Transbuccal With Transoral Versus Transoral-Only Approach for Open Reduction and Internal Fixation of Mandibular...

Mandibular angle fractures, a common type of maxillofacial trauma, often require surgical intervention through open reduction and internal fixation (ORIF) due to the intricate interplay of muscle forces causing displacement. This study compared the transbuccal combined with transoral approach (transbuccal with transoral approach) and the standalone transoral approaches for ORIF of mandibular angle fractures, evaluating ease of surgical access, fracture fixation stability, surgical duration, radiographic alignment, facial scarring, and postoperative occlusion to determine the optimal method.

This prospective, non-randomized clinical study enrolled 32 patients (aged 18-60 years) with mandibular angle fractures at Teerthanker Mahaveer Dental College and Research Centre, Moradabad, India, over 18 months. Patients were allocated to Group A (transbuccal with transoral approach, n = 16, using 3D miniplates) or Group B (standalone transoral approach, n = 16, using 4-hole miniplates) based on the surgeon's preference. Outcomes were assessed by calibrated surgeons: ease of access (good, fair, poor), stability (bimanual palpation on Day 2 and 3 months), surgical duration (incision to closure), radiographic alignment on Day 2, scarring (hypertrophic, barely visible, invisible at 1 and 3 months), and occlusion (satisfactory, mild discrepancy, unsatisfactory at 5 and 10 days). Statistical analysis used independent t-tests and chi-square tests (p < 0.05).

Group A showed complete male predominance (p = 0.032), with no age difference (Group A: 27.12 ± 6.45 years; Group B: 29.37 ± 8.34 years; p = 0.36). Both groups achieved 100% stability on Day 2 and at 3 months (p = 1). Group A had longer surgical times (101.56 ± 7.33 min vs. 69.62 ± 11.89 min; p=0.001). No differences were found in ease of access (p = 0.344) or alignment (p = 0.867). Group A exhibited 100% mild scarring at 1 month and 75% invisible scars at 3 months, while Group B had no visible scars. Occlusion outcomes favored Group A at 5 and 10 days (p < 0.05).

Both approaches ensured excellent stability and alignment, but the transbuccal with transoral approach offered superior occlusal outcomes and minimal scarring, despite longer surgical times, making it preferable for complex fractures. The transoral approach, with shorter duration and no external scarring, is suitable for patients who prioritize aesthetics.