A Prospective Study of 3 Treatment Methods for Isolated Fractures of the Mandibular Angle

Lower Insertional Torque of Fixation Screws for Mandibular Angle Fractures Is Associated With Complications

BACKGROUND

Open reduction and internal fixation (ORIF) is a common treatment for mandibular angle fractures. It is unknown, however, whether the insertional torque of the fixation screws is a risk factor for postoperative complications.

PURPOSE

The purpose of the study was to determine the association between fixation screw insertional torque and postoperative inflammatory complications (POICs).

STUDY DESIGN, SETTING, SAMPLE

The authors conducted a prospective cohort study consisting of all adult patients treated with ORIF of mandibular angle fractures using a single six-hole lateral border plate secured with monocortical screws from January 1, 2020, to October 31, 2022, at a large, urban academic hospital. Patients with gunshot wounds, prolonged maxillomandibular fixation, and bilateral angle fractures were excluded.

PREDICTOR VARIABLE

The predictor variables were the average and lowest insertional torque of the six screws placed for fixation during ORIF.

MAIN OUTCOME VARIABLE

The outcome variable was the presence of POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation.

COVARIATES

Demographics, medical history, mechanism, diagnosis, and treatment-related variables were also analyzed.

ANALYSES

Descriptive and bivariate analyses were performed. A P value of ≤ .05 was considered significant.

RESULTS

There were 51 patients included in the study, 37 (72.5%) men, with a mean age of 31.2 ± 10.1 years. POICs occurred in 15.7% of patients. The average insertional screw torque was 46.9 ± 7.8 Ncm, and the mean lowest insertional screw torque per plate was 34.3 ± 10.2 Ncm. The average torque values were not lower in patients who had POICs versus those who did not (45.0 ± 8.6 Ncm vs 48.4 ± 7.6 Ncm, respectively, P = .16). However, the lowest torque value was less in patients who had POICs compared to those who did not (27.5 ± 11.0 Ncm vs 35.6 ± 9.7 Ncm, respectively, P = .04).

CONCLUSION AND RELEVANCE

Among patients with mandibular angle fractures treated with ORIF, decreased insertional torque for the lowest of the six screws placed for fixation was associated with complications. While previous studies have shown certain plating schemes have been associated with complications, the quality of fixation also plays a role.

Clinical results of two different three-dimensional plate types for the treatment of mandibular angle fractures: a retrospective analysis

OBJECTIVES

The purpose of this study was to compare two different designs of three-dimensional osteosynthesis plates for their suitability in the treatment of mandibular angle fractures in terms of sufficient fracture healing and concomitant complications.

MATERIALS AND METHODS

Retrospectively a total of 54 patients with 56 mandibular angle fractures were evaluated. Two different types of three-dimensional plates from the Medartis Trilock system were analyzed: (A) Square design plate (☐-plate) with a thickness of 1.0 mm, and (B) triangular-shaped 3D-plate (△-plate) with a thickness of 1.3 mm. Patient demographics, fracture mechanism and intraoperative details were recorded during an average follow-up period of 1 year.

RESULTS

The utilization of △-plates was observed to entail a considerably lengthier surgical time in contrast to ☐-plate systems (P = 0.037). The application of △-plate showed a tendency of higher incidence of major complications than ☐-plate (P = 0.06), as evidenced by the occurrence of non-union in 2 out of 22 cases, resulting in higher surgical revision rate for △-plate (P = 0.027).

CONCLUSION

Sufficient treatment of mandibular angle fractures is feasible by using 1.0 mm thick, square shaped three-dimensional plate systems. The use of thicker three-dimensional osteosynthesis plates seems to significantly increase the operating time and complication rates, whereby the geometry of the plate seems to have an influence.

CLINICAL RELEVANCE

The plate design could have an impact on treatment outcomes of mandibular angle fractures.

TRIAL REGISTRATION NUMBER

Not applicable.

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

BACKGROUND

Mandibular angle fractures (MAF) have a recognized complexity of treatment and an increased risk of incurring complications.

METHODS

This retrospective study included 45 consecutive patients who were diagnosed with an isolated MAF and no other facial fractures. The average age was 27.3 (SD = 7.7).

RESULTS

A comparatively low rate of complications (11.1%) and a low rate of reoperation (1.8%) are reported, along with a significant role of smoking in complications (p = 0.022). A non-significant association was noted between complications, male gender and assault as an aetiological factor.

CONCLUSIONS

Review of the data from this study confirms that complication rates for patients attending the National Maxillofacial Unit are similar to or better than that of international studies. An overview of the aetiology of fracture complications is included.

A Finite Element Analysis of Single, Double & Matrix Miniplate in Fracture of the Mandibular ANGLE Region: An In Vitro Study

Purpose

To evaluate and compare the efficacy of three osteosynthesis systems in fixation of mandibular angle fractures using Finite Element Analysis.

Materials and Methods

In this study, we used a three-dimensional finite element analysis to assess the stress, deformation and strain in three different groups with bite force loads. A three-dimensional finite element model of the mandible with three different plating techniques using modelling software 'Solidworks2018' and was analysed for stress, deformation and strain produced in the bone following biting loads of different magnitude using analysing software 'ANSYS Workbench'.

Results

In this study, we found out that the tensile forces in the matrix miniplate with vertical struts were well distributed in the cortical and cancellous bone on comparison with other two fixation systems in fixation of the mandibular angle fracture and therefore prevents lateral displacement, torsion and bending. The matrix miniplate system revealed less displacement of the fracture segments as compared to the other two plating systems.

Conclusion

The use of matrix miniplate for the treatment of mandibular angle fractures can be considered efficacious. The stress transferred onto the cortical & cancellous bone is least in the matrix plate leading to better stability of the fixation system.

Stability and Clinical Outcomes of Angle Fracture Fixation Using Sagittal Split Plate (SSOP) Versus Two Miniplates: Randomized Clinical Trial

The aim of this study was to compare the stability and clinical outcomes between the two miniplates and sagittal split plate (SSOP) in angle fracture fixation. Thirty-eight patients with a mandibular angle fracture were selected and divided randomly into two groups. Intervention was treated with SSOP, and the control group was treated with conventional two miniplates. Clinical evaluation included occlusion, edema, nerve affection, wound dehiscence and mouth opening. Radiographic parameters included the measurement of inter-ramus distance, inter-mental distance and bone density. All clinical parameters were evaluated at one week, one month and three months intervals. Radiographic parameters were evaluated immediately postoperative, and after three months. Results showed that SSOP had less postoperative complications (10.50%) than the two miniplates (31.60%). It can be concluded that both methods offered high performance in management of mandibular angle fractures. However, SSOP group had a significantly shorter operating time, increased bone density and less edema. Clinical trial registration number: NCT03839368.

Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial)

Background

Mandibular angle is the most common site for fractures, accounting for 23-42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture.

Materials and Methods

This prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior-inferior miniplate fixation. The patients were then followed up for one year postoperatively.

Results

It showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively.

Conclusion

CAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes.

Trial Registration

It was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.

Finite element analysis of 3D-printed personalized titanium plates for mandibular angle fracture

This paper discussed the size of 3 D-printed personalized titanium plates that can gain maximum stability of mandibular fracture and minimize stress shielding through finite element analysis. A 3 D virtual model of mandible with mandibular angle fracture was created from the CT data of patient. 3 D-printed personalized titanium plates varying in length and thickness were designed, and finite element analysis was performed under different loading conditions and fracture healing periods. After that, the stress distribution and deformation of the mandible with gonial fracture could be observed, and the stress shielding rate could be obtained. Finally, SPSS21.0 was used for statistical analysis. The results of finite element analysis indicated that as the thickness of titanium plates and the healing time decreased, the maximum displacement increased, under a certain condition in which the pore size, the width, the hole distance and the bridge spacing were 2.0 mm, 4.0 mm, 6.0 mm, 12.0 mm, respectively. What's more, in this condition, the thicker the titanium plate and the shorter the healing time were, the higher the stress shielding was at central occlusion. When the thickness of the personalized 3 D-printed titanium plate was 1.0 mm, the maximum displacement tended to be stable and the stress shielding was minimized. It can not only improve the bone stability after tension band fixation, but also minimize the stress shielding, which is expected to expand the indications of tension band fixation.

Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review

Study Design

Systematic review.

Objective

There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation.

Methods

PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II).

Results

Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (P = .043).

Conclusions

For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.

Application of Anatomically Designed 2-Dimensional V Plate in Management of Mandible Fracture: A Pilot Study

Background

Mandible is the only mobile facial jaw bone and it aides in various functions such as phonation and mastication. Therefore, management of mandible fracture becomes inevitable due to its functional and anatomical importance. Fracture fixation methods and techniques have steadily evolved with various osteosynthesis systems. In this article, we discuss the management of mandible fracture using a newly designed two-dimensional (2D) hybrid V-shaped plate.

Purpose

In this paper, we have evaluated the efficacy of the newly developed 2D V-shaped locking plate in the management of mandibular fractures.

Method

We have assessed 12 cases of different mandibular fractures ranging from symphysis, parasymphysis, angle and subcondylar region. Treatment outcome was assessed both clinically and radiologically at regular intervals with various intraoperative and postoperative parameters.

Result

Results of this study suggest that fixation of mandible fracture with the 2D hybrid V-shaped plate facilitates anatomic reduction and functional stability and carries a low morbidity and infection rate.

Conclusion

The 2D anatomic hybrid V-shaped plate can be a suitable alternative to conventional miniplate and 3D plates as it offers satisfactory anatomic reduction and functional stability. Positioning the plate in relation to the mental nerve and plate adaptation along the angle region are much easier.

One miniplate versus two miniplates in the fixation of mandibular angle fractures. An updated systematic review and meta-analysis

PURPOSE

The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures.

METHODS

A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed.

RESULTS

Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I²=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I²=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I²=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I²=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I²=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I²=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I²=29.33%) were statistically significantly higher in the two miniplates arm.

CONCLUSION

One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.

Macaca mulatta is a good model for human mandibular fixation research

Biomechanical and clinical studies have yet to converge on the optimal fixation technique for angle fractures, one of the most common and controversial fractures in terms of fixation approach. Prior pre-clinical studies have used a variety of animal models and shown abnormal strain environments exacerbated by less rigid (single-plate) Champy fixation and chewing on the side opposite the fracture (contralateral chewing). However, morphological differences between species warrant further investigation to ensure that these findings are translational. Here we present the first study to use realistically loaded finite-element models to compare the biomechanical behaviour of human and macaque mandibles pre- and post-fracture and fixation. Our results reveal only small differences in deformation and strain regimes between human and macaque mandibles. In the human model, more rigid biplanar fixation better approximated physiologically healthy global bone strains and moments around the mandible, and also resulted in less interfragmentary strain than less rigid Champy fixation. Contralateral chewing exacerbated deviations in strain, moments and interfragmentary strain, especially under Champy fixation. Our pre- and post-fracture fixation findings are congruent with those from macaques, confirming that rhesus macaques are excellent animal models for biomedical research into mandibular fixation. Furthermore, these findings strengthen the case for rigid biplanar fixation over less rigid one-plate fixation in the treatment of isolated mandibular angle fractures.

An In vitro study of biomechanical comparison between titanium 4-hole 3D plates and titanium conventional 4-hole miniplates for internal fixation of mandibular angle fractures

Background

Fracture fixation, in the present times, is classically done using mini plates. The position and number of plates to fixate a mandibular angle fracture have been and are still extensively researched and reported in the literature. A more recent addition is 3D mini plates.

Aim

To compare and evaluate the biomechanical behavior of one 2.0 mm titanium 3D miniplate fixation plate (4- hole) and one 2.0 mm titanium 4-hole miniplate in internal fixation of mandibular angle fractures.

Objective

To measure load at break, maximum load, and displacement at maximal load for internal fixation done with 3D mini plates and conventional mini plates respectively.

Methods

Five dry cadaveric mandibles were sectioned into 10 hemi-mandibles. Each cadaveric mandible was sectioned at the angle of mandible to simulate unfavorable mandibular angle fracture. The obtained hemimandible were divided into experimental groups (GROUP 1 and GROUP 2) with 5 samples in each group, plated with a linear miniplate and 3D miniplate respectively. Maximal load, Load at break, and displacement at maximum load were the only obtained parameters for comparison.

Results

Conventional miniplate showed greater mean maximum load values of 174.93 N±54.45 compared to 3D mini plates which recorded a mean maximum load value of 106.96 N ± 23.86. Load at break and displacement at maximum load were found to be both insignificant.

Conclusion

The results in this study showed statistically no significant difference with any of the above parameters except maximal load, between the two groups evaluated. Conventional linear miniplate according to Champy's lines of osteosynthesis can be used successfully for providing satisfactory osteosynthesis with the definitive advantage of cost-effectiveness.

Medial Epicanthoplasty With the Classic and Modified Skin Redraping Method: A Retrospective Case Control Study

ABSTRACT

The skin redraping method for medial epicanthoplasty is characterized by some shortcomings which warrants modification. In this study, clinical data of 193 patients who underwent medial epichanthoplasty by the modified skin redraping technique or the classic skin redraping technique were reviewed retrospectively. The patients underwent operation between May 2018 and June 2020 and were followed up for not less than 6 months. Interepicanthal distance , interpupillary distance, patient satisfaction, and postoperative complications were evaluated. In terms of interepicanthal distance/interpupillary distance ratio (P > 0.05) and satisfaction score (P = 0.759), the modified skin redraping technique and the classic skin redraping technique were similar. In the classic skin redraping group, there were 3 cases of visible scarring in the lower eyelid, corresponding to significantly more cases than in the modified skin redraping group (n = 0, P < 0.001). There were more out-fold cases in the modified skin redraping group (76/90) than in the classic skin redraping group (17/88) (P < 0.001). Utilizing the modified skin redraping medial epicanthoplasty can prevent medial hooding of the upper eyelid, reduce the probability of visible scarring, and produce more out-fold with concurrent double eyelidplasty compared with classic skin redraping epicanthoplasty.Level of evidence: IV.

Mandibular Fractures: Diagnosis and Management

Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.

Biomechanical evaluation of magnesium plates for management of mandibular angle fracture

The aim of this study was to evaluate the efficacy of magnesium plates for the management of fractures of the mandibular angle. Fresh sheep hemimandibles were divided into 7 groups and a biomechanical cantilever bending test was used for the groups: Group 1 included fractured hemimandibles fixed at the angle with a single 1mm magnesium miniplate; Group 2 had fixation with a 1mm double magnesium miniplate; Group 3 used a 2mm thick single magnesium miniplate; Group 4 used double 2mm magnesium plates; Group 5 each had a single 1mm thick titanium plate; Group 6 used 1mm thick double titanium plates; and Group 7 comprised intact hemimandibles. Each group was tested using universal testing machine yield loads; yield displacements and stiffness were compared using one way analysis of variance (ANOVA) Group 1 (1mm single magnesium plate) and Group 2 (1mm double magnesium plates) showed lower stability than other groups, while the 2mm magnesium plate showed stability similar to the corresponding 1mm titanium plate. Pure magnesium has good mechanical properties and when it is designed properly it can be used for the management of mandibular fracture.

Orbital Lateral Cantal Distance Can Predict the Cephalometric Characteristic of Mandible in Iranian Population

ABSTRACT

Orbitofacial anthropometrics have become an important tool used in reconstructive surgery. The authors attempt to evaluate the relation between orbital lateral canthal distance and the cephalometric characteristic of mandible in Iranian population.In a cross-sectional study, anthropometric parameters of face in 200 subjects (100 males and 100 females) with mean age of 34.39 ± 18.83 were evaluated by three-dimensional computed tomography imaging.In this study, there was not a significant difference in the age of sex groups (P = 0.183). Also, there was no significant difference in the left and right mandible angle in different sex groups (P = 0.25, P  =  0.124, respectively). There were significant differences in the anterior mandible distance, inferior mandible angle distance (P = 0.0001) and lateral cantus distance of sex groups (P = 0.0001). There was a significant correlation between lateral contuse distance and left mandible angle (r = 0.226, P = 0.001), right mandible angle (r = 0.283, P = 0.00), mandible angle (r = -0.266, P = 0.00), anterior mandible angle distance (r = 0.655, P = 0.00), and inferior mandible angle distance (r = 0.582, P = 0.00).Here, we conclude that orbital lateral canthal distance can predict the cephalometric characteristic of mandible in Iranian population.

Analysis of Complication in Mandibular Angle Fracture: Champy Technique Versus Rigid Fixation

INTRODUCTION

The mandibular angle endures tension and compression during mastication, and proper internal fixation is essential when a fracture occurs. The authors analyzed the complication rate between Champy technique and rigid fixation, used in the treatment of mandibular angle fracture.

METHODS

The retrospective study included patients with mandibular angle fracture in single center, from January 2003 to December 2019. The patients were categorized into 2 groups by fixation method of angle fracture: Champy technique which uses single miniplate and rigid fixation which uses multiple miniplate, reconstruction plate, compression plate, lag screw, and wire. Pearson chi-square test was used to analyze the complication rates.

RESULTS

A total of 64 patients met inclusion criteria. Thirty-four patients had isolated angle fractures and 30 patients had multiple mandibular fractures. In isolated angle fracture, there were no significant differences in all complications between the Champy technique group and rigid fixation group. In multiple mandibular fractures, there were no significant differences in all complications between 2 groups.

CONCLUSIONS

For isolated angle fractures, Champy technique is a reliable treatment method. Additionally, in case of multiple mandibular fractures, Champy technique is an effective fixation method in angle fractures when proper rigid fixation is performed for accompanying fractures.

Photoelastic analysis of conventional and locking system for treatment of mandibular angle fractures with a single plate

Background

This photoelastic analysis evaluated stress distribution in different osteosynthesis systems, conventional and locking, used for treatment of mandibular angle fractures with a single plate.

Material and Methods

Angle fractures were simulated in mandibles made of photoelastic resin. Following Champy’s method, plate osteosynthesis was performed. The samples were divided into five groups: Group 1, non-fractured mandible; Group 2, two screws were installed in each segment using a conventional system; Group 3, two screws were installed in each segment using a locking system; Group 4, three screws were installed in the proximal segment and four screws in the distal segment using a conventional plate; Group 5, three screws were installed in the proximal segment and four screws in the distal segment using a locking plate. In an universal testing machine coupled to a polariscope, a load was applied to the first molar 10 times. The 50 images were randomly numbered and analyzed qualitatively and quantitatively by two raters.

Results

The locking system promoted better stress distribution along the osteosynthesis. The locking system reduced stress magnitude in the distal segment, with a significant between-group difference (P≤ 0.001).

Conclusions

The locking plate/screw system can distribute stress more evenly throughout the osteosynthesis, especially when long seven-hole plates are used.

Key words:Internal fracture fixation, osteosynthesis, mandibular fracture, bone plates.

Experimental validation of finite element simulation of a new custom-designed fixation plate to treat mandibular angle fracture

BACKGROUND

The objective of the study was to validate biomechanical characteristics of a 3D-printed, novel-designated fixation plate for treating mandibular angle fracture, and compare it with two commonly used fixation plates by finite element (FE) simulations and experimental testing.

METHODS

A 3D virtual mandible was created from a patient's CT images as the master model. A custom-designed plate and two commonly used fixation plates were reconstructed onto the master model for FE simulations. Modeling of angle fracture, simulation of muscles of mastication, and defining of boundary conditions were integrated into the theoretical model. Strain levels during different loading conditions were analyzed using a finite element method (FEM). For mechanical test design, samples of the virtual mandible with angle fracture and the custom-designed fixation plates were printed using selective laser sintering (SLS) and selective laser melting (SLM) printing methods. Experimental data were collected from a testing platform with attached strain gauges to the mandible and the plates at different 10 locations during mechanical tests. Simulation of muscle forces and temporomandibular joint conditions were built into the physical models to improve the accuracy of clinical conditions. The experimental vs the theoretical data collected at the 10 locations were compared, and the correlation coefficient was calculated.

RESULTS

The results show that use of the novel-designated fixation plate has significant mechanical advantages compared to the two commonly used fixation plates. The results of measured strains at each location show a very high correlation between the physical model and the virtual mandible of their biomechanical behaviors under simulated occlusal loading conditions when treating angle fracture of the mandible.

CONCLUSIONS

Based on the results from our study, we validate the accuracy of our computational model which allows us to use it for future clinical applications under more sophisticated biomechanical simulations and testing.

High resolution MRI for quantitative assessment of inferior alveolar nerve impairment in course of mandible fractures: an imaging feasibility study

The purpose of this study was to evaluate a magnetic resonance imaging (MRI) protocol for direct visualization of the inferior alveolar nerve in the setting of mandibular fractures. Fifteen patients suffering from unilateral mandible fractures involving the inferior alveolar nerve (15 affected IAN and 15 unaffected IAN from contralateral side) were examined on a 3 T scanner (Elition, Philips Healthcare, Best, the Netherlands) and compared with 15 healthy volunteers (30 IAN in total). The sequence protocol consisted of a 3D STIR, 3D DESS and 3D T1 FFE sequence. Apparent nerve-muscle contrast-to-noise ratio (aNMCNR), apparent signal-to-noise ratio (aSNR), nerve diameter and fracture dislocation were evaluated by two radiologists and correlated with nerve impairment. Furthermore, dislocation as depicted by MRI was compared to computed tomography (CT) images. Patients with clinically evident nerve impairment showed a significant increase of aNMCNR, aSNR and nerve diameter compared to healthy controls and to the contralateral side (p < 0.05). Furthermore, the T1 FFE sequence allowed dislocation depiction comparable to CT. This prospective study provides a rapid imaging protocol using the 3D STIR and 3D T1 FFE sequence that can directly assess both mandible fractures and IAN damage. In patients with hypoesthesia following mandibular fractures, increased aNMCNR, aSNR and nerve diameter on MRI imaging may help identify patients with a risk of prolonged or permanent hypoesthesia at an early time.

Combination of Rigid and Nonrigid Fixation Versus Nonrigid Fixation for Bilateral Mandibular Fractures: A Multicenter Randomized Controlled Trial

PURPOSE

We aimed to compare complication rates and functional outcomes in patients with bilateral mandibular fractures treated with different degrees of internal fixation rigidity.

PATIENTS AND METHODS

This international, multicenter randomized controlled trial included adults with bilateral mandibular fractures located at either the angle and body, angle and symphysis, or body and symphysis. Patients were treated with either a combination of rigid fixation for the anterior fracture and nonrigid fixation for the posterior fracture (mixed fixation) or nonrigid fixation for both fractures. The primary outcome was complications within 6 weeks after surgery. Secondary outcomes were complications within 3 months, Helkimo dysfunction index, and mandibular mobility at 6 weeks and 3 months after surgery.

RESULTS

Of the 315 patients enrolled, 158 were randomized to the mixed fixation group and 157 to the nonrigid fixation group. The overall complication rate at 6 weeks in the intention-to-treat population was 9.6% (95% confidence interval [CI], 5.3% to 15.6%) in the mixed fixation group and 7.8% (95% CI, 4.0% to 13.5%) in the nonrigid fixation group. With an unadjusted odds ratio of 1.25 (95% CI, 0.51 to 3.17), there were no statistically significant differences in complication rates between the 2 groups (P = .591). A multivariable model for complication risk at 6 weeks found no significant differences between treatment groups, but patients with moderate or severe displacement had a higher complication rate than those with no or minimal displacement (adjusted odds ratio, 4.58; 95% CI, 1.16 to 18.06; P = .030). There were no significant between-group differences in complication rates at 3 months. Moreover, no significant differences in Helkimo dysfunction index and mandibular mobility index at 6 weeks and 3 months were found between groups according to treatment allocated and treatment received.

CONCLUSIONS

A combination of rigid and nonrigid fixation in patients with bilateral mandibular fracture has similar complication rates and functional outcomes to nonrigid fixation for both fractures.

Occlusal Instability Results in Increased Complication Rates After Treatment of Mandibular Fractures

PURPOSE

It is important to understand the factors that can increase the incidence of complications after mandibular fracture (MF) treatment. The objective of the present study was to investigate whether occlusal stability influences the occurrence of postoperative complications in MFs treated with internal rigid fixation.

PATIENTS AND METHODS

We performed a prospective cohort study of patients treated for MF by osteosynthesis with plate and screw fixation. The primary predictor variable was the occlusal stability (yes vs no). Occlusion was scored as stable (group 1) if the patients had all their teeth and no free ends in either dental arch. Occlusion was coded as unstable (group 2) if the patients were partially edentulous with free ends in either dental arch or had edentulism involving more than 6 dental elements. The primary outcome variable was postoperative complication (yes vs no). The secondary outcome variables were the osteosynthesis system used (2.0 or 2.4 mm), local factors, age, and gender. Statistical analysis was performed using the χ² statistical test at 5% significance.

RESULTS

Of 115 patients with 121 MFs, 73 (63.48%) had stable occlusion (group 1) and 42 (36.52%) had unstable occlusion (group 2). The mean age was 34.11 years, and 71.3% were men. The postoperative complication rate was 8.70% (10 patients). Of the 10 patients with complications, 3 (2.6%) were in group 1 and 7 (6.1%) were in group 2 (P = .021 and P < .05, respectively). The 2.0-mm system was used in 107 cases (93%). All the complications were associated with use of the 2.0-mm osteosynthesis plates, occurring in 3 of 69 patients in group 1 (4.34%) and 7 of 38 patients in group 2 (18.42%; P = .032 and P < .05, respectively). The greatest number of complications was associated with unilateral MF (9 of 109). The occurrence of postoperative complications in angle and symphysis/parasymphysis fracture sites was equal.

CONCLUSIONS

The results of the present study suggest that unstable occlusion could increase the rate of postoperative complications in MFs treated with plates and screws. Future studies are required with occlusal stability included as a variable.

Risk Factors Associated With Complications After Treatment of Mandible Fractures

Importance

Complications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes.

Objective

To describe the risk factors associated with complications in patients undergoing treatment for mandible fracture.

Design, Setting, and Participants

A retrospective review was conducted of 137 patients presenting to a tertiary care, level 1 trauma center with mandible fractures between January 1, 2014, and January 1, 2017. Outcomes and demographic characteristics for patients with at least 3 weeks of follow-up were compared using multivariate logistic regression analysis.

Results

Of the 137 patients meeting inclusion criteria, there were 113 males (82.5%) and 24 females (17.5%), with a mean (SD) age at presentation of 32.3 (15.7) years. Median follow-up was 71 days (range, 22-1189 days). Postoperative complications were identified in 29 patients (21.2%); complications included wound dehiscence or surgical site infection (n = 17), bony nonunion (n = 5), and hardware exposure (n = 13). Complications were managed surgically in 19 patients and nonsurgically in 10 patients. On univariate analysis, the initial surgery was completed later (mean [SD], 5.9 [6.6] days after injury) in patients who developed complications than in those who did not (mean [SD], 3.8 [4.0] days). On multivariate analysis, complications were associated with increased time from injury to treatment (odds ratio [OR], 1.60; 95% CI, 1.02-2.53; P = .04), tobacco use (OR, 8.10; 95% CI, 1.26-52.00; P = .03), and dental extraction (OR, 93.00; 95% CI, 1.19 to >999.00; P = .04). Residence in the same city as the medical center was associated with fewer complications (OR, 0.08; 95% CI, 0.01-0.69; P = .02).

Conclusions and Relevance

In a 3-year review of mandible fractures managed at a single academic center, complications were associated with an increased time to treatment, tobacco use, dental extraction, and living farther from the treatment facility. On a systems level, the results of this study suggest that expediting intervention for mandible fractures may improve outcomes.

Level of Evidence

3.

The Influence of the Gonial Angle on the Initial Biomechanical Stability of the Plate Osteosynthesis in Polyurethane Mandibles With Angle Fractures

The aim of the present study was to examine the biomechanical stability of the mandibular angle fractures (MAF) fixated with standard titanium miniplates in polyurethane models with different gonial angles (GA). Three custom molds were prepared for 3-dimensional printed mandibles with low, normal and high GA. Twenty polyurethane replicas were cast per group and standard MAFs were created on each sample. Fractures were stabilized with 1 4-hole standard titanium miniplate inserted over the superior alveolar border. Half of the samples were subjected to molar loading and the other half to the incisal loading up until 150 N force magnitude. The load-displacement curves and the horizontal moment arms were recorded and analyzed. The samples with high GA demonstrated greater displacement than those with normal and low GA during molar loading (P < 0.05 for both). After correcting for the effects of the moment arm, the incisal loading also resulted in higher mean displacement in the high GA group than the others (P < 0.05 for both) and the normal GA samples showed higher displacement after 100 N level compared to those in low GA (P < 0.05). Within the limits of this in vitro study, it can be concluded that the MAFs of the polyurethane mandibles with high GA fixated with 1 standard monocortical plate are more likely to demonstrate higher displacement values under the effects of the molar and incisal loadings than do the mandibles with normal and low GA.

Extraction of impacted third molar with preventive installation of titanium miniplate: Case report

Introduction

Even though is rarely, mandibular fracture after the extraction of third molars can occur in almost 1% of the procedures. Gender, age, position of third molar, tooth volume, bone fragility, systemic disorders, associated lesions, and degree of mandibular atrophy are factors that contribute to increase the incidence of fracture. The installation of the titanium miniplate during exodontia is an important tool to prevent the fracture.

Presentation of case

The objective of this study is to present a clinical case of extraction of inferior impacted third molar, in atrophic mandible, with posterior installation of titanium miniplate, to prevent mandibular fracture.

Discussion and conclusion

preventive installation of titanium miniplate was effective and indeed prevented the mandibular fracture. No trans-operative or immediate post-operative complications were observed. Post-operative follow-up was of three years, with no complications, showing the success of the procedure.

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This study will instruct surgeons on third molar surgery in atrophic mandible.

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It will allow surgeons to avoid mandibular fracture, by installing titanium plate.

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It will ensure the procedure is safe and well conducted for the patients.

Treatment of mandibular angle fracture: Revision of the basic principles

Biodynamics of mandibular angle fractures has been extensively discussed in the literature in search for the best way to fixate and expedite recovery of trauma patients. Pioneers like Michelet and Champy had the greatest impact on evolving of osteosynthesis in maxillofacial traumatology; they introduced their basic principles frequently used to describe the biomechanics of mandibular fixation. Their concept states when a physiologic load is applied on mandibular teeth a negative tension will be created at superior border and a positive pressure will appear at inferior border. These simple definitions are the basis for the advent of fixation modalities in mandibular angle fracture. This article sought to reassess these principals based on load location via finite elements method.

Comparison of single versus two non-compression miniplates in the management of unfavourable angle fracture of the mandible: a prospective randomized clinical study

PURPOSE

The purpose of this study was to compare the efficacy of single versus two non-compression miniplates in the management of unfavourable angle fracture of mandible.

MATERIALS AND METHODS

A total of 28 patients who required open reduction of mandibular angle fracture were included in the study. The patients were randomly divided into two groups. Group I comprised of patients treated with two miniplates and those in group II were treated with single non-compression miniplate. The parameters of assessment were malocclusion, surgical site infection, need for implant removal, duration of surgery, inter-incisal mouth opening and cost of implants used, in both the groups. Statistical analysis was carried out to compare all the parameters.

RESULTS

Out of 14 patients in group II, inadequate reduction was noticed in three patients, whereas screw loosening had occurred in two cases. Screw loosening was always associated with chronic infection. In these cases, hardware removal was deemed necessary. Plate bending was observed in two cases resulting in malocclusion and difficulty in eating. Non-union of fracture occurred in one patient treated in group II. In group I, no plate bending, screw loosening, surgical site infection, non-union or malocclusion was observed. No patient had to undergo implant removal in group I.

CONCLUSION

In the management of unfavourable mandibular angle fracture, two miniplates must be preferred over the use of single miniplate as using two miniplates results in better results with minimal complications.

A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis

Background

The purpose of this study was to design a customized fixation plate for mandibular angle fracture using topological optimization based on the biomechanical properties of the two conventional fixation systems, and compare the results of stress, strain and displacement distributions calculated by finite element analysis (FEA).

Methods

A three-dimensional (3D) virtual mandible was reconstructed from CT images with a mimic angle fracture and a 1 mm gap between two bone segments, and then a FEA model, including volume mesh with inhomogeneous bone material properties, three loading conditions and constraints (muscles and condyles), was created to design a customized plate using topological optimization method, then the shape of the plate was referenced from the stress concentrated area on an initial part created from thickened bone surface for optimal calculation, and then the plate was formulated as “V” pattern according to dimensions of standard mini-plate finally. To compare the biomechanical behavior of the “V” plate and other conventional mini-plates for angle fracture fixation, two conventional fixation systems were used: type A, one standard mini-plate, and type B, two standard mini-plates, and the stress, strain and displacement distributions within the three fixation systems were compared and discussed.

Results

The stress, strain and displacement distributions to the angle fractured mandible with three different fixation modalities were collected, respectively, and the maximum stress for each model emerged at the mandibular ramus or screw holes. Under the same loading conditions, the maximum stress on the customized fixation system decreased 74.3, 75.6 and 70.6% compared to type A, and 34.9, 34.1, and 39.6% compared to type B. All maximum von Mises stresses of mandible were well below the allowable stress of human bone, as well as maximum principal strain. And the displacement diagram of bony segments indicated the effect of treatment with different fixation systems.

Conclusions

The customized fixation system with topological optimized structure has good biomechanical behavior for mandibular angle fracture because the stress, strain and displacement within the plate could be reduced significantly comparing to conventional “one mini-plate” or “two mini-plates” systems. The design methodology for customized fixation system could be used for other fractures in mandible or other bones to acquire better mechanical behavior of the system and improve stable environment for bone healing. And together with SLM, the customized plate with optimal structure could be designed and fabricated rapidly to satisfy the urgent time requirements for treatment.

Evidence-Based Medicine in Facial Trauma

This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors.

Three-dimensional strut plate for the treatment of mandibular fractures: a systematic review

The treatment of mandibular fractures by open reduction and internal fixation is very variable. Thus, there are many controversies about the best fixation system in terms of stability, functional recovery, and postoperative complications. This systematic review sought scientific evidence regarding the best indication for the use of three-dimensional (3D) plates in the treatment of mandibular fractures. A systematic search of the PubMed/MEDLINE, Elsevier/Scopus, and Cochrane Library databases was conducted to include articles published up until November 2016. Following the application of the inclusion criteria, 25 scientific articles were selected for detailed analysis. These studies included a total of 1036 patients (mean age 29 years), with a higher prevalence of males. The anatomical location most involved was the mandibular angle. The success rate of 3D plates was high at this location compared to other methods of fixation. In conclusion, the use of 3D plates for the treatment of mandibular fractures is recommended, since they result in little or no displacement between bone fragments.

Mandible Fractures

Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

Biomechanical Evaluation of Different Plating Methods Used in Mandibular Angle Fractures With 3-Dimensional Finite Element Analysis: Favorable Fractures

PURPOSE

The aim of the present study was to evaluate the performances of 5 different plating techniques for fixation of favorable mandibular angle fractures using the 3-dimensional finite element analysis (FEA) method.

MATERIALS AND METHODS

Five different miniplate placement configurations were considered for the fixation of favorable mandibular angle fractures. The following models were created: a double parallel miniplate (M1) placed at the halfway point of the mandibular angle height; a one-third superior-positioned miniplate (M2); a single miniplate (M3) placed at the halfway point of the mandibular angle height (one-half middle-positioned); a one-third inferior-positioned miniplate (M4); and an X-shape miniplate (M5).

RESULTS

The M1 and M4 miniplates showed the lowest mechanical stress compared with the other configurations, whereas the M3 and M5 miniplates showed the highest stress levels.

CONCLUSION

For favorable mandibular angle fractures, the authors suggest the M1 miniplate or, if used alone, the M4 miniplate is adequate for rigid fixation.

Osteosynthesis using cannulated headless Herbert screws in mandibular angle fracture treatment: A new approach?

INTRODUCTION

Fractures of the mandibular angle are a common type of facial skull fracture. Although operative treatment includes a wide range of fixation techniques, a definite gold standard method has yet to be established. Headless, cannulated Herbert screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation.

MATERIALS AND METHODS

In a prospective, double-randomised, controlled, parallel-group - designed, in vitro trial, the biomechanical behaviour of the Herbert bone screw system was compared to that of a conventional locking plate system in 40 mandibular angle fractures of human mandible cadaver phantoms.

RESULTS

The mean stress values were 250 (±68.0) N in the plate subgroup and 200 (±61.0) N in the screw subgroup. The respective mean strain values were 7.90 (±2.7) mm and 6.90 (±2.2) mm, and the respective mean stiffness were values 1.10 (±0.61) N/m and 0.78 (±0.40) N/m. The differences in the results obtained using the two treatments were not significant (p = 0.55).

CONCLUSIONS

The biomechanical behaviour of the two fixation systems within the tested loads did not significantly differ with respect to postoperative parameters clinically relevant in osteosynthesis. Both systems met the mandibular angle assessment criterion, which is considered to be sufficient for clinical use. The results indicate the potential clinical utility of these two systems, and recommend further testing.

Mandibular angle fractures: a comparative study between one- and two-plate fixation

BACKGROUND/AIM

The mandibular angle fracture is a challenging fracture to manage. Over time, the literature has shown many types of treatment modalities and different kinds of internal fixation. The aim of this study was to evaluate the outcomes and complications of mandibular angle fractures managed by Champy's technique and two-plate fixation, over a period of 20 years.

MATERIAL AND METHODS

The files of 149 patients with 155 angle fractures fulfilled the inclusion criteria and were chosen for this study. Data were collected regarding gender, age, race, date of trauma, addictions, etiology, signs and symptoms, fracture management, and complications.

RESULTS

Prevalence was higher in males (82%), Caucasians (62%), and during the third decade of life (62%). Mean age was 26.5 years. The main cause was interpersonal violence, and the mean follow-up period was 232 days. The main signs and symptoms were pain, edema, and mouth-opening restriction. The most often associated fracture involved the mandibular condyle, and the most common complication was infection.

CONCLUSION

There was no difference between the two modalities of treatment. However, the one-plate fixation technique had fewer complications.

In vitro evaluation of the resistance of three types of fixation to treat fractures of the mandibular angle

The purpose of this study was to compare the mechanical resistance of three different plates used to treat fractures of the mandibular angle: a regular 4-hole plate, a longer 4-hole plate (both positioned using the Champy technique), and a 3-dimensional plate positioned over the oblique line. Three equal groups of replicas of human dentate mandibles made out of polyurethane resin were used (n=21 in each group). The force was applied perpendicular to the occlusal plane at a rate of 2mm/minute at three different points: the first molar on the sectioned side; the first molar on the contralateral side; and between the central incisors. This was followed by a resistance-to-load test. The two varying factors (type of plate and site-of-load application) were tested by analysis of variance, and probabilities of less than 0.05 were accepted as significant. There were no significant differences between the subgroups, or between the mean values of the different types of plates (p=0.925). The three types of plates showed similar mechanical behaviour, which showed that the 3-dimensional plates positioned over the oblique line can produce mechanical scores similar to those of conventional plates.

Evaluation of Three Different Osteosynthesis Methods for Mandibular Angle Fractures: Vertical Load Test

The aim of this study was to evaluate the mechanical behavior of different rigid fixation methods in mandible angle fractures. Three different plates were tested: one 4-hole grid miniplate, one 8-hole curved grid miniplate, and one 4-hole straight miniplate.For the loading tests, 30 polyurethane hemimandibles sectioned at the angle area to simulate a simple angle fracture were used: 10 hemimandibles for each group. The mechanical evaluation revealed that the straight plate positioned at the tension zone presented the best results in supporting vertical loading in the predefined displacement moments of 1, 3, and 5 mm. Regarding the grid plates, there was no statistically significant difference between the smaller and the larger plate.According to this sample, the straight plate positioned in the tension zone presented better results than the other 2 different grid plates positioned at the neutral zone.

Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm

Background

Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised.

Materials and Methods

A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article’s reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis.

Result

Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups.

Conclusions

Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.

Correlation of Third Molar Status with Incidence of Condylar and Angle Fractures

The mandibular angle and condylar regions are most prone to fractures and this has been attributed to the presence/absence or the position of the third molars. This retrospective study was undertaken to analyze the correlation between the third molars and incidence of condylar and angle fractures in 104 patients treated for these fractures during the period from June 2009 to December 2013. Clinical and radiographic records of these patients were studied to look for the presence and position of third molars and their relation to incidence of condylar or angle fractures. There was a definite positive relation to impacted third molars and increased incidence of angle fractures. The condylar fractures were more commonly seen when the third molars were fully erupted or missing. Third molar impactions predispose to angle fractures and missing or fully erupted third molars predispose to condylar fractures.

Management of Mandibular Angle Fractures: Single Stainless Steel Linear Miniplate Versus Rectangular Grid Plate-A Prospective Randomised Study

PURPOSE

This prospective study was conducted to evaluate the efficacy of stainless steel single linear miniplate with rectangular grid plate in the treatment of mandibular angle fractures.

METHODS

This study included 30 patients who were allocated randomly into two groups of each. Group 1 patients were treated with single 2 mm × 4 hole linear stainless steel miniplate and group 2 patients with 2 mm × 4 hole rectangular grid plate. Patients were evaluated for fracture stability, occlusion, mouth opening, and complications at 1st week, 1 and 3 months post operatively.

RESULTS

There were no significant differences between the two groups with respective variables statistically. In group 1 20 % (n = 3) had mild occlussal derangement 6.66 % (n = 1) patient had deranged occlusion at 1 week post operatively and 13.3 % (n = 2) had mild derangement at 1 month post operatively. In group 2 6.66 % (n = 1) had mild derangement at 1 week postoperatively. 20 % (n = 3) had limited mouth opening at 1 week in group 1 and 13.3 % (n = 2) in group 2. All patients in both groups achieved adequate mouth opening by the end of 3 month. None of the patients in both groups had plate fracture, screw loosening, non union or mal-union.

CONCLUSION

Within the limits of the study, use of rectangular grid plates for fixation of mandibular angle fractures was reliable with low complication rates, easy adaptation and an effective alternative to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.

A comparison of three treatment methods for fractures of the mandibular angle

The purpose of this study was to determine a practical and cost-effective treatment method for fixing mandibular angle fractures using miniplates. Patients were divided into three groups for comparison, based on the intraoperative plates and maxillomandibular fixation (MMF) used: group A, single miniplate fixation with MMF (n=37); group B, double miniplate fixation with MMF (n=59); group C, double miniplate fixation without MMF (n=38). Details of the characteristics of the fractures and the treatments and outcomes were collected retrospectively and analyzed statistically. This study was based on 134 cases of isolated mandibular angle fracture. Of the surgically treated patients, 78.4% (n=105) were completely free of complications. A detailed complication correlation matrix is given in the text. Besides screw loosening and malocclusion, no statistically significant difference was observed between the groups. The results of this study suggest that treatment with single miniplate fixation and MMF has a low incidence rate of complications, and this method of treatment is considered to be simple.