Postoperative Maxillomandibular Fixation Research Articles

Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study.

The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF). This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded. Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type. Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.

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.

European multicenter prospective analysis of the use of maxillomandibular fixation for mandibular fractures treated with open reduction and internal fixation

IntroductionThe goal of mandibular fracture treatment is to restore static and dynamic occlusal functions. Open reduction and internal fixation (ORIF) of these fractures can be associated with an intraoperative and/or postoperative maxillo-mandibular fixation (MMF). The aim of this study was to analyse the use of perioperative MMF and its effects on occlusal outcomes in the management of mandibular fractures. Material and methodsThis multicentric prospective study included adult patients with mandibular fractures treated with ORIF. The following data were collected: age, gender, pre-trauma dental status (dentate, partially dentate), cause of injury, fracture site, associated facial fractures, surgical approach, type of ORIF (rigid, non-rigid or mixed), thickness and number of plates, modality of intraoperative MMF (arch bars, self-tapping and self-drilling screws [STSDSs], manual, other) and duration of postoperative MMF. The primary outcome was malocclusion at 6 weeks and 3 months. Statistical analyses were performed with Fisher's exact test or chi-square test, as appropriate. ResultsBetween 1 May 2021 and 30 April 2022, 336 patients, 264 males and 72 females (median age, 28 years) with mandibular fractures (194 single, 124 double and 18 triple fractures) were hospitalized. Intraoperative MMF was performed in all patients. Osteosynthesis was rigid in 75% of single fractures, and rigid or mixed in 85% and 100% of double and triple fractures, respectively. Excluding patients who underwent manual reduction, postoperative MMF (median duration, 3 weeks) was performed in 140 (64%) patients, without differences by type or number of fractures (p > 0.05). No significant difference was found in the incidence of malocclusion in patients with postoperative MMF (5%, 95% confidence interval [CI], 2–10%) compared to those without (4%; 95% IC, 1–11%) (p > 0.05). ConclusionPostoperative MMF was performed in more than half of the patients despite adequate fracture osteosynthesis, with wide variability amongst centers. No evidence of a reduction in the incidence of postoperative malocclusion in patients treated with postoperative MMF was found.

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

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 is 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.

Rigid internal fixation of panfacial fractures without postoperative maxillomandibular fixation: A retrospective study of 25 cases

The aim of this study was to retrospectively investigate the validity of rigid internal fixation of panfacial fractures (PFFs) without postoperative maxillomandibular fixation (MMF) in patients who underwent open reduction and internal fixation (ORIF). The medical records of patients with PFFs who underwent rigid internal fixation without postoperative MMF from April 2015 to November 2021 were retrospectively reviewed. The locations of PFFs were classified by the location affected. All patients except for 2 head-injured patients had regular follow-up examinations including postoperative imaging for over 6 months. There were 25 patients (15 males, 10 females; median age 51.3 years, range 16–89 years); median body mass index (BMI) 22.4 kg/m2, range 17.3–28.2 kg/m2). The most common location of PFFs was orbital bone (80%), with the exception of the maxilla. Mean operating time was 330 min, and mean blood loss was 120 ml. Postoperatively, one patient (4%) had malocclusion and mouth opening limitation, 5 patients (20%) required elastic traction for postoperative occlusal instability, and 2 patients (8%) had suture dehiscence. Three patients (12%) had postoperative soft tissue problems. Malocclusion or limited mouth opening was seen in one patient each (4%), and no patient exhibited facial asymmetry. The overall complication rate was 16%. The majority of patients (13/25) started oral feeding with a solid diet by postoperative day 3. In conclusion, proactively avoiding postoperative MMF for PFFs in which sufficient occlusal and bone stability can be achieved by rigid internal fixation not only avoids the disadvantages of postoperative MMF, but also provides satisfactory outcomes.

Rigid Fixation after Intraoral Vertical Ramus Osteotomy: A Retrospective Study and Description of Technique

The intraoral vertical ramus osteotomy (IVRO) is an osteotomy utilized in oral and maxillofacial surgery to aid in correction of mandibular and facial deformities. Traditionally, performing this osteotomy requires a period of maxillomandibular fixation (MMF) following surgery, which can have effects on the teeth, temporomandibular joints, and patient satisfaction. Completion of the IVRO can be technically difficult due to poor visualization of the lateral mandible and variation in position of the inferior alveolar nerve. The authors' institution has successfully implemented rigid fixation of IVROs that removes the need for MMF following surgery. Seventy-seven patients underwent a total of 134 IVROs between 2017 and 2020 at the institution. Thirty-eight patients had rigid fixation for a total of 65 fixated IVROs. Among patients who underwent rigid fixation of IVRO, 3 experienced temporomandibular joint dysfunction and 2 experienced paresthesia in the V3 distribution. Of 69 IVROs without fixation, 2 patients experienced temporomandibular joint dysfunction and 1 patient had paresthesia in V3 distribution. Rigid fixation of IVROs was noted to add intraoperative time but did obviate the need for postoperative MMF in patients. In this study, the authors describe their institution's method for rigid fixation of IVRO. Additionally, the authors have developed a process for fabricating custom cutting guides to aid in IVRO completion. Utilization of the cutting guides allows for pre-surgical placement of the osteotomy and eliminates the need for direct visualization intraoperatively.

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

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

Complications after mandibular setback with intraoral vertical ramus osteotomies: a retrospective cohort analysis of 133 patients

In the present study, we assessed the rate of complications and morbidity after mandibular setback with bilateral intraoral vertical ramus osteotomy (IVRO). In total, 133 patients were included. The prevalence of neurosensory disturbance (NSD), surgical site infection (SSI), and other complications were registered 2 months and 1 year after surgery. The correlations between complications and age, sex, American Society of Anesthesiologists classification, body mass index, blood loss, and operative time were evaluated. NSD was reported for 6.8% of the patients (9 of 133) 2 months after surgery (3.8% of the operated sites). The prevalence was significantly higher in female patients (P < .05). Two patients described persistent unilateral reduced sensibility after 1 year (1.5%). In total, 0.8% of the operated sites (2 of 266) had persistent NSD after 1 year. None of the patients required prolonged hospitalization, and 95.5% (127 of 133) were discharged the day after surgery. None of the patients experienced severe bleeding, and only 1 patient developed SSI. There were no significant correlations between patient-specific or intraoperative parameters evaluated and registered complications. This study shows that IVRO is a safe surgical technique associated with a low complication rate. IVRO can be an alternative technique for mandibular setback in patients who can tolerate postoperative maxillomandibular fixation.

Efficacy of bioresorbable plates in the osteosynthesis of linear mandibular fractures.

Background and Objectives:There are limited evidences available about the performance of biodegradable system in the treatment of linear mandibular fractures without the aid of postoperative maxillomandibular fixation (MMF). Hence, the present study was planned to evaluate the treatment outcomes in mandibular fractures, using 2.5 mm bioresorbable plates and screws without postoperative MMF.Methodology:This cohort study compares both prospective and retrospective data. The prospective study treated 20 adult patients with linear mandibular fracture using bioresorbable plates and screws, without using postoperative MMF (Group 1). Retrospective data were collected from a previous published study in which patients were treated with bioresorbable plates and screws with 2 weeks postoperative MMF (Group 2) and those treated with metal plates and screws without postoperative MMF (Group 3). Group 1 patients were followed up at 2 and 4 months to evaluate the functional outcomes in terms of fracture mobility, malocclusion, pain, and soft-tissue deformity and compared with its preoperative findings. Further, the treatment outcomes of Group 1, Group 2, and Group 3 were compared among themselves at 2-month follow-up.Results:Group 1 patients showed a significant improvement in the treatment outcomes at 2 and 4-month follow-up. In addition, when 2 months postoperative outcomes were compared among the three groups, no statistically significant difference was observed in the treatment outcomes.Conclusion:Endpoint osteosynthesis can be achieved with the bioresorbable fixation system when used in the treatment of un-displaced linear mandibular fractures, without postoperative MMF. A minor modification of using a lower size osteotomy drill can prevent screw loosening.

Management of Mandibular Fractures Using Locking and Nonlocking Miniplates.

The study proposed to determine the superiority between locking plate and nonlocking miniplate for mandibular fractures (MFs) treatment. A comprehensive electronic search examining Medline-Ovid, Embase, and PubMed databases language without date was performed in February 2018. Inclusion criteria were studies in humans, including randomized controlled trials, controlled clinical trials, with the aim of comparing the 2 techniques. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Thirteen publications were enrolled into the analysis. The results showed that there were significant differences in overall complications (RR, 0.62; 95% CI, 0.351-1.094; P = 0.06), postoperative infection (RR, 0.503, 95% CI, 0.223-1.136) when comparing locking miniplates with nonlocking miniplates in treating mandible fractures. The incidence of malocclusion showed a statistically significant difference in the outcome favoring locking miniplates (fixed: RR, 0.503; 95% CI, 0.125-2.030; P = 0.06). In addition, the use of locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of nonlocking miniplates (RR, 0.414; 95% CI, 0.196-0.872; P = 0.002). The result of meta-analysis revealed that use of locking plate is superior to the nonlocking plate in the reducing of postoperative complication rates in the management of MFs.

Locking Plate System Versus Standard Plate Fixation in the Management of Mandibular Fractures: Meta-Analysis of Randomized Controlled Trials.

The aim of this meta-analysis was to evaluate the efficacy of the 2.0-mm locking miniplate system in comparison with the standard miniplate system in treatment of mandible fractures. A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and PubMed databases, eligible studies were restricted to comparative controlled trials. Inclusion criteria were based on humans randomized controlled trials, controlled clinical trials, with the aim of comparing 2 fixation techniques, namely locking miniplate and standard miniplate (nonlocking miniplate) techniques. In addition, the incidence of complications was evaluated. Nine studies with 380 patients and 551 fracture sites were enrolled into the analysis. The results showed that there were no significant differences in overall complications (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.34-1.22; P = 0.2), postoperative infection (OR, 0.53; 95% CI, 0.23-1.23, P = 0.15), and occlusion discrepancy (P > 0.05) when comparing 2.0-mm locking miniplates with 2.0-mm nonlocking miniplates in treating mandible fractures. However, the use of 2.0-mm locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of 2.0-mm nonlocking miniplates (OR, 0.43; 95% CI, 0.22-0.83; P < 0.0001). Mandible fractures treated with 2.0-mm locking miniplates and standard 2.0-mm miniplates present similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using 2.0-mm locking miniplates also indicates that the 2.0-mm locking miniplate has a promising application in treatment of mandibular fractures.

Three dimensional versus standard miniplate fixation in the management of mandibular fractures: A meta-analysis of randomized controlled trials

The aim of this meta-analysis is to evaluate the efficacy of the 3-dimensional miniplate system in comparison with the standard miniplate system for the treatment of mandibular fractures (MFs). A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and PubMed databases. The primary search objective was to identify all papers reporting the results of randomized control trials (RCTs) for the treatment of adults with mandibular fractures, with the aim of comparing the different techniques. The incidence of complications was evaluated; nine studies including 283 patients with different fracture sites were enrolled in the analysis. The results showed no significant differences in overall complications (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.552–1.542; P = 0.81), postoperative infections (OR, 0.99; 95% CI, 0.40–2.48; P = 0.89), wound dehiscence (OR, 0.96; 95% CI, 0.13–7.37; P = 0.96), paresthesia (OR, 0.47; 95% CI, 0.20–1.07; P = 0.11), or malocclusion (OR, 1.8; 95% CI, 0.39–8.32; P = 0.47) between standard miniplates and 3-dimensional miniplates for treating mandibular fractures. Mandibular fractures treated with 3-dimensional miniplates and standard miniplates presented similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using standard miniplates also indicated that the standard miniplate has a promising application in the treatment of mandibular fractures.

Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients

Objective: This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF).Methods: Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study.Results: Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used.Conclusions: The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.

下顎枝垂直骨切り術術後の呼吸管理用咬合挙上スプリントの考案と応用

Intraoral vertical ramus osteotomy （IVRO） does not achieve internal fixation; therefore, it requires measures to prevent complications from the need for postoperative maxillomandibular fixation （MMF） or strong intermaxillary rubber traction in a short period of time after surgery. We have devised a breathing management splint （BMS） to manage breathing and prevent complications after IVRO. From September 2011, BMS was applied to patients who chose IVRO. In this report, we describe the procedure and management of BMS after IVRO in a typical case and also investigate postoperative nausea and vomiting （PONV） occurrence on BMS application. BMS is used to maintain a gap in the anterior teeth by raising the bite for a few days immediately after surgery. This is one of the methods used to manage problems such as airway obstruction by PONV, difficulty in breathing due to postoperative swelling, and failure of sputum discharge due to MMF, while offering the benefits of IVRO. It uses the benefits of the harmonious relationship formed by adaptive changes in the muscles. The temporomandibular joint is rebuilt once IVRO helps the occlusion to function again after surgery. BMS is also expected to improve the functions of the temporomandibular joint without changing the conventional method. Therefore, it is a highly useful and convenient management method used during MMF, with respect to the patient as well as the medical field.

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.

Miniplate osteosynthesis for mandibular angle fractures--A retrospective comparative study of 3 concepts in a temporal cohort.

Purpose of this retrospective study was to compare fixation of mandibular angle fractures by three different miniplating-concepts (single miniplate, double miniplate, TriLock mandibular angle plate) regarding osteosynthesis failure and hardware removal. In this retrospective study a temporal cohort of 184 patients with 194 simple mandibular angle fractures, which had been treated by open reduction and internal fixation via miniplates at the University Clinic of Cranio-, Maxillofacial and Oral Surgery (General Hospital Vienna) in the period of 2005-2011, were included. Patients with pathologic fractures (e.g. tumour or osteonecrosis related) or comminuted fractures were not considered. 9 of 194 (4.6%) fractures showed osteosynthesis failures. The osteosynthesis failure rates were 2.9% in the single miniplate group, 3.4% in the TriLock plate group, and 11.1% in the double miniplate group. In the double miniplate group 33.3% of the patients had undergone hardware removal, 21.4% in the single miniplate group, and 11.4% in the TriLock plate group. A single 4-hole locking plate with a thickness of 1.25-1.3 mm guarantees for low osteosynthesis failure rates without postoperative maxillo-mandibular fixation and requires less hardware removal in simple mandibular angle fractures. Two miniplates, longer plates with more holes and thicker plates are prone to hardware removal.

A Prospective Study of Strut versus Miniplate for Fractures of Mandibular Angle

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients were randomly assigned to receive the strut plate or Champy miniplate for angle fracture fixation. Patient demographics, fracture characteristics, operative and postoperative outcomes were collected prospectively. Statistical analysis was performed to evaluate the significance of the outcome. A total of 18 patients were included in this study and randomly assigned to receive either the strut plate or Champy miniplate. Out of which five patients were excluded postoperatively due to complex fracture resulting in postoperative maxillomandibular fixation. The final enrollment was 13 patients, N = 6 (strut) and N = 7 (Champy). There was no statistically significant difference in the pretreatment variables. Nine of these patients had other associated facial fractures, including parasymphyseal and subcondylar fractures. Most of the (11) patients had sufficient follow-up after surgery. Both groups exhibited successful clinical unions of the mandibular angle fractures. The complications associated with the mandibular angle were 20% in the strut plate group and 16.7% in the Champy group. One patient in the strut plate group had a parasymphyseal infection, requiring hardware removal. The strut plate demonstrated comparable surgical outcome as the Champy miniplate. It is a safe and effective alternative for management of mandibular angle fracture.

Transoral Miniplate Fixation of Mandibular Angle Fracture with and without 2 Weeks of Maxillomandibular Fixation: A Clinical Trial Study

Background and Objectives The ideal line of osteosynthesis in mandibular angle fractures indicates that a plate might be placed either along or just below the external oblique ridge. Some authors believe that using one miniplate at this line at the mandibular angle region provides sufficient strength to stabilize the fracture but others imply a second plate is required. Such controversies exist in the use of maxillomandibular fixation (MMF). The intention of the present study was to compare efficiency and complications of using one miniplate with and without MMF in mandibular angle fractures. Methods and Materials Forty patients with facial trauma with mandibular angle fractures including displaced and unfavorable fractures were categorized into two groups of 20 persons. In all patients, one miniplate was placed on the external oblique ridge. In the first group, patients had light maxillomandibular elastic bands just after surgery but no rigid MMF. In the second group, patients had rigid MMF for 2 weeks after surgery. Patients were followed to evaluate complications and treatment efficiency. Conclusions Our study showed that use of a single miniplate in the external oblique ridge is a functionally stable treatment for all types of angle fractures (including displaced and unfavorable fractures) except comminuted and long oblique fractures, which were not included in our study. Use of postoperative MMF did not improve the results.

Miniplate Fixation of Fractures of the Symphyseal and Parasymphyseal Regions of the Mandible

To review our experience with miniplate fixation of fractures of the symphyseal and parasymphyseal regions of the mandible. A retrospective review of all mandible fractures treated from July 1, 1999, through July 31, 2011, by one of us (Y.D.) was performed. Intraoral, open rigid fixation of noncomminuted symphyseal and parasymphyseal fractures was performed using a combination of 2 miniplates that were either a 4-hole or a 6-hole miniplate using monocortical screws. The miniplates were 1-mm thick with a 2-mm screw diameter. A total of 218 patients with noncomminuted symphyseal and parasymphyseal mandible fractures were included in this study. Eighteen patients (8.3%) with concurrent panfacial fractures and other indications were left in postoperative maxillomandibular fixation (MMF), whereas 200 patients (91.7%) did not require postoperative MMF. All patients in this series achieved bony union. The following complications were noted: plate exposure, 2.3%; malocclusion, 1.4%; wound infection, 1.4%; and tooth root injury, 0.9%. The use of postoperative antibiotics and either a nonlocking or locking system was not associated with significant differences in the rates of complications. For noncomminuted symphyseal and parasymphyseal mandible fractures, the application of 2 miniplates with monocortical screws offers good surgical outcomes in most patients with minimal complications. The advantages of using miniplates include easy plate adaptability, no need for MMF unless indicated, small screw diameter, and provision of adequate load-sharing rigid fixation for simple, noncomminuted symphyseal and parasymphyseal mandible fractures.

Study of Efficacy of Bioresorbable Plates in the Osteosynthesis of Mandibular Fractures Without Postoperative Maxillomandibular Fixation (MMF)

Study of Efficacy of Bioresorbable Plates in the Osteosynthesis of Mandibular Fractures Without Postoperative Maxillomandibular Fixation (MMF)