Outcome of Comminuted Mandibular Fracture Repair Using an Intraoral Approach for Osteosynthesis

Abstract

PURPOSE: Traditionally, the treatment of comminuted mandibular fractures involves both closed and open reduction. However, modern treatment principles increasingly tend toward open reduction and internal fixation to shorten oro-functional rehabilitation. Although this method increasingly gained popularity to date, a controversy regarding the extraoral versus the intraoral surgical approach still exists. The current study aimed to objectively evaluate the outcome of comminuted mandibular fracture treatment involving open reduction and internal fixation using an intraoral approach. PATIENTS AND METHODS: Consecutive patients treated at the Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, between 2005 and 2012 were included. Demographic, presurgical, perisurgical, and postsurgical data were tabulated and statistically evaluated using the test and the Mann-Whitney U test. RESULTS: Forty-five patients could be included. Excellent postoperative results were seen in 84% (38 patients) of the total cohort. Postoperative complications were seen in 16% (7 patients). These 7 patients had the following complications: wound dehiscence (7% [n = 3]), osteomyelitis (7% [n = 3]), abscess development (4% [n = 2]), bone necrosis (2% [n = 1]), and severe nonocclusion (2% [n = 1]). CONCLUSION: Present data showed that the intraoral approach for open reduction and internal fixation in comminuted mandibular fractures represents a comparable surgical technique regarding fracture repositioning and occlusal rehabilitation. Considerably, the risk of concomitant neurovascular damage or even facial scarring, as demonstrated in the extraoral approach, can be neglected by using this technique. Nevertheless, each case has to be judged on its own accord as to which technique can best treat the underlying fracture.

OCCS Classification and Treatment Algorithm for Comminuted Mandibular Fractures Based on 109 Patients and 11 Years Experiences: A Retrospective Study

“…The mandible is the most protruding bone and is susceptible to fracture in the maxillofacial region, with a fracture incidence rate of 23.8% to 81.3% [ 10 , 11 , 12 ], while CMFs account for only approximately 5–7% [ 2 ]. CMFs mainly result from high-energy impacts, directly or indirectly, to a localized area of the mandible [ 13 , 14 ] and may lead to a series of unfavorable consequences, such as airway obstruction, malocclusion, mouth-opening limitation, infection or bone nonunion, and secondary dento-maxillofacial deformities [ 2 ]. The treatment methods include MMF, external fixation [ 6 ], ORIF with micropletes [ 15 ], mini-plates, reconstruction plates [ 16 ] or titanium mesh [ 7 ].…”

Total Customized Alloplastic Reconstruction for Treatment of Severe Temporomandibular Joint Pathologic Conditions: A Case Series of Combined Intraoral and Extraoral Approach

“…The IA is an alternative to the retromandibular/transparotid approach to install the mandibular component of TMJ replacement devices. Its usage to treat noncomminuted mandibular fractures and to install reconstruction plates are well reported in the literature resulting in no external scarring, lower risk for injury to the facial nerve and parotid gland 9,20,21 . However, it is expected to increase infection rates, since devices will be exposed to oral bacteria during installation.…”

Fracturas Mandibulares Conminutadas por Impacto de Proyectil Balístico: Propuesta de Tratamiento Inicial Mediante Método de Fijación Alternativo

“…Alpert et al y Rana et al hacen énfasis en que toda fractura mandibular conminutada debiese ser tratada mediante placas y tornillos, principalmente por el excelente confort entregado al paciente, rápida reinserción social y buenos resultados en cuanto a la consolidación ósea. Del mismo modo, Schenkel et al (2014) propone el uso de placa de re-construcción para el tratamiento de este tipo de fractura, sin embargo en casos de conminución extrema y compromiso de tejido blando, propone el uso de fijación externa. Las ventajas que posee la fijación externa apuntan principalmente a no desperiostizar la zona conminutada asegurando que todos los fragmentos óseos queden contenidos bajo la capa de periosteo sin riesgo de sufrir secuestros o necrosis.…”