Abstract: A Microplate Fixation for Treatment of Comminuted Mandibular Fractures

Abstract

INTRODUCTION: Strong rigid fixation with miniplates and large plates has been widely used in comminuted mandibular fractures. However, normal bite forces are not generated for months after mandibular fracture1. Therefore, absolute rigidity of the bone segments is not necessary during the bone healing period2, 3. The purpose of this article is to evaluate availability of microplate fixation for comminuted mandibular fractures. METHODS: Fourteen patients with comminuted mandibular fractures were treated by microplate fixation. Accurate reduction of the all bony segments and multiple fixation were performed at each fracture site with 1.2(1.0)-mm microplates with or without wire. At the lower border, no fracture gap of the inner and outer cortices along the inferior margin was confirmed after fixation. At the upper border, interdental wiring was applied to approximate the fracture edges of the inner and outer cortex as external fixation. In edentulous cases, microplate fixation was done at the upper margin. At the middle of the outer cortex, multiple microplate fixation was done at the outer cortex, pushing on the mandibular angles to tightly approximate the fracture edges of the inner cortex. When premature occlusal contact was observed by a thin-paper bite test after fixation, intermaxillary fixation was applied and maintained for 1 week postoperatively, and followed by active mouth opening exercise. The patients without IMF were allowed immediate mouth opening and provided a liquid diet for the first three or four days after the operation. All patients took a soft diet for the 6 weeks after the operation. RESULTS: Comminuted mandibular fractures were located in the symphysis (6), the symphysis and the body (2), the body (4), the angle (1) and the symphysis, the body, the ramus and the subcondyle (1). During the follow-up period from 3 to 16 months, all fractures showed excellent bone healing without major complications requiring further treatment. Minor malocclusion with good functional occlusion was observed in two patients, who required no additional treatment. CONCLUSION: We could achieve complete bone healing and premorbid occlusion using microplates. The microplates are strong enough to keep comminuted mandibular fractures reduced. Their small size and malleability allow multiple fixation of comminuted bony segments in accurate-anatomical position, less periosteal stripping and self-occlusal adjustment. Therefore, microplate fixation may be one of good options for reconstruction of comminuted mandibular fractures. Reference Citations: 1. Gerlach KL, Schwarz A. Bite forces in patients after treatment of mandibular angle fractures with miniplate osteosynthesis according to Champy. Int J Oral Maxillofac Surg. 2002;31:345-348 2. Ellis 3rd E. Treatment methods for fractures of the mandibular angle. Int J Oral Maxillofac Surg. 1999;28(4):243–252. 3. Ellis 3rd E. Selection of internal fixation devices in mandibular fractures: How much fixation is enough? Semin Plast Surg. 2002;16(3):229–241.