Purpose:The aim of this prospective study was to evaluate clinical and radiographic outcomes of combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches in the management of unfavorable displaced mandibular angle fracture with opening mouth immediately postoperatively.
Materials and methods:Thirteen patients (age 16-58 years, 9 males and 4 females) with unfavorable displaced mandibular angle fractures were treated by combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches. The following clinical parameters were evaluated; pain, infection, maximum mouth opening, neurosensory disturbance, malocclusion/ midline shift, presence of unsightly facial soft tissue scar, muscle trismus, ability to chew hard food, loosening of hardware, and need for alternative treatment. Radiographic evaluation included evaluation of fracture type, any abnormal position of hardware and screws, malunion, displacement if present, and malocclusion using cone-beam computerized tomography (CBCT)that was done preoperatively and at 8weeks postoperative. All parameters were evaluated preoperatively, postoperatively,3 weeks,8 weeks, 6 months, and 12 months later.Results: Maximum mouth opening preoperatively (8.52mm) significantly increased postoperatively to 30.57mm, then significantly increased at 3, 8 weeks, and 6 months. All cases (13 patients) were detected with pain perioperatively which continued to 3 weeks then significantly decreased at 8 weeks and disappeared after 6 months. Seven cases presented with infection preoperatively which significantly decreased to 2 cases postoperatively and disappeared after 3 weeks. All cases had trismus which significantly decrease postoperatively and disappeared after 6 months. Three cases were detected with neurosensory disturbance postoperatively and disappeared after 6 months. All patients were unable to chew hard food till 8 weeks. No cases were detected with malocclusion/midline shift, malunion, non-union, unsightly facial soft tissue scare, no need for any alternative treatments or loosening of the hardware was detected postoperatively.
Conclusion:Within the limitation of this study, combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches in the management of unfavorable displaced mandibular angle fracture is an effective treatment modality as it was associated with favorable clinical and radiographic outcomes with reduced complications after one year.