Transoral versus extraoral approach for mandibular angle fractures: A comparative study

ABSTRACT

Introduction: Mandibular fractures represent approximately two-thirds of all the maxillofacial fractures (nearly 70%) out of which fractures of mandibular angle represent for 26-35%. Aim of the Study: The aim of this study is to compare the transoral and extraoral (submandibular) approaches for fixation of mandibular angle fractures. Objectives of Study: The objectives of the following study are to evaluate ease of accessibility, time taken for the procedure, ease of anatomic reduction and complications. Materials and Methods: A prospective study was carried out in 30 patients reporting to the Department of Oral and Maxillofacial surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh during the period of months from November 2011 to August 2013 who were randomly divided in two groups based on computer generated simple randomization chart. Group I patients underwent transoral reduction and fixation and Group II patients underwent extraoral reduction and fixation. The ease of accessibility was analysed by visual analogue scale by the operating surgeon, time taken from incision to closure with digital clock, difficulty level index of surgeon based on the time taken for the procedure and approach related complications. Results: The ease of accessibility in Group I was good in 53.3% while in Group II patients approached extraorally it was good in 86.7%. Group I patients approached transorally showed a mean of 49.7 min while that of Group II patients approached extraorally showed a mean of 73.4 min. Group I had a minimum difficulty level index in 60%, moderate difficulty level in 33.3% and severe difficulty level in 6.7% while Group II had a minimum and moderate difficulty level in 46.7% and severe difficulty level in 6.7%. There was 1 (6.7%) complication reported in each group. Conclusion: The statistical analysis of this study concludes that fracture line starting anterior to mandibular third molar and ending at anteroinferior border of the insertion of the masseter muscle or posterior body of mandible can be approached transorally. Fracture line starting posterior or distal to the third molar or posterior to the insertion of the masseter muscle to the angle of the mandible or fracture line extending high in the ramus, extraoral approach provides a better choice for reduction and fixation of the fractured segments with restoration of anatomical and functional occlusion.

KEY WORDS

Accessibility - difficulty level - extraoral approach - intraoral approach - mandibular angle fractures

 

Conflict of Interest

None declared.

• REFERENCES

• 1 Kuriakose MA, Fardy M, Sirikumara M, Patton DW, Sugar AW. A comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates or mini-plates. Br J Oral Maxillofac Surg 1996; 34: 315-21
• 2 Rix L, Stevenson AR, Punnia-Moorthy A. An analysis of 80 cases of mandibular fractures treated with miniplate osteosynthesis. Int J Oral Maxillofac Surg 1991; 20: 337-41
• 3 Haug RH, Prather J, Indresano AT. An epidemiologic survey of facial fractures and concomitant injuries. J Oral Maxillofac Surg 1990; 48: 926-32
• 4 Fonseca RJ, Walter RV. Oral and Maxillofacial Trauma. 2 nd ed., Vol. 1. Pennsylvania: W.B. Saunders Company; 1997: p. 474-8
• 5 Leonard PF. Fractures: A History and Iconography of their Treatment. No. 3. Novata CA Norman Publishing 1990; 00: 00
• 6 Ellis 3rd E. Treatment methods for fractures of the mandibular angle. Int J Oral Maxillofac Surg 1999; 28: 243-52
• 7 Tams J, van Loon JP, Rozema FR, Otten E, Bos RR. A three-dimensional study of loads across the fracture for different fracture sites of the mandible. Br J Oral Maxillofac Surg 1996; 34: 400-5
• 8 Hamill JP, Owsley Jr. JQ, Kauffman RR, Blackfield HM. The treatment of fractures of the mandible. Calif Med 1964; 101: 184-7
• 9 Dierks EJ. Transoral approach to fractures of the mandible. Laryngoscope 1987; 97: 4-6
• 10 Raveh J, Vuillemin T, Lädrach K, Roux M, Sutter F. Plate osteosynthesis of 367 mandibular fractures. The unrestricted indication for the intraoral approach. J Craniomaxillofac Surg 1987; 15: 244-53
• 11 Ellis 3rd E, Karas N. Treatment of mandibular angle fractures using two mini dynamic compression plates. J Oral Maxillofac Surg 1992; 50: 958-63
• 12 Uglesiæ V, Virag M, Aljinoviæ N, Macan D. Evaluation of mandibular fracture treatment. J Craniomaxillofac Surg 1993; 21: 251-7
• 13 Marciani RD, Anderson GE, Gonty AA. Treatment of mandibular angle fractures: Transoral internal wire fixation. J Oral Maxillofac Surg 1994; 52: 752-6
• 14 Nishioka GJ, Van Sickels JE. Transoral plating of mandibular angle fractures: A technique. Oral Surg Oral Med Oral Pathol 1988; 66: 531-5
• 15 Toma VS, Mathog RH, Toma RS, Meleca RJ. Transoral versus extraoral reduction of mandible fractures: A comparison of complication rates and other factors. Otolaryngol Head Neck Surg 2003; 128: 215-9
• 16 Kimsal J, Baack B, Candelaria L, Khraishi T, Lovald S. Biomechanical analysis of mandibular angle fractures. J Oral Maxillofac Surg 2011; 69: 3010-4
• 17 Choi BH, Kim HJ, Kim MK, Han SG, Huh JY, Kim BY. et al. Management of mandibular angle fractures using the mandibular angle reduction forceps. Int J Oral Maxillofac Surg 2005; 34: 257-61
• 18 Maloney PL, Welch TB, Doku HC. Early immobilization of mandibular fractures: A retrospective study. J Oral Maxillofac Surg 1991; 49: 698-702
• 19 James RB, Fredrickson C, Kent JN. Prospective study of mandibular fractures. J Oral Surg 1981; 39: 275-81
• 20 Andreasen JO, Storgård Jensen S, Kofod T, Schwartz O, Hillerup S. Open or closed repositioning of mandibular fractures: Is there a difference in healing outcome? A systematic review. Dent Traumatol 2008; 24: 17-21
• 21 Moreno JC, Fernández A, Ortiz JA, Montalvo JJ. Complication rates associated with different treatments for mandibular fractures. J Oral Maxillofac Surg 2000; 58: 273-80
• 22 Sugar AW, Gibbons AJ, Patton DW, Silvester KC, Hodder SC, Gray M. et al. A randomised controlled trial comparing fixation of mandibular angle fractures with a single miniplate placed either transbuccally and intra-orally, or intra-orally alone. Int J Oral Maxillofac Surg 2009; 38: 241-5
• 23 Barry CP, Kearns GJ. Superior border plating technique in the management of isolated mandibular angle fractures: A retrospective study of 50 consecutive patients. J Oral Maxillofac Surg 2007; 65: 1544-9
• 24 Kale TP, Baliga SD, Ahuja N, Kotrashetti SM. A comparative study between transbuccal and extra-oral approaches in treatment of mandibular fractures. J Maxillofac Oral Surg 2010; 9: 9-12
• 25 Pattar P, Shetty S, Degala S. A prospective study on management of mandibular angle fracture. J Maxillofac Oral Surg 2013; 1-7
• 26 Cobb AR, Walsh S, Lee NJ, Kumar M, Bailey BM. The addition of a locking plate to a modified transbuccal retractor confers increased stability and easier soft tissue control in the application of miniplates in the management of mandibular angle fractures. Br J Oral Maxillofac Surg 2008; 46: 247-8