Postoperative Intermaxillary Fixation Research Articles

Fibula Jaw-during-Admission

Fibula Jaw-in-a-Day (JIAD) is considered the most advanced approach for segmental mandibular defect reconstruction and dental rehabilitation. However, it has limitations and challenges for further pursuit. We propose Fibula Jaw-during-Admission (JDA) as a solution. From 2019 to 2021, six patients received fibula "Jaw-during-Admission." Segmental mandibulectomy, fibula transfer, and immediate dental implantation were performed simultaneously during a single surgery. Intraoral scans were used to fabricate temporary light occlusion contact dental prostheses while on the ward prior to discharge during the first and second week post operation. The prostheses were installed before discharge and changed to permanent ones with normal occlusal contact in the clinic at about six months after X-ray confirmation of bone healing. All six surgeries succeeded. Four patients received palatal muco-periosteal graft after debridement of peri-implant overgrown granulation tissue. Follow-up ranged from 12 to 34 months (average 21.2 months) and revealed good function and appearance in all patients. Fibula JDA is superior to the Fibula JIAD approach for simultaneous mandibular reconstruction with fibula and dental rehabilitation. There is no need for postoperative intermaxillary fixation. The surgery can be performed more reliably with less stress. It provides an additional opportunity for dental rehabilitation if initial dental prosthesis installation during JIAD fails. Postreconstruction intraoral scans provide greater precision and more flexibility in milling dental prosthesis which are mapped to the reconstructed mandible during the postoperative period.

Open versus closed treatment for extracapsular fracture of the mandibular condyle.

Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and. Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography. A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment. No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

Extraoral vertical ramus osteotomy combined with internal fixation for the treatment of mandibular deformities

Extraoral vertical ramus osteotomy (EVRO) is used in orthognathic surgery for the treatment of mandibular deformities. Originally, EVRO required postoperative intermaxillary fixation (IMF). EVRO has been developed using rigid fixation, omitting postoperative IMF. We examined retrospectively the long-term stability and postoperative complications for patients with mandibular deformities who underwent EVRO with internal rigid fixation. Patients who were treated with EVRO for a mandibular deformity in the period 2008–2017 at the Clinic of Oral and Maxillofacial Surgery, Mölndal, Sweden were included (N = 26). Overjet and overbite were calculated digitally and cephalometric analyses were performed preoperatively, and at three days, six months, and 18 months postoperatively. There was a general setback of the mandible, decreased gonial angle and reduced degree of skeletal opening. Excellent dental and vertical skeletal stabilities were seen up to 18 months postoperatively, although relapse was seen sagitally up to six months postoperatively. Since the overjet did not show any significant change over time, the sagittal skeletal changes have been attributed to dental compensation. There was no permanent damage to the facial nerve and 5.8% neurosensory damage to the inferior alveolar nerve was observed.

The Retromandibular Transparotid Approach for Reduction and Internal Fixation of Mandibular Condylar Fractures.

Introduction:The retromandibular transparotid approach is most useful for condylar and subcondylar fractures and provides the best access to the joint and ascending ramus. The study aims at evaluating the ease of access and outcomes encountered on using the retromandibular transparotid approach to access the fracture site for the open reduction and internal fixation (ORIF) of condylar and sub-condylar fractures.Materials and Methods:An observational clinical study was carried out among 10 patients with unilateral and bilateral condylar fracture requiring ORIF. Maximal interincisal mouth opening, facial swelling, occlusal discrepancy, facial nerve injury, scar formation, and acceptability and complications including wound dehiscence, infection, and sialocele/salivary fistula were assessed and measured preoperatively and postoperatively.Results:There was a notable improvement in mouth opening and facial nerve weakness. Postoperative intermaxillary fixation was done with selective patients who had a discrepancy in their occlusion. Preoperatively, swelling was present in four patients (40%) out of 10 patients studied. There was no incidence of sialocele/salivary fistula in any of the cases studied.Conclusion:Retromandibular transparotid incision is technique sensitive and thorough knowledge about the retromandibular area is must for good results and minimal morbidity. The cosmetic results are good in this approach, as well as the facial nerve injury were less in this without any permanent damages.

Body Weight Loss After Orthognathic Surgery: Comparison Between Postoperative Intermaxillary Fixation with Metal Wire and Elastic Traction, Factors Related to Body Weight Loss.

The aim of this study was to compare body weight loss between postoperative intermaxillary fixation with metal wire and elastic traction and to investigate factors related to body weight loss after orthognathic surgery. Subjects were 59 patients with dentofacial deformity, comprising 31 patients treated with intermaxillary fixation (IMF) and 28 patients treated with elastic traction without IMF (ELT) just after surgery. Body weight loss was measured at 1week (T1) and 2weeks (T2) after surgery. Body weight loss was compared between IMF and ELT, and factors related to body weight loss were statistically analyzed. Body weight loss ratio was significantly increased in IMF (2.6%) rather than in ELT (1.4%) at T1, but only tended to be increased in both groups at T2, showing no statistical difference. Body weight loss ratio was significantly increased at T2 compared to T1 in both groups. Body weight loss was significantly greater at T2 than at T1. Both IMF and ELT cause body weight loss after orthognathic surgery, but IMF causes body weight loss earlier than ELT and increased early body weight loss increases continuous body weight loss after orthognathic surgery.

Comparison of the Accuracy of Manual and Digital Cephalometric Prediction Methods in Orthognathic Surgical Planning: A Pilot Study.

To compare and evaluate the reliability of manual and digital cephalometric prediction methods in orthognathic surgical planning. Ten adults (5 females and 5 males) with skeletal class III malocclusion were included. The mean patient age was 21.97 years. Pre- to postoperative changes were evaluated using paired t-test. Manual surgical predictions made by tracing on acetate paper and digital predictions made using computer software were compared with actual postoperative values using intraclass correlation coefficient and root mean square. Statistically significant changes were observed in SNA, SNB, ANB, U1i-FH, and Nperp-A following bimaxillary orthognathic surgery (p<0.001). Postoperative changes in Co-A and Nperp-Pg were statistically significant (p<0.05). Comparison of manual and digital surgical predictions with actual postoperative values revealed that overbite and overjet showed the lowest agreements. Manual predictions were less accurate for points that were difficult to distinguish (Co and U6). Skeletal predictions were more accurate than dental predictions. Parameters with low reproducibility (Co and U6) decrease the reliability of predictions. Dental predictions were inaccurate in both methods due to the effects of intermaxillary elastics, but both methods yielded similar predictions for skeletal parameters. The impact of applying strong elastics for postoperative intermaxillary fixation should be considered when making surgical predictions.

Comparison of two L shaped Plate on Plate Versus Single Conventional L Miniplate in Fixation of Subcondylar Mandibular Fractures.

To compare and evaluate treatment outcome and postoperative complications in subcondylar fractures of mandible-single L shape plate versus two L shape plate-using plate on plate technique. The clinical trial had a total of ten patients (ten unilateral subcondylar fracture sites), which were divided randomly into two groups of five each. Group I patients underwent open reduction and internal fixation with single L shaped miniplate and Group II ORIF was done with two L shaped miniplates by plate on plate technique. Both the groups showed comparable results in terms of postoperative complications. Few cases in Group I presented with minor occlusal discrepancy which was easily corrected with transitional inter-maxillary fixation(IMF) for 1week, and none of the Group II cases required postoperative IMF, but stability in Group II was better than Group I. The results of this trial suggested that the treatment of mandibular condylar fractures with 2 (2-D) plates placed one over the other is better suited than conventionally practiced single-plate fixation. Increased 3-dimensional stability, low morbidity and infection rates are the advantages offered by 2-plate technique of ours.

Novel Use of Orbita Plates in Mandibular Body Fractures.

Isolated fractures of the mandibular body separate the dentate border and compress lower border when subjected to masticatory forces. This study aims at evaluating the efficacy of two Orbita plates in Champy's osteosynthesis lines along with achieving 3D configuration and preventing trauma to mental foramen. (1) To achieve a near 3D configuration by fixing the terminal parts of both plates in contact with each other; (2) to preserve the mental nerve within the ellipse created by two Orbita plates; and (3) to prevent damage to the root apices from the upper plate. This study was performed on 20 patients with mandible body fracture through the mental foramina. With the intraoral vestibular approach, two Orbita miniplates were fixed in Champy's osteosynthesis lines. A geometrically closed quadrangular relationship was achieved in the shape of an ellipse, with the mental nerve emerging from it. Fracture healing was optimum in all the cases along with satisfactory occlusion. Postoperative intermaxillary fixation was not required. Mental nerve function impairment was insignificant. This served to achieve satisfactory functional outcomes in patients with mandible body fracture without injury to roots and along with achieving a geometrically close quadrangular relationship even where 3D miniplates cannot be placed.

Three-dimensional Locking Plate and Conventional Miniplates in the Treatment of Mandibular Anterior Fractures.

Context:Three-dimensional (3D) locking plates has been designed with the hypothesis that this will overcome the disadvantages of both the systems and also advantages of both systems will be combined for the management of mandibular fractures.Aims:The purpose of this study was to evaluate the efficacy of 2-mm 3D locking miniplate in the management of anterior mandibular fracture and to compare it with Champy's miniplate.Settings and Design:A prospective, randomized, clinical trial was carried out in thirty patients who were divided equally in two groups.Subjects and Methods:Group I and Group II patients were treated with 2-mm 3D locking plates and 2-mm standard miniplates, respectively. They were evaluated according to the outcomes of the study, that is, working time, wound dehiscence, infection, segmental mobility, postoperative occlusion, need for postoperative intermaxillary fixation (IMF), and radiological evaluation of reduction and fixation.Statistical Analysis Used:Student's t-test and Mann–Whitney test were used to compare the two systems. The data were analyzed using Statistical Package for the Social Science version 14.0. The P value was taken as significant when <0.05 (confidence interval of 95% was taken).Results:The mean duration of procedure for Group I was found to be 49.33 min, whereas for Group II was 59.67 min. There was significantly greater pain on day 1 and at 1 week in Group II patients. 6.7% (n = 1) of both groups showed incidence of infection. Postoperative stability was adequate in most cases except in one patient (n = 1) of 3D locking system, which was revealed as postoperative occlusal disharmony, unsatisfactory radiological reduction of the fracture fragments, and the segmental mobility. There was no incidence of wound dehiscence, tooth damage, and nerve damage in either group.Conclusions:The result of the study can conclude that there is no major difference between both systems in terms of treatment outcome.

Abstract: Utility of Postoperative Mandibulomaxillary Fixation after Rigid Internal Fixation of Isolated Mandibular Fractures

INTRODUCTION: The goal of treating mandibular fracture centers on re-establishing continuity of the mandible for bony union and occlusion. Many maxillofacial surgeons feel unnecessary to place the patients on post-surgical mandibulomaxillary fixation (MMF) after open reduction and stable internal fixation (ORIF). However, many feel necessary to add MMF after rigid internal fixation for improved follow up visit, and ‘soft tissue rest’ which may be associated with decreased wound complications.1,2 The purpose of this study is to retrospectively analyze if patients undergoing ORIF with post-operative MMF have improved outcome compared with those treated with ORIF alone at a major trauma center. MATERIALS AND METHODS: A two-year retrospective review was performed on mandibular fractures which were treated by Division of Plastic, Reconstructive & Maxillofacial Surgery at R. Adams Cowley Shock Trauma Center / University of Maryland Medical Center, and Department of Oral & Maxillofacial Surgery. Patients who underwent ORIF of one or more mandibular fractures were included. Edentulous patients, and those who underwent non-rigid fixation or suffered other facial fractures were excluded. Two groups of patients were analyzed: one group was placed on MMF post-operatively after ORIF (‘ORIF+MMF’); the other group had MMF removed intra-operatively after ORIF (‘ORIF only’). Post-operative complications and follow up compliance were compared between these two groups. RESULTS: A total of 100 patients were analyzed; 54 patients were in the ORIF+MMF group, and 46 patients were in the ORIF only group. Average follow up was 3.8 months. Average duration of MMF in ORIF+MMF group was 4.2 weeks (range 1 – 13.3wks). The difference between the two groups was compared using an unpaired t test and p<0.05 for significance. The two groups were similar in terms of age, sex, weight, number or fractures, and smoking status (P<0.05). There was no significant difference in post-operative complications between the two groups (P=0.45); with 22 complications in ORIF+MMF group and 13 complications in ORIF only group. Follow-up compliance was higher in the ORIF+MMF group with 3 patients lost to follow-up compared to 9 in the ORIF only group (P<0.05). CONCLUSION: This study showed that post-operative MMF does not improve clinical outcome after ORIF in dentate patients with isolated mandible fractures. However, the use of post-operative MMF may improve follow-up rates. DISCLOSURE/FINANCIAL SUPPORT:No financial support. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Shenoy NA, Shah N, Shah J. A questionnaire survey on postoperative intermaxillary fixation in mandibular trauma: Is its use based on evidence? Natl J Maxillofac Surg. 2011;2(2):141–146. 2. Saman M, Kadakia S, Ducic Y. Postoperative maxillomandibular fixation after open reduction of mandible fractures. JAMA Facial Plast Surg. 2014;16(6):410–413.

The use of three-dimensional strut plates for the management of mandibular angle fractures: a retrospective analysis of 222 patients

This study was performed to evaluate the use of three-dimensional (3D) strut plates for the surgical management of mandibular angle fractures and to determine the subsequent postoperative complication rate. Two hundred and twenty-two patients met the inclusion criteria for mandible angle fracture at the university hospital in Miami between 2009 and 2013 and were included in this study. The treatment protocol for mandibular angle fractures included open reduction and internal fixation with the utilization of a 3D strut plate. Patients were not placed in postoperative intermaxillary fixation. An evaluation of the cases revealed a complication rate of 15.3%, of which 6.8% were considered major complications requiring a surgical intervention. The 3D strut plate has been found to have many advantages over single miniplate techniques with respect to the stability of the fracture and the rate of complications. Based on the current data, 3D strut plates provide a predictable result in the treatment of mandibular angle fractures.

A Detailed Analysis of Mandibular Angle Fractures: Epidemiology, Patterns, Treatments, and Outcomes

The purpose was to analyze mandibular angle fractures by examining epidemiologic trends and mechanisms of injury and to determine whether a statistically meaningful relation existed between certain treatment modalities and patient outcomes. A retrospective chart analysis was performed, and data were limited to 1 operator. Treatment variables were methods of fixation, postoperative intermaxillary fixation (IMF), and retention versus extraction of teeth in the line of fracture. Outcomes were rates of postoperative infection, fracture healing, and overall patient comfort. Analysis was performed using the Fisher exact test, Wald test, and χ(2) test, with a P value less than .05 considered significant. One hundred three patients were included in this study. The mean age was 30.4years, most patients were men, and most injuries occurred during physical altercations and on the left side of the face. The most common concomitant fracture was of the contralateral parasymphysis. A statistically meaningful relation was noted between methods of fixation and healing and overall patient comfort, with the Champy technique and reconstruction plate being associated with the highest rates of bony union and patient comfort. No statistically relevant correlation was found between methods of fixation and rates of infection. There was no statistically relevant link for extraction versus retention of healthy teeth in the line of fracture or use of IMF with patient comfort, postoperative infection, or fracture healing. Although the Champy technique and reconstruction plates were associated with better postoperative outcomes, such as patient comfort and fracture healing, these should not be used interchangeably. IMF and extraction versus retention of teeth in the line of fracture did not influence any of the outcomes.

Outcome of delayed miniplate osteosynthesis of maxillofacial fractures in a Nigerian tertiary institution

Background: This report describes treatment outcome following delayed miniplate osteosynthesis (MPO) of maxillofacial fractures. Materials and Methods: The records of patients who underwent delayed MPO of facial fractures from January 2011 to December 2014 at the Oral and Maxillofacial surgery Unit of the Federal Medical Centre, Owo, Nigeria were retrospectively reviewed. Data retrieved were age, gender, etiology of trauma, site of fractures, and time lapse from injury to treatment. Follow-up at postoperative intervals consisted of clinical and radiographic examinations. Outcome variables such as wound infection, wound dehiscence, malocclusion, hardware failure, fracture stability, and neurosensory disturbance were recorded. Results: Thirty-one patients with 52 facial fractures were treated. There were 18 (58.1%) mandibular, 8 (25.8%) maxillary fracture while 5 (16.1%) fractures occurred in both jaws. All patients had a stable fixation and normal healing. Thirteen complications occurred in 11 patients representing 35.5% of the total. Malocclusion and wound infection were the most common complication. More complications occurred in late treatment group. Conclusion: MPO with or without postoperative intermaxillary fixation is effective in the delayed facial fracture. Treatment delay may increase the incidence of complications.

顎変形症患者における顎矯正手術および顎間固定施行後の咬合力と食物・栄養摂取状況

顎変形症患者における顎矯正手術および顎間固定施行後の咬合力と食物・栄養摂取状況

An Evaluation of the Effect of Therapeutic Ultrasound on Healing of Mandibular Fracture.

The mandible is the most frequently fractured bone in maxillofacial trauma, the treatment of which consists of reduction and fixation of dislocated fragments by open or closed approach. Innovative techniques toward reducing the period of the postoperative intermaxillary fixation (IMF) are being researched. A relatively unknown treatment that may have an effect on fracture healing is ultrasound. Recent clinical trials have shown that low-intensity pulsed ultrasound (LIPUS) has a positive effect on bone healing. The aim of this study was to evaluate the effect of LIPUS on healing by its application in fresh, minimally displaced or undisplaced mandibular fracture in young and healthy individuals. A total of 28 healthy patients were selected randomly from the outpatient department needing treatment of mandibular fractures. They were then randomly allocated to either of the following two groups-experimental group and study group. After IMF, patients in experimental group received pulsed ultrasound signals with frequency of 1 MHz, with temporal and spatial intensity of 1.5 W/cm(2), pulsed wave for 5 minutes on every alternate day for 24 days, whereas patients in control group received no therapy except IMF. Radiographic density at the fracture zone was assessed from the radiograph by Emago (Emago, Amsterdam, Netherlands) Image Analysis software before IMF then at 1st to 5th weeks post-IMF. The amount of clinical mobility between fracture fragments was assessed by digital manipulation of fractured fragment with the help of periodontal pocket depth measuring probe in millimeters at pre-IMF and after 3 weeks. Pain was objectively measured using a visual analogue scale at weekly interval. The data collected were subjected to unpaired "t" test. The experimental group showed significant improvement in radiographic density compared with control group at 3- and 5-week interval; pain perception was significantly reduced in experimental group compared with study group in the subsequent weeks. No significant difference was found in clinical mobility between fracture fragments at 3-week interval. The present study provides a basis for application of therapeutic controlled ultrasound as an effective treatment modality to accelerate healing of fresh, minimally displaced mandibular fracture.

Callus molding in external and internal distraction of mandible.

Distraction osteogenesis (DO) emerges to be a promising alternative to the traditional method of bone lengthening, by which a significant skeletal and soft tissue enlargement can be obtained in the hypoplastic area in a short period. Manipulations of the newly created callus (regenerate), during DO or as a single step molding procedure at the end of the distraction process, may be necessary to correct the mandibular position. To report the efficacy of callus molding (CM) - floating bone concept in the vertical lengthening of ramus by DO and creating a gonial angle in the difficult case of vector selection or surgically induced asymmetry. Retrospective analysis of patients who underwent DO of mandible followed by CM for correction of mandibular asymmetry at authors centers from 2008 to 2014 formed the study group. Only the mandibular distraction cases were included in the study. After the 5 days of latency period, the mandible was distracted at the rate of 1 mm/day. At the end of DO, CM was completed in the 1-3 weeks before consolidation. CM was done either by removing the lower screws with distractor in place or after removal of distractor based on case selection. Secondary maxillary correction by Le Fort I osteotomy using bone graft and further occlusion is corrected by postorthodontics if necessary. Splints were used during CM for predetermined occlusion. In all the cases, postoperative intermaxillary fixation was maintained for 8 weeks for stable ossification of the callus. The study group consist of four and five cases of external and internal distraction, respectively. Of the 9 patients who underwent DO, 6 were females and 3 were males. The mean age of the population ranged from 10 to 21 years with a mean age of 18 years. The average distracted length of the mandible was 23.55 mm ranging from 20 to 26 mm with the standard deviation of 1.95. The mean deviation of the mandible (crossbite) at the end of distraction was around 8.23 mm ranging from 5 to 12 mm with the standard deviation of 2.17. Of the total 9 cases, only in 3 cases CM is done during DO and the rest 6 cases the CM is done after removal of the distractor. Secondary maxillary correction by Le Fort I osteotomy was done for 4 cases, and postorthodontic correction was done in 3 cases. In all the 9 cases, 100% results (as assessed clinically and radiographically) achieved with the creation of perfect gonial angle. CM plays a crucial role in those cases where proper vector orientation is hindered because of anatomical difficulty for osteotomy cuts and parallel fixation of the distractor to ramus resulting in cross-bite with deviation toward the undistracted side. Manipulation of the regenerates would provide a precise achievement of gonial angle, minimizing the need for secondary corrections, and diminishing treatment duration and costs.

Surgical treatment of condylar head fractures, prevention of post-traumatic TMJ ankylosis

Management of condylar head fractures of the temporomandibular joint (TMJ) remains a source of controversy. Based on established literature, conservative treatment of condylar head fractures increases the risk for TMJ ankylosis. Rigid postoperative intermaxillary fixation (IMF) may have also contributed on pathologic process creating ankylosis. On the basis of perioperative arthroscopic evaluation of the status and position of the disc we determined the ideal surgical repositioning of the fragment and the disc.

A Prospective Study on Management of Mandibular Angle Fracture.

To evaluate the results of management of mandibular angle fracture by open reduction and internal fixation using single non compression miniplate via transbuccal, intraoral or extraoral approaches. In this prospective study, 30 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of non comminuted angle fracture with/or without other associated fractures of the mandible. All the patients were operated under general anaesthesia following routine haematological, biochemical, general physical examination and routine radiographic examination. Patients were randomly distributed into 3 groups namely: (1) intraoral, (2) transbuccal, and (3) extraoral groups depending on the surgical approach used for open reduction and internal fixation of fracture of the angle of mandible. In the intraoral group (12 patients), angle fracture was approached through the intraoral vestibular incision similar to sagittal split incision. In the transbuccal group (8 patients), angle fracture was approached through the intraoral vestibular incision and transbuccal stab incision for screw fixation via trochar. In the extraoral group (10 patients), angle fracture was approached through the Risdon's submandibular incision. In all the patients, fractures were reduced with upper and lower Erich's arch bar fixation as means for IMF intraoperatively. In all the patients, fracture of the angle of the mandible was fixed with single non compression 2.5mm, 4 holed with gap stainless steel miniplate and 6/8mm monocortical screws. All patients were followed up for minimum of 6months to maximum of 24months. Complications were relatively minor such as paresthesia (on average 26.7% first post-operative day which was gradually improved and on average after 1month was 3.3%), mild to moderate occlusal discrepancies (on average 36.7%) which needed the post-operative intermaxillary fixation with elastics for 1-2weeks, infection (20% on average) was mild to moderate which was managed with antibiotic therapy and/or incision and drainage except in one case, plate removal was done under general anaesthesia (extraoral group) because of recurrent infection. Post-operative pain was mild to moderate (mean VAS score pre operative-6.17, post-operative 1week-1.63) which was managed with analgesics. Mouth opening was recorded in all patients which was on average 20.98mm preoperatively which improved to 40.57mm after 1month. The use of a single non compression miniplate for fractures of the angle of the mandible is a simple, reliable technique with relatively rare major complications and few minor complications irrespective of the surgical approach used for the open reduction.

Use of Miniplates in Parasymphysis Fractures : A Survey Conducted Among Oral and Maxillofacial Surgeons of India

Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or post-operative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fifty-four per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy's principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.

A comparative evaluation of different treatment modalities for parasymphysis fractures: a pilot study

Maxime Champy advised the use of two miniplates for parasymphysis fractures because of the high torsional forces in the anterior region of the mandible. According to him there is no need for intraoperative or postoperative intermaxillary fixation, but most surgeons use arch bars for intraoperative or postoperative intermaxillary fixation. This study evaluated the role of the lower arch bar as a tension band eliminating the need for an upper miniplate (tension band plate) in cases of parasymphysis fractures. 3 groups underwent treatment. In the first group, two titanium miniplates were placed across the fracture site along with Erich's arch bar for 6 weeks. In the second group, two titanium miniplates were used for osteosynthesis without Erich's arch bar. In the third group, one titanium miniplate was placed along with Erich's arch bar for 6 weeks. The results of third group were statistically non-significant compared with those of the first and second groups.