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Intraoral fixation of fracture of the angle of mandible: a surgical protocol
Trauma patients using an anterior parotid transmassetric approach for direct plating. Patients and methods: A prospective clinical study was conducted on 31 patients with 35 fractures of the condyle (8 bilateral, 23 unilateral). All 35 fractures were displaced. The fractures were treated surgically with an anterior parotid transmassetric approach using 1.5 mm miniplates and screws for fixation. Intermaxillary fixation was used routinely for the first three postoperative days. Results: Occlusion practically identical to the pretraumatic condition was achieved in all the patients. Postoperative interincisal distance was 30–61 mm (mean 44 mm). Branches of the facial nerve were encountered in five cases (20%). Facial symmetry was achieved in all of the patients. There were three cases of salivary fistulae. No case of facial nerve weakness was observed. Conclusion: If conducted properly, the anterior parotid transmassetric approach offers a safe and effective approach for direct fixation of condylar fractures. This paper is the first of its kind reporting this technique in a large series in India. doi:10.1016/j.ijom.2007.08.415
O17.9 Treatment of condylar fractures: therapeutic controversies continue. . . S. Arunpriya*, B. P. Reddy, R. Desai, S. Manjunath, S. Shubhalakshmi, K. V. Umashankar College of Dental Sciences, Davangere, Karnataka, India The mandible plays an important role, being responsible for the continuity of not only the lower 1/3rd but also the entire facial skeleton, as it interacts with maxilla by occlusion and articulates with the skull bone through tempromandibular joint. Fracture of the condylar process is one of the most common fractures of mandible and deserves special consideration due to its anatomic differences and healing potential. Treatment for condylar fractures is an ongoing controversy. Traditionally, these were treated by closed reduction. However, clinicians have frequently attempted to obtain more predictable results by open reduction and internal fixation. Though the decision on the type of treatment must depend upon patient’s age, medical and dental history, pathogenesis, severity of the injury and behaviour pattern and intermaxillary fixation gave good results in most of the patients without complications and technical difficulties encountered during
surgical procedures. In this paper, various parameters used to assess the treatment outcomes in both closed as well as open reduction were carefully evaluated to identify which modality of treatment would get maximum benefit with good results. doi:10.1016/j.ijom.2007.08.416
O17.10 Ridge plates versus transbuccal plates in the management of mandibular angle fractures; a prospective randomised trial S. Laverick*, P. Siddappa, P. Patel, D.C. Jones Regional Maxillofacial Unit, University Hospital Aintree Fazakerley, Liverpool, U.K. Abstract Aim: To assess whether there is a difference between the postoperative infection rate, occlusion and anatomical reduction of fractures of the angle of the mandible treated by an osteosynthesis plate positioned on the external oblique ridge via an intraoral approach or on the lateral aspect of the mandible via a transbucaal approach. Study design: A prospective randomised trial. Ethics committee approval was obtained and 350 consecutive patients, who provided consent, were entered into the trial over a period of 2 years. Statistical analysis was performed using Fisher’s Exact Test and Pearson Chi-Square Test. Results: Infection resulted in plate removal in 13% of patients. Fractured angles of the mandible treated via a transbuccal approach experienced significantly less infection (P < 0.000). Smoking is related to increased risk of postoperative infection (P < 0.00). Analysis was also made of oral hygiene, degree of fracture displacement, delay between incident and operative procedure, method of fracture reduction, alcohol consumption and postoperative occlusion. Conclusion: Fractures of the angle of the mandible should managed with an osteosynthesis plate placed on the lateral aspect of the mandible via a transbuccal approach. doi:10.1016/j.ijom.2007.08.417
O17.11 Intraoral fixation of fracture of the angle of mandible: a surgical protocol S. Patnaik*, P. Waknis, S. Vaze Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune, India
1073
Fractures of angle of mandible are quite frequently encountered in facial injuries. Extra oral approaches done in olden days are now being replaced by intraoral approach. Achieving a good reduction and fixation by intraoral approach still remains a challenge especially in cases with reduced mouth opening. This paper outlines the various steps for achieving predictable success in treatment of mandible angle fractures by intraoral approach. doi:10.1016/j.ijom.2007.08.418
O17.12 Effect of time lag on the treatment outcome of compound mandibular fractures A. Potturi*, C. S. Soumithran, C. R. Sobhana Dept. of Oral & Maxillofacial Surgery, Govt. Dental College, Trivandrum, India Objectives: To evaluate the treatment outcomes for compound mandibular fractures based on the time of injury to beginning of treatment. Methods: Of all facial fractures, mandible fractures are most frequent and in today’s world of polytrauma the mandible fracture treatment may be delayed due to other major life threatening injuries. In this prospective study, patients with polytrauma and compound mandibular fractures treated at various time intervals from the time of trauma have been followed up for 4 and 8 weeks. Study group has been divided into three. Treated-within 72 h Group I, 72 h to 1 week Group II, later than 1 week Group III. Patients are treated either by closed reduction or by open reduction. At the end of 4 and 8 weeks patients were analysed for malunion, delayed union, nonunion, pseudoarthrosis, infection and stability of occlusion. Results and conclusions: Sixtythree patients with mandibular fractures all associated with life threatening injuries were followed up on their treatment outcome depending upon when they were referred to our unit from their respective parent units. Twenty-eight patients were in Group I, 20 in Group II and 15 were in Group III. It was observed that the effectiveness of healing is directly related to the time of beginning the treatment. Whilst in Group I, all patients showed uneventful healing; in Group II, four patients met with various complications (20%) and in Group III, five patients showed impaired (33%) healing. doi:10.1016/j.ijom.2007.08.419
O17.9 Treatment of condylar fractures: therapeutic controversies continue. . . S. Arunpriya*, B. P. Reddy, R. Desai, S. Manjunath, S. Shubhalakshmi, K. V. Umashankar College of Dental Sciences, Davangere, Karnataka, India The mandible plays an important role, being responsible for the continuity of not only the lower 1/3rd but also the entire facial skeleton, as it interacts with maxilla by occlusion and articulates with the skull bone through tempromandibular joint. Fracture of the condylar process is one of the most common fractures of mandible and deserves special consideration due to its anatomic differences and healing potential. Treatment for condylar fractures is an ongoing controversy. Traditionally, these were treated by closed reduction. However, clinicians have frequently attempted to obtain more predictable results by open reduction and internal fixation. Though the decision on the type of treatment must depend upon patient’s age, medical and dental history, pathogenesis, severity of the injury and behaviour pattern and intermaxillary fixation gave good results in most of the patients without complications and technical difficulties encountered during
surgical procedures. In this paper, various parameters used to assess the treatment outcomes in both closed as well as open reduction were carefully evaluated to identify which modality of treatment would get maximum benefit with good results. doi:10.1016/j.ijom.2007.08.416
O17.10 Ridge plates versus transbuccal plates in the management of mandibular angle fractures; a prospective randomised trial S. Laverick*, P. Siddappa, P. Patel, D.C. Jones Regional Maxillofacial Unit, University Hospital Aintree Fazakerley, Liverpool, U.K. Abstract Aim: To assess whether there is a difference between the postoperative infection rate, occlusion and anatomical reduction of fractures of the angle of the mandible treated by an osteosynthesis plate positioned on the external oblique ridge via an intraoral approach or on the lateral aspect of the mandible via a transbucaal approach. Study design: A prospective randomised trial. Ethics committee approval was obtained and 350 consecutive patients, who provided consent, were entered into the trial over a period of 2 years. Statistical analysis was performed using Fisher’s Exact Test and Pearson Chi-Square Test. Results: Infection resulted in plate removal in 13% of patients. Fractured angles of the mandible treated via a transbuccal approach experienced significantly less infection (P < 0.000). Smoking is related to increased risk of postoperative infection (P < 0.00). Analysis was also made of oral hygiene, degree of fracture displacement, delay between incident and operative procedure, method of fracture reduction, alcohol consumption and postoperative occlusion. Conclusion: Fractures of the angle of the mandible should managed with an osteosynthesis plate placed on the lateral aspect of the mandible via a transbuccal approach. doi:10.1016/j.ijom.2007.08.417
O17.11 Intraoral fixation of fracture of the angle of mandible: a surgical protocol S. Patnaik*, P. Waknis, S. Vaze Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune, India
1073
Fractures of angle of mandible are quite frequently encountered in facial injuries. Extra oral approaches done in olden days are now being replaced by intraoral approach. Achieving a good reduction and fixation by intraoral approach still remains a challenge especially in cases with reduced mouth opening. This paper outlines the various steps for achieving predictable success in treatment of mandible angle fractures by intraoral approach. doi:10.1016/j.ijom.2007.08.418
O17.12 Effect of time lag on the treatment outcome of compound mandibular fractures A. Potturi*, C. S. Soumithran, C. R. Sobhana Dept. of Oral & Maxillofacial Surgery, Govt. Dental College, Trivandrum, India Objectives: To evaluate the treatment outcomes for compound mandibular fractures based on the time of injury to beginning of treatment. Methods: Of all facial fractures, mandible fractures are most frequent and in today’s world of polytrauma the mandible fracture treatment may be delayed due to other major life threatening injuries. In this prospective study, patients with polytrauma and compound mandibular fractures treated at various time intervals from the time of trauma have been followed up for 4 and 8 weeks. Study group has been divided into three. Treated-within 72 h Group I, 72 h to 1 week Group II, later than 1 week Group III. Patients are treated either by closed reduction or by open reduction. At the end of 4 and 8 weeks patients were analysed for malunion, delayed union, nonunion, pseudoarthrosis, infection and stability of occlusion. Results and conclusions: Sixtythree patients with mandibular fractures all associated with life threatening injuries were followed up on their treatment outcome depending upon when they were referred to our unit from their respective parent units. Twenty-eight patients were in Group I, 20 in Group II and 15 were in Group III. It was observed that the effectiveness of healing is directly related to the time of beginning the treatment. Whilst in Group I, all patients showed uneventful healing; in Group II, four patients met with various complications (20%) and in Group III, five patients showed impaired (33%) healing. doi:10.1016/j.ijom.2007.08.419