Surgical Treatment of Bilateral Atrophic Mandible Fracture

Abstract

Poor proprioception, weakness, and impaired reflexes increase the incidence of facial fracture in the elderly. Mandibular fractures in these people range from 10.1% to 56%. Fragment reduction and fracture consolidation are difficult due to bone atrophy, decreased capacity for bone regeneration, and lack of anatomical landmarks to guide the alignment of the fragments. This study reports 2 patients with different conducts regarding the treatment of bilateral fractures in atrophic mandible. The first patient refers to the removal of plates of the 2.4 mm system with low profile, which failed during the mandibular function, being replaced by the 2.4 mm system with high profile. The 2nd clinical reports the use of the 2.0 mm system only to simplify the mandibular fracture, and then reconstructing that with a 2.4-mm system with high profile, using the load bearing principles. Regarding mandibular fractures, an important goal is to neutralize the muscle action aiming the bone stability. There are several methods to treat that the indication should consider the load bearing and load sharing concepts. The incorrect fixation choice in these patients can result in complications as bad union, material failure, infection, and consequent treatment failure.

Dental Implants Acting as External Fixation for the Fracture of Severe Atrophic Mandible: A Case Report

“…There is no consensus on the best treatment, especially in cases with a vertical height of less than 10 mm [ 5 ]. When the fixation was not done appropriately, it causes malunion and nonunion [ 4 ]. Also, considering denture-bearing area and the position of the plate is very important to avoid the infection and/or the plate exposure [ 6 ].…”

“…In these cases, the miniplates and reconstructive plates are used to fix the bone fragment [ 3 ]. However, the failure of fixation may cause the malunion, nonunion or false joint [ 4 ]. We report a case of a severely atrophic edentulous mandible fracture in which the dental implant and implant-supported bridge acted as external fixation and bone union was obtained.…”

Mandibular Fractures: Diagnosis and Management

“…Severe atrophy is classified as 10mm in height or less. 33 Decreased bony height correlates to increased incidence of nonunion, malunion, recurrent fractures, hardware failure, postoperative infection, and osteomyelitis. The incidence of these complications is between 10-20%.…”

“…The incidence of these complications is between 10-20%. 33 ORIF has largely replaced other reduction techniques such as gunning splints, circum-mandibular wires around dentures, and external fixators. Load bearing osteosynthesis with a reconstruction plate for anatomic reduction provides a solid construct for atrophic mandible fractures (►Fig.…”

“…9B). 34,35 In some cases, a large inferior border plate on the lateral border, coupled with a shallow vestibule may make wearing a denture less feasible. In these circumstances, placement of the reconstruction plate on the underside of the mandible, with screws oriented vertically or near vertically, may allow a patient to continue to wear a denture.…”