Jazayeri Hossein E, Lopez Joseph, Khavanin Nima, Xun Helen, Lee Urie K, Best David L, Reategui Alvaro, Urata Mark M, Dorafshar Amir H
From the Section of Oral and Maxillofacial Surgery, Department of Surgery, Michigan Medicine.
Division of Plastic and Reconstructive Surgery, Yale School of Medicine.
Plast Reconstr Surg. 2023 Apr 1;151(4):664e-672e. doi: 10.1097/PRS.0000000000010009. Epub 2022 Dec 9.
Many fractures of the mandibular condylar neck are amenable to both open reduction and internal fixation (ORIF) and closed treatment. Clinical outcomes following these two modalities remains a topic of debate. This systematic review critically appraises the literature to compare them following these treatment options.
A systematic review and meta-analysis was performed to test the null hypothesis of no difference in clinical outcomes in ORIF versus closed treatment of mandibular condyle fractures. The PubMed, Embase, Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov trial registries were queried from 1946 to 2020. The quality of evidence was determined using Grading of Recommendations Assessment, Development, and Evaluation methodology.
Of 1507 screened articles, 14 met inclusion criteria. ORIF was favored significantly when evaluating temporomandibular joint pain [relative risk (RR), 0.3; 95% CI, 0.1 to 0.7] (number needed to treat to prevent an outcome in one patient, 3; 95% CI, 2 to 6), laterotrusive movements of the mandible (mean difference, 2.3; 95% CI, 1.7 to 3.0) (standardized mean difference, 0.9; 95% CI, 0.4 to 1.3), and malocclusion (RR, 0.5; 95% CI, 0.4 to 0.7) (number needed to treat to prevent an outcome in one patient, 19; 95% CI, 10 to 200). However, ORIF yielded a higher incidence of postoperative infection (RR, 3.6; 95% CI, 0.9 to 13.8) and must be weighed against the understood risk of facial nerve injury.
Meta-analysis of high-level evidence in randomized controlled trial suggests that ORIF significantly improves functional outcomes, decreases pain, and restores occlusion and jaw symmetry. These long-term benefits must be weighed against the increased risk of postoperative infection and exposure of the facial nerve to potential injury.
许多下颌髁突颈部骨折既适合切开复位内固定术（ORIF），也适合闭合治疗。这两种治疗方式的临床疗效仍是一个有争议的话题。本系统评价对相关文献进行严格评估，以比较这两种治疗方案的疗效。
进行了一项系统评价和荟萃分析，以检验下颌髁突骨折切开复位内固定术与闭合治疗在临床疗效上无差异的零假设。检索了1946年至2020年期间的PubMed、Embase、Cochrane图书馆、爱思唯尔文本挖掘工具数据库和clinicaltrials.gov试验注册库。使用推荐分级评估、制定和评价方法确定证据质量。
在筛选的1507篇文章中，14篇符合纳入标准。在评估颞下颌关节疼痛时，切开复位内固定术明显更具优势[相对危险度（RR），0.3；95%可信区间，从0.1至0.7]（预防1例患者出现某种结果所需治疗人数，3；95%可信区间，2至6）、下颌骨侧方运动（平均差，2.3；95%可信区间，1.7至3.0）（标准化平均差，0.9；95%可信区间，0.4至1.3）以及错牙合（RR，0.5；95%可信区间，0.4至0.7）（预防1例患者出现某种结果所需治疗人数，19；95%可信区间，10至200）。然而，切开复位内固定术术后感染发生率更高（RR，3.6；95%可信区间，0.9至13.8），并且必须权衡其已知的面神经损伤风险。
对随机对照试验中的高级别证据进行的荟萃分析表明，切开复位内固定术能显著改善功能预后、减轻疼痛并恢复咬合及颌骨对称性。这些长期益处必须与术后感染风险增加以及面神经潜在损伤的风险相权衡。
