The Restoration of Lower Facial Width in Trifocal Mandibular Fractures Using Pre-fabricated Inter-Occlusal Splint: A...

Trifocal (bilateral condyle and anterior mandible) fractures of mandible lead to increased lower facial width. The methods currently described in literature are associated with limitations and offer less predictable intra-operative guidance. This study was designed to evaluate the effectiveness of pre-fabricated inter-occlusal splints in restoring the lower facial width.

A retrospective cohort study was designed involving patients who were treated for trifocal fractures. Pre-fabricated inter-occlusal splint had been used during reduction and stabilization/fixation of symphysis/condyle fracture to establish the lower facial width. Data were collected from clinical records (photographs and case sheets) and computed tomographic (CT) images. Study variables included clinical parameters such as inter-gonial width, lower facial height, mouth opening, and occlusion. Radiological (CT) parameters were inter-gonial width and inter-molar width. Data analysis was done by SPSS (V 26) using Shapiro-Wilk test and paired t test.

A total of nine patients (eight males and one female) with mean age of 27.2 (SD ± 8.47) years were included in the study. The study showed statistically significant decrease (p value-0.001) in inter-gonial width (clinical and radiological), lower facial height, and inter-molar width after treatment. All patients demonstrated improved mouth opening (p value-0.001) and corrected dental occlusion.

The intra-operative use of splints is effective in restituting lower facial width in the management of trifocal fractures. The technique is simple and predictable.