MANDIBULAR CONDYLAR FRACTURES: OPEN VERSUS CLOSED TREATMENT AND FUNCTIONAL OUTCOMES

Abstract

Mandibular condylar fractures are among the most frequent mandibular injuries and remain therapeutically controversial, particularly regarding the choice between closed treatment and open reduction with internal fixation. This integrative review aimed to compare functional outcomes of open and closed approaches in adults with mandibular condylar process fractures, focusing on mouth opening, mandibular excursions, occlusion, pain, mandibular deviation, trismus, temporomandibular joint function, and complications. The guiding question was structured according to the PICO framework. The literature search was conducted on September 25, 2026 in PubMed/MEDLINE, Scopus, Web of Science, and LILACS. A total of 682 records were identified, of which 153 duplicates were removed. After screening 529 records by title and abstract, 19 articles were assessed in full text. Six studies were excluded according to the eligibility criteria, resulting in 13 primary comparative studies included in the final synthesis. Overall, open reduction and internal fixation yielded more consistent anatomical restoration and advantages for selected functional outcomes, particularly in displaced fractures, ramus shortening, subcondylar/neck fractures, and selected bilateral cases. Closed treatment remained effective for minimally displaced fractures with stable occlusion and good adherence to physiotherapy, while avoiding surgical risks such as facial nerve injury, scar, sialocele, and infection. There is no universal indication; treatment should be individualized according to fracture level and displacement, ramus height loss, occlusal condition, laterality, age, comorbidities, surgical expertise, and feasibility of early functional rehabilitation.