A Comparative Review of Treatment of 80 Mandibular Angle Fracture Fixation with Miniplates Using Three Different Techniques

Abstract

Standard treatment of mandibular angle fracture with miniplates according to recommendations of Champy et al. (1976) consists of fixation with one miniplate at superior border of mandible ventral to external oblique line. In certain constellations, second miniplate at lower border may provide additional stability. In this retrospective study 80 patients with mandibular angle fracture were divided into 3 sub-groups reported at DIRDS Faridkot were treated by intraoral, extraoral and combined intraoral and transbuccal approach. There was no significant difference in complication rates encountered with these techniques. Decision regarding treatment approaches for open reduction of mandible fracture often relates to surgeon's experience and training. In some cases, choice is affected by availability of equipment. More difficult cases involving endentulous atrophic mandible or comminution should be considered for extraoral approach. Intraoral open reduction and fixation was used for non-comminuted and non-complicated fractures. The combined transbuccal/ Intraoral procedure is now preferred method because of ease of use and facilitation of placement of plate in neutral mid point area of mandible.

One miniplate compared with two in the fixation of isolated fractures of the mandibular angle

“…Wound healing (infection and wound dehiscence): Nine studies 6,8,9,[16][17][18][20][21][22] The cumulative OR was 0.55, meaning that the use of one miniplate in the fixation of fractues of the mandibular angle reduces the risk of wound infection and dehiscence by 45% compared with the use of two miniplates (Fig. 2).…”

“…Failure of hardware: Seven studies 6,8,[16][17][18]20,21 compared the two techniques from the point of view of failure of hardware. The one miniplate technique had a significant advantage over two miniplates in fixation of fractures of the angle (OR 0.50, 95%CI 0.25 to 0.99; p=0.005).…”

“…The results of the present study confirm those of previous studies. 6,8,17,19,20,26,27 The high complication rate with two miniplates could be attributed to more periosteal and muscle stripping in the region of the angle, which would compromise both blood supply and healing. In addition to contamination with oral bacteria, all these factors could increase the risk of problems with wound healing.…”

“…28 The limitations of the present study were firstly that only 3 RCT 8,17,19 were included in the meta-analysis together with 3 CCT 6,22,23 and 4 retrospective studies. 9,18,20,21 The results of RCT give the most reliable data for inclusion in a true meta-analysis, but I included retrospective studies because the qualitative analysis of all 10 studies indicated that 3 8,17,19 had only a low risk of bias and 7 6,9,18,[20][21][22][23] had only a moderate risk. Secondly, four studies did not deal with isolated fractures alone, whereas 6 were associated with other mandibular fractures (such as those of the contralateral body or symphysis) in addition to the angle.…”

“…Three RCT, 8,16,18 3 CCT, 6,21,22 and 4 retrospective studies 9,17,19,20 were included in the meta-analysis and critical appraisal. A total of 959 patients were enrolled in the 10 studies, 6,8,9,[16][17][18][19][20][21][22] which compared one superior miniplate on the external oblique ridge (n=466) with two miniplates (one superior miniplate on the external oblique ridge and one plate at the inferior border of the mandible) (n= 493).…”