A Comparative Prospective Study of Two Bone Plating Methods for Fractures of the Mandibular Symphysis or Parasymphysis

Abstract

Mandibular symphysis and parasymphysis fractures are a common type of injury to facial skeleton. The purpose of this prospective study was to evaluate outcomes for 2 bone plating techniques used in the treatment of mandibular symphysis/ parasymphysis fractures. Thirty patients reporting to the department with mandibular symphysis/parasymphysis fractures were divided into 2 groups (group A and group B). A prospective study was carried out in 30 patients with defined inclusion and exclusion criteria. Patients were followed for 3 months postoperatively for occlusion, distraction of lower border radiologically, paraesthesia, infection, failure of bone plate (plate fracture) and screw loosening, postoperative segmental stability and radiological evaluation of fixation. Fifteen patients were treated by open reduction and single miniplate fixation below apices of teeth with arch bar acting as tension band (Group A) and 15 with conventional titanium miniplates following Champy's rule i.e. Two miniplates (Group B). Distraction of lower border was seen in both groups (as in group A-1 patient and group B-2 patients), which was noticed radiographically at all follow ups. There was no occlusal discrepancy present in both groups after 3 months post operatively. The fracture segments were stable in both groups at all times. Paraesthesia was noticed in both groups, which gradually decreased in 1 month and resolved completely by 3 rd month follow up. The degree of paraesthesia, distraction of lower border, occlusal discrepancy was not statistically significant between the two groups. Infection was noticed in both groups at the end of 2 weeks, which was treated with antibiotics. The result between both the groups was not significant though. Hardware failure (plate fracture and screw loosening) was not found in both groups. Osteosynthesis by both techniques is effective in providing immediate post operative function but the distinct advantage of less hardware has made the use of a single miniplate quite popular in the recent times.