Management of condylar fractures: a narrative review of closed vs. open approaches

Background and Objective: Mandibular condylar fractures are among the most common facial injuries, yet the course of treatment remains controversial. The two main strategies for treatment, closed (functional) and open reduction and internal fixation (ORIF), differ in philosophy, technical demands, and outcomes. This review synthesizes existing literature with a focused analysis on functional recovery outcomes, complications, and patient selection criteria, aiming to clarify the respective clinical indications for closed reduction and ORIF.

Methods: An English-language search of PubMed and Cochrane databases was performed for studies published between 2000 and 2025. Key outcomes included maximal interincisal opening (MIO), deviation, lateral excursions, occlusal stability, temporomandibular joint (TMJ) function, facial symmetry, and complication rates.

Key Content and Findings: Closed treatment remains effective for minimally displaced fractures and pediatric patients and has low surgical morbidity. ORIF, however, has superior functional recovery with earlier and greater MIO, improved symmetry, better occlusion, and reduced pain in displaced fractures. Closed treatment is associated with higher rates of malocclusion, deviation, and persistent TMJ imbalance, while ORIF carries surgical risks, particularly transient facial nerve injury.

Conclusions: Evidence supports closed management for minimally displaced or pediatric fractures and ORIF for moderate to severely displaced fractures, bilateral injuries, occlusal derangement, or significant ramus height loss. Standardized outcome reporting and randomized controlled trials are needed to draw more definitive conclusions.