Is There an "Ideal" Sequencing for Open Reduction and Internal Fixation of Multiple Mandibular Fractures with...

Background: There is no consensus on the "best" sequencing for open reduction and internal fixation (ORIF) in multiple mandibular fractures involving the condyle. Objective: The objective of this study is to compare the outcomes between a "top-to-bottom" and a "bottom-to-top" ORIF sequence for multifocal mandibular fractures at the author's institution. Patients and Methods: A retrospective cohort study of adult dentate patients with multifocal mandibular fractures treated with ORIF. Inclusion criteria were the presence of at least one condylar neck or basis fracture and one "non-condylar" mandibular fracture. The authors evaluated the reduction quality using radiological and clinical parameters, including the ramus/condylar neck angle, the presence of a gap at the lingual aspect in the dentate area, dental occlusion, the need for a redo operation, and the need for postoperative occlusal fine-tuning. Results: A total of 31 patients had a bottom-to-top sequence, 4 patients had a substandard outcome, 4 had an acceptable outcome, and 23 achieved an ideal outcome. Ten patients underwent a top-to-bottom sequence; one patient had an acceptable outcome, and nine patients achieved ideal outcomes. There was no significant difference between sequencing and outcome. (p = 0.231). However, the odds ratio for a suboptimal outcome regarding the bottom-to-top surgery as opposed to the top-to-bottom surgery was 4.80 (CI: 0.53-236.07). In other words, the odds of having a suboptimal outcome and a bottom-to-top sequence were 4.80 times higher than having a suboptimal outcome and a top-to-bottom sequence. Conclusions: Based on our results, the top-to-bottom ORIF sequence appeared to be a favorable factor.