A comparative study between transbuccal and extra-oral approaches in treatment of mandibular fractures

Abstract

Background and objectives Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications.Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve. In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient. Study design Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach. In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm. Results Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring. Conclusion The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.

Comparison of Management of Mandibular Angle Fractures by Three Approaches

“…It is also a procedure of choice over the submandibular approach in bilateral unfavorable angle fractures, which helps in preventing damage to marginal mandibular nerve. This approach is usually employed because it results in less inconspiquous scar formation and allows direct visualization of the fracture site, confirmation of the occlusion status during placement of bone plates and relatively low risk of facial nerve injury [4,13,14].…”

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

“…Kale et al compared the extraoral and transbuccal approach for treating mandibular fractures and reported shorter operating time with the transbuccal approach. 14 Toma et al 15 compared the operative time between the extraoral and the intraoral approach for mandible fractures and published only a slightly longer duration for the intraoral method. The mean operation time in this study for comminuted mandibular fractures using the intraoral approach was 3.3 hours, with the time to establish the MMF already included.…”

Evaluation of Titanium Lag Screw Osteosynthesis in the Management of Mandibular Fractures

“…1 The management of facial trauma is one of the most important and demanding aspects of maxillofacial surgery. The mandible is the most movable and prominent bone of facial skeleton.…”