Outcomes of non-surgical management of non-condylar mandibular fractures: a systematic review and meta-analysis.

Surgical intervention utilising open and (less commonly) closed reduction, are the main methods for the management of fractures of the mandible that do not involve the condyle or coronoid. Non-surgical management of these fracture patterns is rare. This systematic review aimed to collate current evidence surrounding this topic. A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were adults with mandibular fractures. Exclusion criteria included any form of surgical intervention including open or closed reduction, and fractures of the condyle or coronoid. Four studies satisfied the eligibility criteria and comprised 80 patients. A total of 69 patients (86%) who were managed non-surgically produced satisfactory clinical outcomes with no surgical intervention required. The evidence suggests that non-surgical management can successfully avoid surgery in most cases when certain criteria are applied. This has huge health economic implications as it reduces morbidity and requirements for theatre and inpatient stay. Further research is required to establish which fracture patterns are most amenable to this approach, the most effective non-surgical instructions, and the recommended follow-up period.