Evaluation of Surgical Approaches to Condylar Fractures: A Systematic Review and Network Meta-Analysis.

BACKGROUND

Condylar fractures are common maxillofacial injuries. Although both open and closed treatments are used, the optimal strategy remains debated due to variable functional outcomes and complication rates.

PURPOSE: This network meta-analysis compared the functional outcomes and complications of closed treatment versus various open approaches for mandibular condyle fractures. We evaluated and ranked 6 distinct open approaches: mandibular angle approach (MAA), retromandibular anteroparotid approach (RMAA), endoscopic transoral approach (ETOA), retromandibular through parotid approach (RMPA), preauricular approach (PAA), and submandibular approach (SMA).

DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI) were systematically searched for randomized controlled trials (RCTs) published through March 2024, without language restrictions.

STUDY SELECTION: RCTs comparing closed treatment with at least one open approach and reporting relevant functional or safety outcomes were included. Two reviewers independently performed selection, resolving discrepancies by consensus.

DATA EXTRACTION AND SYNTHESIS: Data extraction followed the PRISMA guidelines. Methodological quality was assessed using the Cochrane risk of bias tool. Random-effects models were applied for both pairwise and network meta-analyses to estimate standardized mean differences (SMDs) and 95% confidence intervals (CIs).

MAIN OUTCOMES AND MEASURES: Primary outcomes were mouth-opening capacity and lateral excursion. Secondary outcomes included deviation in mouth opening and incidence of facial nerve injury.

RESULTS

Fourteen RCTs (3.2% of initial records) were included. Compared with the preauricular approach, RMAA, MAA, and ETOA significantly improved mouth opening [SMD, -2.31; 95% CI, -3.66 to -0.96], [SMD, 2.22; 95% CI, 0.66 to 3.97], and [SMD, 1.93; 95% CI, -0.14 to 3.72]. MAA, RMAA, and retromandibular through parotid approach achieved greater lateral excursion than closed treatment ([SMD, -2.13; 95% CI, -3.68 to -0.58], [SMD, -1.58; 95% CI, -2.91 to -0.25], and [SMD, -1.14; 95% CI, -1.94 to -0.34], respectively). MAA, RMAA, and ETOA were associated with fewer complications. No serious adverse events were reported.

CONCLUSIONS AND RELEVANCE: Compared with closed treatment, specific open approaches-particularly RMAA, MAA, and ETOA-provided superior functional recovery and lower complication rates for condylar fractures. Further high-quality RCTs are warranted to confirm these findings.