Introduction Mandibular fractures are frequently seen in road traffic accidents (RTAs), sports injuries and interpersonal violence, with the most common sites of fracture being parasymphysis and mandibular subcondyle. Mandibular subcondylar fractures (MCFs) account for 25-35% of the total mandibular fractures. 1 The mode, vector and site of impact influence the fracture diversity. MCF hinders various joint movements and hampers optimal mouth opening. 2 These fractures need to be treated to avoid severe functional disabilities, including restricted mouth opening, malocclusion, compromised lateral excursion of the condyle and deviation on mouth opening. Hence, treatment needs to be methodised for effective management of MCFs in terms of adequate mouth opening and patient satisfaction. Two methods have been established to treat MCFs: open reduction and internal fixation (ORIF) and closed reduction with external fixation (CREF). 3 A study suggested appropriate classification to provide fracture insight and treatment commencement. 4 Various authors have devised classifications to describe MCFs to facilitate management decisions. Some discussed anatomical line of fractures, angles of displacement and dislocations, while others suggested displacement and dislocations at high and low level with reference to articulation fossa. 5,6 Studies have supported surgical reduction owing to less morbidity, minimum or no wound infections, optimal occlusion, no damage to nerve or deviance of jaw on opening mouth can be corrected. 6-8 Others have supported both treatments as effective. 9,10 Still others favoured closed reduction over open surgical modality. 11-13 Numerous studies and two consensus meetings were unable to conclusively recommend either of the treatment options. 14 One study provided maxillomandibular fixation (MMF) after ORIF for a shorter period of time to provide occlusal stability and to avoid muscle dystrophy. 15 Another study worked on both conservative and surgical methods but was not satisfied with either modality. 7,16 A recent study conducted in Pakistan also addressed the question and reported open reduction techniques to have better functional outcomes. 17 J Pak Med Assoc 2108 ORIGINAL ARTICLE Comparison of functional outcome after open and closed reduction of mandibular subcondylar fracture Samira Shabbir Balouch, 1 Rana Sohail, 2 Sadia Awais, 3 Riaz Ahmad Warraich, 4 Mir Ibrahim Sajid 5 Abstract Objective: To compare open reduction with internal fixation of mandibular subcondylar fracture with closed reduction in terms of adequate mouth opening. Method: The randomised clinical trial was conducted from March 2014 to February 2015 at the Oral and Maxillofacial Surgery Department, King Edward Medical University and Allied Hospitals, Lahore, Pakistan, and comprised patients who presented with unilateral subcondylar fractures. The patients were randomly divided into 2 groups. Group-A patients were treated with closed reduction and immobilisation and were discharged the same day, while Group-B patients were treated by open reduction with internal fixation and retained in ward for 1 day. Both were recalled for periodic follow-ups, and were compared in terms of achieving adequate mouth opening. Data was analysed using SPSS 20. Results: Of the 70 patients, 35(50%) were in each of the two groups. The mean age in Group-A was 28.88±11.86 years compared to 28.22±10.80 years in Group-B (p>0.05). Mean mouth opening in the two groups were consistently positive, and significant at the last two follow-ups(p<0.001). Conclusion: The difference in results of both treatment modalities was significant, indicating that open reduction and internal fixation should be the preferred treatment. Keywords: Mandibular sub-condylar fracture, Open reduction, Closed reduction, Internal fixation, Mouth opening. (JPMA 70: 2108; 2020) DOI: https://doi.org/10.47391/JPMA.1263 1,3 Department of Oral and Maxillofacial Surgery, 2 Department of Surgery, King Edward Medical University, Lahore, 4 Department of Oral and Maxillofacial Surgery, Central Park Medical College, Lahore, 5 3rd Year MBBS Student, Agha Khan Medical University, Karachi, Pakistan. Correspondence: Samira Shabbir Balouch. Email: samirasajid@hotmail.com