Biplanar plating of mandibular fractures: a new concept with in vitro testing and comparison with the traditional plate-and-screw technique.

Abstract

To introduce the concept of biplanar plating of mandibular fractures and to present an in vitro comparison of this method with traditional use of a single mandibular plate. A device for the delivery of repetitive simulated masticatory stress to mandibular models was developed. Using the device, we compared biplanar with single-plate fixation of vertical mandibular body fractures by determining cycles to failure. Tertiary care academic medical center. A simulated masticatory force was delivered vertically to the anterior end of polymer hemimandibles as used for in vitro teaching of plating methods. Mobility at the fracture site was tested at intervals corresponding to 6000 chewing cycles each. Of 5 specimens plated with a mandibular fixation plate, 4 developed greater than 0.010 cm of vertical mobility at the fracture site after 12 000 cycles. Only 1 of the 5 specimens fixed with biplanar plating developed this degree of mobility. Single-plate fixation of mandibular fractures is greatly enhanced by a miniplate spanning the fracture along the inferior border. We used this technique on 15 patients with unfavorable fractures and found it simple, secure, and reliable. We had no complications. An inferior marginal plate serves the same function as a tension band, and can be placed on mandibles through the same incision as the main fixation plate without additional dissection. We prefer this to a traditional tension band when the percutaneous route of access to a mandibular fracture site is used.