TREATMENT OF MANDIBULAR CONDYLE FRACTURES: FUNCTIONAL OUTCOMES AND COMPLICATIONS OF CLOSED, CONVENTIONAL OPEN, AND ENDOSCOPICALLY ASSISTED APPROACHES — AN INTEGRATIVE REVIEW

Abstract

Introduction: mandibular condyle fractures are among the most controversial topics in oral and maxillofacial trauma, and the choice between closed treatment, conventional open reduction and internal fixation (ORIF) and endoscopically assisted techniques remains under debate. Objective: to comparatively analyze the functional outcomes and complications associated with these three approaches. Methods: integrative literature review, conducted with a PICO-structured guiding question, study selection following PRISMA 2020 and data extraction in a synthesis matrix. Of 198 records screened, 19 studies composed the final sample, including randomized clinical trials, a prospective study, systematic reviews and meta-analyses, and outcome studies. Results: the meta-analysis by Al-Moraissi and Ellis (2015) showed significant differences favoring ORIF in mouth opening, laterotrusion, protrusion, malocclusion and pain, whereas Bera et al. (2022) found no significant difference between closed and open treatment except for deviation on opening. Between extraoral and endoscopically assisted ORIF, functional results were comparable in the trials by Schmelzeisen et al. (2009) and Anehosur et al. (2019); transient facial nerve weakness was lower in the endoscopic group of the latter (6.25% versus 56.25%; P = 0.036), although the meta-analysis by Cavalcanti et al. (2021) found no difference in facial nerve injury or reoperation. The endoscopic technique required longer operative time. Conclusion: there is evidence favoring ORIF over closed treatment for functional outcomes, but the superiority of the endoscopic technique over conventional open treatment is not established, and larger trials with standardized follow-up are needed.