Ridge plates versus transbuccal plates in the management of mandibular angle fractures; a prospective randomised trial

Abstract

Aim: To assess whether there is a difference between the postoperative infection rate, occlusion and anatomical reduction of fractures of the angle of the mandible treated by an osteosynthesis plate positioned on the external oblique ridge via an intraoral approach or on the lateral aspect of the mandible via a transbucaal approach. Study design: A prospective randomised trial. Ethics committee approval was obtained and 350 consecutive patients, who provided consent, were entered into the trial over a period of 2½ years. Statistical analysis was performed using Fisher's Exact Test and Pearson Chi-Square Test. Results: Infection resulted in plate removal in 13% of patients. Fractured angles of the mandible treated via a transbuccal approach experienced significantly less infection ( P < 0.000). Smoking is related to increased risk of postoperative infection ( P < 0.00). Analysis was also made of oral hygiene, degree of fracture displacement, delay between incident and operative procedure, method of fracture reduction, alcohol consumption and postoperative occlusion. Conclusion: Fractures of the angle of the mandible should managed with an osteosynthesis plate placed on the lateral aspect of the mandible via a transbuccal approach.