Surgical sequence of reduction in double mandibular fractures treatment

This study aims to clarify, according to our experience, the correct surgical sequence which should be followed in order to treat double mandibular fractures.

From January 2007 to January 2010, we have conducted a retrospective study on a sample of patients operated on in our department. We include only those cases in which the jaw was fractured in 2 places, in particular patients who suffer a fracture in tooth-bearing areas (symphysis, parasymphysis, and anterior body) and also contralaterally in non tooth-bearing areas (posterior body, angle, ramus, and condyle). The sample was divided into 2 groups based on the fracture sequence of reduction.

At 1-year follow-up, the group of patients who received first the tooth-bearing fractured areas treatment, followed by treatment of non tooth-bearing fractured area on bifocal mandibular fracture (Group A), showed less postoperative complications and reduced surgical time and costs.

In patients of group B, the non-execution of rigid IMF for the non tooth-bearing fractures made bone segments more free to move. Thus, reduction and fixation of non tooth-bearing fractures is facilitated, but poses a greater risk of complications. The surgeon in this case does not have the occlusal help guide; thus, the tooth-bearing fracture reduction and the subsequent fixation may be imperfect.

It is recommended from this study that reduction of the tooth-bearing fragment be prior to that of the tooth-free fragment for the double mandibular fracture.

Double mandibular fractures, Toothbearing area, Multiple mandibular fracture, Non-toothbearing area.