CC BY-NC-ND 4.0 · Indian J Plast Surg 2013; 46(02): 215-220
DOI: 10.4103/0970-0358.118596
Review Article
Association of Plastic Surgeons of India

Avoiding occlusal derangement in facial fractures: An evidence based approach

Derick Mendonca
Departments of Plastic and Reconstructive Surgery, 1Maxillofacial Surgery, Bangalore Baptist Hospital, Bangalore, Karnataka, India
Deepika Kenkere
Departments of Plastic and Reconstructive Surgery, 1Maxillofacial Surgery, Bangalore Baptist Hospital, Bangalore, Karnataka, India
› Author Affiliations
Further Information

Publication History

Publication Date:
07 October 2019 (online)


Facial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.

  • 1 Nakamura S, Takenoshita Y, Oka M. Complications of miniplate osteosynthesis for mandibular fractures. J Oral Maxillofac Surg 1994;52:233-8.
  • 2 Ellis E. Treatment methods for fractures of the mandibular angle. Int J Oral Maxillofac Surg 1999;28:243-52.
  • 3 Passeri LA, Ellis E, Sinn DP. Relationship of substance abuse to complications with mandibular fractures. J Oral Maxillofac Surg 1993;51:22-5.
  • 4 Assae LA. Evaluation of rigid internal fixation of mandible fractures performed in the teaching laboratory. J Oral Maxillofac Surg 1993;51:1315-9.
  • 5 Iizuka T, Lindqvist C, Hallikainen D, Paukku P. Infection after rigid internal fixation of mandibular fractures: A clinical and radiologic study. J Oral Maxillofac Surg 1991;49:585-93.
  • 6 Kearns GJ, Perrott GH, Kaban LB. Rigid fixation of mandibular fractures: Does operator experience reduce complications? J Oral Maxillofac Surg 1994;52:226-31.
  • 7 Peled M, Ardekian L, Abu-el-Naaj I, Rahmiel A, Laufer D. Complications of miniplate osteosynthesis in the treatment of mandibular fractures. J Craniomaxillofac Trauma 1997;3:14-7.
  • 8 Ellis E. Complications of rigid internal fixation for mandibular fractures. J Craniomaxillofac Trauma 1996;2:32-9.
  • 9 Alpert B. Management of the complications of mandibular fracture treatment. Operat Tech Plast Reconstr Surg 1998;5:325-33.
  • 10 Haerle F, Champy M, Terry B. Atlas of Craniomaxillofacial Osteosynthesis. 2 nd ed. New York. Thieme Medical Publishers; 2009.
  • 11 Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillofacial surgery. J Maxillofac Surg 1973;1:79-84.
  • 12 Worthington P, Champy M. Monocortical miniplate osteosynthesis. Otolaryngol Clin North Am 1987;20:607-20.
  • 13 Ellis E, Miles BA. Fractures of the mandible: A technical perspective. Plast Reconstr Surg 2007;120:76-89S.
  • 14 Renton TF, Wiesenfeld D. Mandibular fracture osteosynthesis: A comparison of three techniques. Br J Oral Maxillofac Surg 1996;34:166-73.
  • 15 Schierle HP, Schmelzeisen R, Rahn B, Pytlik C. One- or two-plate fixation of mandibular angle fractures? J Craniomaxillofac Surg 1997;25:162-8.
  • 16 Bradley JC. A radiological investigation into the age changes of the inferior dental artery. Br J Oral Surg 1975;14:82-90.
  • 17 Bradley JC. The clinical significance of age changes in the vascular supply to the mandible. Int J Oral Surg 1981;10(Suppl 1):71-6.
  • 18 Cawood JI. Small plate osteosynthesis of mandibular fractures. Br J Oral Maxillofac Surg 1985;23:77-91.
  • 19 Cohen L. Further studies into the vascular architecture of the mandible. J Dent Res 1960;39:936-44.
  • 20 Hayter JP, Cawood JI. The functional case for miniplates in maxillofacial surgery. Int J Oral Maxillofac Surg 1993;22:91-6.
  • 21 Schortinghuis J, Bos RR, Vissink A. Complications of internal fixation of maxillofacial fractures with microplates. J Oral Maxillofac Surg 1999;57:130-4.
  • 22 Benson PD, Marshall MK, Engelstad ME, Kushner GM, Alpert B. The use of immediate bone grafting in reconstruction of clinically infected mandibular fractures: Bone grafts in the presence of pus. J Oral Maxillofac Surg 2006;64:122-6.
  • 23 Spinatto G, Alberto PL. Teeth in the line of mandibular fractures. Atlas Oral Maxillofac Surg Clin North Am 2009;17:15-8.
  • 24 Lucca M, Shastri K, McKenzie W, Kraus J, Finkelman M, Wein R. Comparison of treatment outcomes associated with early versus late treatment of mandible fractures: A retrospective chart review and analysis. J Oral Maxillofac Surg 2010;68:2484-8.
  • 25 Gerbino G, Tarello F, Fasolis M, De Gioanni PP. Rigid fixation with teeth in the line of mandibular fractures. Int J Oral Maxillofac Surg 1997;26:182-6.
  • 26 Kyzas PA. Use of antibiotics in the treatment of mandible fractures: A systematic review. J Oral Maxillofac Surg 2011;69:1129-45.
  • 27 Vega LG. Reoperative mandibular trauma: Management of posttraumatic mandibular deformities Oral Maxillofac Surg Clin North Am 2011;23:47-61.
  • 28 Koury M. Complications of mandibular fractures. In: Kaban L, Pogrel A. Perrott D, editors. Complications in oral and maxillofacial surgery. 1 st ed. Philadelphia: WB Saunders; 1997. p. 121-45.
  • 29 Coviello V, Stevens MR. Contemporary concepts in the treatment of chronic osteomyelitis. Oral Maxillofac Surg Clin North Am 2007;19:523-34.
  • 30 Mahoney PL, Lincoln RE, Coyne CP. A protocol for the management of compound mandibular fractures based on the time from injury to treatment. J Oral Maxillofac Surg 2001;59:879-84.
  • 31 Senel FC, Jessen GS, Melo MD, Obeid G. Infection following treatment of mandible fractures: The role of immunosuppression and polysubstance abuse. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:38-42.
  • 32 Haug RH, Schwimmer A. Fibrous union of the mandible: A review of 27 patients. J Oral Maxillofac Surg 1994;52:832-9.
  • 33 Gómez ES, Passer LA. complications of mandible fractures related to substance abuse. J Oral Maxillofac Surg 2008; 66:2028-34.
  • 34 Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: An analysis of contributing factors. J Oral Maxiilofac Surg 2000;58:746-52.
  • 35 Furr AM, Schweinfurth JM, May WL. Factors associated with long-term complications after repair of mandibular fractures. Laryngoscope 2006;116:427-30.
  • 36 De Souza M, Oeltjen JC, Panthaki ZJ, Thaller SR. Posttraumatic mandibular deformities. J Craniofac Surg 2007;18:912-6.