Fractures of angle of mandible - A retrospective study

Isolated bilateral mandibular angle fractures: an extensive literature review of the rare clinical phenomenon with presentation of a classical clinical model

Bilateral angle fractures are a rare clinical phenomenon in contrast to the incidence of unilateral angle fractures. However, the rarity has garnered less attention in spite of the uniqueness of fracture pattern and distinctive biomechanics. This article is a detailed review on the etiology, clinical presentation, and management of bilateral angle fractures with the presentation of an interesting case. The bilateral angle fracture reported is a untreated, malunited fracture representing an ideal clinical model to study its biomechanics. The clinical features were anterior open bite, increased facial height, and temporomandibular joint tenderness. The management included osteotomy at the malunion and miniplate osteosynthesis. Bilateral angle fracture presents mandible in three independent fragments (left angle, right angle, and intermediate corpus), each with strong muscles acting in different vectors. This makes the fracture vulnerable to severe displacing forces and unfavorable to achieve the optimal reduction, stability, and healing. This necessitates comprehension of the biomechanical forces involved to avoid malunion following fixation. The article details the complex biomechanics of mandibular angle and its clinical implications in the rare event of bilateral angle fractures. It describes the necessity for a systematic approach and ideal osteosynthesis principles to achieve maximal treatment outcomes and minimal complications.

A Clinical Study of Mandibular Angle Fracture

PURPOSE

To establish management protocol for mandibular angle fracture, we describe pertinent factors including cause, impacted third molar and recent treatment tendency.

METHODS

We examined the records of 62 patients who had unilateral mandibular angle fracture. Sixty patients who had open reduction surgery were examined at postoperative weeks 1, 4, 8, 12, and 28.

RESULTS

Left mandibular angle fracture is frequent in younger males. Presence of the mandibular third molar can increase fracture risk. Because of attached muscle, favorable fractures occurred primarily in the mandibular angle area.

CONCLUSION

Extracting the mandibular third molar can prevent angle fractures, and open reduction with only one plate adaptation is generally the proper treatment method for mandibular angle fracture.