Treatment of atrophic mandibular fractures based on the degree of atrophy--experience with different plating systems: a retrospective study.
ABSTRACT The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems.
Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach.
In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively.
Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height.
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ABSTRACT: Fractures of the atrophic edentulous mandible are relatively uncommon representing less than 1% of all facial bone fractures seen at The Queen Victoria HOspital, East Grinstead. Only 35 patients have been treated for fractures of the atrophic edentulous mandible at this unit from a total of over 4000 facial bone fractures seen here between 1975 and 1994. All traditional treatment modalities have been utilised with varying degrees of success. A technique is presented whereby all displaced fractures of the atrophic edentulous mandible with a measured bony vertical dimension of less than 10 mm at the fractures site are managed with primary autogenous rib grafting. This reduces the risk for formation of pseudarthosis and facilitates subsequent prosthetic rehabilitation.British Journal of Oral and Maxillofacial Surgery 01/1996; · 2.72 Impact Factor
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ABSTRACT: The purpose of this study was to measure the resistance to displacement in an adult bovine rib mandible model as the vertical dimension of the bone decreases, and to compare the fixation strength of titanium miniplates and reconstruction plates. Five groups of 6 ribs each were tested based on the vertical dimension of the rib and method of fixation (group 1, 40 mm, miniplate), (group 2, 30 mm, miniplate), (group 3, 20 mm, miniplate), (group 4, 10 mm, miniplate), (group 5, 10 mm, reconstruction plate). In the 4 groups stabilized with a miniplate, a 3-hole-per-segment, 2.0-mm titanium miniplate and 6.0-mm monocortical titanium screws were used. In group 5, a 3-screw-per-segment, 2.4-mm titanium reconstruction plate and 2.4-mm bicortical titanium screws were used for fixation. A 2-dimensional beam model (Class III lever) was established, and an Instron machine was used initially to develop a load-displacement curve to 100 N for each specimen. An osteotomy was then created, and the segments were reduced without preload. The ribs were then loaded to failure in the Instron machine. The load-displacement curve and failure load were recorded. There was no significant difference (P < or = .05) between any of the groups before the osteotomy. At 75 N, groups 1 and 2 were superior to group 5 in resistance to displacement. Group 4 showed significantly less (P < or = .05) resistance to displacement than the other experimental miniplated subgroups. As loads increased, groups 1 and 2 continued to show increased resistance to displacement when compared with groups 3, 4, and 5. Loads to failure for groups 1 and 2 were comparable to group 5. Decreased resistance to displacement occurs with decreasing vertical dimension of the bovine rib. In fractures of the edentulous mandible, a miniplate is more likely to provide adequate fixation if the mandible is 30 to 40 mm in height (nonatrophic). At higher loads, groups with greater vertical height (30 mm and 40 mm) provided resistance to displacement equivalent to the 10-mm group repaired with a reconstruction plate. Therefore, fractures of the atrophic mandible may be better treated with more rigid techniques.Journal of Oral and Maxillofacial Surgery 02/2000; 58(1):56-61; discussion 62. · 1.33 Impact Factor
- British dental journal 03/1972; 132(4):142-4. · 0.81 Impact Factor