What Method for Management of Unilateral Mandibular Angle Fractures Has the Lowest Rate of Postoperative Complications? A Systematic Review and Meta-Analysis

Abstract

The aim of the present study was to determine which method for internal fixation through a transoral approach has the lowest complication rate for patients with mandibular angle fractures (MAFs). To address our study purpose, we designed and implemented a systematic review with meta-analysis. To identify the studies to include in the review, a comprehensive electronic search without date or language restrictions was performed in April 2014. The inclusion criteria were studies of humans, including randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing fixation techniques (1 vs 2 miniplates, external oblique ridge vs lateral border miniplate placement, and geometric vs conventional miniplate) in the management of MAFs. The incidence of postoperative complications was analyzed. Only those studies in which a transoral approach had been used (with or without transbuccal instrumentation) were selected. A total of 20 publications were included: 9 RCTs, 3 CCTs, and 8 retrospective studies. Eight studies had a low risk of bias, 11 studies a moderate risk of bias, and 1 a high risk of bias. A statistically significant difference was found between a single superior border miniplate and the use of 2 miniplates. The cumulative odds ratio (OR) was 0.63, indicating that the use of 1 miniplate in MAF fixation decreased the risk of postoperative complications by 37% compared with using 2 miniplates. Comparing a miniplate placed on the external oblique ridge to one placed on the lateral surface of the mandible resulted in a cumulative OR of 2.10, indicating that the use of the transbuccal miniplate decreased the risk of postoperative complications by 110% compared with a miniplate placed on the external oblique ridge. Comparing geometric and standard miniplates, the OR was 0.29, indicating that the use of a geometric miniplate decreased the risk of postoperative complications by 71% compared with using conventional miniplates. The results of the meta-analysis have shown that the use of 1 miniplate is superior to using 2 in reducing the incidence of postoperative complications in the management of MAFs. In addition, our results showed that the transbuccally placed lateral miniplate was better at reducing the incidence of postoperative complications than one placed on the external oblique ridge using a transoral approach. Finally, geometric miniplates performed better than conventional miniplates in reducing postoperative complications.