Comparative Evaluation of Conventional Miniplates, Three-Dimensional Miniplates and Lag Screws for Internal Fixation of Parasymphysis Fracture of Mandible-A Double-Blind Randomized Clinical Study

Purpose

The aim of this study is to clinically and radiographically evaluate the stability of parasymphysis fracture managed with lag screws, miniplates and 3D miniplates.

Materials and Method

Ninety- eight patients diagnosed with parasymphysis fracture were treated using lag screws in group 1, two 4-hole miniplates in group 2 and 3D miniplates in group 3. Intraoperative stability and duration of fixation was assessed. Postoperative clinical evaluation was done at 1 week, 1 month, 3rd month, 6th month and 1 year for complications and oral function. Radiological evaluation was done at 3rd and 6th month. Only 92 patients were considered for statistical analysis since 6 patients were lost during follow-up.

Results

Road traffic accident (65.3%) was the primary cause of mandibular fractures. Postoperative pain score showed a statistically significant difference after 1 week and 1 month duration (P value < 0.001). ANOVA test showed VAS was significantly higher at pre-op followed by 1st day and 1 week, but no significant difference after 3 months in all groups. Radiographic analysis did not show significant difference in approximation of fracture segment among 3 groups after 6 months (P-value = 0.117). Chewing efficiency at 6 months and occlusion by surgeon evaluation at 3 months showed a significant difference (P value < 0.001).

Conclusion

Lag screw fixation was technique-sensitive, relatively inexpensive and was less time consuming method when compared to miniplates and 3D plates. Lag screws and 3D plates are superior in reducing the incidence of complications and better in oblique or sagitally displaced mandibular fractures.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-021-01647-5.

Comparative evaluation of a single 2.0-mm AO locking reconstruction plate with conventional miniplate osteosynthesis for treatment of linear non-comminuted fractures of symphysis and parasymphsis region of the mandible

The objective of the study was to evaluate and compare the relative efficacy of treating linear non-comminuted mandibular fracture of symphysis and parasymphysis region using single 2.0-mm AO locking reconstruction plate or using two conventional miniplates. In this study, 80 patients of symphysis or parasymphysis fracture were divided randomly in two equal groups and treated with open reduction and internal fixation using two 2.5-mm miniplates or with a single 2.0-mm AO locking reconstruction plate. Operating time in case of open reduction and fixation using a single 2.0-mm locking reconstruction plate was significantly less when compared to open reduction and fixation using two conventional miniplates. Both groups showed satisfactory fracture reduction and healing. No postoperative malocclusion was noted, and both groups showed comparable improvement in masticatory efficiency. In conclusion, fracture fixation using a single 2.0-mm AO locking reconstruction plate without use of a second plate at the superior border for treatment of linear non comminuted mandibular fracture in symphysis and parasymphysis region gives comparable results as with treatment by conventional miniplate system and provides significant savings in operating time, ease of use and decrease in amount of hardware incorporated in the body.

Comparison of circummandibular wiring with resorbable bone plates in pediatric mandibular fractures

Pediatric patients present a unique challenge to maxillofacial surgeons in terms of their treatment planning as well as in their functional and nutritional needs which are different from that of adult patients. Early literature has advocated conservative closed management of pediatric fractures to prevent complications. However recent advances in maxillofacial surgery has enabled us to use biodegradable plates and screws, which overcomes the limitations of metallic plates. We present a comparison of two cases of parasymphysis fracture treated with circum-mandibular wiring and biodegradable plate fixation their outcome in terms of fracture healing and functional stability.