Internal Fixation of Mandibular Angle Fractures: A Comparison of 2 Techniques

Abstract

To compare treatment outcomes between rigid extraoral fixation and semirigid intraoral fixation for the management of isolated mandibular angle fractures, and to develop a protocol for successfully managing these fractures in an indigent population. This study involved a retrospective analysis of mandibular angle fracture patients treated at Boston Medical Center from 1999 to 2006. All patients were treated by a single attending surgeon, with oral and maxillofacial surgery residents. Data were collected by a review of pertinent inpatient and outpatient clinic records, and radiographic and laboratory results. The criteria for inclusion into the study comprised: 1) patients with isolated unilateral or bilateral mandibular angle fractures; 2) surgical treatment provided within 7 days of injury via 1 of the 2 following techniques: a) open reduction and internal fixation via an intraoral approach (single monocortical miniplate), or b) open reduction and internal fixation (ORIF) via an extraoral approach (inferior border plate with at least 2 holes on either side of the fracture line and bicortical screws); 3) the presence of decayed, partially bony, or full bony impacted third molars requiring removal at time of surgery; 4) the use of postsurgical maxillomandibular fixation (MMF) for 1 week (extraoral rigid-fixation cases) and 2 weeks (intraoral semirigid-fixation cases) and 5) a 1-week duration of postsurgical oral antibiotic therapy. The patient sample ranged in age from 17 to 55 years, with an average age of 24.8 years. The average follow-up was 12.3 weeks (range, 8 to 64 weeks). In total, 98 fractures were treated with intraoral miniplate fixation, whereas 65 fractures underwent rigid fixation using an extraoral approach. The presence or absence of bone gaps in radiographs immediately after surgery had no correlation with surgical success. None of the patients in either group required further surgical intervention in the operating room. Patients with postsurgical infections were successfully managed with localized intraoral incision and drainage, and oral antibiotic therapy. Isolated mandibular angle fractures can be effectively treated in an indigent population with either intraoral monocortical fixation or extraoral bicortical fixation techniques. Use of a standard protocol involving early surgical management with limited periosteal reflection, concomitant removal of third molars, and short-term maxillomandibular fixation ensures predictable success with a low incidence of complications.