Single, Non-Compression Superior-Lateral Border Plate in the Treatment of Mandibular Angle Fractures; a Retrospective Study.
Purpose:
To assess the utility and complication rate of superior-lateral plate open reduction internal fixation (ORIF) of angle fractures.
Methods:
A retrospective chart review of patients with isolated, bilateral, or combination mandibular angle fractures at the LAC+USC Medical Center over the course of one year from 2010-2011 was conducted with IRB approval. The sample was composed of patients with at least one angle fracture, with or without other mandible fractures, that were treated with 2.3 (Stryker) or 2.4 (Synthes) 4- or 5-hole, superior lateral border plate ORIF. Treatment involved an intra-oral approach to expose and reduce the fracture, with plate fixation established trans-facially with trochar. This allowed the use of bicortical screws at the proximal segment, and either bicortical or monocortical screws at the distal segment depending on presence of dentition. No patients were placed in inter-maxillary fixation following surgery. All patients were allowed free range of motion and soft mechanical diets. Outcomes were assessed by malocclusion, infection, wound dehiscence, plate exposure, and nonunion.
Results:
The sample composed of 42 patients; 40 men and 2 women, and 45 total angle fractures. The mean duration of follow-up was 102 days, with a median of 43 days. The most common complication was malocclusion, occurring in 4/45 (8.9%) of patients immediately postoperatively; all four cases were fully resolved with post-operative elastics by the first follow-up visit at one week. Infection occurred in 3/45 (6.7%) patients, developing at a mean of 23.6 days, and 2/45 (4.4%) of those required extra-oral incision and drainage. There was one instance (1/45, 2.2%) of hardware failure at day 23, with loose proximal screws requiring removal and closed reduction for treatment. There were no instances of long term paresthesia, tooth injury, wound dehiscence, or plate exposure.
Conclusion:
The trans-buccal superior-lateral border approach to plate fixation of mandibular angle fractures achieves comparable results to other methods of plate fixation, including transoral miniplate fixation described by Champy, while foregoing inter-maxillary fixation and allowing earlier return to function.
References:
Ellis E and Walker LR. Treatment of mandibular angle fractures using one noncompression miniplate. Journal of Oral and Maxillofacial Surgery. 1996; 54(7): 864-871.
Feller K-U, Schneider M, Hlawitschka M, Pfeifer G, Lauer G, Eckelt U. Analysis of complications in fractures of the mandibular angle—a study with finite element computation and evaluation of data of 277 patients. Journal of Cranio-Maxillofacial Surgery. 2003; 31(5): 290-295.