One miniplate versus two miniplates in the fixation of mandibular angle fractures. An updated systematic review and meta-analysis

The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures.

A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed.

Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I²=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I²=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I²=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I²=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I²=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I²=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I²=29.33%) were statistically significantly higher in the two miniplates arm.

One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.