A Prospective Study on Management of Mandibular Angle Fracture

To evaluate the results of management of mandibular angle fracture by open reduction and internal fixation using single non compression miniplate via transbuccal, intraoral or extraoral approaches.

In this prospective study, 30 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of non comminuted angle fracture with/or without other associated fractures of the mandible. All the patients were operated under general anaesthesia following routine haematological, biochemical, general physical examination and routine radiographic examination. Patients were randomly distributed into 3 groups namely: (1) intraoral, (2) transbuccal, and (3) extraoral groups depending on the surgical approach used for open reduction and internal fixation of fracture of the angle of mandible. In the intraoral group (12 patients), angle fracture was approached through the intraoral vestibular incision similar to sagittal split incision. In the transbuccal group (8 patients), angle fracture was approached through the intraoral vestibular incision and transbuccal stab incision for screw fixation via trochar. In the extraoral group (10 patients), angle fracture was approached through the Risdon's submandibular incision. In all the patients, fractures were reduced with upper and lower Erich's arch bar fixation as means for IMF intraoperatively. In all the patients, fracture of the angle of the mandible was fixed with single non compression 2.5 mm, 4 holed with gap stainless steel miniplate and 6/8 mm monocortical screws. All patients were followed up for minimum of 6 months to maximum of 24 months.

Complications were relatively minor such as paresthesia (on average 26.7 % first post-operative day which was gradually improved and on average after 1 month was 3.3 %), mild to moderate occlusal discrepancies (on average 36.7 %) which needed the post-operative intermaxillary fixation with elastics for 1-2 weeks, infection (20 % on average) was mild to moderate which was managed with antibiotic therapy and/or incision and drainage except in one case, plate removal was done under general anaesthesia (extraoral group) because of recurrent infection. Post-operative pain was mild to moderate (mean VAS score pre operative-6.17, post-operative 1 week-1.63) which was managed with analgesics. Mouth opening was recorded in all patients which was on average 20.98 mm preoperatively which improved to 40.57 mm after 1 month.

The use of a single non compression miniplate for fractures of the angle of the mandible is a simple, reliable technique with relatively rare major complications and few minor complications irrespective of the surgical approach used for the open reduction.