Nasal spine suspension for reduction and immobilization of mandibular fractures

Successful treatment of mandibular fractures involves proper fracture reduction and immobilization for an adequate length of time. A simple wire fixation technique that can be used in many situations involves suspension wiring from the base of the anterior nasal spine to a pair of circummandibular wires. The technique may be used alone or adjunctively with other methods of fixation. It offers several advantages over other methods, particularly in the treatment of pediatric mandibular fractures.     

Mandibular reconstruction: open reduction and internal fixation of mandibular fractures

Open reduction and internal fixation of mandibular fractures by intraosseous wiring in conjunction with intermaxillary fixation remains the mainstay of mandibular fracture treatment despite the availability of newer methods. The principles of treatment are reviewed, including indications for use of this technique and its advantages and disadvantages. Various surgical techniques are also reviewed and key points in their application emphasized.     

Operative time analysis of miniplate fixation of the mandible

Our purpose in this study was to report and compare operating room times for the various methods of mandible fracture repair. We describe a methodology of treatment in selected patients, using efficient repair techniques; namely, miniplate fixation with four-screw mandibular occlusion. We report our outcomes in successful healing, occlusion, complications, and operating times. A retrospective chart review was performed of 68 patients suffering mandible fractures treated by various surgeons at a single institution. Miniplate fixation technique requires significantly less time in the operating room than other mandible repair techniques, including mandibulomaxillary fixation. Miniplate fixation technique is both an efficacious and an efficient means of repairing certain mandible fractures.     

Plate and screw fixation of selected condylar fractures of the mandible.

The majority of condylar fractures can be treated with closed reduction and intermaxillary fixation. In this study, we examine the use of open reduction with plate and screw fixation for the treatment of condylar fractures. Fourteen patients with 18 subcondylar fractures underwent open reduction and fixation using miniplates (12 patients) and lag screws (two patients). Thirteen patients and 16 condylar fractures had adequate follow-up for analysis of results. The follow-up period ranged from 7 to 46 months with a mean of 24 months. Bony union was obtained in all fractures with no permanent facial nerve injuries and good mandibular opening (average of 45 mm). We conclude that condylar fractures can be opened and fixed with plates and screws with good results without the use of intermaxillary fixation. This technique can be an effective approach for the treatment of selected condylar fractures.     

Prospective Comparative Study of the Range of Movement of Temporomandibular Joints After Mandibular Fractures: Rigid or Non-rigid Fixation

Temporomandibular joints (TMJ) are negatively affected by trauma and disuse. In this prospective study, 103 patients with mandibular fractures were evaluated for the influence of trauma and maxillomandibular fixation on the TMJ. A total of 54 patients were treated by maxillomandibular fixation and 49 by titanium miniplate fixation. Those patients with condylar fractures and multiple mandibular fractures and malocclusion at presentation were not included in the study. The control group consisted of 44 randomly-selected healthy people with no past history of mandibular fracture or symptoms referable to the TMJ. Trauma was a major factor leading to TMJ dysfunction and maxillomandibular fixation increased the incidence and severity of TMJ dysfunction.     

Prospective comparative study of the range of movement of temporomandibular joints after mandibular fractures: rigid or non-rigid fixation.

Temporomandibular joints (TMJ) are negatively affected by trauma and disuse. In this prospective study, 103 patients with mandibular fractures were evaluated for the influence of trauma and maxillomandibular fixation on the TMJ. A total of 54 patients were treated by maxillomandibular fixation and 49 by titanium miniplate fixation. Those patients with condylar fractures and multiple mandibular fractures and malocclusion at presentation were not included in the study. The control group consisted of 44 randomly-selected healthy people with no past history of mandibular fracture or symptoms referable to the TMJ. Trauma was a major factor leading to TMJ dysfunction and maxillomandibular fixation increased the incidence and severity of TMJ dysfunction.     

小型钛板内固定治疗下颌骨骨折

目的：评估小型钛板内固定治疗下颌骨骨折的临床疗效.方法：对52例下颌骨骨折的患者行切开复位术，使用小型钛板内固定，保留骨折线上的牙齿.结果：52例患者创口均Ⅰ期愈合，骨折愈合良好，51例恢复到术前咬合关系，有1例固定后出现咬合关系不良，经颌间牵引后恢复正常咬合关系，所有患者钛板均未取出.结论：小型钛板内固定具有良好的稳定性，缩短了颌间固定的时间，可早期恢复张口运动，对骨折线上牙齿可以保留，是一种较好的下颌骨骨折内固定方法。     

Key points in surgical management of mandibular condylar fractures

Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage.Opinions about the management of mandibular condylar fractures differ among surgeons.With the implementation of new technology,an increased understanding of fracture man-agement,and better functional and morphological outcomes reported in the literature,open reduction and internal fixation is becoming many surgeons preferred choice for the treatment of condylar fractures.Because surgical treatment of such fractures is complex,certain factors must be considered to achieve satisfactory outcomes.In this article,we summarise six key points in the management of mandibular condylar fractures:virtual evaluation of condylar fracture,a suitable surgical approach,good reduction,stable internal fixation,repair of the articular disc,and restoration of the mandibular arch width.We believe that these points will help to improve the prognosis of mandibular condyle fractures.     

Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures.

OBJECTIVE: To report the occlusal outcomes of manually provided temporary intraoperative maxillomandibular fixation (MMMF) for the open repair of selected mandibular fractures. STUDY DESIGN/SUBJECTS AND METHODS: A retrospective chart review of the patients who underwent open reduction and internal fixation of mandibular fractures with MMMF was performed. RESULTS: Twenty-six patients underwent open reduction and internal fixation with MMMF. Postoperative data were available for only 16 patients who kept their follow-up appointments. With the exception of one patient who experienced minimal cross-bite in the right molar region, all of the patients had their original normocclusion. CONCLUSION: Preliminary results of MMMF suggest that satisfactory postoperative occlusal outcomes may be obtained without the use of wire-based maxillomandibular fixation methods in selected mandibular fractures.     

Noncompression unicortical miniplate osteosynthesis of mandibular fractures.

The use of transoral noncompression unicortical miniplates in treating 42 consecutive patients with 64 displaced mandibular fractures (excluding subcondylar) was reviewed. Titanium miniplates (Wurzburg) were used for fixation. The principles set forth by Champy and colleagues, with two plates for body and symphyseal fracture fixation and one plate superiorly along the oblique ridge for angle fractures, were performed. Intermaxillary fixation was not used postoperatively. Results compared favorably with other forms of treatment with no evidence of postoperative malocclusion, with an overall complication rate of 3%. The advantage of no external incision, avoidance of intermaxillary fixation, and normal postoperative incisal opening and occlusion make this technique our treatment of choice.     

Rigid internal fixation vs. traditional techniques for the treatment of mandible fractures

Treatment results were compared between mandibular fractures repaired with vitallium miniplates versus intermaxillary fixation (IMF) and wire osteosynthesis in 79 patients treated over a 4-year period. The postoperative courses of 35 patients treated with 46 plates were compared to those of 44 individuals treated with traditional reduction techniques. The plated group contained nine complications (26%) versus ten (23%) in the non-plated group. This difference was not statistically significant, despite the presence of more severe fractures in the plated group. Major complications (nonunions, malocclusions) were noted in only three (8%) of the plated group; there were six complications (14%) in the non-plated group. We conclude that the plating of mandibular fractures incurs no greater overall risk of complications than traditional methods of fixation, and a lower risk of major complications, and that the advantages of plate fixation, including decreased time of intermaxillary fixation and cost effectiveness, make this the method of choice in complex mandibular fractures, even in a high-risk population.     

Fractures of the mandible

An overview of the various methods available for treatment of mandibular fractures is presented; these range from the application of arch bars and intermaxillary fixation alone to open reduction with compression plating. Whenever possible, particularly in young patients, mandibular fractures requiring open reduction are approached transorally.     

Inferential therapy to promote union of mandibular fractures.

Non-union of mandibular fractures is uncommon, but when it does occur it requires protracted treatment including further surgery. Nine patients with factors known to predispose to non-union out of 150 consecutive mandibular fractures received interferential therapy (I.T.) during the fixation period; all fractures united satisfactorily. In a retrospective study of 150 consecutive mandibular fractures previously treated by the same surgeons without I.T., three fractures resulted in non-union requiring grafting. Thus the incidence of non-union was 0% when I.T. was used and 2% in the control group.     

INFERENTIAL THERAPY TO PROMOTE UNION OF MANDIBULAR FRACTURES

Non-union of mandibular fractures is uncommon, but when it does occur it requires protracted treatment including further surgery. Nine patients with factors known to predispose to non-union out of 150 consecutive mandibular fractures received interferential therapy (I.T.) during the fixation period; all fractures united satisfactorily. In a retrospective study of 150 consecutive mandibular fractures previously treated by the same surgeons without I. T., three fractures resulted in non-union requiring grafting. Thus the incidence of non-union was 0% when I. T. was used and 2% in the control group.     

Bone-screw mandible fixation: An intraoperative alternative to arch bars

OBJECTIVES: Bone-screw mandible fixation (BSMF) is evaluated as an alternative to intraoperative arch-bar maxillomandibular fixation before plating of mandibular fractures. BSMF is achieved by wire ligation of opposing bone-screws placed in the maxilla and mandible. METHODS: A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs. BSMF was used instead of arch bars to ensure proper dental occlusion. All fractures were then plated, after which BSMF was removed before termination of anesthesia. RESULTS: Normal occlusion was observed in 21 patients (91.3%), Class II malocclusion was noted in 1 patient (4. 3%), and 1 patient was edentulous. No complications related to the use of BSMF were observed. CONCLUSION: BSMF can serve as a viable alternative to arch-bar maxillomandibular fixation for obtaining temporary intraoperative occlusion. BSMF produces acceptable malocclusion rates and offers the advantages of decreased intraoperative time, lower risk for percutaneous and mucosal wire punctures, and ease of use.     

Maxillomandibular fixation with a combination of arch bars and screws

A method is presented for the treatment of mandibular fractures in which maxillomandibular fixation was achieved with a combination of an arch bar and screws which was not dependent on the condition of the patient’s teeth for the treatment of the mandible fracture. The technique and a representative case is discussed. Received: 14 March 1997 / Accepted: 10 September 1997     

The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study

A prospective study was performed to evaluate the efficacy of noncompression miniplates in the repair of mandible fractures treated at a large regional trauma center. The study included 54 cases of all types of adult mandible fractures with the exception of fractures of the condylar neck and ascending ramus. Cases were excluded in which preexisting infection was present. The technique consisted of a transoral approach followed by monocortical juxtaalveolar and subapical osteosynthesis without long-term intermaxillary fixation. Overall, there were 7 complications associated with this technique (13%): 4 infections (7.4%), 1 malunion (1.9%), and 2 mental nerve paresthesias (3.7%). These results compare favorably with those reported in the literature and suggest that mandibular osteosynthesis using miniature malleable plates is a useful and effective method for the repair of selected mandible fractures.     

Plate and screw fixation in the management of mandible fractures

The use of compression plates and screws in the management of mandibular fractures is a reliable method of producing rigid internal fixation and a functionally stable fracture site. Early mandibular function is possible, resulting in a decrease in intermaxillary fixation time, improved oral hygiene and nutrition, and maintenance of normal neuromuscular physiology. Compression osteosynthesis results in primary bone healing, which has been shown to hasten osseous regeneration. With adherence to strict technical details and the use of sound clinical judgment, compression plate and screw techniques provide for a predictable method in the treatment of mandible fractures.     

Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.     

小型钢板固定治疗下颌骨多发性骨折

对34例下颌骨多发性骨折采用小型钢板经口内进路按 Champy 理想线固定,辅助短期颌间固定,本组病例术后经 X 线摄片检查和临床随诊观察,全部达到良好复位固定和1期愈合,2例出现切口处软组织感染;未发现咬合错乱、骨折延迟愈合和手术造成神经或牙齿损伤等并发症。提示用小型钢板单层骨皮质固定治疗下颌骨多发性骨折,方法简便,效果可靠。