Management Of Mandibular Angle Fractures Research Articles

Evaluation of osteosynthesis of miniplate versus lag screw in management of mandibular angle fracture - A comparative study

The aim of the study was to compare lag screw and standard (Champy’s) miniplate fixation in the management of mandibular angle fractures and to analyze advantages and disadvantages of one over the other. A total of 30 patients involving mandibular angle fracture reporting to the Department of Oral, Maxillofacial and Reconstructive Surgery, Bapuji Dental College and Hospital, Davangere, were included in the study. Patients were divided into two groups randomly. The procedure was carried out under general anesthesia. Following strict aseptic precautions, an appropriate intraoral/extra-oral incision was selected; fracture site identified, reduced, and after obtaining satisfactory occlusion, temporary maxillo-mandibular fixation was placed using either Erich’s arch bar or Ivy loop eyelet wiring. Fixation was done using either standard miniplate (Group 1) or lag screw (Group 2). The patients were followed up for a period of 2 months at the interval of 1 week, 2 weeks, 4 weeks, and 8 weeks by a blinded experienced oral surgeon for infection, segmental mobility, postoperative occlusion and radiological evaluation of reduction and fixation. Duration of fixation was found to be less in lag screw group than in miniplate group. Radiological evaluation of reduction and fixation was significant in both the groups. No significant difference was found between both the groups in clinical parameters such as infection, segmental mobility and postoperative occlusion. The clinical outcomes of both the lag screw system and standard miniplate systems in the present study were similar. However, the following advantages with the use of lag screw can be highlighted: Relatively lesser fixation time, Superior fracture fragment stability, fewer complications, Stable occlusion & less hardware, less cost required.

Comparison of Conventional Versus Right Angled Fixation Technique in Management of Mandibular Angle Fractures – A Prospective Randomized Clinical Study

The treatment of mandibular angle fractures ranges from observation to closed reduction with maxillomandibular fixation to open reduction and internal fixation. The study aims to compare the effectiveness of three different techniques (transoral, transbuccal, and right-angled fixation technique) for single adaptational monocortical upper border plating in mandibular angle fracture. The study conducted at our center was a prospective randomized study. The study duration was from November 2019 to August 2021. The three groups included in our study were transoral, transbuccal, and transoral approach using the right-angled drill. Patients who required open reduction and internal fixation of mandibular angle fracture were included in the study. Computer-generated randomization method was used to assign the participants among the 3 groups, ie, transoral, transbuccal, or right-angled fixation technique. The primary outcome clinical variables were mouth opening (MO), occlusion stability, scar or laceration, facial nerve weakness, infection, and the radiological variables were gap between the fracture segments and displacement of the fracture segment. The secondary outcome of our study is a comparison of the perioperative complications including plate exposure during the entire fracture healing period. The covariates of the study were age, sex, etiology, and tooth in line of fracture. Statistical analysis was done using ANOVA, post hoc Tukey test, and Pearson χ2 test. A P value less than 0.05 was considered statistically significant. A total of 48 patients were included in our study. According to randomization, each group was allotted 16 patients. In the study, 66.7% of the study population were male and 33.3% were female; 75% of the study population were victims of road traffic accidents, and 25% were injured due to assault. The mean and standard deviation for MO at 1month were 31.3±2.9 for the transoral group, 35.8±1.7 for the transbuccal group, and 35.5±1.3 for the right-angled fixation group. On intergroup comparison, statistically significant results were seen at the 1-month postoperative MO clinical parameter. The P value here was 0.02 which was statistically significant. The comparison of the right-angled fixation technique to transoral and transbuccal fixation methods have not been documented. Our study is the first of its kind to compare the right-angled fixation technique to various other approaches. Our study showed that the MO was better postoperatively with the transbuccal approach. The other variables showed no difference among the three techniques.

Evaluation of mandibular angle fractures in patients with maxillofacial injuries, in and around Indore- A retrospective and prospective study

: Mandibular angle fracture is a common type of maxillofacial injury that can lead to significant morbidity if not managed properly. The management of mandibular angle fracture depends on various factors such as the severity of the injury, associated injuries, patient's age and overall health, and availability of resources. The purpose of this study is to evaluate the incidence, etiology, management, and outcomes of mandibular angle fracture in patients with maxillofacial injuries in and around Indore, using a combined retrospective and prospective approach.: A combined retrospective and prospective study was conducted at a tertiary care hospital in and around Indore. Data were collected on patient demographics, injury characteristics, diagnostic evaluation, treatment, and outcomes. A total of 1510 patients with maxillofacial injuries were included in the study, out of which 114 patients had mandibular angle fractures. The incidence of mandibular angle fracture in our study population was 19%. The majority of the patients with mandibular angle fracture were males (80.9%) and in the age group of 21-40 years (56.1%). The most common cause of mandibular angle fracture was road traffic accidents (77.7%), followed by assault (17.7%). The most common associated injuries were fractures of para symphysis (63.6%) followed by fractures of the condyle (25.3%). The follow-up of patients with mandibular angle fracturs showed a good clinical outcome in the majority of cases. Mandibular angle fracture is a common type of maxillofacial injury in our study population, with road traffic accidents being the most common cause. Early diagnosis and appropriate management of mandibular angle fractures can prevent long-term complications and improve patient outcomes.

Postoperative Complications after Surgical Management of Mandibular Angle Fracture

Introductions: Mandibular angle fractures represent a high percentage and an important clinical challenge because of their treatment pattern and the highest postsurgical complication rate among all mandibular fractures. Materials and methods: The objectives of this cross-sectional observational study were to observe the postoperative complications after surgical management of a mandibular angle fracture and to facilitate early detection of complications and reduction of patients’ morbidity. This study was carried out among forty patients with mandibular angle fractures who were managed by open reduction and internal fixation by miniplate osteosynthesis. All the study patients were evaluated clinically pre- and postoperatively for various parameters at the 1st week, 2nd week, 1st month, and 4th month. Radiographs (OPG, PA skull, lateral skull, and CT scan of the oral and maxillofacial region) were taken pre- and postoperatively to assess complications. The infection was detected by culture and a sensitivity test. Nerve injury was evaluated by the “tactile test”, the brush directional stroke test by using a ’00’ camel hair brush, and the pinprick test performed by using a sterile 27-gauge syringe needle. Occlusion and chewing were evaluated postoperatively according to the Treatment Scoring System developed by V. Uglesic in 1993. The data was analyzed using the SPSS version 20 statistical software. Results: In this study, most of the patients (85%) were male and the mean age was 24.5 years. In the fracture line third molar was present in 55% cases. The most common complication of this study shows postoperative nerve injury 30% cases. Infection in 10% cases, malocclusion in 7.5% cases. Slight restricted mouth opening in 5% cases. Other complications such as malunion,, delayed union, and non-union were absent. Conclusion: The most common complication after surgery is nerve injury along with infection and malocclusion. A careful preoperative assessment, early surgical intervention, meticulous surgical technique, postoperative care and appropriate rehabilitation are the main concern to prevent neurological and other complications. Update Dent. Coll. j: 2023; 13(1): 9-13

Transoral versus Extraoral Approach in the Management of Mandibular Angle Fracture: A Retrospective Study

Introduction: Mandibular fractures are the most common of all maxillofacial fractures and almost one third of these have mandibular angle fractures. Restoration of anatomic form and the union of bone fragments is of utmost important during the management of mandibular angle fractures and several methods have been discussed in the literature. Aim: To compare the transoral and extraoral approaches for the management of mandibular angle fractures in terms of postoperative outcomes including the incidence of postoperative pain, infection, scarring mouth opening and facial nerve injury. Materials and Methods: This retrospective study was performed in the Department of Plastic Surgery, Father Muller Medical College and Hopsital, Mangalore, Karnataka, India, from January 2019 to December 2021. A total of 21 patients were divided into two groups; transoral (n=12) and extraoral (n=9), based on the type of approach used for surgery. The outcomes were assessed in both groups in terms of postoperative outcomes including the incidence of postoperative pain, infection, scarring, mouth opening and facial nerve injury. Data were statistically analysed using appropriate statistical tests. Results: Out of the 21 patients studied, one patient in the extraoral group developed postoperative surgical site infection. There was a statistically significant difference in duration of surgery and postoperative mouth opening (p-value=0.006) and a highly significant difference in postoperative pain (p-value<0.001) and scar (p-value<0.001) between the two methods, proving transoral approach as effective method. Conclusion: The transoral approach is a better approach for fixation and management of mandibular angle fractures, as compared to the extraoral approach.

Three-dimensional customized titanium plate versus conventional titanium miniplate for management of mandibular angle fractures

Background Surgical treatment of mandibular angle fractures using an internal fixation has changed in the last decades to achieve the required rigidity, stability, and immediate restoration of function. Purpose The aim of the study was to evaluate both clinically and radiologically the efficacy of three-dimensional customized titanium plate versus conventional titanium miniplate in the management of mandibular angle fractures. Patients and methods Sixteen adult patients with unilateral mandibular angle fracture indicated for reduction and internal fixation were selected from the Outpatient Clinic, Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Tanta University. Patients were divided into two equal groups according to the type of plating system used in fracture fixation, for group I mandibular angle fractures were fixed with 3-D customized titanium plate while for group II mandibular angle fractures were fixed with single conventional titanium miniplate. Postoperative clinical and radiographic evaluations were performed immediately, one week, two weeks, one month, three months and six months. The postoperative clinical evaluation included presence or absence of infection, position and stability of the mandibular lower border, state of occlusion, maximal mouth opening, sensory nerve function, condition of teeth related to the fracture line and patient's tolerance to the plate. The postoperative radiographic examinations evaluated the accuracy of reduction and bony union by measuring the inter-fragmentary gap and the intergonial distance. Results Uneventful wound healing was obtained in all cases of both groups except case no 4 of group II in which dehiscence and mild infection was happened. Satisfactory occlusion was obtained in all cases of both groups except case no 7 of group II where it had mild occlusal derangement. Other parameters including clinical stability, maximal mouth opening, sensory nerve function, and plate tolerance were comparable in both groups. There were no significant differences between group I and group II regarding inter-fragmentary gap and intergonial distance regarding postoperative radiographs. Conclusion The use of three-dimensional customized titanium plate and conventional titanium miniplate fixation systems provided enough stability for proper bone healing, establishment of optimal occlusion, and early return to normal function.

New design titanium miniplate versus conventional miniplate in treatment of mandibular angle fractures: A comparative study.

Mandibular angle fracture (MAF) is the second most common site of all fractures of the mandible with the highest complication rate. Management of MAF has evolved in the past four decades. The purpose of the prospective study was to compare the efficacy of new design titanium miniplate (NDM) with conventional titanium miniplate (CTM) in the treatment of MAF. Mouth opening, occlusion, bite force measurement, and radiographs compared preoperatively and first week, first month and third month postoperatively. Fourteen patients diagnosed with MAF were randomly divided into two groups: Group A (seven patients) was treated with NDM and Group B (seven patients) with CTM. Patients were assessed preoperatively and postoperatively at an interval of one week, one month and three months. Repeated measures ANOVA and Post hoc Tukey test showed a significant increase in bite force and mouth opening for both groups in first and third postoperative months. Unpaired t-test showed slightly better mouth opening in Group B and slightly higher bite force in Group A. Both miniplates fulfilled all the study objectives and equally satisfactory healing was seen at the end of third month. NDM offers better stability, rigidity, and anatomic reduction of the fracture with a drawback of difficulty in adaptation and increased operative timing compared to CTM. Hence, we would like to conclude that both miniplates are equally efficient in the treatment of non-comminuted angle fractures with the NDM having upper hand in stability.

Comparison of the Intra and Postoperative Outcomes between 3-D Plates versus 2.0 mm Miniplates in Displaced Mandibular Angle Fractures

Aim: This study aimed to compare intraoperative and postoperative outcomes by using Conventional 2mm Miniplate versus 3-D plates in management of Mandibular Angle Fractures.
 Study Design: Randomized control trial.
 Place and Duration of Study: Department of Oral & Maxillofacial Surgery (OMFS), Liaquat University Hospital, Hyderabad over 6 months.
 Methodology: The study included a total of 60 patients having mandibular angle fractures randomly allocated into two groups. 30 of them were treated with 2mm conventional miniplates in group A and 30 cases were 3D plated in group B. Outcomes such as intraoperative time was measured in terms of minutes from the start of surgery till fixation using a stopwatch. Stability was assessed clinically and by postoperative radiographs. Mean and standard deviation was calculated for age duration of fracture and intraoperative time. Whereas frequency and percentage
 were calculated for gender, occupation, type of displacement. A comparison of the said parameters was also done, subsequently. The collected data were analyzed by SPSS version 22.0.
 Results: The average age of the patients was 29.50±6.24 years. There were 38(63.3%) male and 22(36.7%) female. Mean intraoperative time in terms of minutes was significantly low in group B than in group A [45.27±7.09 vs. 50.50±7.12; p=0.006]. The rate of stability was 100% in group B and 90% in group A, however, it was not statistically significant between groups (p=0.237).
 Conclusion: The results of the current study showed good stability, less procedure time required with a 3-D plating system. It could be concluded by the findings that the 3-D plating system has advantages over conventional 2mm miniplates.

A Comparison of Post-Operative Occlusion with 3-D vs. 2-D Miniplate Fixation in the Management of Isolated Mandibular Angle Fractures

Mandibular angle fractures (MAFs) are treated in a variety of ways; however, the standard therapy is still up for debate. Despite the fact that many studies have generated evidence for the appropriate biomechanical stability of 3-D miniplates, there is an insufficient amount of data on the treatment of mandibular angle fractures with these plates. A comparative study was conducted at The Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients were randomly divided into two groups of 52 patients each. Patients in group A were treated with 3-D miniplate placement on the lateral cortex following the principle of 3-D fixation proposed by Farmand and Dupoirieux, whereas patients included in group B were treated using 2-D conventional miniplate, placed according to Champy’s line of ideal osteosynthesis. A single surgical team performed the procedure. On the first and seventh post-operative days, the first month, and then the third month after surgery, regular evaluations were conducted. Assessment regarding Post Open Reduction and Internal Fixation (ORIF) occlusion was performed with the help of measuring tools. On the first day post-operative follow-up, 41 (78.8%) patients in group A and 31 (59.6%) patients in group B had satisfactory occlusion. The seventh day post-operative follow-up showed that 43 (82.7%) patients in group A and 41 (78.8%) patients in group B had satisfactory occlusion (p > 0.05). In both treatment groups, the first and third month follow-up evaluations revealed optimal occlusion. In comparison to conventional 2-D miniplate, the 3-D miniplate system produced better results and can be recommended as a better option for the management of mandibular angle fractures.

Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review.

Systematic review. There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation. PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II). Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (P = .043). For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.

Biomechanical evaluation of magnesium plates for management of mandibular angle fracture

The aim of this study was to evaluate the efficacy of magnesium plates for the management of fractures of the mandibular angle. Fresh sheep hemimandibles were divided into 7 groups and a biomechanical cantilever bending test was used for the groups: Group 1 included fractured hemimandibles fixed at the angle with a single 1mm magnesium miniplate; Group 2 had fixation with a 1mm double magnesium miniplate; Group 3 used a 2mm thick single magnesium miniplate; Group 4 used double 2mm magnesium plates; Group 5 each had a single 1mm thick titanium plate; Group 6 used 1mm thick double titanium plates; and Group 7 comprised intact hemimandibles. Each group was tested using universal testing machine yield loads; yield displacements and stiffness were compared using one way analysis of variance (ANOVA) Group 1 (1mm single magnesium plate) and Group 2 (1mm double magnesium plates) showed lower stability than other groups, while the 2mm magnesium plate showed stability similar to the corresponding 1mm titanium plate. Pure magnesium has good mechanical properties and when it is designed properly it can be used for the management of mandibular fracture.

Management of mandibular angle fractures through single and two mini-plate fixation systems: Retrospective study of 112 cases

IntroductionThe aim of this paper is to compare the clinical results between the different methods of fixation of standard mini-plates for the management of mandibular angle fractures. Study designThis was a retrospective analysis study of 196 patients with mandibular angle fractures divided into 3 groups at our hospital 20 august 1953 specialist hospital, which is a referral center between January 2015 and January 2020. The patients were assessed for malocclusion, infection, wound dehiscence, neuro-sensory deficit, mouth opening, stability, operating time, blood loss, and hardware failure. Group (I) comprised 72 men and 40 women with a mean age of 43 years. Group (II) comprised 36 men and 12 women with a mean age of 47 years. Group (II) comprised 29 men and 7 women with a mean age of 33 years. The assessment of surgical outcomes after the last follow-up visit clearly showed a lack of stability in patients group II compared to the other groups. The operating time was reduced in group I compared to Group II/ III. (P = 0.03) The wound dehiscence occurred mostly in Group III unless it was statistically no significant. The infection events occurred in 36 patients of the sample, which was not statistically significant (Table 4). DiscussionFractures of the mandibular angle represent 23–42% of all mandibular fractures, in our context road accidents followed by aggression are the most frequent mechanisms found. A various types of treatment approaches for the treatment of angular fractures have been described. Our analysis revealed that surgical time and complication rate has been reduced when using the Group I technique compared to the other groups. ConclusionThe use of the monocortical external oblique miniplate provides the best results. Successful treatment of mandibular fractures depends on stability in the ideal anatomical position since abnormal mobility at the fracture site will lead to non-union, malocclusion, and infection.

Management of Mandibular Angle Fractures Using Single Y-Shaped Titanium Miniplate at the Superior Border: A Prospective Clinical Study.

Treatment of angle fractures remains controversial. The various techniques documented for the treatment are: wire osteosynthesis, one miniplate at superior border (2.0mm), a single plate on inferior border (2.3 or 2.7mm) along with tension band in the form of arch bar at the upper border, 2 miniplates (1 at superior border and 1 at inferior border), 3-D strut plates or lag screw. To evaluate the efficacy of single Y-shaped titanium miniplate at the superior border in the management of mandibular angle fractures. Total of 15 healthy adult patients reporting to the department of Oral and Maxillofacial Surgery for the treatment of mandibular angle fractures was randomly selected. All the cases were assessed clinically at 1st post-operative day, 1st, 3rd, 6th and 12th week post-operatively for pain, status of occlusion, neurosensory deficit and postoperative hard & soft tissue healing. Radiographic assessment was also done at 1st postoperative day, 6weeks and 12weeks. Postoperative pain, infection, wound dehiscence, neurosensory deficit were not evident during the follow- up periods. Radiographically, the fracture reduction was good and plate fracture was not seen in any case. Y- shaped titanium miniplate is an effective method in the management of the mandibular angle fractures and provided satisfactory results.

A Comparative Evaluation of Transbuccal versus Transoral Approach for the Management of Mandibular Angle Fractures: A Prospective, Clinical, and Radiographic Study.

Introduction:In the facial bones, the angle of the mandible is the common site of fractures. Furthermore, it is the site with the highest number of complications after fracture and hence needs an efficient fixation. The right approach is still debatable for the angle fractures. In the light of these factors, we evaluated the transoral and the transbuccal approaches for the treatment of fractures at the angle of the mandible.Materials and Methods:Twenty patients were equally divided into two groups of transoral and transbuccal methods. The parameters such as ease of access, surgical time, occlusion, postsurgical infection, fracture gaps, scarring, and complications were noted, and the values that were compared were statistically analyzed. P < 0.05 was considered statistically significant.Results:No significant variations were seen in the variables such as ease of access, occlusion, postsurgical infection, and fracture gaps. Surgical time was significantly less for the transoral method. Negligible scarring was noted in the transbuccal method.Conclusion:Although both the methods were comparable, the transbuccal approach was more efficient for the mandibular angular fracture treatment.

Clinical applicability of three-dimensional plates in mandibular angle fractures - A review

Fractures involving the angle of the mandible has been a long-term controversy next only to the condylar fractures. Several methods and hardware configurations exist in literature with its attendant advantages and disadvantages. A study was conducted to provide a comprehensive review of existing literature regarding the utility of three-dimensional plates (3DPs) in the management of mandibular angle fractures (MAFs). Electronic database was searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines without date and language restrictions. The inclusion criteria were human studies in the form of randomized control trials, non-randomized trials and comparative studies, retrospective studies, prospective studies, and observational studies with at least one of the treatment arms including management of MAF using 3DP. Case reports/case series, technical notes, letters to the editor, studies which do not report the results of MAF management with 3DP separate from other fractures of the mandible, and laboratory/model/computer simulation-based/ animal studies were excluded. The relevant data of the selected articles were tabulated and compiled for review. Twenty-seven articles were included in the review among which 3 were systematic reviews, 12 were found to be observational studies in a prospective or retrospective manner without controls, and 12 were comparative studies with a control group. Based on the review, it can be concluded that 3DP in MAF can be used as an effective alternative to standard miniplates with comparable clinical utility if not superior but with a definite inclination toward less complications.

The Efficacy of Fixation of Unilateral Mandibular Angle Fracture with Single 3D Plate vs Single Miniplate Using Transbuccal Approach.

The management of mandibular angle fractures is often challenging and results in the highest rate of complications. The optimal treatment modality still remains controversial. This study was done to compare the treatment outcomes of single 3D plate versus single miniplate. The objective was to compare and evaluate the clinical and radiological outcome in patients who underwent treatment with single 3D plate versus single miniplate using transbuccal approach for unilateral angle fractures with other associated mandibular fractures. A randomized control study was done in 12 patients with unilateral angle fracture who were divided into two groups. Group A patients were treated using single 3D plates, and Group B patients were treated using single miniplates. Study parameters were evaluated at different time intervals. The results of the study showed that postoperatively in Group A, fracture reduction, occlusion and mouth opening were comparatively better than Group B. Hardware failure was seen in one patient in Group B. Postoperative morbidities showed no statistical difference. The single 3D plates showed a statistically insignificant advantage over single miniplates, although clinically Group A proved better than Group B with respect to the study parameters. Therefore, we recommend the use of single 3D plates for effective unilateral angle fracture treatment. More studies are required to prove the significant statistical significance.

Outcomes of extra oral versus intraoral approach for Mandibular angle fracture reduction

Abstract&#x0D; Objective: To compare the outcomes of intraoral versus extraoral approach in the treatment of mandibular angle fracture.&#x0D; Method: The randomised controlled trail was conducted at the Department of Maxillofacial Surgery, Mayo Hospital, Lahore Pakistan, from September 2016 to March 2017, and comprised patients of mandibular angle fracture who were divided into two equal extraoral group A and intraoral group B. . Baseline and post-operative data on 1st and 7th days as well as 3 months following the surgery was collected. Data was analysed using SPSS 20.&#x0D; Results: Of the 100 patients, there were 50(50%) in each of the two groups. Mean age of group A was 32.28±7.79 years compared to 33.72±8.13 years in group B. There were 39 (78%) males in group A and 36(72%) in group B. The mean pain score at baseline in the groups was not significantly different (p=0.795). On the 7th day and 3 months post-operation, mean pain score was significantly lower in group A (p=0.002). Nerve complication in group A was significantly high compared to group A (p=0.005).&#x0D; Conclusion: Extra oral approach for the management of mandibular angle fracture is better with regards to pain while intra-oral approach is less associated with nerve complications.&#x0D; Key Words: Angle of mandible, Fracture, Intraoral approach, Extraoral approach, Incision.

Surgical Management of Mandibular Angle Fractures: Does the Extraction of the Third Molar Lead to a Change in the Fixation Pattern? A European Multicenter Survey

The authors conducted a retrospective, multicenter study to investigate the differences in the fixation patterns, in terms of number and thickness of plates, between patients in whom a third molar (3M) was maintained or removed in the line of mandibular angle fractures. The study was conducted in 6 European level I and II maxillofacial trauma centers. Data were collected on patients ≥ 16years of age who underwent open reduction internal fixation (ORIF) for mandibular angle fractures (MAF) from 2008 to 2018, in whom a 3M in the fracture line was present and who had a follow-up duration of 6months. The study population was divided into 2 groups: patients treated with ORIF in whom the 3M was maintained (group 1) and those treated with ORIF in whom the 3M was extracted (group 2) during treatment. The 2 groups were compared for differences in the internal fixation pattern, specifically in terms of the number and thickness of the plates. A total of 749 patients with 774 MAF were collected. A total of 1,050 plates were placed: 849 were ≤ 1.4mm thick (80.9%) and 201 plates≥1.5mm thick (19.1%). 548 patients were treated with ORIF and 3M maintained (group 1), and 201 treated with ORIF and 3M extracted (group 2). Statistically significant differences were seen in the number of ≤1.4mm plates between the 2 groups for single undisplaced/displaced MAF(P value≤0.5) and for undisplaced/displaced angle+parasymphysis/body fractures (P-value≤0.5). Analyses of data collected from 6 European maxillofacial centers indicated that the majority of surgeons of our sample perceived the MAF as being more unstable when removing the 3M during ORIF leading them to perform a rigid fixation in the angular region.

Transbuccal Approach in Management of Mandible Angle Fracture.

With expanding dimensions and an eminent member of trauma team many Ear Nose Throat specialists are exposed to Oro-maxillofacial trauma. Mandibular angle is a difficult region to operate owing to its unique anatomy. Anglefractures form around 30-40% of the mandibular fracture. Open reduction and internal plating is the management of choice in most angle fractures and various approaches have been described in literature. We conducted a study of trans-buccal approach for management of mandibular angle fractures. It was a non-randomised observational study. 57 patients of mandible angle fractures were included in the study. The ORIF was done in these pts under general anaesthesia after careful surgical planning using trans-buccal approach. This approach included an intraoral exposure with stab incision for the trans-buccal passage of drill and screw diver. Out of 57 cases in our study 33 were males and 24 were females. 23/57 patients were in age group 25-35years whereas 19/57 patients were in age group 15-25years All 57 patients had good fracture healing. Occlusion dysfunction was seen in only 1 case. Infection was seen 3 cases while intraoral exposure of plates occurred in 2 cases. Average mouth opening was 43.3mm at 6weeks with progressive improvement on follow up. Extraoral scar healed well with very good cosmesis in all cases. We strongly suggest the use of transbuccal approach for ORIF in mandibular angle fractures owing to the ease of procedure, comfort of surgeon and less complication rate.

A modification of ward's incision for management of mandibular angle fracture

It is a well-known fact that mandibular angle fracture is one of the most frequently encountered fractures in the facial skeleton. Lot of emphasis is given to the kind of fixation devices as well as number of fixation devices used in the management of these fractures. However, it is noteworthy that some of the distinguished complications are associated with the flap design and soft-tissue handling. This short communication highlights the fact that the Ward's incision without the distal release is a very valuable surgical approach in the management of these fractures.