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Surgical management of anterior mandibular fractures: a systematic review and meta-analysis
Essam Ahmed Al-Moraissi1, Edward Ellis2
1PhD Student, Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt; Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
Purpose:
The aims of this study were to 1) determine which fixation method has the fewest complications in the treatment of anterior mandibular fractures (AMFs) and 2) provide scientific data to enable surgeons to make evidence-based decisions regarding the best technique.
Materials And Methods:
A comprehensive electronic search without date and language restrictions was performed in March 2014. Studies in humans, including randomized or quasi-randomized controlled trials, controlled clinical trials, and retrospective studies, were included with the aim of comparing fixation techniques (lag screws, 3-dimensional plates, 1 plate, and 2 miniplates) in the management of AMFs. The incidence of postoperative complications was evaluated.
Results:
Thirteen publications were included: 8 randomized controlled trials, 3 controlled clinical trials, and 2 retrospective studies. Seven studies showed a low risk for bias, 3 studies showed a moderate risk for bias, and 3 studies showed a high risk for bias. There were statistically significant advantages for lag screws and 1 plate plus an arch bar. There was no statistically significant difference between 3-dimensional plates and 2 miniplates. The cumulative odds ratio was 0.29, meaning that the use of lag screws in the fixation of AMFs decreases the risk for postoperative complications by 71% over the use of 2 miniplates. The cumulative odds ratio for 1 plate plus an arch bar was 0.28, showing that the use of 1 plate plus an arch bar in the fixation of AMFs decreases the risk for postoperative complications by 72% over the use of 2 plates.
Conclusions:
The results of this meta-analysis revealed that the use of both lag screws and 1 plate plus an arch bar were superior to 2 miniplates in reducing the incidence of postoperative complications in the management of AMFs. Also, there were significantly shorter operating times with lag screws and 3-dimensional miniplates over 2 miniplates in the fixation of AMFs.
