Narrative review of closed (nonsurgical) treatment modalities for mandibular fractures

Background and Objective: Nonsurgical treatment options continue to play a central role in the management of mandibular fractures, providing osseous stabilization and re-establishment of pre-trauma occlusion without the need for direct surgical exposure. Key advantages include preservation of periosteal blood supply, reduced risk of infection, and avoidance of sensory and motor nerve dysfunction. Although open reduction and internal fixation (ORIF) has gained prominence for unstable or complex fractures, nonsurgical methods remain important in favorable fracture patterns, condylar fractures, medically compromised patients, and scenarios where minimally invasive management is preferred. This narrative review aims to evaluate contemporary nonsurgical techniques, including their indications, outcomes, and complications, to support evidence-based clinical decision making.

Methods: A narrative review of the literature was conducted to assess nonsurgical treatment modalities for mandibular fractures. Relevant studies were identified and evaluated to compare techniques, indications, duration of fixation, and associated complication profiles.

Key Content and Findings: Considerable variability exists among nonsurgical modalities with respect to indications, techniques, duration, and complication profiles. Maxillomandibular fixation (MMF) screws demonstrated shorter operative times and improved patient comfort compared with traditional arch bars, while maintaining comparable stability in selected fracture patterns. Arch bars remained advantageous in cases requiring prolonged fixation or precise dental control. Complication rates varied by technique, with mucosal injury and dental trauma more frequently associated with arch bars, and hardware loosening more commonly observed with screw-based systems.

Conclusions: Contemporary nonsurgical techniques provide reliable stabilization with distinct advantages and limitations. Selection of fixation method should be individualized based on fracture pattern, dentition, anticipated duration of fixation, and patient-specific factors. These findings support a tailored approach to MMF rather than a universal strategy, offering clinicians a comparative framework to optimize outcomes while minimizing complications.