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.

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.

ASSESSMENT OF PRESENCE AND ABSENSE OF IMPACTED MANDIBULAR THIRD MOLAR ON ANGLE AND CONDYLE FRACTURE

Background: Various studies in the past have proven that impacted mandibular third molars increase the risk of angle fractures and decrease the risk of concomitant fractures of the condyle. The present study aimed to assess the effect of presence of mandibular third molars on mandibular angle and condyle fracture. Methods: A retrospective study was conducted in Department of Oral and Maxillofacial Surgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal between September 2016 to July 2020 after obtaining ethical approval. Hospital case records and panoramic radiographs were used to assess the presence, position and angulation of impacted mandibular third molar and the incidence of mandibular angle and condyle fractures were determined. Data were analyzed by using descriptive statistics. The frequency, percentage, means and standard deviation were calculated. Results: A total of 78 cases with 103 angle and condyle fractures were included in this study. Sixty two cases of angle fracture had presence of mandibular third molars. Among 25 condyle fracture 16 cases had either fully erupted or missing mandibular third molars. Conclusions: The presence of impacted mandibular third molar makes the angle region more vulnerable to fracture while presence of erupted third molar or its absence increases the risk of condylar fracture.

Rigid versus Nonrigid Fixation for Bilateral Mandibular Angle Fractures: A Retrospective Multicenter Review.

Fractures involving the bilateral mandibular angle are an uncommon occurrence with limited evidence to inform the ideal fixation requirements for adequate treatment. The aim of this study was to evaluate the outcomes of managing bilateral mandibular angle fractures and determine whether rigid fixation on 1 side improves outcomes compared with bilateral nonrigid fixation. Patients with isolated bilateral mandibular angle fractures treated surgically at the Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Gold Coast University Hospital, and Townsville University Hospital between January 1, 2010, and December 31, 2022, were identified retrospectively. Data collected included patient demographics, mechanism of injury, fixation scheme, postoperative occlusion, and the occurrence of postoperative complications and subsequent management. Eighty-four patients met the inclusion criteria. Fifty-two patients had nonrigid fixation applied to both fractures, and 32 had rigid fixation placed on at least 1 side. All cases proceeded to union. There was no statistically significant difference between the groups for occlusal outcomes, wound dehiscence, infection, or plate or screw loosening. The authors' results suggest that bilateral nonrigid fixation can be used to treat bilateral mandibular angle fractures in the appropriate clinical context. Therapeutic, III.

Comparison of bite force evaluation for mandibular angle fracture fixation by conventional miniplates versus new design miniplates: a clinical study.

To evaluate postoperative masticatory efficacy of a new design non-compression titanium miniplate compared to conventional non-compression titanium miniplate on the basis of bite force for treatment of mandibular angle fractures. The prospective study included 20 patients with mandibular angle fractures randomly categorized into 2 groups: Group I, fixation of angle fractures by conventional miniplates, and Group II, fixation of angle fractures by new design miniplates. Evaluation was done for clinical outcome, primarily bite force; radiological outcome; and associated postoperative morbidities at different time intervals. The results showed to be highly significant in terms of mean operating time for plate adaptation and fixation and bite force adaptation (p = 0.003 at follow-up of 6 months) for the newer miniplate compared to the conventional miniplate. No statistically significant difference was seen for postoperative paresthesia, malunion, non-union, occlusal discrepancy, or hardware failure. Within the limits of the study, it appears that the single, monocortical, non-compression, superior border new design miniplate proved to be a successful procedure for treating non-comminuted mandibular angle fractures specifically in terms of enhanced postoperative masticatory efficiency as compared to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.

The Effect of Mandibular Impacted Third Molar on Fracture of Mandibular Angle and Condyle: An Observational Study

Objective: The factors that may increase the risk of mandibular angle fractures are the abrupt change in angulation and its association with impacted teeth. Condyle, a common mandibular fracture site, is spared if the impact is absorbed in the angle. The study aimed to determine the relationship between the status of impacted mandibular third molars and mandibular angle and condylar fractures in patients with a history of road traffic accidents, within the age group of 18 to 50 years. Methods: In this observational study, 136 patients were examined clinically to diagnose mandibular angle and/or condylar fractures which were confirmed using an orthopantomogram. The status of the mandibular third molars was assessed radiographically. Results: Among the 173 fracture sites detected, 43 were diagnosed at the angle and 130 at the condyle. The demographic assessment demonstrated an age predisposition between 31 and 50 years (44%) in males and 21 and 30 years (47%) in females, with an overall peak incidence in the age group of 21 to 30 years (45%). There was a significant relationship between the status of impacted third molars and the occurrence of angle (P<0.01) and condylar fractures (P=0.05). The incidence of angle and condylar fractures in patients with/without associated impacted mandibular third molars were found to be 91% and 64% and 9% and 36%, respectively. Conclusions: The presence of impacted third molars had a significant relationship with the high incidence of angle fractures and the low incidence of condylar fractures. Knowledge about the common fracture patterns associated with impacted mandibular third molars would alert the clinician to contemplate fractures based on the anatomic distribution.

Distraction test for simple mandibular angle fractures – a useful test to aid clinical decision making

Distraction test for simple mandibular angle fractures – a useful test to aid clinical decision making

Does the Level of Impaction Affect the Management of Third Molars in the Treatment of Mandibular Angle Fractures?

Does the Level of Impaction Affect the Management of Third Molars in the Treatment of Mandibular Angle Fractures?

Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire

PurposeThe purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.MethodsA retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi’an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient’s medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.ResultsOut of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.ConclusionThe treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.

Assessment of Condylar Position in Treated Unilateral Unfavorable Mandibular Angle Fracture After 1-year Follow-up: A Prospective Study

Assessment of Condylar Position in Treated Unilateral Unfavorable Mandibular Angle Fracture After 1-year Follow-up: A Prospective Study

Biomechanical analysis of a novel screw system with a variable locking angle in mandible angle fractures.

Locking plates nowadays represent an important treatment in bone trauma and bone healing due to its strong biomechanical properties. The purpose of this study was to both computationally and experimentally validate a novel screw locking system by comparing it to another locking system from state-of-the-art and to apply it in an environment of a fractured mandible. FEA was used to test both systems prior to experimental tests. The systems were locked in the plate holes at 0°, 10°, 15°, and 20°. Cyclic bending tests and push-out tests were performed in order to determine the stiffness and push-out forces of both locking systems. Finally, newly designed locking system was implemented in mandibular angle fracture. Control locking system was biomechanically superior in push-out test, but with no greater significance. In contrast, the new locking system showed greater stiffness by 17.3% at the deflection angle of 20° in cyclic tests, with lower values for other deflection angles. Similar values were displayed in fractured mandible angle environment. Greater stiffness of the new locking system in cyclic loading tests, together with polyaxiallity of the new locking screw, could lead to easier application and improved biomechanical stability of the mandible angle fractures.

Mandibular angle fractures: a demographic review, with particular reference to post-operative complications.

Mandibular angle fractures (MAF) have a recognized complexity of treatment and an increased risk of incurring complications. This retrospective study included 45 consecutive patients who were diagnosed with an isolated MAF and no other facial fractures. The average age was 27.3 (SD = 7.7). A comparatively low rate of complications (11.1%) and a low rate of reoperation (1.8%) are reported, along with a significant role of smoking in complications (p = 0.022). A non-significant association was noted between complications, male gender and assault as an aetiological factor. Review of the data from this study confirms that complication rates for patients attending the National Maxillofacial Unit are similar to or better than that of international studies. An overview of the aetiology of fracture complications is included.

Comparison of Single Versus Two Non-Compression Miniplates in the Management of Unfavourable Angle Fracture of the Mandible Orginal Research.

To compare the postoperative complications of fixing Mandibular angle fractures with two non-compression mini plates, on the superior and lateral the aspects of the mandible, to the standard technique of using a single non-compression miniplate on the superior border. Fifty patients with MAF were divided equally into two groups. Patients in Group 1 were secured with two mini plates at the lateral and superior border of the MA using an extraoral approach; for patients in Group 2 a single non-compression miniplate was used via an intraoral extended third molar approach as described by Champy et al. The post-operative complications in both groups were compared statistically. The findings of this study revealed that there was no significant difference in postoperative complications between the two groups when fixing MAF with two non-compression mini plates versus the standard technique of using a single non compression miniplate on the superior border of the mandible. However, the surgery time with one miniplate was significantly more than the dual plate approach. We advocate using two mini plates to treat an unfavorable angle fracture.

Postoperative wound dehiscence in mandibular fractures

Objective To clarify the occurrence and causes of non-infection-related surgical wound dehiscence (SWD) in intraorally treated mandibular fractures. Material and Methods Patients with one or two fractures of the dentate part of the mandible treated surgically via an intraoral approach were included in this retrospective study. The primary outcome variable was SWD. Associations between patient-, fracture- and surgery-related variables and SWD were evaluated. Results Altogether 232 patients with 270 mandibular angle, body, symphysis and/or parasymphysis fractures were included in the analysis. In all, 22 SWDs were detected. These occurred in 9.5% of patients and in 8.1% of fractures. Surgery performed at night-time showed a significantly higher SWD rate than daytime surgeries (p = .012). Additionally, a significantly greater SWD rate was found among smokers (p = .041). Other studied variables remained statistically non-significant for SWD. In a multivariate analysis, night-time was the only significant independent variable with an odds ratio of 3.297 (95% CI 1.238 − 8.780, p = .017) for SWD. Conclusion The approach or closure technique used and the fracture type had only a minor effect on non-infection-related SWD in patients with mandibular fractures. To avoid SWDs, mandibular fracture surgeries should be conducted during the daytime with adequate support from an experienced surgeon.

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

Masticatory muscles activity in patients with mandibular angle fractures: A literature review on which procedure to use to reverse the best masticatory muscles functionality

IntroductionMandible is the first or the second most fractured bone of facial skeleton. Fractures of the angle account for 23–43% of all mandibular fractures. Soft and hard tissue are affected in a traumatized mandible. Bite forces are an essential factor in masticatory muscles activity. An improved function is a result of improvement in the bite force. AimThe objective of this research was to conduct a systematic review of all available literature regarding the masticatory muscles’ activity and bite forces in patients with mandibular angle fractures. MethodsPubMed, and Google Scholar databases have been searched with the following keywords: “mandibular angle fractures” AND “bite forces “OR “masticatory muscles activity”. ResultsThis research methodology provided 402 articles. Of which 33 were selected for analysis if they were pertinent to the topic. Then only 10 results have been identified and included in this review. ConclusionsWe can conclude that bite force decreased significantly after trauma, specifically during the first month after injury, and then increases gradually over time. More randomized clinical trial studies and the incorporation of more methods such as electromyography (EMG) for measuring the electrical activity of muscles and bite force recorder could be considered in the future.

Effect of Mandibular Third Molar Presence and Position on the Risk of Mandibular Angle Fracture

Background: Mandibular third molar presence and position may have an effect on the risk of mandibular angle fracture.
 Objective: The purpose of the present study was to see the effect of mandibular third molar presence and position on the risk of mandibular angle fracture.
 Methodology: This cross-sectional study was conducted in four centers in Bangladesh from July 2009 to June 2010 for a period of one year. The mandibular angle fractured patients were selected for the study. The medical records and panoramic radiographs of patients with mandibular angle fracture were examined. The presence or absence and degree of impaction of the mandibular third molars were assessed for each patient and related to the occurrence of fracture of the mandibular angle. Data were also collected for age, sex, mechanism of injury, number and location of mandibular angle fractures.
 Results: A total number of 100 patients with mandibular angle fracture were analyzed. The mean age is 44.36±21.9 years. Among 100 cases, 75 cases had lower third molars and 25 cases had without lower third molars. Within the 75 patients, 64 cases had impacted third molars while 11 cases had erupted third molars. Among the impacted group, 64.1% cases were mesioangular, 15.6% cases were horizontal, 12.5% cases were distoangular and 7.8% cases were vertical.
 Conclusion: In conclusion mandibular angle that contains an impacted lower third molar is more susceptible to fracture when exposed to trauma than an angle without lower third molar.
 Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):181-184

Does a Short Period of Maxillomandibular Fixation Decrease Complications in Open Reduction Internal Fixation of Mandibular Angle Fractures?

A short duration of postoperative maxillomandibular fixation (MMF) has the potential to reduce complications following open reduction and internal fixation (ORIF) of mandibular angle fractures. The purpose of this study was to determine if a short duration of MMF is associated with a reduced rate of postoperative inflammatory complications (POICs) in patients with mandibular angle fractures undergoing ORIF. The authors conducted a retrospective cohort study consisting of patients treated with ORIF for mandibular angle fractures from August 1, 2015 to May 31, 2020 at an urban, level 1 trauma center. Patients under the age of 18 years, bilateral angle fractures, those with MMF periods of more than 3weeks, and those patients without documentation of the duration of MMF were excluded from the study. The primary predictor variable was the use of a short duration (less than 2weeks) of postoperative MMF. The outcome variable of interest was the presence of POICs. Categorical covariates were compared using Fisher's exact tests, while continuous variables were compared using Wilcox rank-sum tests. Multivariable logistic regression adjustment was also performed. There were 307 patients included in the study, 84.4% of which were men. The average age was 32.5years. Patients with a short duration of MMF had a POIC rate of 8.3% compared to 18.2% for no MMF (P=.08). In the adjusted analysis, patients with a short duration of MMF time had a significant decrease in POIC risk compared to no MMF (adjusted odds ratio [aOR]=0.32, 95% confidence interval [CI]=0.11 to 0.97). Other significant variables in the regression analysis included plating type and noncompliance. Inferior border rigid fixation was associated with decreased POIC risk compared to ladder plates and lateral border plates (aOR 5.8, 95% CI=1.8 to 18.4 and aOR 5.1, 95% CI=1.4 to 18.7, respectively). The findings from our study suggest that a short duration of postoperative MMF may reduce POICs following ORIF of mandibular angle fractures.