Mandibular Angle Fractures

Abstract

Background: Noncompression monocortical miniplate fixation of the mandibular angle is an accepted and reliable method for providing rigid internal fixation. High complication rates have been reported for internal fixation of angle fractures.Objective: To analyze the outcome and complications in cases in which patients were treated with 2-miniplate fixation at the mandibular angle.Design: A retrospective analysis of outcomes for a case series.Setting: Treatment performed at a level 1 traumarated teaching hospital.Methods: From May 1992 to September 2001, a total of 88 patients with angle fractures of the mandible were treated with 2-miniplate fixation. Sixty-eight of the 88 patients, with 70 angle fractures, were included in the study; 13 were unavailable for follow-up and 7 had less than the minimum follow-up of 6 weeks. The time of trauma to treatment, cause of injury, and associated fractures were recorded. Postoperative complications, including infection, malunion, nonunion, dehiscence, osteomyelitis, and nerve injury due to surgical manipulation, were tabulated. Follow-up examinations were performed up to 12 weeks after surgery, with additional examinations if necessary. Postreduction panoramic radiographs were obtained in most cases.Results: No patients treated with monocortical 2-miniplate fixation had malunion, nonunion, or osteomyelitis. Twelve (17.6%) of the 68 patients were identified as having at least 1 postoperative complication. Postoperative infection occurred in 2 patients (2.9%). Infection was controlled with oral antibiotic therapy. One patient required removal of miniplates after the acute phase resolved. Occlusal disturbances were noted in 4 patients (5.9%) (2 with a slight anterior open bite, 1 with a crossbite, and 1 with premature contact of a molar) after surgery. Three of the 4 patients had associated midfacial or multiple mandibular fractures. None required further surgery. Wound dehiscence, with exposure of an underlying plate, occurred in 4 patients (5.9%); the wounds were treated conservatively and subsequently resolved. Nerve injury due to surgical manipulation occurred in 3 patients (4.4%).Conclusions: Monocortical 2-miniplate fixation of the mandibular angle is a reliable and effective technique for providing rigid fixation. The complications were minimal in our study, and the infection rate was 2.9%, which is comparable to or better than the infection rate reported with the use of a single miniplate fixation technique in other studies. Disturbances of occlusion were associated with midfacial or additional mandibular fractures. In view of the contradictory published results, further studies are needed to determine the ideal approach for noncompression monocortical plate fixation of angle fractures.

Management of Mandibular Angle Fractures: Single Stainless Steel Linear Miniplate Versus Rectangular Grid Plate—A Prospective Randomised Study

“…compression, tension and torsion, where as when a single miniplate is placed across the tension zone in superior border of mandible it might lead to splaying of fracture ends in the lower border of mandible due to decreased resistance to shearing and tensional forces across the plate causing reduction in stability of fixation [24].…”

Transoral approach alone in single miniplate osteosynthesis of angle fracture - our experience

“…The advantages of the rigid intraoral fixation over closed reduction technique are: shorter MMF period or no MMF, early return to function, increased patient satisfaction, stable anatomic reduction, minor risk of postoperative fractured fragments displacement, decreased hospital stay, and faster healing. [51516]…”

“…[33] Fox and Kellman studied complications in patients treated with two-miniplate fixation for mandibular angle fractures and reported the incidence of damage to inferior alveolar nerve in 4.4% of their patients. [5]…”

“…[12] There are several reasons proposed for the increased occurrence of mandibular angle fracture: The abrupt change in the anatomy at mandibular angle region which is 20° in the vertical plane and 90° in the horizontal plane at the upper border, the presence of impacted mandibular third molars, which weakens the region,[56] less cross-sectional area due to the large amount of space occupied by the crypt of mandibular third molars, and biomechanical consideration of angle as a lever area of mandible. [7]…”

Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture

“…Rigid internal fixation can provide stability, reducing the risk of malunion and infection due to postoperative displacement of segments and improving quality of life for patients who would otherwise require intermaxillary fixation. 4 The angle is one of the sites most frequently fractured as a result of a traumatic event involving the mandible. 5 Such fractures are commonly treated using miniplate osteosynthesis.…”