Mandibular Angle Fractures Research Articles

Comparison of Post-Operative Outcomes of Intermaxillary Fixation and Open Reduction with Internal Fixation of Simple Mandibular Angle Fracture: A Randomized Control Trial

Background: Surgical management of simple mandibular angle fracture is a very crucial process.Objective: The purpose of the present study was to compare the post-operative outcomes of intermaxillary fixation and open reduction with internal fixation of simple mandibular angle fracture.Methodology: This randomized control trial was conducted in the Department of Oral and Maxillofacial Surgery at Dhaka Dental College & Hospital, Dhaka and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to December 2010 for a period of one (01) year. Among all patients admitted/attended to the hospital IPD with fracture of mandibular angle with or without other associated fracture sites were selected as study subjects. After recruitment of the patients, they were assigned either as group A or group B after randomization. In group A the patients of this group were treated by open reduction and internal miniplate fixation with additional placement of intermaxillary fixation; in group B the patients of this group were treated by open reduction and internal miniplate fixation without any additional placement of intermaxillary fixation. During follow up period stability of fracture segments, post reduction alignment and inter-incisal opening were recorded.Result: A total of 30 patients presented with mandibular angle fractures were included in the study. They were allocated in two groups named miniplate osteosynthesis with Inter-maxillary fixation group (n=16) and without inter-maxillary fixation group (n=14) randomly. Time required to accomplish the surgical procedures was significantly high (p=0.000) group A (99.38±15.26 minutes) than group B (55.38±6.34 minutes). Among them 01 patient developed instability after inter-maxillary fixation. And 01 patient developed such in other procedure; however this difference is not statistically significant (p=0.724). In post operative radiography the mean score of post reduction alignment was slightly higher in group A than group B which was 2.50±0.516 and 2.214±0.426 respectively (p=0.107). The inter-incisal opening in baseline was 14.69 and 18.14 in group A and group B respectively. However, in review 3 it was found 36.19 and 37.64 in group A and group B respectively (p=0.0001).Conclusion: In conclusion significantly less operative time was required to accomplish the operative procedure in without IMF group as well as there was also a significant difference of inter-incisal opening between two procedures in subsequent review findingsJournal of National Institute of Neurosciences Bangladesh, 2018;4(2): 108-112

Management of fractures of anterior mandible with different fixation methods: A single institutional experience

Objective: To evaluate the effectiveness of various internal fixation hardware used for treatment of symphyseal and parasymphyseal mandibular fractures based on a single institution`s experience. Patients and methods: In this retrospective clinical study, one hundred patients with fractures of the anterior region of the mandible involving both the symphysis and parasymphysis areas were included. All cases were selected from the patients` records who were treated in the oral and maxillofacial surgery department in a 4 years period extended from May 2013 to May 2017. Surgical admission notes, x-ray reports, operation records, outpatient notes, and complications were recorded. The patients were followed up periodically until a minimum of 6 weeks. Results: The distribution of fracture pattern was as follows; 53 patients with anterior mandible associated with subcondylar/condylar fractures, 31 with anterior mandible in association with mandibular angle fractures, and only 16 patients with isolated anterior mandible fracture. The majority of the fractures (40%) were treated by 2 miniplates, followed by the 3-D miniplates (17%), equal use (12% each) of (2 lag screws, 1 lag plus 1 miniplate and 1 reconstruction plate), then 1 lag screw (4%), and the least was the use of only 1 miniplate (3%). Conclusion: Proper selection of the fixation method for anterior mandibular fractures is essential to guarantee a successful treament and early restoration of function. Each method has its own advantages and disadvantages, and each case should be treated individually based on proper diagnosis and planning.

Lag Screw Technique for Treating a Mandibular Angle Fracture: Case Report

The treatment of mandibular angle fractures involves several postsurgical complications and is in greater demand when compared to therapeutic approaches for other types of mandibular fractures. Such postsurgical complications as bleeding, swelling, infection, dehiscence, pseudoarthrosis and paresthesia might affect individuals in both sexes and at all age groups. The presence of a mandibular third molar, a cross-sectional area thinner than the tooth-bearing region, and biomechanical forces might hamper the surgery, making it longer and more complex. Internal fixation is aimed at undisturbed healing under condition of functional and without any period of intermaxillary fixation. Adequate fixation depends on different fracture types, patients' general health and compliance, and the timing of the operation. This case report involves a mandibular angle fracture successfully treated with the lag screw technique, a simple approach to treat one of the most common fractures involving the mandible, quickly restoring the patient ́s oral functions.

A comparison of panoramic radiography and cone beam computed tomography in the detection of osteosynthesis complications in sheep mandibular angle fractures

The aim of this study was to compare the diagnostic efficacy of panoramic radiography (PANO) and cone beam computed tomography (CBCT) in detecting simulated complications of plate osteosynthesis applied to mandibular angle fractures (MAFs). Unfavorable MAFs were created in 100 fresh sheep hemimandibles. Fractures were fixed with 4-hole titanium miniplates and screws. Bone necrosis around the screws, penetration of the screw into the inferior alveolar canal, screw loosening, and plate breakage were simulated. The diagnostic efficacy of the imaging techniques was compared by using intra- and interobserver agreement scores and area under the receiver operating characteristic curve (AUC) values. Examination time (ET), confidence scores (CS), and planar preference (PP) in CBCT evaluation were assessed. Intra- and interobserver agreement scores varied between 0.61 and 0.91. AUCs for screw penetration into the inferior alveolar canal and screw loosening were significantly higher in CBCT than in PANO (P < .05). CBCT presented significantly higher ET and CS values compared with PANO (P < .05). PP showed significant differences among types of complications (P < .05). PANO provided acceptable outcomes in the detection of bone necrosis and broken plates around the screw, but CBCT was more likely to enable detection of all simulated types of complications with higher confidence.

Surgical Management of Mandibular Angle Fractures.

The study proposed to determine the superiority between different fixation methods in the mandibular angle fractures (MAFs) and to evaluate best option for surgeon and patient. A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. The quality of studies was assessed, and the odds risk (OR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Subgroup analyses by different fracture regions and different miniplate sizes were performed. Publication bias was measured by a funnel plot. Twenty-one articles were enrolled in this review: 8 randomized controlled trials , 2 controlled clinical trials, and 11 retrospective studies. There were significant advantages for 3-dimensional (3D) miniplate (OR = 0.48, P = 0.003, 95% CI, 0.35-0.67) and 1 miniplate (OR 0.38, 95% CI 0.25-0.58, P < 0.00001). The cumulative OR for locking miniplate was 0.45, showing that the utilizing of locking mini-plate in management of MAFs decreases postoperative complications risk by 55% over the use of nonlocking mini-plate. The results of this review indicated that the use of 3D miniplate, locking plate, and 1 plate were more advanced to 2 miniplates technique in low incidence of postoperative complications in the treatment of MAFs.

The Relation Between Morphometric Features and Susceptibility to Mandibular Angle Fractures.

The study was aimed to determine possible relations between skeletal morphologic parameters to mandibular angle fractures. Retrospective study of 100 patients suffering from mandibular fractures and treated in the Rambam Health Care Campus between the years 2013 and 2017 was conducted. Predictor variable was facial skeletal morphologic features as derived from the measurements. Outcome variable was mandibular angle fractures. About 42 patients suffered from angle fractures. Gonial angle (131.3° versus 118.1°), condylar neck width (8.3 mm versus 6.8 mm sagittaly and 7.1 mm versus 5.8 mm horizontally), and wisdom tooth prevalence and impaction were positively correlated to the fracture. Ramus height (48.3 mm versus 53.4 mm) was negatively correlated to angle fractures. Many reports in the literature show positive relations between impacted 3rd molars and angle fractures, yet only sporadic reports describe relations between facial fractures and facial features. Our results showed the predictable positive relation between angle fractures and 3rd molar prevalence and impaction. Yet surprisingly, we found unequivocal significant positive correlation between angle fractures to gonial angle and condylar neck width and negative correlation to ramus height. Based on the correlation to the gonial angle and ramal height, it is concluded that enlarged anterior vertical growth is a predictor for angle fractures, as are condylar neck width, and wisdom teeth.

Biomechanical evaluation of double Y-shaped versus conventional straight titanium miniplates for the treatment of mandibular angle fractures

Aim of this experimental study: Was to test the resistance to mechanical force of a doubleY- shaped titanium miniplate versus conventional straight titanium miniplate for the treatment ofmandibular angle fracture.Materials and methods: Ten fresh sheep hemi mandibles, sectioned at the angle region, wereused to evaluate two plating techniques. One group (Group A) received fixation via a double Yshapedtitanium miniplate and the second group (group B) via a six-hole conventional straightnon-compression titanium miniplate .Each hemi mandible in group A and group B was subjected totensile forces using universal testing machine.Results: During the test, the group (A) fixed by double Y-shaped miniplate, the plates werefractured in all group samples at mean of the Yield load (745N). The mean degree of displacementof this group was 7.8mm). While in group (B), the conventional straight titanium mini plates werefractured at force (the mean; 665.6N). The mean of degree of displacement of this group was7.8mm)Conclusion; Double Y-shaped miniplate with 6 holes and 9.0 mm spacing had greater resistanceto displacement and provided more favorable biomechanical behavior than the conventional straightminiplates in the repair of mandibular angle fractures.

Correlation Between Lower Third Molar Impaction Types and Mandibular Angle and Condylar Fractures: A Retrospective Study

The purpose of this study was to investigate and determine the relations between mandibular third molar (M3) impaction types and mandibular angle and condylar fractures. A retrospective study was conducted in patients with mandibular angle and condylar fractures referred to the Oral and Maxillofacial Surgery Department of the Shahid Kamyab Hospital (Mashhad, Iran) from 2013 to 2018. Data sources were patients' hospital documents and panoramic radiographs. Predictor variables were the presence and position of impacted M3s. ThePell-Gregory classification was used to identify the horizontal and vertical positions of impaction. The impaction angulation was determined using the Schiller classification. Outcome variables were the presence of angle and condylar fractures. Data were analyzed using SPSS 16 (IBM Corp, Armonk, NY) and χ2 and Fisher exact tests. The study sample consisted of 117 patients (63.2% with condylar fractures, 30.8% with angle fractures, and 6% with concomitant fractures of the condyle and angle). Most patients (88.9%) with angle fracture had impacted M3s; however, impacted M3s were absent in 59.5% of condylar fracture cases. Mesioangular and vertical positions were the most prevalent impaction angulation types in patients with mandibular angle fracture. Classes II and B were the most frequent horizontal and vertical impaction types, respectively, according to the Pell-Gregory classification. There was a statistically significant difference between fracture site and the presence or absence of impacted M3s (P<.001). Moreover, a significant relation was observed between horizontal impaction type and fracture site in patients with impacted M3s (P=.001). The presence of impacted M3s increased the risk of angle fractures and simultaneously decreased the risk of condylar fractures. Fractures of the angle region were more commonly seen in patients with superficially impacted (vs deeply impacted) M3s.

Mandibular angle fracture following closed extraction of lower third molar: A case report and systematic review

Objectives Mandibular third molar extraction is among the most commonly performed dental procedures. Fracture of the angle of mandible after third molar extraction is a rare complication of this procedure.Case Herein, we report fracture of the right angle of mandible immediately after extraction of mandibular right third molar in a 38-year old healthy female patient, which was surgically managed. A review of the relevant literature is also presented. Thirty four cases of mandibular fracture following third molar extraction are reported in the literature. Most of these cases were removed surgically.Conclusion Systematic review of papers showed that angulation of impacted third molar is one of the most related factors in following fractures of mandibular angle.

Postoperative Complications Associated With Different Fixation Methods of Isolated Mandibular Angle Fractures.

The objective of this study was to review the medical records of patients with a history of mandibular angle fracture who were attended at the Service of Oral and Maxillofacial Surgery and Traumatology of FOAr/UNESP in the last 5 years. The data collected were subjected to chi-squared test (significance level of 5%). The authors reviewed 19 medical records. The main cause was physical aggression (58.00%), but with no statistical difference in relation to the other etiologies (P > 0.05). Regarding the type of fixation, one 2.0-mm system plate associated with one 2.4-mm system plate and the fixation using only two 2.0-mm system plates were used in 7 patients each. The fixation method with a monocortical plate at the upper border was used in 5 patients. However, there was no statistically significant difference in the frequency of complications among the 3 fixation methods used (P > 0.05). In 52.64% of the patients, the third molar was removed intraoperatively. Despite this, there was no statistically significant difference in the frequency of complications when the third molar was in the fracture line or when it was removed postoperatively (P > 0.05). The complications observed were dehiscence associated with pain (44.44%), trismus (22.22%), infection (22.22%), and presence of bone spicules (11.11%). However, no statistical differences were observed between the frequency of different types of complications (P = 0.779). In the sample studied, there were no differences in the frequency of complications among the fixation methods applied.

Integrity of a Single Superior Border Plate Repair in Mandibular Angle Fracture: A Novel Cadaveric Human Mandible Model

The purpose of this study was to compare the integrity of human mandibular angle fracture after fixation with a single titanium plate along the upper lateral border with that of the native human mandible. This cross-sectional anatomic study involved the left hemimandibles of 16 human cadavers. They were selected and divided in 2 groups by remaining dental status. Additional predictor variables, such as height of the left mandibular body and gender, were noted. Left hemisected native mandibles were mounted at the condyle and loaded on an Instron 5565 mechanical unit (Instron Corp, Norwood, MA) until fracture. Fractured left hemimandibles were fixated with a titanium miniplate and screws. After plate fixation, each hemimandible was reloaded on an Instron 5565 until fracture. Data pertaining to primary outcomes of load application were recorded in newtons at displacement values of 3.0, 5.0, and 7.0mm and at displacement at fixation failure. Primary outcomes of maximum load and displacement at maximum load were recorded in newtons and millimeters, respectively. Descriptive statistics were used to summarize sample characteristics. Statistical comparisons were performed using t test, χ2 (or Fisher exact) test, and linear regression. Pearson correlation was used to examine relations between select biomechanical measurements. The study sample was composed of 12 female and 4 male cadaveric hemimandibles. Donors' age at time of death ranged from 54 to 95years (mean age, 78.94yr). The mean maximum load in native and plated hemimandibles was 943.56 and 292.57N, respectively (P<.0001). Key clinical findings of this study include the inability of single plate mandible fixation to restore the mandible to preinjury levels and verification that gender, dental status, and height of the mandible do not alter the stability of a single plate fixated mandible.

Demographic Characteristics and Etiology of Simple Mandibular Angle Fracture: Experience of 30 Cases in Dhaka City

Background: Simple mandibular angle fracture can occur in different group of people due to different etiology.Objective: The purpose of the present study was to find out the demographic characteristics and etiology of simple mandibular angle fracture.Methodology: This cross-sectional study was conducted in the Department of Oral and Maxillofacial Surgery at Dhaka Dental College &amp; Hospital, Dhaka and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to December 2010 for a period of one (01) year. Among all patients admitted/attended to the hospital IPD or OPD with fracture of mandibular angle with or without other associated fracture sites were selected as study subjects. The details of demographics characteristics and etiology of fracture were recorded. Result: A total number of 30 patients were recruited for this study. Majority of the respondents 21(70%) were male and rest 09(30%) were female. Mean age of the patients was 29.5±6.795 years. Among the 30 respondents 46.7% had history of Road Traffic Accident, 43.3% due to assault and only 10% for other causes.Conclusion: In conclusion the most common etiology of mandibular angle fracture is road traffic accident. Male and younger adult are frequently encounter the mandibular angle fracture.Journal of Current and Advance Medical Research 2018;5(2):45-48

Three-Dimensional Finite Element Analysis of Different Plating Techniques for Unfavorable Mandibular Angle Fractures.

The purpose of the current study was to assess the biomechanical behavior of 5 different fixation schemes for unfavorable mandibular angle fractures using the three-dimensional finite element analysis method. Five different miniplate fixation schemes were modeled for the fixation of unfavorable mandibular angle fractures. A double parallel miniplate (M1), which was placed at the halfway point of the mandibular angle height; a 1/3 superior-positioned miniplate (M2); a single miniplate (M3), which was placed at the halfway point of the mandibular angle height (1/2 middle-positioned); a 1/3 inferior-positioned miniplate (M4); and an X-miniplate which was placed at the halfway point of the mandibular angle height (M5). The lowest mechanical stresses were detected in the double miniplate model when compared with the other schemes, whereas 1/3 inferior-positioned miniplate had the highest stress and displacement values. The authors suggest that the double miniplate is an adequate rigid fixation technique, whereas the 1/3 inferior-positioned miniplate configuration should not be used in case of unfavorable mandibular angle fracture.

Management of fractures of anterior mandible with different fixation methods : A single institutional experience

Aim: To evaluate the effectiveness of various internal fixation hardware used for treatment of symphyseal and parasymphyseal mandibular fractures based on a single institution`s experience.Materials and Methods: In this retrospective clinical study, one hundred patients with fractures of the anterior region of the mandible involving both the symphysis and parasymphysis areas were included. All cases were selected from the patients` records who were treated in the oral and maxillofacial surgery department in a 4 years period extended from May 2013 to May 2017. Surgical admission notes, x-ray reports, operation records, outpatient notes, and complications were recorded. The patients were followed up periodically until a minimum of 6 weeks.Results: The distribution of fracture pattern was as follows; 53 patients with anterior mandible associated with subcondylar/condylar fractures, 31 with anterior mandible in association with mandibular angle fractures, and only 16 patients with isolated anterior mandible fracture. The majority of the fractures (40%) were treated by 2 miniplates, followed by the 3-D miniplates (17%), equal use (12% each) of (2 lag screws, 1 lag plus 1 miniplate and 1 reconstruction plate), then 1 lag screw (4%), and the least was the use of only 1 miniplate (3%).Conclusion: Proper selection of the fixation method for anterior mandibular fractures is essential to guarantee a successful treament and early restoration of function. Each method has its own advantages and disadvantages, and each case should be treated individually based on proper diagnosis and planning.

Effect of different miniplate osteosynthesis in different mandibular angle fracture patterns on bite force: A 3D finite element analysis

ObjectiveBite force can be used as a clinical indicator of masticatory performance. As bite force is reduced with fractures and also, miniplate fixation has become the standard treatment, the aim of this study is to determine the optimal method for mini-plating in the fracture of the mandible angle to reach the best mastication power. MethodsA three-dimensional model generated from CBCT (Cone-beam computed tomography) of human mandible for Finite Element Analysis. Four different fracture patterns were simulated on the models. Each fracture pattern was fixed by five different methods of miniplate fixation. Each compared to others after simulation and applying the force of the masticatory muscles and result reported in Newton unit. ResultsThe highest mastication force belonged to a pattern in which a miniplate was placed on an outer oblique ridge and another miniplate in the lower border of the buccal mandibular cortex. The lowest mastication force also belonged to placing a mini plate on the upper side of the cortex. ConclusionFinite Element Analysis is an effective method for indirect measurement of mastication power. In order to biomechanically rebuild optimal mastication force in patients with fracture of the lower angle of the jaw, it is recommended to use two miniplates in two different planes.

The correlation between mandibular third molar and mandibular angle fracture among patients in Hospital Universiti Sains Malaysia

AbstractAimThe purpose for this study was to investigate and elucidate the relationships between the mandibular third molar and mandibular angle fractures.Materials and methodsThis retrospective study incorporated the presence, position and angulation of mandibular third molar and prevalence of fracture of angle of mandible among patients treated in Hospital Universiti Sains Malaysia. The medical records were scanned and 427 patients with mandibular fractures from 2001 until 2016 were identified. Depending on the notes and various radiographic images, 77 of 427 patients had mandibular angle fracture. The presence or absence of impacted mandibular third molar was assessed for each patient that had angle fracture. In presence of impacted mandibular third molar, their position and angulation of the tooth were evaluated. The positions were classified using Pell and Gregory system while the angulations were classified using Winter's classification. Data were analysed using SPSS 22.0 system and applying a chi‐square test.ResultsAmong 77 patients with angle fracture, 67 (87%) had impacted mandibular third molar while 10 (13%) had no evidence of mandibular third molar. The incidence of mandibular angle fracture was found to be significantly greater when impacted third molar was present (P &lt; 0.05).ConclusionThe results of this study showed that the patients with impacted mandibular third molar have an increased risk of mandibular angle fracture compared to those without.

Comparison of single versus two non-compression miniplates in the management of unfavourable angle fracture of the mandible: a prospective randomized clinical study.

The purpose of this study was to compare the efficacy of single versus two non-compression miniplates in the management of unfavourable angle fracture of mandible. A total of 28 patients who required open reduction of mandibular angle fracture were included in the study. The patients were randomly divided into two groups. Group I comprised of patients treated with two miniplates and those in group II were treated with single non-compression miniplate. The parameters of assessment were malocclusion, surgical site infection, need for implant removal, duration of surgery, inter-incisal mouth opening and cost of implants used, in both the groups. Statistical analysis was carried out to compare all the parameters. Out of 14 patients in group II, inadequate reduction was noticed in three patients, whereas screw loosening hadoccurred in two cases. Screw loosening was always associated with chronic infection. In these cases, hardware removal was deemed necessary. Plate bending was observed in two cases resulting in malocclusion and difficulty in eating. Non-union of fracture occurred in one patient treated in group II. In group I, no plate bending, screw loosening, surgical site infection, non-union or malocclusion was observed. No patient had to undergo implant removal in group I. In the management of unfavourable mandibular angle fracture, two miniplates must be preferred over the use of single miniplate as using two miniplates results in better results with minimal complications.

Complications and Reoperations in Mandibular Angle Fractures.

Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates. To analyze patient, injury, and surgical factors, including approach to the angle and plating technique, associated with postoperative complications, as well as the rate of reoperation with regard to mandible angle fractures. Retrospective cohort study analyzing the surgical outcomes of patients with mandible angle fractures between January 1, 2000, and December 31, 2015, who underwent open reduction and internal fixation. Patients were eligible if they were aged 18 years or older, had 3 or less mandible fractures with 1 involving the mandibular angle, and had adequate follow-up data. Patients with comminuted angle fractures, bilateral angle fractures, and multiple surgical approaches were excluded. A total of 135 patients were included in the study. All procedures were conducted at a single, large academic hospital located in an urban setting. Major complications and reoperation rates. Major complications included in this study were nonunion, malunion, severe malocclusion, severe infection, and exposed hardware. Of 135 patients 113 (83.7%) were men; median age was 29 years (range, 18-82 years). Eighty-seven patients (64.4%) underwent the transcervical approach and 48 patients (35.6%) received the transoral approach. Fifteen (17.2%) patients in the transcervical group and 9 (18.8%) patients in the transoral group experienced major complications (difference, 1%; 95% CI, -8% to 10%). Thirteen (14.9%) patients in the transcervical group and 8 (16.7%) patients in the transoral group underwent reoperations (difference, 2%; 95% CI, -13% to 17%). Active smoking had a significant effect on the rate of major complications (odds ratio, 4.04; 95% CI, 1.07 to 15.34; P = .04). During repair of noncomminuted mandibular angle fractures, both of the commonly used approaches-transcervical and transoral-can be used during treatment with equal rates of complication and risk of reoperation. For a patient undergoing surgery for mandibular angle fracture, smoking status is more likely to predict surgical outcomes rather than how the surgeon chooses to approach and fixate the fracture. 3.

Are three-dimensional plates as effective as superior border plating in mandibular angle fractures? A comparative evaluation of effectiveness

Purpose: The purpose of this study is to evaluate the effectiveness of three-dimensional (3D) miniplates over standard miniplates in the management of mandibular angle fracture. Materials and Methods: This study included 40 individuals who were diagnosed clinically and radiographically to have sustained mandibular angle fracture and subsequently underwent open reduction and internal fixation (ORIF). All participants were divided randomly in to two groups. Group I included 20 patients who underwent ORIF for angle fracture with superior border plating using 2 mm 4 hole with gap miniplate while Group II included 20 patients who underwent ORIF with rectangular 3D miniplate placed through an intraoral incision in conjunction with the use of a trocar through percutaneous route for fixation of plate. Results: Patients who were treated using 3D plates had more pain on visual analog scale score and reduced mouth opening in the immediate postoperative phase. However, the stability at the facture site was superior to that of those treated by superior border plating. Conclusion: 3D plate was found to be standard in profile, strong yet malleable, facilitating reduction, and stabilization at both the superior and inferior borders, thereby giving a 3D stability at the fracture site and early return to normal function.

Herbert cannulated bone screw osteosynthesis versus miniplates osteosynthesis in the treatment of mandibular angle fractures

Purpose: Mandibular angle fractures are commonly encountered in the maxillofacial field, their surgical treatment includes a wide range of fixation techniques. Herbert cannulated bone screw is a successful minimally invasive mean of fracture fixation that is used routinely in orthopedic surgery. The aim of this study was to evaluate the clinical and radiographic performance of a solitary Herbert bone screw in the treatment of mandibular angle fractures and compare it with the commonly established treatment modality with double 2.0-mm miniplates.Patients and methods: Twenty patients, 15 males and 5 females,with unilateral isolated fracture in the mandibular angle region were selected and randomly allocated into the following groups: group I (n=10) treated with a solitary Herbert Bone Screw and group II (n=10) treated with doubleminiplates. Patients were clinically and radiographically monitored for twelve weeks.Results:The occlusal examination showed a normal occlusion in all of the cases in both groups. Both groups showed a statistically significant gain in the mean bone density across the follow-up period(P<0.001). The difference between groups was statistically insignificant (P=0.761).Conclusions: The utilization of a solitary Herbert cannulated bone screw osteosynthesis provides a successful, more economic, minimally invasive and predictable treatment modality for the treatment of mandibular angle fractures.