Rigid fixation of comminuted mandibular fractures

• Published in: Journal of oral and maxillofacial surgery Vol. 51; no. 12; pp. 1320 - 1326
• Main Authors: Smith, Brian R., Johnson, James V.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.1993; Elsevier
• Subjects: Adult; Biological and medical sciences; Bone Plates; Bone Screws; Dentistry; Evaluation Studies as Topic; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Male; Mandibular Fractures - pathology; Mandibular Fractures - surgery; Maxillofacial surgery. Dental surgery. Orthodontics; Medical sciences; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Wound Infection - etiology; Treatment Outcome; Human; Postoperative; Fixation; Stomatology; Comminutived fracture; Surgery; Diseases of the osteoarticular system; External; Technique; Condyle of mandible; Maxillary disease; Result
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/S0278-2391(10)80135-1

Treatment of comminuted mandibular fractures has traditionally involved closed reduction with external fixation in an effort to avoid stripping periosteum from the bony segments. The purpose of this study was to evaluate retrospectively the success rate of rigid fixation used to treat 16 consecutive comminuted fractures of the mandible in 15 patients. The comminuted fractures were as follows: symphysis and body, 10; angle, 3; and ramus, 3. In 13 cases, AO stainless steel reconstruction plates were applied, with a minimum of three 2.7-mm tapped bone screws in each of the two stable segments. In most cases additional screws were placed into the comminuted fragments to stabilize them. In two patients, the mandibular ramus was comminuted (one case bilaterally), which made it impossible to place a large plate. These fractures were stabilized with multiple titanium miniplates (2.0 mm, tapped). All patients' fractures healed to a bony union without bone grafting. The mean maximum incisal opening at longest follow-up was 40 mm (range, 20 to 50 mm). All patients had a satisfactory facial form and none required further surgery for facial recontouring or malocclusion. Complications were observed in three patients. Two patients (13%) developed infections. Both infections were caused by loose hardware and responded to removal of the hardware and did not require any other treatment. One mandible refractured during manipulation after coronoidectomy to treat mandibular hypomobility, a sequellae of a gunshot wound that traversed both mandibular rami. This fracture healed after plate removal and a course of maxillomandibular fixation without bone grafting. This study suggests that rigid fixation of comminuted mandibular fractures is a viable treatment that satisfies the necessity for reestablishment of form and function with minimal morbidity.