Versatility of various 3D non locking miniplates in treatment of mandibular fractures

Abstract

Context: The optimal management of mandibular fractures continues to evolve. Fractures of mandible predispose the patients to structural, functional and aesthetic compromise if not treated. The current understanding of the biomechanics and fracture healing of the mandible has influenced the modern approach to the open reduction and internal fixation of these fractures. These help us to evaluate shortcomings of compression plates and 2D miniplates leading to development of 3D plates. Aims: To evaluate the versatility and efficacy and complication of 3 different varieties of 3D non locking plates–2x2 and 2x3 and delta plates in the treatment of mandibular fractures at different sites.Materials and Methods: A total of 86 patients of mandibular fractures were managed by open reduction and internal fixation utilizing total 114 three dimensional plates (109 non locking 3D plates (2X2,3X2) and 5 delta plates) were used for fractures of the mandible including symphysis, parasymphysis, body, angle, ramus and condyle over a period of 3 years.Results: The use of 3D plates provided semi-rigid fixation of fractured fragments with no immediate post-operative mobility. Immediate and subsequent postoperative clinical and radiographic evaluation was carried out at 15 days, 1 month, 3 months and 6 months. Post-operative complications observed were post-operative neurosensory deficit in 3 patients, occlusal discrepancy in 3 patients, wound dehiscence in 2 patient, plate exposure in 1 patient and parotid fistula in 1 patient which accounted for 8.6% of total patients. None of the patient suffered from Infection, segmental mobility, paraesthesia. Malunion, non-union. All these were treated successfully with definitive measures.Conclusion: The 3D mini-plate system is a versatile and efficient method for fixation of mandibular fractures. Delta plates are efficient method for reduction and fixation of subcondylar fracture. The only contraindication for 3D plates is their use in mental foramen region (where distance between mental foramen and inferior border is less than 1.5cm).