| Objective: Condylar fractures is one of the most common sites of mandibular fracture,accounting for 21-49%.Condylar fractures may be divided into condylar head,condylar neck,and subcondylar region types according to the anatomic location of the fracture.It is always controversial whether conservative treatment or surgical treatment should be used for condylar fracture,especially for intracapsular fracture of mandibular condyle.According to accepted guidelines from a decade ago,DFs of the mandibular condyle are treated with a closed functional therapeutic regimen(CTR).There is a suspicion of risk of avascular necrosis,osseous,and fibrous ankylosis in cases of DFs.With the improvement of surgical treatment technology and fixation materials,more and more clinicians choose surgical treatment for intracapsular condylar fracture.However,several surgeons have begun to report their experiences with open reduction and internal fixation(ORIF)for DFs with good results.Therefore,the purpose of this study is to retrieve the results of surgical and conservative treatment for intracapsular fracture of mandibular condyle.Evidence-based medical method-meta-analysis was used to collate and analyze the post-operative response of conservative treatment and surgical treatment of intracapsular fracture of condyle,and to evaluate the risk of surgical and conservative treatment,so as to provide some treatment basis for clinicians in decision-making on treatment of intracapsular fracture of condyle.Methods: An electronic search in Cochrane Library、PubMed、Embase、Web of science 、CNKI 、Wanfang、Weipu was undertaken in June 2018.The inclusion and exclusion criteria were established,the quality of selected articles was analyzed,the inclusion articles were determined,and the inclusion documents were quantitatively analyzed.Based on the analysis results,the treatment of intracapsular condylar fracture was discussed.Results : The search strategy resulted in 7 publications.The estimates of an intervention were expressed as the risk ratio(RR)and mean difference(MD)in millimetres.A statistically significant effect was observed for the outcome ofpost-treatment maximum incisal opening(WMD:-4.28,P=0.0004),malocclusion(RR:2.77,P=0.01)chin deviation(RR:3.84,P=0.01),joint pain(RR:2.17,P=0.03),joint click(RR:2.91,P=0.01),resorption of condyle(RR:2.56,P=0.002).Conclusion: Meta-analysis showed that in the comparison of complications after the treatment of intracapsular fracture of mandibular condyle,there were significant differences in the maximum opening,malocclusion,mandibular deviation,joint pain,joint bounce,condylar absorption and so on.The surgical treatment group was superior to the conservative treatment group.Therefore,conservative treatment has great limitations in the treatment of mandibular condylar intracapsular fracture.It is impossible to achieve complete reduction of the fracture and the incidence of complications is higher than that of surgical treatment.With the improvement of surgical materials and techniques,the incidence of complications after surgery is gradually reduced,while the long-term complications after conservative treatment are more obvious.Therefore,in the choice of surgical and non-surgical treatment of clinical decision-making,intracapsular fracture is not an absolute indication of conservative treatment,different types of intracapsular fracture should have their corresponding treatment options,from the patient’s age,fracture fracture end dislocation,soft tissue damage,whether bilateral fracture or accompanied by other mandibular fractures,and so on,to determine whether to adopt or not.,surgical treatment or conservative treatment.Combined with this analysis and some studies,conservative treatment of mandibular condylar intracapsular fracture with lower mandibular ramus height or displacement of soft tissue injury such as articular disc is less effective than surgical treatment.Therefore,surgical treatment can be preferred in the decision-making of clinical treatment.However,there are still some risks in surgical treatment,such as injury of temporal branch of facial nerve,scar and loss of fixation material after operation.Therefore,proper surgical approach should be selected as far as possible during the operation,and the surrounding tissues around the displaced fracture segment should be carefully separated to ensure the exposure of fracture ends.When reducing the fracture fragments of condyle,attention should bepaid to protecting the lateral pterygoid muscle from peeling off from the upper part.It does not destroy the surface structure of condylar cartilage. |
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