C-arm Guided Minimally Invasive Percutaneous Fixation Technique of Mandibular Angle and Ramus Fractures - a Prospective Clinical Study at a Tertiary Care Center of Odisha, India.

Sourav Kumar Rout,Subrat Kumar Jena

doi:10.46405/ejms.v2i2.53

Abstract

Background: Rigid internal fixation of displaced mandibular angle and ramus fractures often poses a unique challenge to oral and maxillofacial surgeons. Various methods have been published to provide a safe and secure gateway for these circumstances. Intra-oral approach supplemented by a limited percutaneous method of fixation offers a distinct advantage of rigid fixation, reducing the known morbidity of using the sole internal as well as external techniques. The objective was to describe a minimally invasive technique for the mandibular angle and ramus fractures using the combined intraoral and extra-oral approach.Methods: This study was conducted on ten patients with mandibular angle or ramus fractures. All patients underwent open reduction and internal fixation. The intra-oral incision was used for visualization and reduction of fractures, and supplemental percutaneous stab incision was utilized to create a path for insertion of the handheld battery-operated microdrill shaft and screwdriver to permit screws fixation perpendicular to the plates.Results: This combined technique depicted minimal or no soft tissue infections, wound dehiscence, occlusal disturbances, or seventh cranial nerve paralysis. The mean surgical duration was 41.5 minutes. No patient had an visible scar marks, which would require further intervention.Conclusion: The described minimally invasive combined percutaneous and intraoral approach for mandibular angle, and ramus fracture provides a satisfactory alternative which could be safely applied to provide rigid fixation of these fractures with minimal damage to vital structures.

Highlights

Mandibular fractures are one of the most common fractures in the facial skeleton due to its vulnerable location and lack of support.[1]
Treatment of mandibular angle fracture brings a fair share of challenges because of its association with the greater risk of complications such as infection, malunion, malocclusion, and seventh cranial nerve injury ranging from 0% to 14.7% in various studies.[4,5]
This study aims to describe a minimally invasive technique for the mandibular angle and ramus fractures using the combined intraoral and extraoral approach under fluoroscopic guided images

Summary

Introduction

Mandibular fractures are one of the most common fractures in the facial skeleton due to its vulnerable location and lack of support.[1]. A lateral traumatic force on mandible can cause fracture of angle, body, ramus and contralateral condylar.[2] The angle is one of the most common locations of the mandibular fractures from blunt trauma force to the face accounting for 23%to 42% of all mandibular fractures.[3]. Rigid internal fixation of displaced mandibular angle and ramus fractures often poses a unique challenge to oral and maxillofacial surgeons. Intra-oral approach supplemented by a limited percutaneous method of fixation offers a distinct advantage of rigid fixation, reducing the known morbidity of using the sole internal as well as external techniques. The objective was to describe a minimally invasive technique for the mandibular angle and ramus fractures using the combined intraoral and extra-oral approach

Objectives

Methods

Results

Discussion

Conclusion