Is Manual Reduction Adequate For Intraoperative Control Of Occlusion During The Fixation Of Mandibular Fractures? A Systematic Review And Metanalysis

Abstract

Abstract The aim of this systematic review was to evaluate if manual intraoperative control of occlusion is adequate for mandibular fracture reduction, compared to intermaxillary fixation (IMF). We searched PubMed, Embase, Cochrane library and Clinical trial registry as well as references of included trials. Our primary outcome of interest was the reduction of fracture anatomically and radiographically, occlusal disturbances and incidence of revision procedures due to poor occlusion or reduction. Our secondary outcomes of interest were operative time and infective complications. Of the studies retrieved, 4 were included (n= 257, manual reduction= 136, IMF= 121) The studies had an unclear risk of bias. Nevertheless, the overall effect is statistically significant and in favour of manual reduction with low number of adverse events in the manual reduction group (n=43) compared to the IMF group (n=78), Odds ratio (0.42 [0.27, 0.64]. Absolute reduction in adverse events seen was occlusion disturbance (120 fewer per 1000), revision procedure (164 fewer per 1000) and infective complications (178 fewer per 1000). There is a low quality evidence supporting manual reduction over IMF for intraoperative control of fracture fragment and occlusion, derived from few studies with unclear risk of bias, and the results are not different when condylar fractures are present. The overall certainty of evidence is moderate. The clinician should select the appropriate technique based on the patient’s injury pattern, as well as the treating surgeon’s experience and available resources.