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

하악 우각부 골절 시 2개의 miniplate를 이용한 관혈적 정복술에 대한 전향적 예비 임상연구

  • Yang, Seung-Bin (Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University) ;
  • Jang, Chang-Su (Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University) ;
  • Kim, Ju-Won (Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University) ;
  • Yim, Jin-Hyuk (Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University) ;
  • Kim, Jwa-Young (Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University) ;
  • Yang, Byoung-Eun (Department of Oral and Maxillofacial Surgery, School of Medicine, Hallym University, Department of Oral and Maxillofacial Implantology, Graduate School of Clinical Dentistry, Hallym University)
  • 양승빈 (한림대학교 의과대학 구강악안면외과학교실, 한림대학교 임상치의학대학원 구강악안면임프란트학과) ;
  • 장창수 (한림대학교 의과대학 구강악안면외과학교실, 한림대학교 임상치의학대학원 구강악안면임프란트학과) ;
  • 김주원 (한림대학교 의과대학 구강악안면외과학교실, 한림대학교 임상치의학대학원 구강악안면임프란트학과) ;
  • 임진혁 (한림대학교 의과대학 구강악안면외과학교실, 한림대학교 임상치의학대학원 구강악안면임프란트학과) ;
  • 김좌영 (한림대학교 의과대학 구강악안면외과학교실, 한림대학교 임상치의학대학원 구강악안면임프란트학과) ;
  • 양병은 (한림대학교 의과대학 구강악안면외과학교실, 한림대학교 임상치의학대학원 구강악안면임프란트학과)
  • Received : 2010.04.14
  • Accepted : 2010.06.10
  • Published : 2010.08.31

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

References

  1. Kreutziger KL, Kreutziger KL. Comprehensive surgical management of mandibular fractures. South Med J 1992;85:506-18. https://doi.org/10.1097/00007611-199205000-00011
  2. Stacey DH, Doyle JF, Mount DL, Snyder MC, Gutowski KA. Management of mandible fractures. Plast Reconstr Surg 2006;117:48e-60e. https://doi.org/10.1097/01.prs.0000209392.85221.0b
  3. Murr AH. Mandibular angle fractures and noncompression plating techniques. Arch Otolaryngol Head Neck Surg 2005;131: 166-8. https://doi.org/10.1001/archotol.131.2.166
  4. Ellis E 3rd. Treatment methods for fractures of the mandibular angle. Int J Oral Maxillfac Surg 1999;28:243-52. https://doi.org/10.1016/S0901-5027(99)80152-0
  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. https://doi.org/10.1016/j.cxom.2008.10.009
  6. Fox AJ, Kellman RM. Mandibular angle fractures: two-miniplate fixation and complications. Arch Facial Plast Surg 2003;5:464-9. https://doi.org/10.1001/archfaci.5.6.464
  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 intra-orally, or intra-orally alone. Int J Oral Maxillfac Surg 2009;38:241-5. https://doi.org/10.1016/j.ijom.2008.11.001
  8. Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery. J Maxillofac Surg 1973;1:79-84. https://doi.org/10.1016/S0301-0503(73)80017-7
  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. https://doi.org/10.1016/S0301-0503(78)80062-9
  10. Mehra P, Murad H. Internal fixation of mandibular angle fractures: a comparison of 2 techniques. J Oral Maxillofac Surg 2008;66:2254-60. https://doi.org/10.1016/j.joms.2008.06.024
  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. https://doi.org/10.1016/j.joms.2006.10.069
  12. Schierle HP, Schmelzeisen R, Rahn B, Pytlik C. One- or twoplate fixation of mandibular angle fractures? J Craniomaxillofac Surg 1997;25:162-8. https://doi.org/10.1016/S1010-5182(97)80009-1
  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. https://doi.org/10.1016/j.joms.2009.07.109
  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. https://doi.org/10.1001/archotol.1991.01870140037002
  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.