant improvement in occlusion and mouth opening with fewer complications within a reasonable period of 2-4 weeks to achieve functional recovery. On applying closed reduction with arch bar application or MMF, the mouth opening was improved up to >35mm without significant malocclusion or any other complications. It needed about 4-8 weeks for functional recovery to be achieved. In surgical intervention for open reduction and internal fixation, Malocclusion was noted in 2.8% of patients compensated with the growth of the mandible and teeth eruption. In addition, there were significant postoperative complications noted in some patients. Conclusion:Based on the studies, all modalities in the management of pediatric condylar and sub-condylar fractures are clinically accepted and can be applied. However, the point of negotiation is the indications for each modality and the associated possible complications. Conservative management and closed reduction with MMF application prevent the risk 375 of some functional complications that may occur with the invasive surgical intervention.