Outcome of comminuted mandibular fracture repair using an intraoral approach for osteosynthesis

Traditionally, the treatment of comminuted mandibular fractures involves both closed and open reduction. However, modern treatment principles increasingly tend toward open reduction and internal fixation to shorten oro-functional rehabilitation. Although this method increasingly gained popularity to date, a controversy regarding the extraoral versus the intraoral surgical approach still exists. The current study aimed to objectively evaluate the outcome of comminuted mandibular fracture treatment involving open reduction and internal fixation using an intraoral approach.

Consecutive patients treated at the Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, between 2005 and 2012 were included. Demographic, presurgical, perisurgical, and postsurgical data were tabulated and statistically evaluated using the χ test and the Mann-Whitney U test.

Forty-five patients could be included. Excellent postoperative results were seen in 84% (38 patients) of the total cohort. Postoperative complications were seen in 16% (7 patients). These 7 patients had the following complications: wound dehiscence (7% [n = 3]), osteomyelitis (7% [n = 3]), abscess development (4% [n = 2]), bone necrosis (2% [n = 1]), and severe nonocclusion (2% [n = 1]).

Present data showed that the intraoral approach for open reduction and internal fixation in comminuted mandibular fractures represents a comparable surgical technique regarding fracture repositioning and occlusal rehabilitation. Considerably, the risk of concomitant neurovascular damage or even facial scarring, as demonstrated in the extraoral approach, can be neglected by using this technique. Nevertheless, each case has to be judged on its own accord as to which technique can best treat the underlying fracture.