Invited review: small versus large plate fixation of mandibular fractures

Since the introduction of antibiotics in the late 1940s, open reduction and internal fixation (ORIF) gradually replaced various dental splints and devices as a means of providing additional reduction and fixation of mandibular fractures. Stainless steel wire has been recently replaced by plate-and-screw fixation. When properly utilized, this method provides convalescent function without maxillomandibular fixation (MMF). The purpose of this article is to review the evolution of small versus large plate fixation of mandibular fractures.

In the context of reports in the literature and 26 years of clinical experience, the authors review the types of mandibular rigid fixation, healing of fractures, morbidity of fracture repair, indications for rigid fixation, and evolution of techniques of treatment.

Although numerous devices and techniques--bone clamps, intra- and extramedullary K-wires, metallic mesh, and other means--have been used and abandoned, modern plate and screw systems, if not the standard of care, have become widely accepted and used.