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

Abstract

Comminuted mandibular fractures (CMFs) pose significant challenges to surgeons for their serious complications and poor outcomes. We aimed at proposing a classification with treatment algorithm of each category for CMFs. Patients with CMFs were retrospectively reviewed and classified into five categories: Type I: relatively good occlusion, no or slightly displaced fragments, no continuity destruction or bone defect; Type II: relatively good occlusion, damaged morphology, low comminution degree but intact continuity without bone defect; Type III: damaged morphology and higher comminution degree with intact continuity and relatively good occlusion; Type IV: high comminution, impaired continuity and poor occlusion without segmental bone defect; Type V: segmental bone defect. Conservative treatment, open reduction and internal fixation or microvascular osteocutaneous free flap transplantation was performed, accordingly. Demographics, perioperative data, complications and reasons for reoperations were recorded. The chi-square test was used for statistical analysis. In total, 109 patients were included in the study. After surgery, in the following group, 5 manifested infections, 1 manifested bone non-union, and 2 experienced reoperations, while in the unfollowing group, 10 manifested infections, 5 manifested bone non-union and 8 experienced reoperations. The OCCS classification and algorithm for CMFs achieve better outcomes and with lower complication rate.

Comparison between mini-plate and reconstruction plate osteosynthesis in the treatment of the comminuted mandibular fracture.

“…Comminuted mandibular fractures are high impact injuries that offer crucial concerns to surgeons due to their substantial consequences and unpredictable squalae. 8 The mode of injury should be evaluated since impacts, such as gunshot wounds, can cause soft tissue loss.…”

“…: Type 1: Relatively good occlusion, undisplaced fracture and no continuity defect Type 2: Low degree of comminution but achievable occlusal disharmony and no bony defect Type 3: Deteriorated morphology, more fragmentation, no discontinuity of mandible. Type 4: greater degree of comminution, discontinuity of mandible and poor occlusal relationship Type 5: segmental mandibular loss 8 A detailed history and a comprehensive clinical examination should be carried out to assess malocclusion, fracture site as well as dental, soft tissue and osseous defects. A preliminary digital orthopantomogram should be followed by CTscan face with 3D reconstruction.…”

“…Reconstruction plate fixation lacks this treatment's flexibility. 8 In terms of maximising function and morphological recovery and reducing the possibility of iatrogenic patient harm, reconstruction plate systems may not always be the best option and are inappropriate for addressing all types of comminuted mandibular fractures. 5 The objective of this study is to compare the treatment outcome for reconstruction plates and mini plates in treating comminuted mandibular fracture.…”

Which of 51 Plate Designs Can Most Stably Fixate the Fragments in a Fracture of the Mandibular Condyle Base?

“…The first to be created were squares, rectangles and deltas. Nowadays, they are treated in a number of surgical ways using a wide collection of dedicated titanium plates [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. This plethora of choices raises the question of whether, therefore, each plate is equally suitable for treating fractures of the base of the condylar process.…”

Which of the 37 Plates Is the Most Mechanically Appropriate for a Low-Neck Fracture of the Mandibular Condyle? A Strength Testing

“…The market offers a multitude of plate designs for the osteosynthesis of low-neck fractures in the mandibular condyle. However, the existing literature does not conclusively identify the most effective dedicated plate for such fractures [4][5][6][7][8]. It is worth noting that newer plates specifically designed for surgical treatment of this fracture type have been introduced recently [9][10][11][12][13].…”