A Study of 2 Bone Plating Methods for Fractures of the Mandibular Symphysis/Body

Effective strategies in the management of anterior mandibular fractures: a comprehensive systematic review

This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures.

Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures

AIM

The aim of this study was to evaluate a clinically and radiographically Z-shaped miniplate for the fixation of the parasymphyseal fractures.

PATIENTS AND METHODS

Twenty patients (10 patients in each group) who had parasymphseal mandibular fractures were randomly selected for this study. In this study, open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using two miniplates as group I, and open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using a newly designed Z-shaped miniplate as group II. Clinical and radiographic evaluations were made. Each patient was evaluated: (1) clinically evaluated preoperatively and postoperatively for operating time, ease of placement of the miniplate, and occlusion and (2) radiological: postoperative reduction of fracture was evaluated radiologically at 5-day, 1-month, 2-month, and 3-month intervals with orthopantomogram, and lingual splaying was evaluated by cone-beam computed tomography (CBCT) immediately postoperatively and at an interval of 3 months. The collected data were subjected to statistical analysis. Data analysis was performed by SPSS software, version 25 (SPSS Inc., PASW statistics for Windows version 25). Chicago: SPSS Inc.

RESULTS

There was a statistically significant difference (p < 0.001) between the mean intraoperative time. This indicates that group I had a longer time for fracture fixation than group II. Group I had a longer time elapsed for plate adaptation and definitive fixation than group II. Occlusion and reduction stability in both groups were similar. There was a statistically significant difference in postoperative lingual display control after 5 days and 3 months between the studied groups. This indicates that lingual display control in group II is better than in group I.

CONCLUSION

The Z-shaped miniplate is effective and provides three-dimensional stability for the fixation of parasymphyseal fractures, ease of use, easily adapted in cases of fractures near the mental nerve reduced operative time, and better control of lingual splaying than conventional miniplates.

CLINICAL SIGNIFICANCE

The newly designed Z-shaped miniplate is a valuable option for fixation parasymphysis fractures that need open reduction and internal fixation instead of using conventional miniplates, which are less successful in controlling lingual splaying.

The impact of patient-related factors on complications when treating mandible fractures by load-sharing and load-bearing osteosynthesis

The decision about the choice of load-sharing (LS) or load-bearing (LB) osteosynthesis is determined by an interplay of fracture-related and patient-related factors. In some situations a similar fracture in two different patients may be treated successfully by either of these methods. Our aim was to identify preoperative patient-related factors that may assist in deciding which form of osteosynthesis is employed. All adult patients who underwent open reduction and internal fixation of mandibular fractures (excluding condyle) between 1 October 2018 and 1 June 2021 were retrospectively identified. The odds of developing postoperative complications and requiring a return to theatre (RTT) were calculated for each method of fixation together with the following patient factors: smoking, excess alcohol, substance misuse, and severe mental health issues. Of 337 fractures treated using LS principles, 27 (8%) developed complications, of which 20 (6%) required a RTT for repeat osteosynthesis. Of 74 fractures treated using LB principles, seven (10%) developed complications and two (3%) required a RTT for repeat osteosynthesis. The only patient factor that had statistically significant increased odds of a complication requiring RTT was LS osteosynthesis in patients who admitted drinking excess alcohol (OR = 7.83, p = 0.00, 95% CI = 3.13 to 19.60). Complications when treating mandibular fractures are rarely reported in the literature, and lack standardisation in their clinical significance. Figures generally represent overall numbers of patients, whereas the number of individual fractures treated is more accurate. In our study complications occurred in 8% of treated fractures and 10% of patients. The RTT rate was 7% of patients, which compares favourably with a recently stated standard of 10% of patients, as suggested by the Getting it Right First Time (GIRFT) report.

An approach for simultaneous reduction and fixation of mandibular fractures

This article presents a new approach for the design of a flexible V-shaped miniplate for mandibular fractures, which combines simultaneous fracture reduction and fixation. A Computerized Tomography (CT) based finite element model was developed to assess the reliability of this design. Muscle and mastication forces were included to replicate post-surgery loading. The V-plate is compared with a standard, linear miniplate, typically used for mandibular fixation. The results indicate that the proposed design can support the fracture while inducing limited fracture displacement, in addition to reducing the duration of the surgery due to fracture reduction by tightening the wire.

Comparison Between Conventional Titanium Miniplates and Indigenous Detachable Custom made 3D Titanium Plates (VAS 3D Bone Plate) for Fixation of Mandibular Fracture in Mental Foramen Region: A Randomized Clinical Trial and Finite Element Analysis

Purpose

To overcome limitation of 3D plate for fracture fixation in mental foramen region, by designing an indigenous custom made detachable 3D titanium plate (VAS 3D bone plate) and comparing it with two miniplate fixations for fractures of aforementioned region.

Methodology

Finite element analysis (FEA) of VAS plate and randomised clinical trial was performed and compared with miniplates. Twenty fractures in 19 patients with fracture in mental foramen region were divided randomly into two groups (Group I-fixation by miniplates and Group II with VAS plate) and evaluated for ease of fixation, neurosensory deficit, bite forces, occlusion and adequacy of fracture fixation.

Results

FEA of VAS plate revealed better performance for stress distribution, deformation and rigidity. A total of 20 mental foramen region fractures in 19 patients (18 male and 1 female) were treated. Group II had better results for bite forces and lingual control. Except for two patients with screw exposure in Group II and transient neurosensory deficit (resolved by 6 months), no other complications were observed. Ease of fixation was significantly better in miniplate group.

Conclusion

VAS plate was successful in providing satisfactory fixation and was observed to be better in terms of lingual control and masticatory efficiency.

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.

Mandibular Body Fractures

Fractures of the mandibular body most commonly occur after interpersonal violence or motorized vehicle accident but can occur in athletes. Mandibular body fractures are often associated with additional mandibular fractures. The treatment goal is to achieve preinjury occlusion and facial appearance, and this can be done via a closed reduction and maxillomandibular fixation or open reduction and fixation with or without maxillomandibular fixation. The authors present 3 cases in this article.

Postoperative Computed Tomography for Facial Fractures

In order for a radiologist to create reports that are meaningful to facial reconstructive surgeons, an understanding of the principles that guide surgical management and the hardware employed is imperative. This article is intended to promote efficient and salient reporting by illustrating surgical approaches and rationale. Hardware selection can be inferred and a defined set of potential complications anticipated when assessing the adequacy of surgical reconstruction on postoperative computed tomography for midface, internal orbital, and mandible fractures.

Comprehensive review of the incisive branch of the inferior alveolar nerve

The incisive branch of the inferior alveolar nerve is a vital anatomical structure within the anterior mandible that has not been thoroughly defined and outlined in reports in the literature until recent years. Advances in radiological imaging, particularly the widespread use of cone-beam computed tomography has allowed for accurate visualization of the mandibular incisive canal (MIC) and its associated incisive branch of the inferior alveolar nerve. Surgical damage to the MIC, which could result in hemorrhage and sensory disturbance, may occur in commonly practiced oral and maxillofacial procedures, such as chin bone harvesting, implant placement, fracture repair and removal of pathologic entities of the anterior mandible. Knowledge of both the presence, dimensions and location of the incisive branch is a vital component to pre and peri-operative planning of oral and maxillofacial surgeries performed within the mandible, particularly within the interforaminal zone. In this article, the terminology, anatomy, imaging, surgical consideration, and pathology of the incisive branch will be discussed.

Neurosensory Recovery Following Mental Nerve Skeletonization in Intraoral Open Reduction and Internal Fixation of Mandible Fractures

PURPOSE

The purpose of this study was to evaluate neurosensory recovery after mental nerve skeletonization in open reduction and internal fixation (ORIF) of mandible fractures.

METHODS

This was a prospective nonrandomized observation study of adult subjects treated at a Level I trauma center between April 1, 2016 and December 31, 2019, with mental nerve skeletonization for ORIF of mandible fractures. Age, sex, and mandibular injury severity score (MISS), and functional sensory recovery (FSR) and subjective neurosensory recovery of skeletonized mental nerve were recorded at preoperative and regularly scheduled follow-up appointments. Uninomial and multinomial logistic regressions were conducted with a significance level of < 0.05.

RESULTS

Twenty-six subjects (all male) completed all the postoperative protocol requirements and were included in this study. All subjects had a loss of FSR (S0) and subjective neurosensation immediately after surgery. Half of the subjects achieved FSR (S3) and subjective neurosensory recovery (VAS < 4) an average of 42 days after surgery. All subjects improved FSR (S4) by 57 days and subjective neurosensory recovery by 90 days after surgery. These were independent of MISS but had decreased recovery time with increased age. No incidences of mental nerve neuropathic pain during the trial period were found.

CONCLUSIONS

FSR and subjective neurosensory recovery from mental nerve skeletonization in intraoral ORIF of mandible fractures was achieved in all subjects by the end of this study. Neurosensory recovery was independent of MISS but decreased with increased age. Initial inverse correlations between objective and subjective neurosensory assessments were insignificant at study completion. No incidences of neuropathic pain were identified during the time of this study. Mental nerve skeletonization in ORIF of mandible fracture may be performed with an anticipated return of functional and subjective neurosensory recovery within 3 months of surgery.

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.

The risk of tooth root injuries using cortical screws for intermaxillary fixation and osteosynthesis plates - A retrospective analysis

Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004-2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries.

In Vitro Evaluation of the Effects of Different Fixation Methods on Stabilization of Mandibular Body Fractures

PURPOSE

Mandibular body fractures are considered to be one of the most affected fracture sites in the maxillofacial region. Although the rates of fracture in this region are high, biomechanical evaluations related to this region are rare. The purpose of this investigation was to reveal the effects of different treatment methods onmandibular body fractures.

METHOD

Twenty-five synthetic polyurethane hemi-mandibles were used in this study. The hemi-mandibles, which simulated simple unfavorable mandibular body fractures, were divided into 5 groups (n = 5/group) according to the treatment method. The bone segments were fixed using different osteosynthesis methods and 2.0 mm miniplate/screw systems. The groups consisted of locking or conventional systems, 5 or 11 mm long screws and 4 or 6 holes. The hemi-mandibles were loaded vertically with compressive strength until they reached 120 N.

RESULTS

The results were analyzed using Tamhane's T2 post hoc test, and the significance level was 0.05. Group 1 had the lowest mechanical resistance of all groups and group 5 had the highest. No significant differences were observed in group 2 or 3.

CONCLUSION

The locking system miniplate group showed better fixation stability than the conventional systems for the same screw length, and the number of holes and screw length seemed to be effective for stabilization.

Median Perforating Canal in Human Mandible

Surgical interventions in the anterior region of the human mandible are associated with many complications. Some anatomical structures like the median perforating canal were discovered in mammals. Such canals may be a cause of concern that needs attention in human mandible. The purpose of the present study was to evaluate the occurrence, location, and course of median perforating canal and its associated extensions in the anterior segment of the human mandible in cone beam computed tomography scans (CBCT). Data were collected from 160 CBCT scans, and evaluated. The incidence was 23.75% for median perforating canal with wide anatomical variations concerning the related lingual and labial extensions. Median perforating canal and their associated lingual and labial foramina are frequently seen in human mandible. A thorough investigation of the symphyseal region using CBCT must be taken into account when targeting surgical intervention in this area.

Biomechanical evaluation of two plating configurations for fixation of a simple transverse caudal mandibular fracture model in cats

OBJECTIVE To evaluate biomechanical properties of intact feline mandibles, compared with those for mandibles with an experimentally created osteotomy that was stabilized with 1 of 2 internal fixation configurations. SAMPLE 20 mandibles from 10 adult feline cadavers. PROCEDURES An incomplete block study design was used to assign the mandibles of each cadaver to 2 of 3 groups (locking plate with locking screws [locking construct], locking plate with nonlocking screws [nonlocking construct], or intact). Within each cadaver, mandibles were randomly assigned to the assigned treatments. For mandibles assigned to the locking and nonlocking constructs, a simple transverse osteotomy was created caudal to the mandibular first molar tooth after plate application. All mandibles were loaded in cantilever bending in a single-load-to-failure test while simultaneously recording load and actuator displacement. Mode of failure (bone or plate failure) was recorded, and radiographic evidence of tooth root and mandibular canal damage was evaluated. Mechanical properties were compared among the 3 groups. RESULTS Stiffness, bending moments, and most post-yield energies for mandibles with the locking and nonlocking constructs were significantly lower than those for intact mandibles. Peak bending moment and stiffness for mandibles with the locking construct were significantly greater than those for mandibles with the nonlocking construct. Mode of failure and frequency of screw damage to tooth roots and the mandibular canal did not differ between the locking and nonlocking constructs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that both fixation constructs were mechanically inferior to intact mandibles. The locking construct was mechanically stronger than the nonlocking construct.

Is the Three-Dimensional Strut Plate an Adequate Fixation Technique for Mandibular Symphysis Fractures?

PURPOSE

We present a series of cases of mandibular symphysis fractures treated at our institution with a 3-dimensional strut plate. The aim of the present study was to confirm the stability of this fixation technique and discuss its advantages, disadvantages, and potential complications.

PATIENTS AND METHODS

We designed and implemented a retrospective cohort study of patients who underwent surgery by the same surgeon at our institution from July 2012 to April 2014 for a mandible fracture with a symphysis component. The patients were evaluated to identify aspects of occlusion, fracture mobility, postoperative infection, and the need for hardware removal.

RESULTS

The sample included 12 subjects who had met the inclusion criteria. The inclusion criteria were a linear noncomminuted fracture, sufficient distance from the mental foramina, a maximum of 5 days between the trauma and surgery, and a minimum postoperative period of 3 months. The mean age of the sample was 33.4 years, and 1 of the 12 patients (8.3%) was female. Of the 12 patients, 10 did well, and 2 developed a surgical site infection, 1 of whom also experienced nonunion and required additional fixation.

CONCLUSIONS

The results of the present study suggest a 3-dimensional strut plate applied to symphysis fractures provides adequate fracture stabilization with a risk of complications comparable to that of more traditional fixation methods. In addition, the technique has the added advantage of minimal manipulation and adaptation, which could shorten the overall operating time.

Efficacy of Titanium Mesh Osteosynthesis in Maxillofacial Fractures

Introduction

Trauma is steadily increasing in the modern world and thus becoming a major public problem. Maxillofacial injuries constitute a substantial proportion of cases of trauma and occur in a variety of situations like road traffic accidents, interpersonal violence, falls or as a result of contact sports. The aim of this prospective study was to evaluate the efficacy of titanium mesh for osteosynthesis of maxillofacial fractures.

Materials and Methods

Fifteen patients of maxillofacial fractures who were treated with titanium mesh were included in this prospective study. The patients were evaluated preoperatively, intraoperatively and postoperatively at 7th day, 3rd week, 6th week and 12th week.

Results

The mean age of fifteen patients was 31.3 years with a male:female ratio of 14:1. The most common mode of injury was road traffic accident (86.6%). The mean time interval between injury and surgical procedure was found to be 7.6 days. The majority of fracture sites (88%) were comminuted. 93.3% of the patients achieved good occlusion by 12th week postoperatively. Postoperative complications included residual hypoaesthesia in four patients and wound dehiscence in one patient.

Conclusion

We conclude that titanium mesh is a versatile option for maxillofacial fractures. It provided good stabilization especially in comminuted fractures. As a fixation method, it was quick in placement and highly adaptable, and thus, it proved to be valuable in restoring the form and function in maxillofacial trauma patients.

Multidetector CT of Mandibular Fractures, Reductions, and Complications: A Clinically Relevant Primer for the Radiologist

After the nasal bones, the mandible is the second most common site of facial fractures, and mandibular fractures frequently require open reduction. In the trauma injury setting, multidetector computed tomography (CT) has become the cornerstone imaging modality for determining the most appropriate treatment management, fixation method, and surgical approach. Multidetector CT is also used to assess the adequacy of the reduction and evaluate potential complications in the postoperative period. For successful restoration of the mandible's form and function, as well as management of posttraumatic and postoperative complications, reconstructive surgeons are required to have a detailed understanding of mandibular biomechanics, occlusion, and anatomy. To provide added value in the diagnosis, treatment planning, and follow-up of mandibular fractures, radiologists should be aware of these concepts. Knowledge of the techniques commonly used to achieve occlusal and anatomic reduction and of the rationale behind the range of available treatment options for different injury patterns-from isolated and nondisplaced fractures to multisite and comminuted fractures-also is essential. This article focuses on the use of multidetector CT for pre- and postoperative evaluation of mandibular fractures and outlines fundamental concepts of diagnosis and management-beginning with an explanation of common fracture patterns and their biomechanical underpinnings, and followed by a review of the common postoperative appearances of these fractures after semirigid and rigid fixation procedures. Specific considerations regarding fractures in different regions of the tooth-bearing and non-tooth-bearing mandible and the unique issues pertaining to the edentulous atrophic mandible are reviewed, and key features that distinguish major from minor complications are described. (©)RSNA, 2016.

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.

Prognosis of teeth in the line of jaw fractures

BACKGROUND/AIM

The decision as to whether teeth in the line of jaw fractures should be extracted or retained remains a controversial issue. The aim of this study was to assess the prognosis of teeth directly in the line of, and adjacent to, jaw fracture sites.

MATERIALS AND METHODS

The study consisted of 50 patients with facial fractures in the dentate region, the diagnosis of which was made on the basis of clinical and radiographic examinations. A total of 124 teeth were present in 69 fracture sites (50 patients), of which 89 teeth were evaluated both, clinically (tooth mobility, pocket depth, pulp sensibility) and with periapical radiographs (degree of fracture displacement, marginal bone loss, root resorption).

RESULTS

The results revealed that 61.9% of teeth in directly in the line of fractures showed no response to electric pulp testing compared with 48.9% teeth adjacent to fractures. The maximum frequency of non-responsive teeth was observed in Type I fractures followed by Type II fractures. Response to pulp tests was highly significant at postoperative 3- and 6-month periods (Wilcoxon's test). There was continuous reduction in the measurement for mean pocket depth at both test and control sites of teeth. The measurement of marginal bone levels of teeth in the line of fractures revealed a significant reduction (P < 0.01) from preoperative to postoperative 7-day period only. In teeth adjacent to fracture sites, the mean marginal bone levels of control site and test sites were not significant at any time interval. There was no difference in postoperative complications pertaining to whether the tooth at the fracture site was extracted or retained.

CONCLUSIONS

Teeth in line of jaw fractures should not be removed on a prophylactic basis and should be followed up clinically and radiographically to determine any treatment needs.

Use of a single 2.0-mm locking AO reconstruction titanium plate in linear, non-comminuted, mandible fractures

Purpose:

The aim of the following study is to prospectively evaluate the use of a single Arbeitsgemeinschaft für Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear non-comminuted mandibular fractures without the use of a second plate.

Materials and Methods:

This study consisted of a sample of 10 patients who reported to the department with fractures of the mandible and were treated over a period of 24 months from November 2010 to November 2012. Out of these, there were 8 male patients and 2 female patients. There were four cases of isolated parasymphysis fractures, 1 of the case had a parasymphysis fracture associated with subcondylar fracture, 4 had a body fracture and 2 had a symphysis fracture.

Results:

All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Only one patient (10%) developed minor complications.

Conclusion:

The study has demonstrated that treating linear non-comminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plate provides excellent stability at the fracture site which in turn leads to sound bone healing and early functional rehabilitation.

Assessment of the fixation of mandibular symphysis fractures using conical cannulated screws: mechanical and photoelastic tests

OBJECTIVE

The aim of this study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with other fixation methods in mandibular symphysis fractures.

STUDY DESIGN

Ten polyurethane mandibles were allocated to each group and fixed as follows: group PRP, 2 perpendicular miniplates; group PLL, 1 miniplate and 1 plate, parallel; and group CS, 2 cannulated screws. Vertical linear loading tests were performed. The differences between mean values were analyzed with the Tukey test. The photoelastic test was carried out using a polariscope.

RESULTS

The results revealed differences between the CS and PRP groups at 1, 3, 5, and 10 millimeters of displacement. The photoelastic test confirmed higher stress concentration in all groups close to the mandibular base, whereas the CS group showed it throughout the region assessed.

CONCLUSIONS

Conical cannulated screws performed well in mechanical and photoelastic tests.

Soft tissue coverage for mandibular fractures using two miniplates

Recent reports have raised the concern that the two miniplate fixation technique for mandibular symphysis and body fractures may lead to greater complications than previously thought. However, it is possible that the surgical exposure and methods of soft tissue closure may be a major contributor to plate exposure. In this article, we detail a technique for vascularized tissue coverage of the hardware used to repair these mandibular fractures. We believe that this soft tissue coverage is crucial for minimizing complications associated with plate fixation.

The 7-hole angle plate for mandibular angle fractures

PURPOSE

To evaluate the 7-hole angle plate for open reduction, internal fixation of mandibular angle fractures when the Champy technique is inadequate and more rigid or semirigid fixation is beneficial and to provide rational indications for the choice of the 7-hole angle plate.

PATIENTS AND METHODS

Retrospective evaluation of 10 patients selected at Parkland Memorial Hospital over a 2-year period when the 7-hole angle plate stabilized their angle fracture. Patients were evaluated for postoperative complications including pain, malocclusion, and infection.

RESULTS

All 10 patients had sufficient follow-up for inclusion in this retrospective study. Correct placement of the 7-hole angle plate, easily accomplished with adequate assistance, produced no reportable postoperative complications.

CONCLUSION

The 7-hole angle plate is a good first option when more rigid or semirigid fixation is required, and the best fallback when the Champy technique is ineffective.