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
1. Manson PN. Facial Injuries. In: McCarthy JG ed. Plastic Surgery Vol. 2. Philadelphia: WB Saunders, 1990:916-78.
2. Dingman RO, Natvig P. The Mandible: Surgery of facial fractures. Philadelphia: WB Saunders, 1964:133-92.
3. Abbas I, Mirza YB. Presentation and current trends in treatment modality of mandibular trauma at Punjab Dental Hospital, Lahore. Dissertation CPSP 2000:30-50.
4. Haider Z, Haider M. A study of maxillofacial injuries at Abbasi Shaheed Hospital, Karachi. Dissertation CPSP 1999:47-50.
5. Khan M. Management of Maxillofacial Trauma. AFID Dent Jr. 1998; 10(1): 18-21.
6. Amanat N. An analysis of maxillofacial fractures in Aga Khan University Hospital. Pakistan J Surg 1993; 9(4): 128-32.
7. Mezitis M, Zachariades N, Rallis G. An audit of mandibular fractures treated by intermaxillary fixation, intraosseous wiring and compression plating. Br J Oral Maxillofac Surg 1996; 34: 293- 97.
8. Jaques B, Richter M, Arza A. Treatment of mandibular fractures with rigid osteosynthesis using AO system. J Oral Maxillofac Surg 1997; 55: 1402-7
9. Spiessl B. New concepts in maxillofacial bone surgery. Berlin, Germany: Springer-Verlag 1976.
10. Spiessl B. Internal fixation of the mandible: A manual of AO/ASIF principles. Berlin, Germany: Springer-Verlag 1989.
11. Karlis V, Glickman R. An alternative to Arch-bar maxillomandibular fixation. Plast Reconstr Surg 1996; 99: 1758-59.
12. Arthur G, Bernardo N. A simplified technique of maxillomandibular fixation. J Oral Maxillofac Surg 1989; 47: 1234
13. Kohno M, Nakajima T, Someya G. Effects of intermaxillary fixation on respiration. J Oral Maxillofac Surg 1993; 51: 992-4.
14. Hausamen JE. The scientific development of maxillofacial surgery in the 20th century and an outlook into the future. J Cranio-Maxillofac Surg 2001; 29(1): 2-21.
15. Lazow KS. The mandible fracture: A treatment protocol. J Cranio-Maxillofac Trauma 1997; 3(3): 39-45.
16. Fordyce AM, Lalani Z, Songra AK, Hilhreth AJ, Carton ATM. Intermaxillary fixation is not usually necessary to reduce mandibular fractures. Br J Oral Maxillofac Surg 1999; 37(1): 52-7.
17. Shetty V, McBrearty D, Fourney M. Fracture line stability as a function of the internal fixation system. J Oral Maxillofac Surg 1995; 53: 791-95.
18. Kearns GJ, Perrot DH, Kaban LB. Rigid fixation of mandibular fractures: Does operator experience reduce complications. J Oral Maxillofac Surg 1994; 52(3): 226-32.
19. Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillofacial surgery. J Maxillofac Surg 1973; 1: 79-84.
20. Champy M, Lodde Jp, Jaeger JH, Wilk A. Mandibular osteosynthesis according to the Michelet technique I. Biomechanical basis. Rev Stamatol Chir Maxillofac 1976; 77(3): 569-76.
21. Brons R, Boering G. Fractures of the mandibular body treated by stable internal fixation: A preliminary report. J Oral Surg 1970; 28(6): 407- 15.
22. Ellis E. lag screw fixation of mandibular fractures. J Cranio-maxillofac Trauma 1997; 3(3): 27-37.
23. Edward Ellis III, DDS, MS, Oscar Muniz, DDS, MD, and Kapil Anand, DDS, MD. Treatment Considerations for Comminuted Mandibular Fractures. J Oral Maxillofac Surg 61:861-870, 2003
24. Izuka T, Lindiqvist C, Hallikainen D, Paukku P. Infection after rigid internal fixation of mandibular fractures: A clinical and radiologic study. J Oral Maxillofac Surg 1996; 49(6): 585-93.
25. Bolaji O. Ogundare, DDS, Andrea Bonnick, DDS, and Neil Bayley, DDS. Pattern of Mandibular Fractures in an Urban Major Trauma Center. J Oral Maxillofac Surg 61:713-718, 2003.
All published material becomes the sole property of the Pakistan Journal of Plastic Surgery, copyrighted by the Pakistan Association of Plastic Surgeons (PAPS). By submitting an article or brief communication, all authors agree to these conditions.
During the submission process, all authors have required to complete a copyright transfer agreement, “Author Consent form” By completing the copyright transfer agreement, you are transferring copyright of figures, tables, videos, and the content of the manuscript to the Pakistan Association of Plastic Surgeons (PAPS).
If you do not wish to or cannot transfer copyright of some or all of your content, please contact the editorial office at pjpspakistan@gmail.com