Lingual Splint for Sagittal Fractures of Mandible; An Effective Adjunct to Contemporary Osteosynthesis: A Case Series with Review of Literature

Abstract

).Sagittal/oblique fractures of the mandible are a common but challenging entity. The fracture line in such cases separates the buccal and lingual cortices over a variable extent depending on the anteroposterior extent of the fracture line, the presence of teeth in the arch, and the resultant pull exerted by muscles such as geniohyoid, genioglossus, and mylohyoid (►Fig. 1A). 1 Unlike linear fracture patterns, oblique fractures render complexity in management in three aspects: (1) The fracture line on the buccal and lingual cortical plates is in different planes, the buccal usually being anterior which make use of miniplates less effective in achieving interfragmentary reduction, (2) difficulty in approximating the displaced lingual cortical plate to the buccal cortical plate to achieve precise anatomic reduction, and (3) inability to verify fracture reduction on the lingual side, intraoperatively.Accurate anatomic reduction of sagittal fractures or correction of lingual splay is a critical step before positioning of miniplates or lag screws, to achieve precise fixation. Reduction of mandibular splay is made either by manual compression at the angle region by "hand-holding technique" 2 or by using instruments such as reduction clamps, 3 temporary screw, 4 positioning wires, 5 Becker bone holding forceps, 6 or temporary intraoperative external fixation of mandibular fractures. 7 However, these methods are associated with practical limitations. Manual compression and hand-holding techniques require a skilled assistant and are not reliable for predictable results, while application of the abovementioned instruments is cumbersome, time-consuming, and associated with potential soft tissue injury.Alternatively, techniques such as (1) modification of fixation implants like over bending the miniplate 2 or (2) use of different designs of implants like reconstruction spanning plate, 8 threedimensional (3D) plates, 9,10 and 2-mm 3D rectangular grid compression plates 11 help in simultaneous lingual reduction as well as fracture fixation. However, these are relatively expensive and require precision in surgical technique.This article presents a simple and effective method of using a prefabricated lingual splint to reduce the displaced lingual cortical plate in sagittal fractures of the mandible. Keywords► mandible ► fracture fixation ► splints ► sagittal fracture AbstractSagittal fractures of the mandible frequently pose challenges in open reduction and internal fixation due to their unfavorable fracture pattern. The powerful lingual musculatures of the mandible exert tremendous displacing forces on the fracture fragments, resulting in gross lingual displacement. The control of the displaced lingual cortical plate and its restitution to the normal anatomical position before fixation is technically demanding. The article presents a simple and practically effective method of reducing such fractures with the use of a prefabricated lingual splint. The article also reviews the numerous types of lingual splints with their clinical...

March’s 2024 Full Issue PDF

“…Management of dentulous mandibular fractures can include application of completely different types of intermaxillary and MMF appliances. Like, vacuum-formed splints with bonded wire cleats for temporary intermaxillary fixation (Lloyd and colleagues, 2001), 12 intraoral cortical bone screws and specially designed metal Otten hooks (also known as Ottenhaken) (Poeschl and colleagues, 2008), 13 Ivy loops/eyelet wiring (Chacon and Larsen, 2004; Touré and colleagues, 2023), 14,15 lingual splint (Chacon and Larsen, 2004; Balasubramanian and colleagues, 2017), 14,16 Tigershtedt arch bars, Tymofieiev, 2012), 17 Erich/Vasyliev arch bars (Blitz and Notarnicola, 2009;Tymofieiev, 2011), 18,19 intermaxillary fixation with bra hook (Pynn and colleagues, 2022), 20 Risdon cables with elastics for patients with primary and mixed dentitions (Marschall and colleagues, 2023), 21 and many more.…”

Correction of Traumatic Transverse Mandibular Widening With Interdental Wiring

“…The widening may be profound in the setting of concomitant subcondylar fractures, where loss of the lateral pterygoid attachments to the skull base causes flaring of the mandibular rami 3 . Prior studies have described 2 classic methods to address mandibular widening intraoperatively including manual compression of the rami 2,5 and custom lingual splints 6,9 . Although these methods are useful in certain cases, they carry disadvantages such as need for a skilled assistant, difficulty sustaining a constant manual pressure during reduction and fixation, and the added time and cost to fabricate a prosthesis.…”