A Study on the Surgical Management of Mandibular Fractures by Different Treatment Modalities

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Author(s): Muhammad Anwar, Tariq Iqbal, Saleem A. Malik

Pages: 1-10 |

Treatment of mandibular fractures is basic to the treatment of maxillofacial trauma. As the principles of internal fixation and compression osteosynthesis were adopted by maxillofacial surgeons during recent years the time-honoured methods of intermaxillary fixation and transosseous wiring has gradually become less favoured method of treatment in most of the cases. Objectives: The objectives of this study was to evaluate the results achieved in the surgical treatment of mandibular fractures by different techniques with respect to restoration of the preexisting anatomical form, functional occlusion of the dentition, facial esthetics and to propose a simple, efficient, and cost-effective technique for mandibular fractures. Materials and Methods: This cross-sectional study was conducted in the plastic surgery department of Pakistan Institute of Medical Sciences (PIMS) Islamabad during 1½-year period from 1st July 1999 to 31st December 2000. 105 cases of mandibular fractures were included in this study and a total of 174 fractures were treated by different surgical techniques. The mean age was 27.3 years and male to female ratio of 6:1. The patients were assigned into three groups according to the type of surgical technique used: 35 patients had closed reduction plus intermaxillary fixation (CR+IMF); 20 patients had non-rigid osteosynthesis; 50 patients had rigid/semi-rigid osteosynthesis. Outcome was measured by preoperative variables (age, gender, mechanism of fracture, site and number of fractures, nerve function, associated injuries and delay in treatment) and postoperative variables (duration of intermaxillary fixation (IMF), duration of admission, malunion, nonunion, infection, and nerve function), which were assessed during the follow up period. Results: The results showed that the preoperative variables and demographic features were similar in all groups. All the three treatment modalities were successful in restoring functional occlusion. Ten patients required reoperation or readmission and a total of 25 complications were noted. These complications were observed in fractures treated by CR+IMF (6), non-rigid osteosynthesis (6), rigid osteosynthesis (13), and included 05 soft tissue infection (4.8%), 09 malocclusion (8.5%), 04 malunion (3.8%), 05 mental nerve dysfunction (4.7%), and 02 cases of facial nerve (mandibular branch) damage (1.9%). There was no incidence of non-union or osteomyelitis. Bone healing was satisfactory in 100% of cases. The rigid osteosynthesis avoided the use of IMF better than the nonrigid group. There was a higher incidence of malunion in CR+IMF (5.7%) compared with nonrigid (5%), and rigid (3.8%) groups, but 8.5% patients of the open reduction and internal fixation (ORIF) group developed mental nerve paresthesia and 4% facial nerve weakness. Conclusion: Based on the results of this study we concluded that a brief period of intermaxillary fixation (IMF) helps to stabilize the occlusion, allows reattachment of the soft tissue drape and promotes initial primary bone healing, and overall CR+IMF with 2.7-mm cortical bone screws is the simplest, less invasive, efficient, and cost-effective technique