Management of fractures of anterior mandible with different fixation methods : A single institutional experience

Abstract

Aim: To evaluate the effectiveness of various internal fixation hardware used for treatment of symphyseal and parasymphyseal mandibular fractures based on a single institution`s experience. Materials and Methods: In this retrospective clinical study, one hundred patients with fractures of the anterior region of the mandible involving both the symphysis and parasymphysis areas were included. All cases were selected from the patients` records who were treated in the oral and maxillofacial surgery department in a 4 years period extended from May 2013 to May 2017. Surgical admission notes, x-ray reports, operation records, outpatient notes, and complications were recorded. The patients were followed up periodically until a minimum of 6 weeks. Results: The distribution of fracture pattern was as follows; 53 patients with anterior mandible associated with subcondylar/ condylar fractures, 31 with anterior mandible in association with mandibular angle fractures, and only 16 patients with isolated anterior mandible fracture. The majority of the fractures (40%) were treated by 2 miniplates, followed by the 3-D miniplates (17%), equal use (12% each) of (2 lag screws, 1 lag plus 1 miniplate and 1 reconstruction plate), then 1 lag screw (4%), and the least was the use of only 1 miniplate (3%). Conclusion: Proper selection of the fixation method for anterior mandibular fractures is essential to guarantee a successful treament and early restoration of function. Each method has its own advantages and disadvantages, and each case should be treated individually based on proper diagnosis and planning.

Single 2.3 Reconstruction Plate Versus Two Miniplates in the Treatment of Mandibular Fractures (Randomized Clinical Trial)

“…It was managed with proper endodontic treatment, daily normal saline irrigation, antiseptic mouth wash, prophylactic antibiotic coverage, and proper oral hygiene maintenance until healing was achieved. This matches with Khalil et al, (20) who managed the treatment of anterior mandibular fractures (AMF) using various fixation methods and stated that 5% of the patients had postoperative wound infection.…”

“…5 (71.4 %) males to 2 (28.6 %) females in group A, and 4 (57.1 %) males to 3 (42.9%) females in group B. The patient's ranged in age from years, with 32.12 ± 7.59 years average in group A and that of group B being 29.62 ± 5.18 years, with age groups similar to those seen in other studies (1,11,20). Hu Increased road traffics, and travelling without using safety precautions, are common findings in developing countries, which may contribute to its high rates followed by aggravated assaults (11).…”

“…Naturally, anterior mandibular region is vulnerable. They lack two of the supporting factors found in posterior tooth-bearing mandible fractures; the interdigitation of molar and premolar teeth, as well as counterbalance caused by the lateral masseter and medial pterygoid muscles, which assemble the natural pterygomasseteric sling (20).…”

“…However, given the presence and location of facial lacerations, an extraoral approach was used to extend the primary wound to provide minimal surgical access and expose all fractures for fixation, registered by Kanno et al, (8). The AO/ASIF technique, which uses a single low-profile reconstruction plate placed near the inferior border and has recently been shown to provide excellent stability, was used in Group A (1,8,11,20,21). Group B, on the other hand, was treated using Champy's principles of application, with many authors reporting high success rates (3,(34)(35)(36).…”

“…There have been enough studies on the conventional two miniplates, but not on the single low-profile non-locking reconstruction plate used in anterior mandibular fractures. Registered by Khalifa et al,(20) other limitations include an increased thickness in comparison to miniplates, which increases tactility, a higher incidence of wound dehiscence due to its bulk, Alexandria Dental Journal. Volume 47 Issue 2 Section A 44…”