Use of Miniplates in Parasymphysis Fractures : A Survey Conducted Among Oral and Maxillofacial Surgeons of India

Abstract

Aim of the study was to find out the number of miniplates used by Indian Oral and Maxillofacial Surgeons for parasymphysis fractures. A survey was done among Oral and Maxillofacial Surgeons of India at the 34th annual meeting of Association of Oral and Maxillofacial Surgeons of India. Four questions were given to each individual to find out their opinion regarding use of miniplates in parasymphysis fractures. Eighty-eight per cent of Indian surgeons were in favour of using intra-operative or postoperative intermaxillary fixation. Thirty-eight per cent responded in favour of using single miniplate for parasymphysis fracture instead of using two miniplates. Fiftyfour per cent maxillofacial surgeons use various modifications depending on different conditions. Forty-two per cent of maxillofacial surgeons accepted that lower arch bar can be used as a tension band. Use of miniplates for the treatment of parasymphysis fracture varies from centre to centre and from surgeon to surgeon. Though miniplates are best used following Champy's principle, still many surgeons use single miniplate. Arch bars placed for intermaxillary fixation can be used as a tension band, again eliminating the need for upper plate.

Comparison of outcome of two plate fixation with one plate fixation along with arch bar in management of parasymphysis; A Randomized Control Trial.

“…Loosening/ fracture of screw or plate occur in 4 patients (13.3%) in group B at 15 days follow up and group A patients have no loosening / frcature of screw or plate at any follow up visit. These results were exactly the same as in the study by saluja et al 17 in which loosening of implanted material occur in one out of 10 patients treated with one miniplate with arch bar at 3 month folow up, no patient in the group treated with two miniplates in the parasymphysis reagion but statistically no radiographic values were significant (p>0.05) which support the fact that two miniplates are better able to resist torsional force present in the parasymphysis region than that by arch bar. So, statistical analysis of this study shows that arch bar are not as effective as miniplate placed in the subapical rgion of the teeth in the parasymphysis fracture.…”

“…Because of increase manipulation of parasympsis region group A shows more subjects that are taking more time to recover from paresthesia. This result is supported in the studies by Saluja et al 17 , in which treatment protocol influence the resultant post-op sign / symptom of paresthesia with more subjects treated with two miniplates shows prolonged paresthesia as compared to the group treated with one miniplate with arch bar. The inferior border discrepency was observed and 3 patients (n=30) in group B have immediate postop inferior boarder discrepency and the resultant increase in the subjects in the same group B to 6 at 15 days follow up, while in the group A none of the subject showed inferior border discrepency / malignment.…”

“…There, overall infection rate in both the groups was 4 (6.7%). Result of this is supported by the above mentioned studies by saluja et al 17 and others in which patients treated with one miniplate with arch bar have more post -op infection (10%) than those patients treated with two miniplates and this is because of the of intra oral hardware use and also movement occcuring between fracture segment which is more than desired. Presence of arch bar increase the chances of periodontal diseases resulting in increase bone loss and also it hinders proper cleaning of the teeth which plays and important role in the healing of incision wound.…”

Anterior Mandible and Condylar Fracture;

“…8 In favorable fractures detected radio graphically, closed method is preferred but reports suggests that conservative management may result in non union Following champy's principle of ORIF two miniplates are sufficient to compensate the torsional forces acting on that area 9 , but many authors had use various modifications for the parsymphysis fracture treatment instead of using two miniplates, and thus treatment of anterior mandible varies from surgeon to surgeon and center to center. 10 For range of motion, patient's mouth opening was assessed and classified in two groups i.e. mouth opening less than 25mm were considered as poor and mouth opening more than 25mm were considered as good mouth opening.…”

The Use of Double Y - Shaped versus Conventional Titanum Miniplates in Fixation of Anterior Mandibular Fractures

“…concluded single mini titanium plates are an easy to use alternative to conventional mini plates but contraindicated its use in fractures with less inter fragmentary bone contact [23,[25][26][27][28][29][30].…”