Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(4) > 1032408

TOOLS
Yang, Jang, Kim, Yim, Kim, and Yang: The prospective preliminary clinical study of open reduction and internal fixation of mandibular angle fractures using 2 miniplates
Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(4):320-324.

Published online: 10 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.4.320

The prospective preliminary clinical study of open reduction and internal fixation of mandibular angle fractures using 2 miniplates

Seung-Bin Yang, Chang-Su Jang, Ju-Won Kim, Jin-Hyuk Yim, Jwa-Young Kim, Byoung-Eun Yang

Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Anyang, Korea

Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University, Chuncheon, Korea

Byoung-Eun Yang Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University 896 Pyeongandong, Dongangu, Anyang, Gyeonggi, 431-070, Korea Tel: +82-31-380-3875 Fax: +82-31-380-3872 E-mail: omsyang@gmail.com

Received 14 April 2010       Revised 11 May 2010       Accepted 10 June 2010

Copyright © 2010 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures.

Materials and Methods

The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery.

Results

The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery.

Conclusion

The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients’ discomfort and simplify the surgical procedure.

Keywords: Mandible, Angle fracture, Contra-angle drill, Intra-oral approach

References

1. Kreutziger KL, Kreutziger KL. Comprehensive surgical management of mandibular fractures. South Med J. 1992; 85:506–18.
crossref
2. Stacey DH, Doyle JF, Mount DL, Snyder MC, Gutowski KA. Management of mandible fractures. Plast Reconstr Surg. 2006; 117:48e–60e.
crossref
3. Murr AH. Mandibular angle fractures and noncompression plating techniques. Arch Otolaryngol Head Neck Surg. 2005; 131:166–8.
crossref
4. Ellis E 3rd. Treatment methods for fractures of the mandibular angle. Int J Oral Maxillfac Surg. 1999; 28:243–52.
crossref
5. Lazow SK, Tarlo I. Mandible fracture: transoral 2.0-mm locking miniplate plus 1 week maxillomandibular fixation. Atlas Oral Maxillofac Surg Clin North Am. 2009; 17:27–34.
crossref
6. Fox AJ, Kellman RM. Mandibular angle fractures: two-miniplate fixation and complications. Arch Facial Plast Surg. 2003; 5:464–9.
7. Sugar AW, Gibbons AJ, Patton DW, Silvester KC, Hodder SC, Gray M, et al. A randomised controlled trial comparing fixation of mandibular angle fractures with a single miniplate placed either transbuccally and intraorally, or intraorally alone. Int J Oral Maxillfac Surg. 2009; 38:241–5.
crossref
8. Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillofacial surgery. J Maxillofac Surg. 1973; 1:79–84.
crossref
9. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg. 1978; 6:14–21.
crossref
10. Mehra P, Murad H. Internal fixation of mandibular angle fractures: a comparison of 2 techniques. J Oral Maxillofac Surg. 2008; 66:2254–60.
crossref
11. Barry CP, Kearns GJ. Superior border plating technique in the management of isolated mandibular angle fractures: a retrospective study of 50 consecutive patients. J Oral Maxillofac Surg. 2007; 65:1544–9.
crossref
12. Schierle HP, Schmelzeisen R, Rahn B, Pytlik C. One- or two-plate fixation of mandibular angle fractures? J Craniomaxillofac Surg. 1997; 25:162–8.
crossref
13. Seeman R, Schicho K, Wutzl A, Koinig G, Poeschl WP, Krennmair G, et al. Complication rates in the operative treatment of mandibular angle fractures: a 10-year retrospective. J Oral Maxillofac Surg. 2010; 68:647–50.
14. Levy FE, Smith RW, Odland RM, Marentette LJ. Monocortical miniplate fixation of mandibular angle fractures. Arch Otolaryngol Head Neck Surg. 1991; 117:149–54.
crossref
15. Choi BH, Yoo JH, Kim KN, Kang HS. Stability testing of a two miniplate fixation technique for mandibular angle fractures. An in vitro study. J Craniomaxillofac surg. 1995; 23:123–5.
crossref

Fig. 1.
Internal fixation on mandibular angle was performed using contra-angle drill laterally. A. Approach of contra-angle drill, B. Clinical view after internal fixation in case 6.
jkaoms-36-320f1.tif
Fig. 2.
Radiograph of case 3. A. Preoperative panoramic view, B. Postoperative panoramic view after 6 weeks, C. Preoperative computed tomography (CT) view, D. Postoperative CT view.
jkaoms-36-320f2.tif
Fig. 3.
A. Costomized drill bit, B. Length of this drill bit is 5 mm.
jkaoms-36-320f3.tif
STable 1.
Summary of patient received ORIF by this protocol
  Site of Fracture Type of fracture (1) Type of fracture (2)
Case 1 Left angle Compound Non-displaced
Case 2 Left angle Compound Non-displaced
Case 3 Left angle Compound Displaced
Case 4 Left angle and right parasymphysis Compound Non-displaced
Case 5 Right angle Compound Displaced
Case 6 Left angle Compound Non-displaced
Case 7 Left angle Compound Non-displaced

(ORIF: open reduction and internal fixation)

Table 2.
Treatment results of patient received ORIF by this protocol
  Time of operation1 IMF period2 NCP-pre-op. NCP-post-op.3 NCP-6 weeks Pre-op. complication
Case 1 60 0 1 8 8 Paresthesia
Case 2 90 3 1 7 7 −
Case 3 60 7 3 4 4 Paresthesia
Case 4 110 7 0 4 4 Paresthesia
Case 5 80 0 0 4 4 −
Case 6 80 0 2 10 10 −
Case 7 80 0 2 8 8 Infection

1 unit is min

2 unit is day

3 NCP post-op. is result of 1 weeks postoperatively, IMF: intermaxillary fixation, NCP: number of contact point)

TOOLS
Similar articles