title: Surgical treatment of adult mandibular condylar fractures provides better outcomes than closed treatment: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The purposes of this study were to identify significant differences in clinical outcomes between open reduction and rigid internal fixation (ORIF) and closed treatment (CT) for adult mandibular condylar fractures (MCFs) and to support or refute the superiority of one method over the other.
  
  
  METHODS
  To address our purpose, we designed and implemented a systematic review with meta-analysis. A comprehensive electronic search without date and language restrictions was performed in May 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials, controlled clinical trials, and retrospective studies, that compared ORIF and CT regarding maximal interincisal opening, laterotrusive and protrusive movements, pain, malocclusion, chin deviation on mouth opening, and temporomandibular joint signs or symptoms for the management of unilateral or bilateral adult MCFs. Meta-analysis was conducted only if there were studies of similar comparisons reporting the same outcome measures. For binary outcomes, we calculated a standard estimation of the odds ratio by the random-effects model if heterogeneity was detected; otherwise, a fixed-effects model with a 95% confidence interval was performed. Weighted mean differences or standard mean differences were used to construct forest plots of continuous data.
  
  
  RESULTS
  Twenty-three publications were included: 5 randomized controlled trials, 16 controlled clinical trials, and 2 retrospective studies. Five studies showed a low risk of bias, whereas 18 showed a moderate risk of bias. There were statistically significant differences between ORIF and CT regarding maximal interincisal opening, laterotrusive movement, protrusive movement, malocclusion, pain, and chin deviation on mouth opening (P = .001, P = .001, P = .001, P = .001, P = .001, and P = .05, respectively).
  
  
  CONCLUSIONS
  The result of the meta-analysis confirmed that ORIF provides superior functional clinical outcomes (subjective and objective) compared with CT in the management of adult MCFs.
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen. Electronic address: dr_essamalmoraissi@yahoo.com.
authors.forename: Essam Ahmed
authors.initials: EA
authors.lastname: Al-Moraissi
authors.affiliation: Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX.
authors.forename: Edward
authors.initials: E
authors.lastname: Ellis
mesh_terms: D018849:Controlled Clinical Trials as Topic; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D008335:Mandibular Condyle / Q000293:injuries* / Q000601:surgery; D008337:Mandibular Fractures / Q000601:surgery* / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome