[Traumatology. Mandibular fractures excluding condylar fractures]

Functionally stable fixation via bicortical osteosynthesis on the one hand, and monocortical non-compression osteosynthesis on the other, are still two competing concepts in treating mandibular fractures. A survey of the literature shows that complicated fractures with severe dislocation of the fragments have the lowest rate of complications after functionally stable fixation, whereas non-complicated fractures without significant dislocation in the distal part of the mandible can be treated successfully via monocortical non-compressive osteosynthesis as well. It seems that pre- and intraoperative parameters can be helpful in describing the character of a mandibular fracture in order to give a differential indication between the two therapeutical concepts. The consideration of only seven parameters, as the mandibular fracture score does, provides many combinations of describing a fracture, so that former studies with their small number of patients make only a rather inaccurate differential indication possible. As long as there is no prospective multi-center study giving a guideline to classify mandibular fractures, the rigid internal fixation via functionally stable osteosynthesis should be preferred in all cases which are not "clear, easy to handle" fractures.