Abstract
Background and objectives
Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications.
Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve.
In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient.
Study design
Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach.
In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm.
Results
Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring.
Conclusion
The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.
Keywords: Transbuccal, Trochar and cannula, Occlusion, Scar
Full Text
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References
- 1.Kroon F.H., Mathisson M., Cordey J.R., Rahn B.A. The use of miniplates in mandibular fractures — An in vitro study. J Craniomaxillofac Surg. 1991;19(5):199–204. doi: 10.1016/s1010-5182(05)80547-5. [DOI] [PubMed] [Google Scholar]
- 2.Choi B.H., Yoo J.H., Kim K.N., Kang H.S. Stability testing of a two miniplates fixation technique for mandibular angle fractures. An in vitro study. J Craniomaxillofac Surg. 1995;23(2):122–125. doi: 10.1016/s1010-5182(05)80460-3. [DOI] [PubMed] [Google Scholar]
- 3.Toma V.S., Mathog R.H., Toma R.S., Meleca R.J. Transoral versus extra-oral reduction of mandible fractures: A comparison of complication rates and other factors. Otolaryngol Head Neck Surg. 2003;128(2):215–219. doi: 10.1067/mhn.2003.59. [DOI] [PubMed] [Google Scholar]
- 4.Dierks E.J. Transoral approach to fractures of the mandible. Laryngoscope. 1987;97(1):4–6. doi: 10.1288/00005537-198701000-00002. [DOI] [PubMed] [Google Scholar]
- 5.Shira R.B. Open reduction of mandibular fractures. J Oral Surg (Chic) 1954;12(2):95–111. [PubMed] [Google Scholar]
- 6.Wagner W.F., Neal D.C., Alpert B. Morbidity associated with extra-oral open reduction of mandibular fractures. J Oral Surg. 1979;37(2):97–100. [PubMed] [Google Scholar]
- 7.Wittenberg J.M., Mukherjee D.P., Smith B.R., Kruse R.N. Biomechanical evaluation of new fixation devices for mandibular angle fractures. Int J Oral Maxillofac Surg. 1997;26(1):68–73. doi: 10.1016/S0901-5027(97)80852-1. [DOI] [PubMed] [Google Scholar]
- 8.Lizuka T., Lindqvist C., Hallikainen D., Paukku P. Infection after rigid internal fixation of mandibular fractures a clinical and radiological study. J Oral Maxillofac Surg. 1991;49(6):585–593. doi: 10.1016/0278-2391(91)90340-R. [DOI] [PubMed] [Google Scholar]
- 9.Tams J., Loon J.P., Rozema F.R., Otten E., Bos R.R. Three dimensional study of loads across the freacture for different fracture sites of the mandible. Br J Oral Maxillofac Surg. 1996;34(5):400–405. doi: 10.1016/S0266-4356(96)90095-9. [DOI] [PubMed] [Google Scholar]
- 10.Berg S., Pape H.D. Teeth in the fracture line. Int J Oral Maxillofac Surg. 1992;21(3):145–146. doi: 10.1016/S0901-5027(05)80781-7. [DOI] [PubMed] [Google Scholar]
- 11.Chuong R., Donoff R.B. Intra-oral open reduction of mandibular fractures. Int J Oral Surg. 1985;14(1):22–28. doi: 10.1016/S0300-9785(85)80006-5. [DOI] [PubMed] [Google Scholar]