Surgical Treatment Of Mandibular Fractures Research Articles

Surgical treatment of mandibular fractures: Review Article

Surgical treatment of mandibular fractures: Review Article

Digitally driven surgical guide planning.

To investigate the role of a fully digital process in the surgical treatment of mandibular fractures in children. We analyzed a complete dataset from 22 children with mandibular fractures treated with digital surgical assistance. The patient's treatment process included preoperative thin layer CT (Computed Tomography) scanning, computer-aided design (3D reconstruction, virtual reduction, and internal fixation device determination and shaping), and 3D printing (jaw model, bite plate). We used occlusal and shaping plates during surgery to assist in fracture reduction and fixation. During the follow-up, we observed the occurrence of fracture healing, occlusal relationships, opening degrees, and complications in pediatric patients after surgery. Next, we used the 3D overlay function of MIMICS software to compare the preoperative surgical design with postoperative jaw imaging data to evaluate the overall surgical effect. The postoperative imaging data showed good fracture healing, normal occlusion during follow-up, and significant improvement in opening degrees. The mean preoperative opening degree was 23.59 ± 2.89 mm, and the mean postoperative opening degree was 29.82 ± 1.79 mm; there was a significant difference between these two parameters (p < 0.05). There were no complications such as tooth germ injury, nerve injury or fracture block displacement. The postoperative mandibular imaging data was imported into MIMICS software for 3D overlay visualization, and the postoperative mandibular morphology recovery was well-matched with the preoperative design. We measured the average upper deviation (0.65 ± 0.09) mm and the average lower deviation (-0.57 ± 0.14) mm. The fully digital process has a precise, minimally invasive, and safe effect in the surgical treatment of mandibular fractures in children, and the clinical effect is satisfactory.

Tomographic Evaluation of Bone Height Between the Mandibular Canal and the Inferior Cortex of the Mandible Related to Bicortical Screws Fixation

Study Design: Original Article. Objective: The surgical treatment of mandibular fractures has undergone several changes over the past 100 years, since the use of wires and intermaxillary fixation, until today where most of the fractures are treated with internal fixation using plates and screws. For the correct use of this hardware, the surgeon must have adequate knowledge of jaw anatomy to prevent complications during the insertion of screws like in fractures of the mandibular body and angle, when the screws of the plate installed in the compression zone can damage the inferior alveolar nerve within the mandibular canal. Methods: To minimize this complication, 66 hemimandibles of adult patients were analyzed in CT scans and manipulated with Dental Slice® software, (BioParts®, Brazil) and measured the shortest distance from the inferior cortex of the mandibular canal to the inferior cortex of the mandibular body during the path of the inferior alveolar nerve, since the mandibular foramen until the mental foramen. Results: The result obtained showed a wide variation of the shortest distance measured (3.52 mm–11.5 mm) with an average of 7.99 mm. Conclusion: The conclusion demonstrated a minimum distance of 3.52 mm below the cortical mandibular canal to the lower border of the mandible and should be considered as a safety margin during the application of fixing the material in the region of the mandibular body.

Trends in Maxillomandibular Fixation Technique at a Single Academic Institution.

Retrospective chart review. Restoration of premorbid occlusion is a key goal in the treatment of mandibular fractures. Placement of the patient in maxillomandibular fixation (MMF) is performed during mandibular fracture repair to help establish occlusion. A number of techniques are available to achieve MMF. We sought to examine trends in MMF technique at our institution. A retrospective chart review was conducted to evaluate patients who underwent surgical treatment of mandibular fractures between January 1, 2011 and March 31, 2021. Data including fracture characteristics, mechanism of injury, patient demographics, complication rates, and MMF technique utilized were collected. One hundred sixty-three patients underwent MMF (132 males). The most common etiology of fracture was assault (34%). There was an increasing preference for rapid MMF techniques over time, as opposed to standard Erich arch bars. No significant difference in obtaining adequate fracture reduction as determined by postoperative imaging or complications were noted between those who underwent MMF with newer rapid techniques vs traditional MMF techniques. Our institution has demonstrated changing trends in the technique utilized for establishing occlusion intraoperatively, more recently favoring rapid MMF techniques, with similar rates of complications and ability to adequately reduce fractures.

Analysis of the risk factors influencing complications in surgical treatment of mandibular fractures: A retrospective study

The study aim was to identify risk factors associated with complications following open reduction and internal fixation of mandibular fractures.A retrospective cohort study was conducted in patients who were treated for mandibular fractures in a single center between January 2010 and December 2020. Authors classified postoperative complications as overall complications, infections, and reoperations. Factors that may be associated with these complications were grouped as patient, wound, and management variables. Statistical analysis was performed to determine whether these factors influenced complications.Among 175 patients, 125 underwent open reduction and internal fixation. Among patient variables, alcohol consumption was a risk factor for overall complications (p = 0.03) and reoperation (p = 0.02). Among wound variables, the more severe the external wound, the greater the incidence of overall complications (p = 0.001) and infections (p < 0.001). Presence of two or more fracture sites was a risk factor for reoperation (p = 0.038). Among management variables, intraoral and extraoral approaches increased the rates of overall complications, infections, and reoperation. In the multivariate analysis, only intraoral and extraoral approaches were associated with significant risks for overall complications (OR = 5.63, p = 0.017) and infections (OR = 11.53, p = 0.005).Alcohol consumption, external wound severity, multiple fracture site, and incision approach were related to postoperative complications. These findings can help guide surgical decisions and manage patient expectations after surgery.

Optimization of surgical treatment of mandibular fracture in children with a variable bite

Children aged 6 to 12 are characterized by increased activity, begin to engage in active sports and this increases the risk of traumatic injuries of the facial skeleton. Among such lesions, fractures of the mandible rank first. Using acrylic mandibular splints and mandibulomaxillary fixation are considered to be a traditional method of treating mandibular fractures in children. In the period of variable occlusion due to physiological changes of teeth, caries and its complications, loss of teeth due to traumatic injuries and unexpressed equatorial teeth, mandibulomaxillary fixation is difficult or impossible and using acrylic mandibular splints is ineffective when line of fracture goes out of dental arc. Due to these and other circumstances, there is a need for open reposition and internal fixation of fragments with miniplates. Children have a risk of damage to the rudiments and roots of permanent teeth or mandibular canal when miniplates are fixed with screws. In order to prevent complications in the surgical treatment of mandibular fractures during variable occlusion in children, we analyzed cone-beam computerized tomograms and identified areas for safe fixation of screws, established a safe depth of immersion of screws in bone tissue.

Surgical treatment of mandibular fracture resulting from first molar extraction: case report

Extraction is one of the most common procedures performed by dental surgeons in their daily clinical practice. Among the trans and postoperative complications associated with this procedure can be mentioned the occurrence of trismus, infections, edema, alveolitis, paresthesia or fractures. The purpose of this study was to report a clinical case of a mandibular fracture associated with first molar extraction, approaching its main risk factors and treatment. Patient JSS, 24 years old, female, was referred to the service of Maxillofacial Surgery due to complications resulted from the extraction of element 36. On physical examination, was observed the presence of fragment mobility, communication of bone tissue with the oral environment and pain complaint was reported by the patient. Computed tomography showed the presence of a fracture in the region of the mandibular body on the left side. The planned surgical proposal was the intraoral debridement of bone fragments, extraoral access in the base of the mandible, fixation of the fracture with plate 2.4 and intraoral and extraoral access suture. During the surgical procedure, it is of great importance that the dental surgeon be aware to the signals emitted by the patient, such as clicks associated with severe pain, profuse bleeding or crackling as these symptoms may be the result of mandibular fracture. When any of these signs are found during the operation, the professional must investigate the occurrence of a possible fracture. It is concluded that in addition to performing a good preoperative evaluation, the dental surgeon must carry out a correct planning of the surgical act based on the basic principles of the surgical technique.

Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures.

Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits. A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus). Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture. The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.

REHABILITATION IN MAXILLOFACIAL SURGERY AND DENTISTRY AFTER FRACTURE OF THE MANDIBLE

Fractures of the mandible are very common injuries, so modern authors are widely developing the latest approaches to surgical treatment of these types of injuries, as well as approaches to postoperative recovery of patients. Physical rehabilitation and therapy of persons after surgical treatment of mandibular fractures is of paramount importance in the process of recovery of patients, as it helps to restore lost functions and promotes the fastest recovery. In order to restore the process, special individual rehabilitation programs are developed, which depend on the nature of the injury, the patient’s condition and the methods used in the treatment process. In recent years, there has been a tendency to increase the number of patients with fractures of the facial skeleton, and to complicate the nature of injuries due to a combination of injuries to the face and other parts of the body as a result of transport, street, occupational, sports and domestic injuries. The article investigates approaches to the treatment and rehabilitation of patients after mandibular fracture. In particular, the features and types of mandibular fractures in maxillofacial surgery and dentistry are noted, the causes of their occurrence, methods of diagnosis and treatment are considered. It is noted that a very important stage of treatment and recovery of the body after fractures of the mandible is the physical rehabilitation of patients. Physical rehabilitation programs are developed individually depending on the nature of the fracture, and the characteristics of the patient’s body, usually the physical rehabilitation program includes exercise therapy, massage, mechano- and physiotherapy. It is noted that a professionally developed individual rehabilitation program has a positive effect on the patient’s condition and accelerates the process of recovery and recovery, so the issues explored in the article are relevant.

Endoscopic Removal of a Migrated Fragment of Wire used for Intermaxillary Fixation in Surgical Treatment of Mandibular Fracture

Endoscopic Removal of a Migrated Fragment of Wire used for Intermaxillary Fixation in Surgical Treatment of Mandibular Fracture

Predictors of Adverse Outcomes in the Management of Mandibular Fractures.

Mandibular fractures are the most common isolated facial fractures in the United States. Various risk factors have been associated with increased rates of postoperative complications. However, national outcome reports are limited and data are conflicting. Using a national multi-institutional database, the authors sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation. Retrospective review of the American College of Surgeons National Surgical Quality Improvement database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015 using current procedural terminology codes. Primary outcomes included: wound complications, overall complications, as well as readmission and reoperation rates. Multivariate regression analysis was performed to adjust for confounders. A total of 953 patients were eligible for analysis. Mean patient age was 34.5 years, 84% were males, and 50% were active smokers. Wound complications, overall complications, 30-day reoperation, and readmission occurred in 4.0%, 7.9%, 2.2%, and 33% of patients, respectively. Age was a significant risk factor for 30-day readmission (odds ratio [OR] = 1.06, P = 0.01), reoperation (OR = 1.05, P = 0.01), and overall complications (OR = 1.03, P = 0.02) on multivariate analysis, and smoking was a significant risk factor for 30-day reoperation (OR = 4.86, P = 0.03). The analysis identified age as an independent risk factor for readmission, reoperation, and overall complications. Smokers were also nearly 5 times as likely to undergo additional surgery. This is particularly important given that over half of patients were active smokers, highlighting the importance of perioperative patient education and smoking cessation within this population.

Abstract: Predictors of Adverse Outcomes in the Management of Mandibular Fractures: An Analysis of 953 Cases

PURPOSE: Mandibular fractures are the most common isolated facial fractures in the United States and often require surgical treatment with open reduction and internal fixation to prevent infection and promote adequate bone healing. Various clinical risk factors have been associated with increased rates of postoperative complications, including smoking, substance abuse, and surgical approach. However, national outcomes reports are limited, and data are conflicting. Using a national multi-institutional database, we sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation. METHODS: Retrospective review of the American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015. Case distribution was based on available CPT codes and included open treatment of mandible fracture with external fixation (21454), open treatment of mandible fracture with and without interdental fixation (21462, 21461), and open treatment of complex fractures involving multiple approaches (21470). Preoperative demographic data and postoperative outcomes were analyzed. Primary outcomes included: wound complications (superficial surgical site infection (SSI), deep SSI, and wound dehiscence), overall complications (wound complications and/or medical complications), as well as 30-day readmission and reoperation rates. For risk factors significant on univariate analysis, multivariate analysis was performed to control for confounders. RESULTS: Review of the database identified 953 eligible patients who underwent surgical treatment of mandibular fractures. Mean age was 34.5 years and 84% of the cohort was male. Fifty percent of patients were active smokers. Wound complications occurred in 38 patients (4.0%) and the overall complication rate was 7.9%. The 30-day reoperation and readmission rates were 2.2% and 3.3%, respectively. Multivariate analysis demonstrated age to be a significant risk factor for 30-day readmission (OR = 1.06, p=0.01) and reoperation (OR = 1.05, p=0.01), as well as overall complications (OR = 1.03, p=0.02). Additionally, active smoking was a significant risk factor for 30-day reoperation (OR = 4.86, p=0.03). The odds of readmission for smokers was more than 3 times higher than non-smokers (OR=3.25; 95% CI 0.93–11.43); however, this approached but failed to reach our threshold for statistical significance (p=0.07). CONCLUSION: Our analysis demonstrates that surgical treatment of mandibular fractures can be performed safely and with low rates of wound and overall complications. However, increased age is an independent risk factor for readmission, reoperation, and overall complications. Active smoking was also found to be an independent risk factor for reoperation, with active smokers nearly five times as likely to undergo additional surgery. This is a particularly important finding given that over half of all mandibular fracture patients in our nationwide study were active tobacco users, highlighting the importance of patient education and smoking cessation in the perioperative period within this population.

A Comparative Assessment of Postoperative Analgesic Efficacy of Lornoxicam versus Tramadol after Open Reduction and Internal Fixation of Mandibular Fractures.

Pain after any surgical procedure is inevitable but can be controlled by administration of analgesics in most cases. Postoperative pain after surgical treatment of mandibular fractures can be treated by nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The purpose of this study is to critically compare the postoperative analgesic efficacy of small doses of intravenous TRAMADOL (opioid analgesic) versus LORNOXICAM (NSAID) in patients with mandibular trauma undergoing open reduction and internal fixation (ORIF) and to assess the presence of any adverse effects due to NSAID or opioid use. Forty adult ASA grade I-II patients with mandibular trauma, scheduled for ORIF under general anesthesia in the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, were selected for the study. The patients were randomly assigned into a tramadol group (Group T) and a lornoxicam group (Group L) and were administered intravenous tramadol 50 mg and intravenous lornoxicam 8 mg, respectively, at specific postoperative intervals. Pain intensity was quantitatively assessed at the 2nd, 4th, 6th, 12th, and 24th postoperative hours using a visual analog scale of 10 cm. Adverse effects of the analgesics were also recorded and compared. Both the drugs resulted in a significant decrease in pain intensity from 2nd to 24th postoperative hours, but better pain control was observed in Group L at 24th postoperative hour. Only two patients experienced nausea and vomiting in Group T and one patient experienced gastric acidity in Group L. The comparative results clearly demonstrate that pain control by intravenous lornoxicam is significantly better than by intravenous tramadol at 24th postoperative hour after ORIF of mandibular trauma. Side effects produced by both the drugs were minor and had no apparent effect on the study results.

Mandible Fracture Complications and Infection: The Influence of Demographics and Modifiable Factors

Mandible fractures account for 36 to 70 percent of all facial fractures. Despite their high prevalence, the literature lacks a comprehensive review of demographics, fracture patterns, timing of management, antibiotic selection, and outcomes, particularly when evaluating pediatric versus adult patients. The authors aim to determine the complication and infection rates after surgical treatment of mandibular fractures and the bacterial isolates and antibiotic sensitivities from mandible infections after open reduction and internal fixation at their institution. Data were collected retrospectively for all mandible fractures treated at the authors' institution between 2003 and 2013. Patients were divided into pediatric (younger than 16 years) and adult (16 years or older) subgroups. Demographics, fracture location, fracture cause, comorbidities, antibiotic choice, and subsequent complications and infections were analyzed. Data were evaluated using appropriate statistical tests for each variable. Three hundred ninety-five patients were evaluated. Demographics and fracture cause were similar to those reported in current literature. Of the 56 pediatric patients, complications occurred in 5.6 percent. Time from injury to operative intervention did not affect outcome. The complication rate was 17.5 percent and the infection rate was 9.4 percent in the adult subgroup. Time from injury to operative intervention, sex, and edentulism were not significant predictors of complication or infection. Tobacco use, number of fractures, number of fractures fixated, and surgical approach were predictors of complication and infection. Perioperative ampicillin-sulbactam had a significantly lower risk of infection. Certain demographic and operative factors lead to significantly higher risks of complications after surgical management of mandibular fractures. Ampicillin-sulbactam provides effective antibiotic prophylaxis. Risk factor modification may improve outcomes. Risk, IV.

Health-related quality of life after surgical treatment of mandibular fracture

We evaluated health-related quality of life (HRQoL) before and after surgical treatment of mandibular fracture and assessed patients' perceptions of the esthetic and functional outcomes of surgery. We established a prospective study of adult patients who were to undergo open reduction and rigid fixation of mandibular fracture. Of the patients, 49 met the inclusion criteria, and of these, 45 agreed to participate. HRQoL was measured with the generic 15-dimensional (15-D) instrument, and patients' satisfaction was assessed with an additional questionnaire. The average preoperative 15-D score among patients (0.891) was significantly lower than that in the general population (0.964) (P < .01). Patients were worse off on 9 of the 15 dimensions of HRQoL; however, at 3 months following surgery, all dimensions had improved to the level observed in the general population. HRQoL is significantly reduced after mandibular trauma but improves in a few months after surgery. Sensory disturbance is the most significant disadvantage of the surgery.

Influence of perioperative dexamethasone on delayed union in mandibular fractures: A clinical and radiological study.

BackgroundThe aim was to clarify the occurrence of delayed union after surgical treatment of mandibular fracture and investigate whether an association exists between perioperative use of dexamethasone and delayed union.Material and MethodsThirty-seven patients were included in a prospective randomized study. Of these patients, 19 (51.4%) were randomized to receive a total dose of 30 mg of dexamethasone and 18 (48.6%) served as controls. Patients underwent clinical and radiological investigation immediately, one month, three months and six months postoperatively. Radiographs were evaluated by an experienced, blinded senior oral radiologist.ResultsDelayed fracture union was found in 9 patients (24.3%). It was associated significantly with angle fractures (p=0.012). Delayed union occurred more frequently in patients who received dexamethasone (36.8%) than in those who did not (11.1%) (p=0.068). The association of infection with delayed union was significant (p=0.027). Moreover, dexamethasone was significantly (p=0.019) associated with delayed fracture union with concomitant infection. Gender, age group, smoking habit, treatment delay and duration of surgery were not associated with delayed union.ConclusionsInfection was associated with delayed union. Short-term high-dose dexamethasone predisposed to complicated fracture union, especially in patients with angle fractures. The relationship between dexamethasone and delayed bone healing without infection remains unresolved. Key words:Mandibular, radiology, fracture union, dexamethasone.

Effect of surgical treatment of mandibular fracture: electromyographic analysis, bite force, and mandibular mobility.

This study aimed to examine individuals undergoing surgery for the treatment of the fractured mandibular angle, using bite force, mandibular mobility, and electromyographic (EMG) analysis in many different clinical conditions, after 2 months postoperatively. Bite force was recorded with a digital dynamometer, model IDDK. The EMG activity (Myosystem-Br1) included the analysis of the masseter and temporal muscles. Mandibular mobility was measured using a digital pachymeter. The subjects were divided into 3 groups: G1, mandibular angle fracture (n = 7); G2, condylar process fracture (n = 5); and G3, control (n = 12). Data were tabulated and submitted to statistical analysis using the repeated-measure test carried out over time and the Student's t-test (P < 0.05), using the Statistical Package for the Social Sciences software, version 19 (SPSS Inc, Chicago, IL). G1 and G2 had an increase in bite force. In G1, there was a regular decrease in the EMG activity in the second postoperative month. G2 presented an irregular pattern in EMG data during the period tested. Regarding the mandibular mobility, both groups obtained amplitude of all mandibular movements with a high percentage, when compared with control. A good functional recovery was achieved by the individuals who had a mandible angle fracture or condylar process fracture, after 2 postoperative months.

Peculiarities of Employment of Polymeric Miniplates for Mandibular Osteosynthesis: A Preliminary Study

Searching for new materials for bone substitution, fixation, and reconstruction is a challenging task that attracts scientists and researchers of different fields of medicine. During the last few decades, much interest has been paid to polymeric materials, polyethylene in particular. The aim of this study is to present generalizations about our own experience in the employment of polyethylene miniplates for the surgical treatment of mandibular fractures. Ninety patients with 139 uni- and bilateral mandibular fractures in different locations were involved. Treatment modalities included open reduction and internal fixation with self-made polyethylene miniplates of straight, T-shaped, Y-shaped, and X-shaped configurations and titanium screws. In 88 (97.8%) cases of surgical treatment of mandibular fractures using polymer miniplates, good anatomical and functional results were achieved. Regardless of the necessity for improvement of some mechanical properties of polyethylene, the results obtained in our clinical investigation allow us to recommend polyethylene miniplates for routine practice.

Prospective study of postoperative sensory disturbances after surgical treatment of mandibular fractures

This present study's purpose is to evaluate the degree of paresthesia and recovery of inferior alveolar nerve in patients with mandible fractures who underwent surgical treatment. Nineteen patients were evaluated (27 hemimandibles) at six different times: preoperative (T1), postoperative 1 week (T2), postoperative 1 month (T3), postoperative 3 months (T4), postoperative 6 months (T5), and postoperative 1 year (T6). Subjective and objective methods were used for this evaluation. The results were analyzed using likelihood ratio chi-square test for the hypothesis of no association between indicators of sensitivity and responses to the questionnaire, and the Cochran-Mantel-Haenszel test for equality hypothesis. All objective tests showed a statistically significant worsening in sensitivity at T2 (p < 0.0001) and a significant improvement after T4 (α < 0.05). The subjective tests showed an association with the objectives tests, and improvement in sensitivity after T4 (p < 0.0001) was noted. The first postoperative week is the period in which there are major changes with respect to sensitivity, and after 3 months postoperatively, the recovery reaches its apex with little difference observed after this period. In this research 100 % of the patients analyzed recovered all sensibility until T6.

Assessment of the marginal mandibular nerve function after Risdon approach

Detailed knowledge of the anatomy of the facial nerve and its branches, especially the marginal mandibular, is of fundamental importance in surgical treatment of mandibular fractures by making use of the Risdon surgical approach, avoiding possible injury which may lead to partial or total incapacity of the motor function. The aim of this study is to evaluate the function of the marginal mandibular branch of facial nerve after surgical treatment of mandibular fractures by access type Risdon. 44 patients with fractures of the mandibular body and angle, and the marginal mandibular nerve function being analyzed through visual inspection based on the rating scale in House-Brackmann facial nerve, in the preoperative and postoperatively (24 h). Patients who had some degree of dysfunction within 24 h were reassessed during 01 week, 01 month and 03 months postoperatively. Of all patients studied, thirteen (29.55%) had some degree of dysfunction in a postoperative day and thirty one (70.45%) patients had normal function at that time, being females the most affected ones (71.43%). At the end of the third month, 91% of patients had grade I (normal) on the rating scale, and 9% had grade II (mild dysfunction). Thus we can conclude that the majority of patients tested showed normal function of the marginal mandibular nerve at all times postoperatively, with mild dysfunction found most frequently and at the end of the study, patients who still had dysfunction, this one was showed in a milder degree, demonstrating safety in the Risdon approaches performed.