MANDIBULAR FRACTURES: OPEN VERSUS CLOSED TREATMENT — A NARRATIVE LITERATURE REVIEW

Abstract

Mandibular fractures require a careful assessment to define the therapeutic approach, especially regarding the choice between open treatment, based on open reduction and internal fixation, and closed treatment, based on conservative methods and maxillomandibular stabilization. This study aimed to analyze the scientific evidence available on these two approaches, comparing their clinical indications, advantages, limitations, functional and occlusal results and possible complications. To this end, a narrative review of the literature was carried out, with a bibliographic survey in the databases PubMed/MEDLINE, Scopus, Web of Science and Cochrane Library. Studies related to open and closed treatment of mandibular fractures were considered, including systematic reviews, meta-analyses, randomized clinical trials, retrospective studies and literature reviews. After analyzing the thematic relevance and the availability of bibliographic records and summaries, 23 studies were selected to compose the review and organized into thematic categories. There was a predominance of publications related to fractures of the condylar process. The findings of a meta-analysis on unilateral extracapsular condylar fractures indicated that open reduction with internal fixation was associated with better results in terms of occlusion, maximum mouth opening, lateral deviation and lateral movements, with no statistically significant difference in relation to pain in the temporomandibular joint. Furthermore, retrospective studies have shown that the level of the fracture and the degree of displacement are relevant factors for therapeutic choice. However, there was a lack of specific evidence for fractures located outside the condylar process and heterogeneity between the methodological designs analyzed. It is concluded that the choice between open and closed treatment must be individualized, considering the location and displacement of the fracture, the occlusal condition and the patient's clinical characteristics, since there is insufficient evidence to establish the absolute superiority of one approach for all mandibular fractures.