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Lag Screw Fixation of Anterior Mandibular Fractures: A Retrospective Analysis of Intraoperative and Postoperative Complications
Abstract
To review, retrospectively, the outcomes of 102 patients who underwent lag screw technique fixation of fractures of the anterior mandible.
A total of 102 consecutive, skeletally mature patients who have undergone open reduction internal fixation for fractures of the anterior mandible utilizing the lag screw technique were reviewed. All patients had a clinically mobile fracture between the mental foramina of the mandible. The patients were followed at usual postoperative intervals with shortest long-term follow-up of 2 months. Intraoperative and long-term postoperative outcomes including status of union, infection, and intraoperative surgical misadventure were recorded.
Data from the 102 patients showed that there was 1 fixation failure due to inappropriate patient selection, 1 nonunion requiring bone grafting, 1 with infected screws but with union, 1 with an infected screw and delayed union treated conservatively, and 6 with broken drills from intraoperative surgical misadventures.
Lag screw osteosynthesis of anterior mandibular fractures is a sensitive, facile, predictable, and relatively inexpensive method for internal fixation of indicated fractures. As with all methods of rigid internal fixation, most failures or complications are the result of operator judgment or technique.
... Lag screw fixation for AMFs is a responsive, simplistic, reliable, and relatively affordable approach for internal fixation of suggested fractures. [7] The lag screw technique was first used as an option in the treatment of maxillofacial trauma in 1970. [8] Later on, it was reintroduced by Niederdellmann et al., [9] subsequently claimed that as a minimum two screws were required to avoid the rotational movement of the broken segments in the mandibular oblique fractures. ...
... However, lag screw groups achieved better outcomes in terms of surgical period, postoperative radiographic distance, and biting ability than mini plate groups. [4,11,12,17,19,22] Tiwana et al. [7] performed a retrospective analysis to determine the difficulties associated with AMFs lag screw fixation. Complications such as fixation loss, nonunion, delayed union, and contamination were discovered. ...
... However, the majority of faults or complications occur as a result of an operator's decision or technique. [7] Conclusions Lag screw fixation presents many benefits for rigid internal fixation of AMFs. It is an effective way to achieve fast and efficient fixation, preceded without any significant complications by primary bone healing without lasting neuro-sensory disturbance or the increased possibility of abnormal occlusion in the AMFs. ...
Different techniques that meet the basic principles of open reduction and internal fixation with either plates and screws or lag screws may treat anterior mandibular fractures (AMFs).This review article aims at assessing the effectiveness of lag screw fixation in the treatment of AMFs. Using the following electronic databases, a systematic electronic search was carried out: PubMed, Elsevier, Google Scholar, and Wolters Kluwer. The following search words were used in single or in combination: AMFs, fixation, and lag screw. Any randomized or quasi-randomized controlled trials, controlled clinical trials, or retrospective studies regarding the lag screw fixation in the management of AMFs were included. Studies of more than 10 years were not included in this study. This study was reviewed in compliance with the PRISMA guidelines. A total of 13 articles were included in the qualitative synthesis of this review. The majority of the studies were comparative studies between the lag screw and the mini plate. In lag screw groups, the duration of surgery, postoperative radiographic distance, and biting ability reported better outcomes than in miniplate groups. A sensitive, simplistic, accurate, and relatively inexpensive approach to internal fixation for AMFs is the lag screw fixation. The Lag screw provides an effective and rapid rigid internal fixation in the treatment of AMFs. Although it is a technique-sensitive procedure for fixation of AMFs, it permits the skilled surgeon to achieve the most favorable stability and functional rehabilitation with the minimum amount of materials.
... (4,6,7) Not to mention that failure of inexperienced surgeons to use a proper drilling angel while performing the osteotomy in the anterior mandibular fracture result in increased pressure on the drill bit farther above its shear strength limit ending up with a fractured bit imbedded in the bone, needing excessive bone removal to access the bit for removal. (4,6,8) ...
... (7,9) In our current study we did not experience drill bit fracture in any of the cases of both groups, this contradict with results of kallela et al 1999 who had one broken bit out of 11 patients and with the results of Tiwana et al 2007 who had 6 broken bits in 6 patients out of 102 patients. (6,8) In our study we did not experience injury to teeth roots or collision with mental foramen as experienced by previous authors including Assael 1993 and Ellis 2012. (7,10) It was noted that after drilling through the surgical guide and its removal in the intervention group debris was found from the material of the surgical guide on the bone, they were washed off by saline solution and no tissue reaction was observed during the follow-up period ...
Background and Objective: This study aimed to compare the use of computer guided technology to placelag screws in anterior mandibular fracture in comparison to convectional techniqueMaterials and Method: This study included twenty-six patients divided into two equal groups, wherefixation in group A utilized computer guided patient specific guide to fix anterior mandibular fractures usinglag screws. In group B anterior mandibular fractures were fixed using lag screws in the conventional way.Both groups were compared in terms of stability and the need of auxiliary fixation devices.Results: Both techniques showed uneventful healing and showing insignificant difference between themconcerning stability and the need for auxiliary fixation device.Conclusion: Although the use of computer guided technology didn’t offer significant advantage over theconventional technique yet it provides more easy and reliable way especially for beginners introduced tothe technique.
... They observed that out of all the complications, broken drill bit represented the largest subgroup (5.9%) of patients. 13 Intraosseous drill bit fracture was reported while attempting to drill the traction hole in lag screw technique by Emam and Stevens 12 and Tiwana et al. 13 We did not encounter any instance of drill bit breakage probably because our method requires the use of only a single drill bit instead of two drill bits with different diameter. ...
... The rationale for using a single HCS along with a lower arch bar in interforaminal fractures of the mandible was the need for a method which was neither time consuming and riddled with complications as two miniplates osteosynthesis 2 nor was it technique sensitive as in the case of lag screw osteosynthesis. 8,13 As this is a pilot study with a small sample size, further research is required for determining the efficacy of a single HCS as a fixation device along with a lower arch bar for interforaminal fractures of the mandible. A prospective randomized control trial with comparative analysis with other treatment methods (two miniplates and/or two lag screws) for isolated interforaminal fractures of the mandible with a larger sample size would be an ideal study design for this purpose. ...
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Abstract
The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach was used either intraorally or extraorally. A second-generation 3.0 HCS (headless compression screw), 24 to 32 mm in length, diameter at the head of 3.5 mm, smooth shaft with 2.0 mm and at the leading edge 3.0 mm (Synthes, Paoli, PA) was used for the fixation along with a lower arch bar. Postoperative clinical and radiographic follow-up was performed at 3 weeks, 3 months, 6 months, and 1 year. A single, cannulated HCS was found to be effective in fixation of interforaminal mandible fractures except in one case where a miniplate had to be applied subapically. Clinical and radiographic follow-up revealed accurate reduction and fixation in all cases and no postoperative occlusal disturbances. A single, second-generation HCS along with a lower arch bar provides good results when used for the fixation of interforaminal mandible fractures. Headless compression screw fixation of interforaminal mandible fracture is a simple, quick, economic, and efficient method of rigid fixation with minimum complications.
Keywords
interforaminal mandible fractures - parasymphysis mandible fractures - headless compression screw - lag screw - cannulated screw
... Так, Н. Teiheiden et al. [9] повідомляють про ефективне використання 2 компресійних гвинтів у 32 випадках лікування серединних та центральних переломів нижньої щелепи. В аналогічному клінічному дослідженні P. S. Tiwana et al. [14] констатовано відсутність інтра-та післяопераційних ускладнень у 102 випадках, наголошуючи водночас на необхідності Рис. 1. Лінії «ідеального остеосинтезу» нижньої щелепи за М. Champy [6]. ...
... 2, 3). У день госпіталізації хворому фіксовано брекети на зубах 13,14,24,25,34,35,31,41,42,43,44, 45 для забез-печення тимчасової моно-та міжщелепної іммобілізації та фіксації зуба 42, що знаходився у щілині перелому. 14.07.2012 ...
In this scientific research on the basis of literary review and own clinical experience the results of treatment of 15 patients with symphyseal/parasymphyseal fractures in 12 patients were combined with fractures of other sites (angle, condylar process) by means of functionally stable osteosynthesis with additional mono- or intermaxillary fixation with elements of non-removable orthodontic technique (brackets Victory®(3М Unitek®, USA)), which were fixed on teeth according to standart method, are generalized. In all 15 cases anatomical and functional results of symphyseal/parasymphyseal osteosynthesis with additional bracket fixation were evaluated by us as good. A normalization of mandibular anatomical shape and bite was confirmed both clinically and roentgenologically. The terms of temporary intermaxillary fixation were from 1 to 8 days depending on amount and locations of fractures. There were no inflammatory complications or non-union. It was established that employment of bracket system, oppositely to traditional splinting techniques, provides teeth stabilization in fracture gap as well as interfragmentary compression due to directed elastic pull, which allow to widen the indications for leaving teeth in situ, especially in aestetically important areas.
... The etiology of mandibular fractures mainly includes assaults, road traffic accidents (RTA), falls and sports injuries [1]. Although there is a wide variance in the reported percentage of fractures of the anterior mandible, aggregate analysis places this at approximately 17% of all mandibular fractures [2]. ...
... The drill bits broke while attempting to drill traction hole and was removed without any further damage. This complication has already being reported by many authors but Paul Tiwana in (2007) [2] suggested that the surgeons must recognize the appropriate angle required to engage the opposing fracture cortex, and while drilling the traction hole the surgeons must attempt to engage the opposing cortex as perpendicular as possible to avoid forcing the drill. If forced, the drill will be deflected by the inner cortex of the mandible in a ''U'' shape reflective of the anatomy until the shear strength of the metal bit is exceeded resulting in breakage. ...
Objective
To compare the efficacy and surgical outcome of treatment of anterior mandibular fracture using either 2.0 mm titanium miniplate or 2.4 mm titanium lag screw technique.
Materials and Methods
A total of 30 patients were managed by open reduction and internal fixation utilizing the miniplate and lag screw technique for fractures of anterior mandible. The patients were randomly divided into two groups. Group I: (15 patients) were treated with Leibinger, 2.0 mm titanium mini plates system with self-tapping screws and Group II: (15 patients) were treated with 2.4 mm cortical lag screw (Synthes). Intraoperatively duration of surgery was measured from the time incision was placed till the closure of wound. Subsequent follow up was done at 3, 6, 12, 24 weeks, postoperatively. During every follow up, patients were assessed clinically for malocclusion, neurosensory deficit, biting efficiency, implant failure, mal-union/non-union. Pre and postoperative radiographs were taken to assess the gap between fracture segments. Results were evaluated using Chi square and the unpaired t test.
Results
In our study, the mean duration of surgery (hours) was 1.97 ± 0.52 for group I and 1.26 ± 0.55 for group II. The difference was found to be statistically significant (p value 0.001). i.e. more time was taken in case of surgery with mini-plates when compared to the lag screw. Short surgical procedure reduces the incidence of infectious complications, which significantly lowers the financial burden. The mean post-operative radiographic distance between all measuring points were considerably more in case of mini-plate group as compared to lag screw group. Lag screw group showed faster improvement in terms of biting efficiency as compared to mini-plate group which showed a tendency to masticate only medium hard food items by 24 weeks. In both groups, no postoperative malocclusion was noted. In initial weeks, neurosensory deficit was seen more in mini-plate group as compared to lag screw group but after six weeks all patients showed improvement in neurosensory function without any permanent nerve damage.
Conclusion
According to this prospective study, rigid internal fixation provided by lag screw technique for anterior mandibular fracture offers several advantages over conventional bone plating. It is an excellent means of achieving rapid and safe fixation which is followed by primary bone healing in anterior mandibular fractures, without any major complications.
... Lag-screws are also shown to be useful in fixation of oblique fractures of body, angle and vertical component of the mandible, as well as condylar fractures. It can also be used as transgingival screw in maxilla [1,[13][14][15][16]. ...
Introduction
Mandibular fractures are among the commonest fractures of maxillofacial region with anterior-mandibular fractures accounting for 8–15%. Mini-plates with or without arch bar is the most commonly used fixation method to achieve ORIF. However, the mandible symphysis is uniquely shaped for the application of lag-screws.
Aim
This study aims at evaluating the effectiveness of lag-screws in comparison with mini-plates in fixation of anterior mandibular fractures.
Methodology
20 patients diagnosed with anterior mandibular fractures were divided into 2 equal groups. Group-A was treated using lag-screws and Group-B was treated using mini-plates. Radiographs were taken for evaluation of fracture site. The results were assessed for mobility of fracture segments, stability of occlusion, paresthesia, and pre-operative, intra-operative and post-operative distances between fracture segments.
Results
There was a significant reduction in clinical distance between the reduced fracture fragments in the lag-screw group. A substantial reduction of radiographic distance between fracture segments was observed post-operatively in the lag-screw group, unlike the mini-plate group. A lesser interfragmentary distance was observed in patients treated with the lag-screw technique.
Conclusion
While lag screws and miniplate techniques are both stable forms of fixation, there is more interfragmentary bony contact with lag-screws, thus ideal for fixation of anterior mandibular fractures.
... Usually, as it is tightened, the inter-fragmentary distance is compressed, due to the articular portion of the screw being engaged. [15] A single small bone plate is adequate to handle the majority of mandibular fractures, but two plates are considered necessary to resist rotational force in anterior mandibular fractures (AMFs). [6] Two lag screws are required to handle AMFs and resist rotational forces during jaw functional activities. ...
Objectives: Mandibular fractures are treated surgically by either rigid or semi‑rigid fixation. The focus of this study was to determine the efficacy of lag screws in treating mandibular parasymphysis fractures.
Materials and Methods: We conducted a quasi‑experimental study in which ten patients with mandibular sagittal parasymphysis fractures were enrolled. In these patients, two 2.0 mm stainless steel lag screws were installed for open reduction and internal fixation. Throughout the study, patients were examined for occlusion, fracture stability, screw location in relation to vital anatomical structures, reduction precision, maximum mouth opening (MMO), biting efficiency, and several other complications on the 1st day, 1st, 2nd, and 6th weeks postoperatively.
Results: All parasymphysis fractures had a good bony union after surgery. One patient had mild occlusal discrepancies postoperatively, and statistical significance was found between preoperative and postoperative occlusion (P < 0.0004). Only one patient had abnormal mobility between the fracture lines postoperatively, with a highly meaningful statistical observation (P < 0.001). The comparative statistical analysis of MMO
at different follow‑up periods showed highly significant (P < 0.00001) results. Substantial improvement in biting effectiveness yielded a high statistical significance (P < 0.00001). There was no evidence of postoperative complications such as wound infection, wound dehiscence, intraoral screw exposure, or mental nerve injury in any of these patients.
Conclusions: Lag screw fixation is a realistic and reliable method of internally fixing mandibular parasymphysis fractures. This technique allows the skilled surgeon to achieve optimum stability and functional healing by using the least amount of material.
Keywords: Fixation, fractutres, lag screw, mandibular, parasymphysis
... After releasing the MMF, it appears that manipulating the jaw segments to check for stability is important in cases of lag screw fixation.There was one incidence of drill breakage in miniplate group and no such incidence in lag screw group. Tiwana., et al.[8] encountered drill breakage in 5.9% of cases of lag screw fixation. This problem was not encountered in the present study. ...
... This common injury results mainly from personal assaults, road traffic accidents, heavy falls, and sports traumas [2] . Likewise, cumulative analyses revealed that anterior mandibular fractures represent over 17 % of all mandibular fractures [3,4] . ...
... In the current study, the length of the screws used ranged from 28-40 mm. The most commonly indicated conditions for the application of the CLSFT in the present study were symphyseal and parasymphyseal fractures (51.5%) followed by fractures of the body and angle (48.5%), and our findings agreed with those of Tiwana et al. 22 and Terheyden et al. 10 . No condylar fractures were fixed with lag screws in this study sample. ...
Objectives: Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites.
Materials and Methods: This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05.
Results: Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035).
Conclusion: We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized
characteristics.
... This is attributed to fracture stability and pain experience. (14,25) In this work Fracture primary stability was achieved in both groups in contrary with another work in which lag screw fixation achieve primary stability than miniplate group and some investigators reported that increasing stability is related to increasing the number of screws. (12) The mouth opening was improved gradually in both groups and non of the patients had prolonged malocclusion. ...
... The locking screw is attached to the plate in a rigid stable unit [6]. The previous studies indicated that a single mini-locking plate is sufficient to maintain stability during the healing period reducing the amount of fixation material [7,8]. ...
Purpose
There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures.
Methods
This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema.
Results
Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152 min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation.
Conclusion
The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.
... This was also reported by other studies. 9,20,42 Regarding the postoperative complications, the patients were assessed for the presence or absence of postoperative infection, wound dehiscence, and malocclusion. The wound dehiscence usually appeared within 6 to 10 days after surgery as reported by Ellis. ...
... The mandible is the second most commonly fractured bone of the maxillofacial skeleton because of its position and prominence (1,2). Although there is a wide variance in the reported percentage of fractures of the anterior mandible, aggregate analysis places this at approximately 17% of all mandibular fractures (3). ...
... In addition, a bicortical screw placed near the mandibular canal might irritate or damage the nerve. [11,[15][16][17] In our study, no patients had preoperative neurosensory disturbances. Immediate postoperatively, mental nerve paresthesia was encountered with 3 (30%) cases in Group A and 5 (50%) cases in Group B, which resolved postoperatively. ...
Introduction
The aim of the present study was to compare fixation of mandibular anterior fractures following open reduction using lag screws or miniplates.
Materials and Methods
This prospective study was conducted on 20 patients diagnosed with cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups – Group A: two 2.5 mm stainless steel lag screws were placed in 10 patients. Group B: two 2.5 mm miniplates were placed in 10 patients for the fixation of fractures. Subsequent follow-up was done on the 1st day, 1st, 4th, and 36th week postoperatively. During every follow-up, patient was assessed clinically for infection, malocclusion, loosening of plate/screw, malunion/nonunion, and masticatory efficiency. Radiographs (orthopantogram) were taken preoperative, 1st, 4th, and 36th postoperative week to compare the osteosynthesis between the two groups. Pain was objectively measured using a visual analog scale. The data collected was subjected to unpaired t-test and paired t-test for statistical analysis.
Result
It was found that lag screw placement was rapid in comparison of miniplate placement. 3rd month postoperative assessment revealed Lag screw group to have better biting efficiency, and better bone healing which was statistically significant when compared with miniplate group.
Conculsion
Our study suggests that lag screw osteosynthesis can be advocated as a valid treatment modality in the management of mandibular symphysis and parasymphysis fractures.
... Another disadvantage described for the lag screw procedure is intraoperative fracture/breakage of the drill [11]. However, by countersinking the cortex beforehand, it is possible to then guide the direction of the drill, and as Tiwana et al. [27] described in 2007, such event should not occur with correct recognition of the angle and perpendicularity of the drill, and this did not occur in any of the cases in our study. ...
Objectives:
The objective of this study is to investigate two internal fixation surgical techniques for mandibular fractures in order to compare modified lag screw techniques with standard miniplates.
Materials and methods:
This is an observational prospective study. Three hundred eighteen patients were operated on for mandibular fractures. The patients were divided into two groups according to the type of surgical technique used: modified lag screws (155 patients) and traditional miniplates (163 patients). Analyses were made of sociodemographic and preoperative variables, the parameters related to the fracture type and postoperative data.
Results:
There were no differences between the two groups regarding their sociodemographic characteristics. The modified lag screws were primarily used with double fractures, while conventional miniplates were more often used with simple fractures. The number of complications was higher with the miniplate technique. The unfavorable fractures had an OR of 5.75 due to postoperative complications; double fractures had an OR of 8.87 and simple fractures an OR of 19.53, which, in both cases, were lower with conventional miniplates than with modified lag screws.
Conclusion:
Modified lag screws provide a rigid fixation system that is as secure as miniplates, but with greater compression between the fragments, less postsurgical gap, faster ossification, and fewer postoperative complications.
Clinical relevance:
The modified screw technique is a safe tool that does not require any specific osteosynthesis materials not found in a basic traumatology kit and has a lower cost, due to the reduced amount of material used.
... Since then, the compression screw technique has been widely used. [16][17][18] Lag screws were also used in the midface area by Pribtkin et al. 19 Screws and implants have been introduced through the mucosa without complications for a long time. Fracture of the alveolar process is a common injury, comprising 2 to 8% of all craniofacial injuries. ...
The purpose of this study is to check the efficacy of trans-gingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this study, 20 mixed age group patients with alveolar process fracture were included. All the patients were treated by a 2.0mm trans-gingival screw fixation under local or general anesthesia. All the patients were evaluated for fracture stability, anatomical reduction, bone loss and bone resorption of alveolar process, tooth loss, and wound Infection at three months follow-up. A simple descriptive statistical analysis was done in order to evaluate the parameters and it was shown that the treatment of alveolar process fracture with 2or3 lag screw provides adequate fracture stability, anatomical reduction with no signs of bone loss, tooth loss, and wound infections were noted post lag screw fixation. The study concludes that transgingival lag screw fixation is a suitable alternative for alveolar process fractures in all the age group and 2-3 lag screws are generally sufficient to fix fractured alveolar process either under local anesthesia or general anesthesia.
... 21,30 Lag screws lead to traction of the stumps, promoting compression and fixation of the fracture. 31 The type of compression generated by a lag screw is referred to as ''static interfragmental compression,'' which does not change significantly with load. 32 However, 2 parallel plates also promoted adequate stability of fixation, as also found by other authors, 19,33 although more stress peaks could be noted in the symphyseal bone region. ...
Purpose
The fixation of combined mandibular fractures, especially symphysis-condyle fracture, although a common occurrence and higher complication rate in clinic, is rarely investigated regarding predictable therapeutic approaches. Thus, the present study’s aim was to assess different forms of condyle fixation when combined with symphysis fracture fixation.
Methods
Stress distribution that occurs when a condyle fracture is fixed using one miniplate, two miniplates, or a trapezoidal condyle miniplate and when symphyseal fracture is fixed using two parallel plates, two perpendicular plates or two lag-screws were analyzed by FEM. The null hypothesis was no differences in among different fixation techniques.
Results
The results showed stress concentration in the anterior region of condyle, close to the sigmoid notch. Moreover, adequate fixation in the symphysis could result in less tension in condyle region. Therefore, when the symphysis was fixed with a lag-screw technique, the condyle fixation was less required, showing more adequate stress distribution when the condyle was fixed with one or two plates. Conversely, when the symphysis fixation was less effective, using perpendicular plates, there was a change in stress distribution on condyle region, altering fixation behavior, resulting in more tension and displacement in condyle, especially when trapezoidal plate was used.
Conclusion
In conclusion, the lag-screw and parallel double plates appear to be suitable for symphyseal fixation, while two straightly positioned plates and a trapezoidal plate are suitable for condyle fixation. However, the combination of perpendicular plates in symphysis fixation and a trapezoidal plate in condyle fixation demonstrated altered stress distribution.
... Prevalence rates reported by epidemiological studies is between 60 and 81 % [2]. Although there is a wide variance in the reported percentage of fractures of mandibular anterior region, aggregate analysis places this at 17 % of all the mandibular fractures [3]. The goal of treatment of mandible fractures should be to return the patient to a preinjury state of function and aesthetics, restore proper function by ensuring union of the fractured segments and re-establishing preinjury strength; to restore any contour defect that might arise as a result of the injury; and to prevent infection at the fracture site [4]. ...
Introduction:
The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12-45 years) and healthy individuals of poor socioeconomic status.
Method:
This prospective study was conducted on 30 patients diagnosed as cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups--Group A: Two 2.5 mm stainless steel lag screws were placed in 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis.
Results:
During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency.
Conclusion:
The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick treatment modality to accelerate healing of fresh, displaced mandibular anterior fracture.
... With advancements in hardware technology, there is an increasing national trend toward most mandible fractures being treated with an open-reduction approach alone or in combination with closed reduction. 1 In a biomechanical study 14 on symphyseal and parasymphyseal fractures, lag screws offered superior stability rather than using 2 miniplates during the molar-loading condition, whereas 2 miniplates still provided sufficient stability during the incisor-loading condition. Although the 2-lag screw technique can be safe and effective, the use of lag screws requires surgical experience, and there is an approximately 6% reported risk of a drill bit breaking when a traction hole is being created. ...
Objective:
To review our experience with miniplate fixation of fractures of the symphyseal and parasymphyseal regions of the mandible.
Methods:
A retrospective review of all mandible fractures treated from July 1, 1999, through July 31, 2011, by one of us (Y.D.) was performed. Intraoral, open rigid fixation of noncomminuted symphyseal and parasymphyseal fractures was performed using a combination of 2 miniplates that were either a 4-hole or a 6-hole miniplate using monocortical screws. The miniplates were 1-mm thick with a 2-mm screw diameter.
Results:
A total of 218 patients with noncomminuted symphyseal and parasymphyseal mandible fractures were included in this study. Eighteen patients (8.3%) with concurrent panfacial fractures and other indications were left in postoperative maxillomandibular fixation (MMF), whereas 200 patients (91.7%) did not require postoperative MMF. All patients in this series achieved bony union. The following complications were noted: plate exposure, 2.3%; malocclusion, 1.4%; wound infection, 1.4%; and tooth root injury, 0.9%. The use of postoperative antibiotics and either a nonlocking or locking system was not associated with significant differences in the rates of complications.
Conclusions:
For noncomminuted symphyseal and parasymphyseal mandible fractures, the application of 2 miniplates with monocortical screws offers good surgical outcomes in most patients with minimal complications. The advantages of using miniplates include easy plate adaptability, no need for MMF unless indicated, small screw diameter, and provision of adequate load-sharing rigid fixation for simple, noncomminuted symphyseal and parasymphyseal mandible fractures.
... Fracture of anterior mandible fracture may be treated by various techniques that follow the standard principles of open reduction and internal fixation with either plates and screws or lag screws. Lag screw osteosynthesis of anterior mandibular fractures is a sensitive, facile, predictable, and relatively inexpensive method for internal fixation of indicated fractures [1]. A modification of traditional method of lag screw fixation is proposed following the principle of minimal access surgery with potential advantages , which include shorter time, more economical, decreased morbidity, and early improvement in functional rehabilitation due to the less traumatic procedure. ...
Purpose of this study to introduce a new minimal access technique for management of anterior mandible fracture with several advantages over conventional methods.
Four cases of undisplaced anterior mandibular fracture were selected. Tension band was achieved either by arch bar fixation to mandible or placement of interdental wire followed by intermaxillary fixation. With a 1 cm vertical incision was placed adjacent to fractured line. Fractured segment was immobilized with lag screw with minimal stripping. All patients were followed for 6 months.
All four cases shown good stable segment after 6 months of post operative follow up. OPG revealed well placed lag screw and there were no surgical complications, for example parasthesia, scarring and odema.
Fixation of anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique is simple and easily performed, reducing the surgical time, reduce the chances of infection due to less exposure and promote the healing process by producing stress in the fracture lines.
... 10 This outcome may be related to the concept of osteosynthesis with lag screws because this procedure leads to traction of the stumps, promoting compression and fixation of the fracture. 11 The type of compression generated by a lag screw is referred to as static interfragmental compression. It is static because it does not change significantly with load. ...
The aim of this study was to make a comparative evaluation of the mechanical behavior of 4 different internal fixation systems for mandibular symphysis fractures.
Forty polyurethane mandible replicas (Nacional, Jaú, SP, Brazil) were used. These were divided into 4 groups of different fixation methods: group 1P, 1 2.0-mm miniplate; group 2PLL, 2 2.0-mm parallel miniplates; group 2PERP, 2 2.0-mm perpendicular miniplates; and group LST, 2 2.0-mm lag screws. Each group was subjected to linear vertical loading in the molar region in an Instron 4411 servohydraulic mechanical testing unit (Instron Corporation, Norwood, MA). The load resistance values were measured at load application displacements of 1, 3, 5, and 10 mm. Means and standard deviations were compared with respect to statistical significance using analysis of variance (P < .05) and compared by the Tukey test.
Group 1P showed the lowest peak load scores compared with other fixation methods. Group LST showed a statistically significant higher resistance than group 2PLL for all displacements. Group 2PERP showed lower resistance than group LST when displacements were 1 and 3 mm and statically significant similarity at displacements of 5 and 10 mm. However, group 2PERP showed no statistically significant differences compared with group 2PLL.
The LST showed better mechanical behavior for symphysis fracture fixation than the other systems when the fixation methods were subjected to linear vertical loading in the molar region.
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0–5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2–6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1–5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7–10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
This chapter details the surgical management of anterior mandibular fractures, posterior mandibular fractures, mandibular condyle fractures, atrophic edentulous mandibular fractures, pediatric mandibular fractures, and comminuted mandibular fractures. It focuses on surgical indications, contraindications, pertinent anatomy, virtual surgical planning, operative techniques, postoperative management, complications and key points of mandibular fractures. Patients with multiple mandibular fractures are plated from anterior to posterior and from rigid to nonrigid fixation. Open reduction of indicated condyle fractures results in anatomical repositioning with rigid fixation of displaced segments, increased long‐term occlusal stability, restoration of the vertical dimension of the ramus, and rapid return to function. Most patients with atrophic edentulous mandibular fractures have significant medical comorbidities that may influence operative management and postoperative healing. The chapter also provides several case reports with high‐quality images.
Introduction: Mandible is well known for its unique anatomy and
is the second most prevalent facial bone to fracture followed by
fracture of nasal bone. Fracture of the mandible causes deranged
occlusion, trismus, mobility of fractured fragments, pain,
oedema and results in functional as well as aesthetic deformity.
Therefore, the fixation of mandibular fracture plays a major role
in rehabilitation of the jaw. The goal of management is to restore
the premorbid occlusion and function.
Aim: To compare the efficacy of osteosynthesis of mandibular
anterior fracture by two different methods of open reduction, i.e,
titanium lag screw and titanium 3 Dimensional miniplate.
Materials and Methods: This prospective interventional study
was conducted in the Department of Oral and Maxillofacial Surgery
of Navodaya Dental College and Hospital, Raichur, Karanataka,
India from January 2019 to February 2021. A total of 10 patients
with symphysis and parasymphysis fracture were included in this
study and were divided into two groups, five patients for Group A
(osteosynthesis by titanium lag screw fixation) and five patients for
Group B (osteosynthesis by titanium 3D plate fixation) and were
treated accordingly. Parameters such as occlusion, mobility of
fracture segments, interincisal mouth opening, facial oedema, pain,
approximation of the lower border and lingual cortex and hardware
failure were assessed clinically and radiographically, and the patients
were followed up for three months. Recorded data was compared
and was analysed using Statistical Package for Social Sciences
(SPSS) version 26.0. Independent sample t-test was used for
comparison between the groups. Chi-square test and Fisher exact
test were used for qualitative data and p-value was set at 0.05.
Results: There was no significant difference noted between two
groups when assessed radiographically on 1st day, one and a
half month later and after three months. There was no significant
difference noted in occlusion as well as in pain when measured
postoperatively between the groups, but lag screw fixation provided
normal immediate postoperative occlusion in all the cases. A
significant improvement in the postoperative mouth opening was
noted with lag screw group when compared to 3 Dplates with a
p-value of 0.015 when measured after a week postoperatively.
When oedema was measured in transverse direction, it was
statistically significantly less in 3D plates group postoperatively
first day with a p-value of 0.028 and after a week with a p-value of
0.044. Oedema when measured in vertical direction revealed no
statistically significant difference between two groups.
Conclusion: In the present study a significant improvement in the
mouth opening as well as in terms of reduction in pain and oedema
was noted with lag screw osteosynthesis group. Immediate
postoperative occlusion was better with titanium lag screw
osteosynthesis when compared to titanium 3D plates. Based on
our study we conclude that both the osteosynthesis materials
provide good interfragmentary stability in the management of
anterior mandibular fractures and can be used satisfactorily for
the fixation of mandibular fractures.
Mandibular symphysis fractures pose several technical challenges for the craniomaxillofacial surgeon. One classic challenge is restoration of the transverse dimension when the mandible is widened secondary to splaying of the lingual cortex. Failure to diagnose or correct this problem can result in widening of the lower facial third, inadequate fracture reduction, and/or a malocclusion. Surgeons have traditionally utilized techniques such as manual pressure to the rami or lingual splint application to address transverse defects intraoperatively. However, these methods may be inadequate in situations with significant widening, such as in the case of concomitant subcondylar fractures. More recently, virtual surgical planning and custom hardware have been utilized to address mandibular widening, though this method also has various shortcomings. In this technical note, the authors present a simple technique using interdental wiring to precisely control mandibular width intraoperatively. The technique is cost effective, does not require an assistant, and can be used in conjunction with any of the above methods. The authors also present a case of secondary reconstruction in which use of this technique was necessary given a large degree of mandibular widening not amenable to reduction and fixation with manual pressure alone.
Background:
Mandibular fractures constitute about 80.79% of maxillofacial injuries in Alexandria University, either as isolated mandibular fractures or as a part of panfacial fractures. The combination of symphyseal and parasymphyseal fractures represent 47.09% of the total mandibular fractures.
Aim:
To compare the effectiveness of lag screws vs double Y-shaped miniplates in the fixation of anterior mandibular fractures.
Methods:
This study is a prospective randomized controlled clinical trial, performed on sixteen patients with anterior mandibular fractures. Patients were divided equally into two groups, each consisting of eight patients. Group 1: Underwent open reduction and internal fixation using two lag screws. Group 2: Underwent open reduction and internal fixation using double Y-shaped plates. The following parameters were assessed: operating time in minutes, pain using a visual analog scale, edema, surgical wound healing for signs and symptoms of infection, occlusion status and stability, maximal mouth opening, and sensory nerve function. Cone beam computed tomography was performed at 3 and 6 mo to measure bone density and assess the progression of fracture healing.
Results:
The study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years (mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidents in 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and other causes in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures (62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except for the mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).
Conclusion:
Both lag screws and double Y-shaped miniplates provide favorable means of fixation for mandibular fractures in the anterior region. Fractures fixed with lag screws show greater mean bone density at 3 mo post-operation, indicative of higher primary stability and faster early bone healing. Further studies with larger sample sizes are required to verify these conclusions.
Purpose:
The use of plates for open reduction and internal fixation of mandibular fractures has become a widely accepted method in the past 3 decades. However, the anterior mandible is well suited to lag screw fixation owing to the thickness of its bony cortices. Hence, the purpose of the present study was to comparatively evaluate clinical outcomes of fixation using lag screws and miniplates in anterior mandibular fractures.
Patients and methods:
Fifty patients reporting to the department of oral and maxillofacial surgery with noncomminuted anterior mandibular fractures were randomly divided into 2 groups of 25 patients each. Patients in group A were treated with 2.5-mm lag screws 22 to 26 mm in length and those in group B were treated with 2.0-mm 4-hole miniplates with a gap using monocortical screws. Subsequent follow-up was performed at 3, 6, 12, and 24 weeks postoperatively. The primary determinants included radiographic analysis of the fracture gap and biting efficiency of the patients in groups A and B. The secondary determinants included evaluation of duration of surgery, occlusion before and after injury, and postoperative complications. Results were evaluated using χ2 and unpaired t tests.
Results:
The mean age of the patients in this study was 29.1 ± 8.32 years (range, 18 to 67 yr). The mean postoperative fracture gap was considerably larger in group B. The mean duration of surgery (minutes) was 37.60 ± 9.30 for group A and 47 ± 6.55 for group B. The difference was statistically significant (P = .001). The lag screw group showed faster improvement in biting efficiency compared with the miniplate group.
Conclusions:
Lag screw fixation was found to have good stability and rigidity, was inexpensive, and was less time consuming in treating anterior mandibular fractures compared with miniplates.
The principle of axial compression for better adaptation of fracture segments, with the advantage of increased stability and early function, is a promising means of avoiding the bulky rigid plates used previously. This study was done to compare the treatment outcomes between Herbert screw and lag screw fixation in mandibular fractures. Thirty patients with oblique displaced or undisplaced mandibular fractures requiring open reduction and internal fixation with rigid screw fixation, under general anaesthesia, were included. Herbert screws were used in 15 patients (group 1) and lag screws were used in the other 15 patients (group 2). Patients were followed up at 1 week, 6 weeks, 3 months, and 6 months for postoperative occlusion, inter-fragmentary mobility, pain, nerve sensation, and isodensity values on panoramic radiographs. Postoperative occlusion, inter-fragmentary mobility, pain, and nerve sensation were similar in the two groups. Group 1 patients attained isodensity values similar to the final follow-up value much faster than group 2 patients (P < 0.05). This study strongly suggests that the use of Herbert screws results in significantly faster healing as compared to lag screws, in terms of achieving higher isodensity values faster.
Congenital or acquired facial differences can have significant functional and aesthetic implications. Craniomaxillofacial surgery offers the means to improve the lives of affected patients through the repair, replacement, and/or augmentation of malformed or damaged tissues. Advances in radiographic imaging, operative techniques, anesthesia, and alloplastic materials have greatly advanced therapies in this field. Nevertheless, significant technical challenges still exist. This chapter provides a brief history and overview of the biomaterials currently used in craniomaxillofacial bone and soft tissue replacement and augmentation.
Purpose
Symphyseal and parasymphyseal fractures and bilateral condylar fractures represent a pattern that is quite challenging to manage. This study evaluated the treatment outcomes of a group of patients who underwent surgery using miniplate fixation for anterior mandibular fractures.
Materials and Methods
This retrospective case series study reviewed patients with bilateral condylar fractures and noncomminuted symphyseal and parasymphyseal fractures. The patients were surgically treated from 2008 to 2014 in the department of oral surgery. Evaluation of facial width control was considered the primary outcome variable, which consisted of clinical assessment and measurement of the lingual gap using computed tomography. Medical information was collected before surgery. Temporomandibular joint function and postoperative complications also were evaluated during follow-up. A paired sample t test was used for statistical analysis.
Results
Forty-five patients (37 male, 8 female; mean age, 34.8 ± 14.5 yr; range, 16 to 74 yr) were included in this study. Lingual gaps measured before surgery (3.38 ± 0.61 mm) and after surgery (0.64 ± 0.14 mm) were significantly different (P < .001). No patient was rated as “unsatisfactory” after esthetic evaluation of facial width.
Conclusion
For noncomminuted symphyseal and parasymphyseal fractures associated with bilateral condylar fractures, 2 2.0-mm miniplates with monocortical screws are stable and efficacious in controlling mandibular width when bilateral condylar fractures are anatomically reduced and stably fixated.
This chapter begins with a discussion on the management of anterior mandibular fractures. The patient is nasally intubated to allow for the placement of maxillomandibular fixation (MMF). Local anesthesia containing a vasoconstrictor is injected within the anterior mandibular vestibule to include the mentalis muscle. Maxillary and mandibular arch bars are placed, and the anterior mandible is exposed from an intraoral approach. The chapter further talks about posterior mandibular fractures. This is followed by a discussion on the management of the atrophic edentulous mandible fracture. The patient is medically optimized prior to surgery as most patients are elderly and have associated medical comorbidities. Most patients with atrophic edentulous mandible fractures have significant medical comorbidities that may influence operative management and postoperative healing. These factors need to be considered when placing the patient under general anesthesia for an extended period of time.
In Analogie zu einem aufgeschlagenen Buch weit lateralwärts dislozierte Unterkieferhälften nach einem Gesichtsschädeltrauma sind Folge eines typischen Frakturmusters: die Symphysen-/Parasymphysen- bzw. Kinnregion ist aufgesprengt, gleichzeitig sind beide Kiefergelenkfortsätze nach Brüchen auf dem Niveau von Basis, Kollum oder Walze disloziert und/oder aus der Gelenkgrube luxiert. Aus derartigen Dreifachfrakturen resultieren massive Okklusionsstörungen (Kreuzbiss, frontal offener Biss), die nach Konsolidierung in Fehlstellung kaum funktionell kompensiert werden können. Daneben kann es zu einer ästhetisch ungünstigen Breitenzunahme des Untergesichts in Kombination mit einer Abnahme der hinteren Gesichtshöhe kommen. Aktuelle Konzepte tendieren daher zu einer operativen Versorgung sämtlicher Frakturzonen mit anatomisch korrekter Reposition und rigider Fixierung der Fragmente. Dieses aggressive Prozedere konnte sich erst auf der Grundlage von Fortschritten in der Behandlung von Kiefergelenkfortsatzfrakturen entwickeln, wo ein Paradigmenwechsel von der geschlossenen Behandlung zur Osteosynthese über offene transfaziale oder transorale Zugänge stattgefunden hat. Die Biomechanik, die klinische und bildgebende Diagnostik und die operative Gesamtstrategie der „Open book“-Frakturen des Unterkiefers werden hier dargestellt. Die Differenzialindikation der operativen Zugänge, ebenso wie Entscheidungskriterien, wo (Gelenkfortsatzbereich oder Unterkiefermitte?) in der OP-Behandlungssequenz mit der Fixierung begonnen werden sollte sowie die Auslegung und Dimensionierung von Osteosynthesematerial finden dabei ausführliche Berücksichtigung.
“Open Book” Fractures of the Mandible: Bilateral Condylar Process Fractures Combined with Paramedial/Medial Fractures of the Lower Jaw. Strategies for Surgical Treatment
Lateral displacement of the mandibular body divisions analogous to an open book after trauma to the facial skeleton are the result of a typical fracture pattern: a disjunction of the symphyseal/parasymphyseal region goes along with bilateral condylar process fractures at the level of either the base of the process, the neck or the condylar head. The condylar process fragments are commonly displaced and/or dislocated from the glenoid fossa. Such triple mandibular fractures result in severe malocclusion (cross bite, frontal open bite) that can hardly be compensated for if the fractures consolidate in bony malalignment. Besides, the lower face may be widened and diminished in vertical height posteriorly in an aesthetically unpleasing manner. Present day concepts suggest open surgical treatment of all fracture sites with anatomic reduction and rigid fixation. This aggressive approach was only recently developed based on the advances in the treatment of condylar processes, where the paradigms have shifted from closed treatment to open reduction and osteosynthesis using a transfacial or a transoral access. The biomechanics, the clinical signs and symptoms, and imaging diagnostic work-up as well as the overall surgical strategy in the treatment of “open book” mandible fractures are presented in this article. The appropriate choice of the surgical access, the operative sequence at which site (condylar process or symphysis/parsymphysis) to start with the fixation of fragments as well as the type, number, location and dimensions of osteosynthesis material are thoroughly outlined.
Lag screw osteosynthesis is a well proven technique. Its application is limited by the fact that the spherical head of the screw act as wedge. Combining this screw with a bioconcave washer has broadened the range of applications for lag screw osteosynthesis in the maxillofacial region.
The aim of the study was to compare the efficacy of anchor lag screw with conventional lag screw in anterior mandibular fractures.
Thirty patients with anterior mandible fractures with no concomitant fractures, infection or extraoral communication, who visited our outpatient Department of Oral and Maxillofacial Surgery, were included in the study after obtaining their informed consent. Patients were randomly divided into two groups; where Group A underwent fixation using conventional lag screw and Group B anchor lag screw. The fixation system used included 2 mm titanium lag screws of sizes 25 mm, 27 mm and 30 mm and 3 mm titanium bioconcave washer. At each follow up visit, clinical data was collected detailing clinical presentation of healing and radiographic findings.
Radiographic features at post surgery evaluation indicated loss of bone contact around the screw head and bone resorption in five patients of Group A, thus causing loosening of lag screw whereas none of the patient in Group B, was found to have any such complication.
The findings support the hypothesis that bioconcave washer aids in holding up the farthest fragment at the interface of the fracture fragment. Application of bioconcave washer provides easy loading of lag screw.
The management of facial trauma is one of the most rewarding and demanding aspects of oral and maxillofacial surgery. Being the most prominent mobile bone of the facial skeleton, mandible fracture occurs more frequently than any other fracture. In this study, open reduction and internal fixation was performed for isolated mandibular symphyseal region fractures using cortical screws (as lag screws) in 40 patients and using miniplates in 40 patients. Clinical and radiological evaluations were made at 6 months postoperatively. Primary stability of fracture segments, postoperative swelling, restricted lip mobility, infection, wound dehiscence, implant removal, and mal-union or non-union of fracture segments was evaluated. Primary stability was achieved in 100% of cases treated with cortical screws, whereas for patients treated with miniplates, 97.5% attained primary stability, while one case (2.5%) showed persistent clinical mobility. Postoperative complications were noted in 13 (16.25%) of the total 80 patients. The duration of postoperative swelling was less in patients treated with cortical screws compared to patients treated with miniplates. It is concluded that cortical screw fixation is an effective procedure for the treatment of symphyseal region fractures, but the procedure is somewhat technically sensitive.
The purpose of the present study was to evaluate the efficiency of fixation with a novel (bulge core type system) rigid internal fixation system.
Mandibular linear fractures were created artificially in dogs and fixed using a bulge core type system or a miniplate system in vitro. A 3-point load cell was used to contrast the fixation strength of the 2 systems in vitro. Histologic sections were used to analyze the healing of mandibular linear fractures and to contrast the efficiency of fixation of the 2 systems in vivo. Tetracycline-fluorescein staining technology was used to evaluate the bone healing speed in the mandibular fracture lines during bone healing.
In vitro, the 3-point load cell showed that the fixation strength of the bulge core type system was greater than that of the miniplate system (P < .05). In vivo, the histologic sections and tetracycline-fluorescein staining showed that greater and quicker bony healing occurred using the bulge core type system (P < .05) and that the efficiency of fixation of the 2 systems was similar.
Our results have shown that the bulge core type system can provide sufficient strength for mandibular linear fracture healing.
Achieving functional and anatomic restoration is remarkably difficult in patients with symphyseal mandibular fractures associated with bicondylar fractures. Our objective was to evaluate the functional and esthetic outcomes of a group of patients who underwent surgery using rigid fixation.
In our study, 25 patients with symphyseal mandibular fractures associated with bicondylar fractures surgically treated from 1998 to 2008 at the Division of Maxillofacial Surgery of the University of Turin were retrospectively analyzed. The standardized evaluation consisted of an evaluation of occlusion, assessment of mandibular motion, and esthetic evaluation of facial width.
The patients showed good mandibular motion and good occlusion. After esthetic evaluation of the facial width of the 25 patients, 23 patients were rated as "excellent" or "good."
Successful treatment of multiple mandibular fractures may be achieved by different techniques. The key point is the re-establishment of the transversal bigonial dimension by a correct reconstruction of the mandibular arch.
Incluye bibliografía e índice
One hundred consecutive extraoral open reductions of mandibular fractures were analyzed in an attempt to quantitate the morbidity of this technique and demonstrate possible predisposing factors. A complication rate of 13% was found in this series. Age of the patient, coexisting systemic disease, operative delay and operative and postoperative misadventures could not be correlated with morbidity. An obvious relationship was found between the area of the fracture and the presence and disposition of teeth in the fracture line, and the incidence of complications. Open reductions of the mandibular angle associated with teeth removed from the fracture line produced the greatest incidence of complications both quantitatively and qualitatively.
A technique of applying lag screws for treating fractures of the anterior mandible is presented. A review of 41 patients who had lag screws placed to treat such fractures showed that it is a successful method of providing rigid internal fixation. The advantages of this technique over bone-plate fixation are discussed.
This study describes a procedure used for treating angle fracturs of the mandible by means of lag-screw osteosynthesis. Eighteen patients from the university clinic of Freiburg were examined, and the type of fracture, the healing process, and the results of the treatment were analyzed. The procedure proved reliable and caused no problems.
The lag screw is the simplest means of rigid internal fixation. By virtue of its ability to compress bone fragments without the use of a bone plate, it has wide application and achieves great stability. This article presents techniques to apply lag screws to fractures of the mandibular symphysis, the mandibular body, and the mandibular angle. Results are reviewed in studies of 315 patients whom the author has treated with lag screw fixation. The advantages of the lag screw technique over bone-plate fixation, such as a more rapid application, obviation of the need to adapt a bone plate, minimal displacement of bone segments, and the rapid application of fixation without diminishing the rigidity of the fracture reduction, are discussed, as are the technique's contraindications.
Mandibular fractures Oral and Maxillofacial Trauma
- Bruce R Fonseca
Bruce R, Fonseca RJ: Mandibular fractures, in Fonseca, W (ed): Oral and Maxillofacial Trauma. Philadelphia, Saunders, 1991 pp 359-417
Mandibular fractures
- Bruce