A Prospective Quality Control Study on Methods Used for the Treatment of Non-Complicated Mandibular Angle Fractures by Open Reduction and Internal Fixation in Manitoba

Abstract

Mandibular fracture is a common diagnosis that the Oral and Maxillofacial Surgeon is presented with, and its management is a critical skill for a competent trauma surgeon. One of the most commonly fractured regions of the mandible is that of the mandibular angle, found where the tooth-bearing corpus of the mandible meets the ascending ramus. While the mandibular angle fracture is a particularly common injury, there remains some openness in the interpretation of the best manner in which to establish fixation in these cases. The Oral and Maxillofacial Surgery Department at the University of Manitoba treats mandibular angle fractures by open reduction internal fixation using one of two typical plating orientations. The first method positions a miniplate angled along the superolateral aspect of the external oblique ridge spanning the fracture site, while the second method positions a miniplate strictly on the lateral aspect of the mandible across the fracture site. The purpose of this study was to compare the post-operative outcomes of these two plating methods. The study consisted of eighteen patients with mandibular angle fractures eligible for treatment by open reduction internal fixation that were randomly assigned to two treatment groups: Group A (N=8) with the miniplate oriented at the superolateral aspect of the mandible, and Group B (N=10) with the miniplate oriented on the lateral aspect of the mandible. Patients in each group were followed prospectively at 1-week, 4-week and 6-month post- operative time intervals for outcomes that included post-operative malocclusion, maximal interincisal opening, paresthesia, pain, swelling, development of infection, and surgical site dehiscence. There was no statistically significant difference found between the two plating orientation methods in each of the aforementioned outcomes.