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JOURNAL OF MAXILLOFACIAL TRAUMA
A Journal on Maxillofacial Trauma
Official Journal of the International Society of Maxillofacial Trauma
Journal of Maxillofacial Trauma 2013 August;2(2):33-45
Clinical and radiologic evaluation of mandibular fracture treatment: a prospective clinical study
Yadav A. 1, Tauro D. P. 2, Kamath R. 3, Yadav G. S. 4, Kumar S. 5
1 Department of Oral and Maxillofacial Surgery Kothiwal Dental College and Research Centre Moradabad, Uttar Pradesh, India;
2 Department of Craniomaxillofacial Plastic and Reconstructive Surgery, S.S Institute of Medical Sciences and Research Centre Davangere, Karnataka, India;
3 Department of Craniomaxillofacial Plastic and Reconstructive Surgery College of Dental Sciences, Davangere, Karnataka, India;
4 Department of Oral and Maxillofacial Pathology, Kothiwal Dental College and Research Centre Moradabad, Uttar Pradesh, India;
5 Department of Dental and Oral Surgery Christian Medical College, Vellore, Tamil Nadu, India
Aim: The aim of this paper was to evaluate the success rate of mandibular fracture treatment according to the type of technique used, fracture site, severity and treatment delay and compare intraoral and extra oral approaches used for treatment of mandibular fracture along with the assessment of complication rates associated with various modalities of mandibular fracture treatment.
Methods: Twenty five patients who reported with mandibular fractures were included. Mid face fractures and condylar fractures were excluded. The type of treatment was; Intermaxillary fixation exclusively (IMF) or IMF followed by rigid fixation (intra oral approach or extraoral approach) with immediate jaw mobility. The treatment outcome was evaluated on the basis of; occlusion, masticatory ability, appearance and complications. In all cases, thorough follow-up was done clinically and radiographically at stipulated intervals; immediately following surgery, 1 week, 4 weeks, 3 months and 6 months.
Results: Out of 25 patients, IMF was done in 7 patients and 18 patients were treated with ORIF (13 through intraoral approach and 5 through extraoral approach). Most commonly affected age group with mandibular fracture was 21-30 years. RTA followed by fall was the most common etiology, and parasymphysis followed by angle was the most common site for mandibular fractures. Treatment outcome was similar in both the group but complications were seen more in ORIF group. ORIF by extraoral approach showed less complications and better treatment outcome than intraoral approach but nerve injury was seen more in frequency in extraoral approach. An overall complication rate of 24 % was found. The reduced mouth opening was the most common complication seen which was invariably associated angle fracture. The overall infection rate was 4 % which was only seen in surgical treatment.
Conclusion: Factors (alone or in combination) like angle fracture site, displaced fracture, treatment modality of ORIF with intraoral approach and injury treatment interval less than 1 week, predispose mandibular fracture patient to develop post operative infection and malocclusion more often. However, the type of treatment, site, severity, and delay do not significantly influence the treatment outcome and complication rate of mandibular fractures. ORIF by extraoral approach has advantages over intraoral approach. Based on our observations, IMF produces equally good results while addressing symphysis and parasymphysis fractures, however, associated angle fractures should be addressed preferably via the intraoral approach for ORIF. For fractures older than one week and displaced fractures, miniplate fixation produced superior results.