EPIDEMIOLOGICAL ANALYSIS AND THERAPEUTIC CRITERIA IN THE MANAGEMENT OF MANDIBULAR FRACTURES IN HOSPITAL EMERGENCY SETTINGS

Abstract

The mandible represents the most vulnerable bone in the lower third of the face, presenting a high incidence of trauma in maxillofacial emergency services. Objective: To analyze, through an integrative literature review, the epidemiological, clinical, anatomical, and biomechanical factors associated with the indication of osteosynthesis compared to conservative treatment in mandibular fractures. An integrative review guided by the PICO framework was conducted across the PubMed, EMBASE, Scopus, Web of Science, and VHL/LILACS databases, including studies published between 2020 and 2026. Nine studies were selected, aggregating a sample of 3,840 patients. A predominance of young adult males (78.5%) and interpersonal violence (41.2%) as the primary etiology were observed. The mandibular body (31.4%), angle (27.8%), and condyle (24.1%) were the most affected regions. Open reduction and internal fixation (ORIF) was performed in 68.4% of cases, strongly associated with displacements greater than 2 mm, comminution, and severe malocclusion, avoiding postoperative maxillomandibular fixation in 92.1% of surgical patients. Conservative management achieved a 94.3% success rate in non-displaced fractures. For condylar fractures with severe displacement, ORIF yielded superior mouth opening (42.1 mm vs. 35.4 mm), whereas closed treatment prevented ankylosis in intracapsular injuries. Surgical complications (11.4%) were mostly manageable local events, while closed treatment failures (8.7%) resulted in permanent malocclusion. Therapeutic choice demands individualization: ORIF is indicated for unstable and displaced fractures, while conservative management remains effective for aligned and intracapsular injuries.