Management of Mandibular Fractures Treated By Champy Technique Without Postoperative Maxillomandibular Fixation: A Retrospective Study

Champy technique has been well accepted as a treatment modality for surgical management of mandibular fractures. Placing monocortical plates along the ideal lines of osteosynthesis allows surgeons to meet ideal surgical goals. These goals include minimal invasiveness, early return to function, and avoidance of skin incisions. Studies have demonstrated that mandibular trauma patients produce reduced occlusal forces.²Our hypothesis is that Champy technique allows for an earlier return to function and does not necessitate post-operative maxillomandibular fixation (MMF).

A retrospective review was conducted at Nova Southeastern University’s Department of Oral and Maxillofacial Surgery from October 2007 to January 2015. Mandibular fractures reviewed for this study were treated by residents under the supervision of one attending surgeon. Inclusion criteria required that all fractures must have been treated exclusively by Champy technique without postoperative MMF. Patients were not excluded based on age, gender, systemic health, mechanism of injury, or severity of fracture displacement. Major postoperative complications are those that would require a return to the operating room, and occurred within two months of the original surgery date.

The records of 254 patients with mandible fractures were reviewed and 69 were identified as meeting inclusion criteria with 78 fractures. Eleven were lost to follow up. Patient population included 49 males and 9 females with age ranges from 13 to 54. Location of fractures included 49 angles, 26 parasymphseal, and 3 symphyseal. All patients had at least 4 to 6 weeks of follow-up. Two patients had a nonunion that required plate removal, debridement of the mandible and application of an inferior border plate with bicortical screws. Two patients with poor oral hygiene had a minor dehiscence, two had a slight (1 mm) open bite that was managed with elastics, and one had a subperiosteal infection managed with antibiotics. Major complication rate given this data is 3.4%, and minor complications amounted to 8.6%.

Today’s healthcare is centric around patient satisfaction, which requires surgeons to provide high quality care while simultaneously being judicious with hospital resources. By avoiding postoperative MMF, patient care can further be enhanced by allowing an earlier return to function and earlier jaw physiotherapy. Furthermore, comorbidities that can be associated with MMF such as poor oral hygiene, caries, weight loss, and restricted jaw mobility are minimized. Our results show that major complication rates remain very low with patients treated exclusively via Champy plating technique without postoperative maxillomandibular fixation.

References:

1. Champy M, Lodde´ JP, Schmitt R, Jaeger JH, Muster D: Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg 6:14–21, 1978

2. R Kshirsagar, N Jaggi, R Halli: Bite force measurements in mandibular parasymphyseal fractures: A preliminary study. Craniomaxillofacial Trauma Reconstruction 4:241-244, 2011