Management Of Mandibular Fractures Research Articles

Efficacy of locking miniplate in the treatment of mandibular fractures without intermaxillary fixation

Background: The introduction of locking plate/screw miniplate and reconstruction plating systems for the treatment of mandibular fractures and continuity defects has offered advantages over other plating systems. The present study was conducted to assess the efficacy of locking miniplate in the treatment of mandibular fractures without intermaxillary fixation. Materials & Methods: 56 patients with undisplaced or minimally displaced mandibular fractures of both genders were treated by open reduction and internal fixation using the 2.0 mm locking plates. Parameters such as cause of injury, site of fracture, complications etc. was recorded. Results: Out of 56 patients, males were 30 and females were 26. Causes of injury was RTA in 34, sports injury in 10, fall in 8 and miscellaneous in 4 cases. The site was right body in 12, left body in 15, right angle in 10, left angle in 8 and parasymphysis in 11 cases. Common complications was non- union seen in 2, infection in 5 and delayed union in 1 case. Conclusion: The locking miniplate system was found to be effective in management of mandibular fractures.

Evaluation of postoperative complications following management of mandibular fractures with open reduction & internal fixation under regional anaesthesia

Aim: To assess the rate of postoperative complications and its association with respect to aetiology, gender, age, time lapse between injury and commencement of treatment, history of substance abuse, number and location of the fractures in mandibular fracture patients treated with open reduction and internal fixation (ORIF) under regional anaesthesia. Materials and method: All patients fulfilling the selection criteria with mandible fracture reporting to our institution, from March 2017 to August 2021, were included in the study and were divided into three groups based on anatomic site involved. Patient’s records were analysed for deriving complications that occurred during the postoperative period of ORIF andassociation with different variables. The values were subjected to Chi-square tests. Results: Out of 160 study population, patients with combined Para symphysis involving angle (Group C) were reported with the highest number of complications such as minor occlusal discrepancies (20.4%), surgical site infection (4.1%), wound dehiscence and paraesthesia (4.1%) as compared to fractures involving symphysis & para symphysis region (Group A and Group B respectively). Conclusion: The most common postoperative complication in this study was surgical site infection which can be managed effectively with local wound care, antibiotics and can be prevented with aseptic technique.

Comparison of Efficacy and Safety of Hybrid Arch Bar with Erich Arch Bar in the Management of Mandibular Fractures: A Randomized Clinical Trial.

A clinical randomized control trial. To compare the efficacy and safety of Hybrid arch bar (HAB) with Erich arch bar (EAB) in fracture management of the mandible. In this randomized clinical trial, 44 patients were divided into 2 groups:- Group 1, N = 23 (EAB group) and Group 2, N = 21 (HAB group). The primary outcome was time taken for the application of arch bar, while the inner and outer glove puncture, operator prick, oral hygiene, arch bar stability, complications of HAB, and cost comparison were secondary outcomes. The time taken for the application of arch bar in group 2 was significantly shorter than group 1 (55.66 ± 17.869min vs 82.04 ± 12.197min) and the frequency of outer glove puncture was also significantly lesser for group 2 (0 punctures vs 9 punctures). Better oral hygiene was found in group 2. EAB was cost-effective than HAB (Rs 700 ± 239.79 vs Rs 1742.50 ± 257.14). The stability of the arch bar was comparable in both groups. Group 2 had associated complications of root injury in 2 out of 252 screws placed and the screw head got covered by soft tissue in 137 out of 252 screws placed. Thus, HAB was better than EAB with a shorter time of application, less risk of prick injury, and improved oral hygiene.Clinical trial registry name- clinical trials registry- India, URL-http://ctri.nic.in, registration number- CTRI/2020/06/025966.

Etiology, Clinical Presentation, and Outcome of Mandibular Fractures in Immature Dogs Treated with non-Invasive or Minimally Invasive Techniques.

This study was performed to report etiology, clinical presentation, and outcome of mandibular fractures in immature dogs treated with non-invasive or minimally invasive techniques. Immature dogs diagnosed with mandibular fractures from 2001 to 2016 were included in this study. Diagnosis of the mandibular fracture was achieved by oral examination and diagnostic imaging in the anesthetized dog. Twenty-nine immature dogs with 54 mandibular fractures were selected. Within the mandibular body, the regions of the developing permanent canine and first molar teeth were most commonly involved (46.4% and 35.0%, respectively). Within the mandibular ramus, 53.8% of the fractures were located in its ventral half, and 38.5% in the condylar process. Muzzling was applied in 72.4% of the dogs. All dogs had clinical healing with resolution of signs of pain and recovery of mandibular function. Mean time for clinical healing was 21 ± 9 days. Age of the dog and duration of muzzling were significantly associated with the time needed for clinical healing. In immature dogs, fractures of the mandibular body occur most commonly in the regions of the developing permanent canine and first molar teeth, while fractures of the mandibular ramus are most commonly found in its ventral half and the condylar process. Non-invasive or minimally invasive management of mandibular fractures in immature dogs carries a good prognosis regarding clinical healing and recovery of mandibular function. Dogs should be monitored for the development of dental abnormalities and/or skeletal malocclusion until permanent teeth have erupted and jaw growth is completed.

Prevalence and Pattern of Mandibular Fractures: A Retrospective Study in India.

Objective:The main objective of this study is to analyze the prevalence of age, gender distribution, etiology, anatomic distribution, and treatment of mandibular fractures.Materials and Methods:This 2-year retrospective study was carried out in few multispeciality hospitals in India. The results were collected, and descriptive statistics were analyzed using SPSS.Results:Of 180 patients that were analyzed, males and the age group of 20–30 years had a higher prevalence of mandibular fractures with road traffic accidents being the most common etiological factor. Condyle was the most common site affected. Open treatment with rigid and nonrigid fixation was the commonly used method of treatment.Conclusion:Stratification of various epidemiological studies with data obtained over a large study period and sample size must be obtained to understand the plausible factors associated with mandibular fractures for appropriate diagnosis and management of mandibular fractures.

Incidence and management of mandibular fractures in a low-resource health facility in Ghana.

ObjectivesThe mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our study gives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana.Patients and Methods This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries.ResultsA total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the leading cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and industrial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) occurred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation.ConclusionClosed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, especially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.

Management of Isolated Mandibular Body Fractures in Adults

Objective
 The mandible is the most common fractured craniofacial bone of all craniofacial fractures
 in the Philippines, with the mandibular body as the most involved segment of all mandibular
 fractures. To the best of our knowledge, there are no existing guidelines for the diagnosis and
 management of mandibular body fractures in particular. General guidelines include the American
 Academy of Otolaryngology – Head and Neck Surgery Foundation (AAOHNSF) Resident Manual
 of Trauma to the Face, Head, and Neck chapter on Mandibular Trauma, the American Association
 of Oral and Maxillofacial Surgeons (AAOMS) Clinical Practice Guidelines for Oral and Maxillofacial
 Surgery section on the Mandibular Angle, Body, and Ramus, and a 2013 Cochrane Systematic
 Review on interventions for the management of mandibular fractures. On the other hand, a
 very specific Clinical Practice Guideline on the Management of Unilateral Condylar Fracture
 of the Mandible was published by the Ministry of Health Malaysia in 2005. Addressing the
 prevalence of mandibular body fractures, and dearth of specific guidelines for its diagnosis and
 management, this clinical practice guideline focuses on the management of isolated mandibular
 body fractures in adults.
 
 Purpose
 This guideline is meant for all clinicians (otolaryngologists – head and neck surgeons, as
 well as primary care and specialist physicians, nurses and nurse practitioners, midwives and
 community health workers, dentists, and emergency first-responders) who may provide care
 to adults aged 18 years and above that may present with an acute history and physical and/
 or laboratory examination findings that may lead to a diagnosis of isolated mandibular body
 fracture and its subsequent medical and surgical management, including health promotion and
 disease prevention.
 
 It is applicable in any setting (including urban and rural primary-care, community centers,
 treatment units, hospital emergency rooms, operating rooms) in which adults with isolated
 mandibular body fractures would be identified, diagnosed, or managed.
 
 Outcomes are functional resolution of isolated mandibular body fractures; achieving
 premorbid form; avoiding use of context-inappropriate diagnostics and therapeutics; minimizing
 use of ineffective interventions; avoiding co-morbid infections, conditions, complications and
 adverse events; minimizing cost; maximizing health-related quality of life of individuals with
 isolated mandibular body fracture; increasing patient satisfaction; and preventing recurrence in
 patients and occurrence in others.

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.

1616 Antibiotic Use in The Management of Mandibular Fractures: A Survey of Current Practice in the UK

Abstract Aim Traumatic mandibular fractures account for a significant proportion of UK oral and maxillofacial trauma. Prophylactic antibiotics is standard practice for management of these patients, however evidence for this is weak and relevant RCTs are insufficiently powered or poorly designed. The Maxillofacial Trainee Research Collaborative (MTReC) aims to survey current antibiotic regimens in UK OMFS units treating mandibular trauma, Method A multicentre online survey was shared via email and social media. Questions focused on current practices regarding management of mandibular fractures during pre-, peri-, and post-operative phases. Results 89 responses from 50 UK OMFS units including 76 trainees and 4 consultants were collated over 2.5-months. 45 units routinely admitted patients; 88% clinicians starting pre-operative IV antibiotics;11 different pre-operative antibiotic regimens were identified across all surveyed clinicians, with 65% prescribing Augmentin, and remaining 35% using variable combinations of penicillins with 4 other antibiotic classifications. 5 different protocols were identified in use across the 88.8 % of respondents who chose to prescribe post-operative antibiotics. Conclusions There is inter-unit and inter-clinician variability in prophylactic antibiotic prescription in UK patients undergoing ORIF mandibles. Given antimicrobial resistance has been declared a WHO public health threat, efforts must be made to reduce antibiotic overuse and understand regional situation specific sensitivities. The survey highlights need for nationalised protocols for antibiotics use in mandibular fractures, if at all. This survey of clinician reported practice will be used to inform a prospective observational study on 30-day outcomes of ORIF mandibles taking into account patient factors, fracture pattern, fixation type and antibiotic use.

Mandibular Fractures: Diagnosis and Management.

Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.

Is Outpatient Management of Mandibular Fractures Associated with Inflammatory Complications? An ACS NSQIP Study

PurposeThe timing of mandibular fracture repair has long been debated. Prior studies have suggested that expedited treatment with inpatient admission and repair may improve surgical outcomes, though at an increased cost of care. The purpose of this study was to compare the rates of postoperative inflammatory complications (POICs) in patients with isolated mandibular fractures treated non-urgently using an outpatient protocol versus an urgent inpatient protocol. MethodsThe investigators utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to enroll a national-level, multi-institutional sample of patients with isolated mandibular fractures who underwent open repair between 2011 and 2018. The primary predictor variable was treatment protocol: outpatient (elective) and inpatient (urgent/non-elective). The primary outcome variable was POIC (present/absent) within 30 days. POICs included wound infection, wound dehiscence, sepsis, or septic shock, reoperation, readmission, or death. Other reported complications were deemed non-POICs. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between treatment protocol and POICs. ResultsThe study sample was composed of 1848 subjects with 1134 in the outpatient group and 714 in the inpatient group. The frequency of POICs were 6.53% and 8.96% for the outpatient and inpatient groups, respectively, with no significant difference between groups (P = .052). However, subjects treated as inpatients were 1.51 times more likely to experience any complication (P = .008) due to an increase in non-POICs (P = .028), in particular urinary tract infections (P = .035). After adjusting for variables associated with POICs in bivariate analysis, including age, hypertension requiring medical treatment, and smoking, classification as ASA II (P = .046, OR = 2.21, 95% CI 1.01-4.83), classification as ASA III (P = .020, OR = 2.88, 95% CI 1.18 -7.02), diabetes (P = .004, OR = 3.11, 95% CI 1.43-6.74), and preoperative hematocrit (P = .010, OR = .950, 95% CI 0.913-0.988) were independent predictors of POICs in the regression model. Length of stay was 0.83±2.61 days compared to 2.36±3.63 days for the outpatient and inpatient groups, respectively (P ≤ .001). ConclusionThere was no significant difference in POICs between patients treated as outpatients versus inpatients, though outpatients had fewer non-POICs and a 1.53-day shorter duration of hospital stay. Greater ASA status, diabetes, and lower preoperative hematocrit were independent risk factors for POICs. These data could be useful for institutions seeking to reduce the cost of mandibular fracture repair without compromising the rate of short-term POICs. It may also be relevant for surgeons practicing outside tertiary care centers where an outpatient treatment protocol could make management of mandibular fractures more feasible.

TO COMPARE THE EFFECTIVENESS OF INTERMAXILLARY FIXATION USING ERICH ARCH BAR AND SCREWS IN MANDIBULAR FRACTURES – A RANDOMIZED CLINICAL STUDY.

Purpose: Intermaxillary xation (IMF) is an essential principle in the management of mandibular fractures; but with the recent advent of open reduction and internal xation (ORIF), the use of IMF is almost limited to intraoperative procedure only. This study aims to investigate and compare the effectiveness of Erich arch bar & intermaxillary xation (IMF) screws for the management of mandibular fractures. Materials And Method: A randomized prospective study was conducted on 20 patients with mandibular fracture, who were randomly allotted to two groups. Group A patients received intermaxillary xation using Erich arch bar and group B patients received IMF screws. The parameters assessed were time taken for application and removal of appliance, stability of occlusion, glove perforation, and pre-and post-operative plaque accumulation. Results: The mean time for placement of the Erich arch bar was 43.10 minutes as compared to 18.60 minutes with intermaxillary xation screws. Better occlusal stability was shown with an arch bar over IMF screws, and was statistically signicant. More glove tears or penetrations occurred during application in group A than Group B (p<0.01). Also, The Plaque Index assessment on removal of appliance showed a statistically signicant difference between the two groups; higher in the arch bar group. Conclusion: This study indicates that with acceptable occlusal stability, IMF screws technique is an effective and favourable alternative to Erich arch bars for temporary intermaxillary xation in mandibular fractures.

Combined Symphyseal and Condylar Fractures: Considerations for Treatment in Growing Pediatric Patients.

Combined symphyseal-condylar mandible fractures are relatively common but difficult to manage in children. This study investigated the cause and management of symphyseal-condylar fractures in pediatric patients. This study presents a retrospective review and expert opinion of pediatric symphyseal-condylar mandibular fracture management at the authors' institution between 1990 and 2019. National data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (2000 to 2016) were used to determine whether institutional data had national applicability. Twenty-one patients at the authors' institution met inclusion criteria. Of these patients, 26.7 percent of deciduous dentition patients underwent open reduction and internal fixation, 40 percent underwent closed treatment (maxillomandibular fixation), and 33.3 percent received a soft diet. All mixed dentition patients underwent open reduction and internal fixation or closed treatment; all permanent dentition patients underwent open reduction and internal fixation. The national database (n = 1708) demonstrated similar treatment patterns: most permanent dentition patients (88.7 percent) underwent open reduction and internal fixation, most mixed dentition patients (79.2 percent) underwent closed treatment, and among deciduous dentition patients, 53.5 percent patients received a soft diet; 38 percent received closed treatment. In this study, the overall posttreatment complication rate was 62.5 percent among open reduction and internal fixation patients, 14.3 percent among closed treatment patients, and 16.7 percent among patients treated with a soft diet. Symphyseal-condylar mandibular fractures were associated with substantial morbidity in children. The authors created a treatment algorithm to maximize outcomes in children who suffer from this challenging fracture pattern. Therapeutic, III.

Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice

Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections. A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals]. Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes. It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.

A Comparative Assessment of the Management of Mandibular Fracture using 3D Plates and 2D Miniplates

A Comparative Assessment of the Management of Mandibular Fracture using 3D Plates and 2D Miniplates

Application of Anatomically Designed 2-Dimensional V Plate in Management of Mandible Fracture: A Pilot Study.

Mandible is the only mobile facial jaw bone and it aides in various functions such as phonation and mastication. Therefore, management of mandible fracture becomes inevitable due to its functional and anatomical importance. Fracture fixation methods and techniques have steadily evolved with various osteosynthesis systems. In this article, we discuss the management of mandible fracture using a newly designed two-dimensional (2D) hybrid V-shaped plate. In this paper, we have evaluated the efficacy of the newly developed 2D V-shaped locking plate in the management of mandibular fractures. We have assessed 12 cases of different mandibular fractures ranging from symphysis, parasymphysis, angle and subcondylar region. Treatment outcome was assessed both clinically and radiologically at regular intervals with various intraoperative and postoperative parameters. Results of this study suggest that fixation of mandible fracture with the 2D hybrid V-shaped plate facilitates anatomic reduction and functional stability and carries a low morbidity and infection rate. The 2D anatomic hybrid V-shaped plate can be a suitable alternative to conventional miniplate and 3D plates as it offers satisfactory anatomic reduction and functional stability. Positioning the plate in relation to the mental nerve and plate adaptation along the angle region are much easier.

Management of Mandibular Fractures: Report of Three Cases

The mandibular bone is an important component of the facial bone, which has a unique role in digestive system, speech, and facial esthetics. For these important functions of mandibular bone, it is vital that surgeons should not only treat function but also consider the esthetics together. Mandibular fractures are among the most common traumatic injuries of the maxillofacial, and it is in facial region, the second most frequently fractured adult facial bone is the mandible due to its vulnerable position and projected onto the face. The objective of this study is to show in detail all the specific aspects, the management and the efficacy of the use of treatments by means of closed reduction and open reduction+stable internal fixation in patients with mandibular fractures. Special emphasis was placed on the potential impact of socioeconomic standards on the mechanism and pattern of jaw fractures.

Is Outpatient Management of Mandibular Fractures Associated With Inflammatory Complications? An ACS-NSQIP Study

Timing of mandibular fracture repair has long been debated. The purpose of the present study was to assess the incidence of postoperative inflammatory complications (POICs) following open repair of mandibular fractures managed non-urgently in the outpatient setting versus urgently in the inpatient setting. The authors utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to enroll a sample of patients with mandibular fractures who underwent open repair. The primary independent variable was treatment protocol: outpatient (elective) versus inpatient (urgent/non-elective). The primary dependent variable was POIC (yes/no). Descriptive, bivariate, and multiple logistic regression statistics were utilized to evaluate the relationship between treatment protocol and POICs. The study cohort was comprised of 1,848 subjects with 1,134 outpatients and 714 inpatients. The incidence of POICs was 6.53% for the outpatient group compared to 8.96% for the inpatient group, with no significant difference between groups (P= .052). However, subjects treated as inpatients were 1.51 times more likely to experience any complication (P=.008) due to an increase in non-POICs (P=.028), in particular urinary tract infections (P=.035). After adjusting for age, hypertension requiring medical treatment, and smoking, classification as ASA II (P=.046, OR=2.21, 95% CI 1.01 to 4.83), ASA III (P=.020, OR=2.88, 95% CI 1.18 to 7.02), diabetes (P=0.004, OR=3.11, 95% CI 1.43 to 6.74), and preoperative hematocrit (P=0.010, OR=0.950, 95% CI 0.913 to 0.988) were independent predictors of POICs. Length of stay was 0.83 ± 2.61 days compared to 2.36 ± 3.63 days for the outpatient and inpatient groups, respectively (P ≤ .001). There was no significant difference in POICs between patients treated as outpatients versus inpatients, though outpatients had fewer non-POICs and a shorter length of hospital stay.

Are Embrasure Wires Effective and Reliable Method for Intraoperative Maxillomandibular Fixation in Mandibular Fractures?

Maxillomandibular fixation (MMF) is a basic and fundamental principle in the management of the maxillofacial trauma patients. Some fractures require only intraoperative MMF, during open reduction and internal fixation but not in the postoperative period. The present study was aimed to assess and compare the efficacy of embrasure wire with Erich arch bar as methods of intraoperative maxillomandibular fixation in the management of mandibular fractures. The prospective randomized study was undertaken in 30 patients who required intraoperative maxillomandibular fixation for mandibular fractures. Patients were randomly divided into two groups of 15 each (Erich arch bar in Group A and embrasure wire in Group B). The preoperative assessment included evaluation of demographic data, fracture location, mechanism of injury, degree of displacement of fracture and occlusion. Intraoperative parameters assessed were the time consumed for the application of MMF technique, injury to the operator/assistant, injury to the patient, stability of MMF technique, incidence of glove perforations and the cost of the MMF device. The mean time required for MMF and incidence of glove perforation were significantly (P < 0.001) less in embrasure wire group than the Erich arch bar group. The MMF technique maintained stable occlusion during open reduction and internal fixation in both the groups. Embrasure wire is an effective, reliable alternative form of intraoperative MMF, as needle-stick injury and time taken for placement were less as compared to the Erich arch bar group. However, Erich arch bar wiring is a versatile method and recommended where postoperative maxillomandibular fixation is also required.

Role of lingual splint in prevention of mandibular flaring in management of mandibular fracture

Introduction For the past decades, there has been a significant increase in head–maxillofacial traumas, and mandible fracture occupies the second most frequent incidence of facial bone fractures, with incidence of approximately 38%. They are mainly caused by road traffic accidents (RTA). Aim The aim was to study the effect of repairing the parasymphyseal mandibular fractures with rigid fixation alone vs usage of lingual splint with rigid fixation regarding occurring of mandibular flaring. Patients and methods A prospective randomized clinical study was carried out in Benha University Hospital, and it included 30 patients who had isolated parasymphyseal mandibular fractures. Patients were allocated into two groups: group A (15 patients underwent rigid fixation of parasymphyseal mandibular fracture) and group B (15 patients underwent rigid fixation of parasymphyseal mandibular fracture with usage of lingual splint). Results This study showed that in group B the mean bigonial width and bicondylar breadth were lower than that in group A; these differences were statistically significant at 3 months after operation, but there were no significant difference between both groups in the preoperative time and just after operation. Regarding complications, there were no significant differences between the two groups regarding intraoperative and postoperative complications. Conclusion Adding lingual splint as adjuvant to rigid fixation will offer more stability and accuracy for reduction, and it will prevent occurrence of lingual splay of fracture fragments and mandibular angle flaring, with subsequent minimizing effect on temporomandibular joint.