Use of Rectangular Grid Miniplates for Fracture Fixation at the Mandibular Angle

Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis

PURPOSE

This study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, potentially offering an opportunity to reduce health-care costs, and aiming to guide effective clinical practice.

METHODS

In this systematic review with meta-analyses, a review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was conducted using Embase and PubMed for articles published between 1989 and 2023. Inclusion criteria targeted studies on open reduction and internal fixation mandibular fractures comparing intraoral and extraoral approaches and reporting infection rates. Exclusion criteria eliminated non-English articles, case reports, and studies with insufficient approach-specific data. The primary outcome was the postoperative infection rate, with surgical approach as the predictor. Covariates such as age, sex, diabetes, and smoking status were included when reported. Data were analyzed using R software, employing random-effects models due to anticipated heterogeneity (I2 statistics).

RESULTS

From 61 studies, 11 provided direct comparisons involving 1,317 patients-937 intraoral and 380 extraoral. Infection rates were 5.9% for intraoral and 10% for extraoral approaches. Pooled relative risk was 0.94 [95% confidence interval, 0.63, 1.39], suggesting no significant risk difference. Prevalence of infections was estimated at 9% for intraoral and 6.1% for extraoral procedures, with significant heterogeneity (I2 = 84% for intraoral and 56% for extraoral).

CONCLUSION

Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.

Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis

Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.

Three-Dimensional Osteosynthesis Plates for the Surgical Treatment of Mandibular Fractures

OBJECTIVES

Mandible fractures can be treated with different plate systems, that is, miniplates or three-dimensional (3D) plates. This systematic review describes the effectiveness and clinical outcomes of 3D plates used in fractures of the mandible and aims to critically evaluate its risks and benefits.

MATERIALS AND METHODS

A comprehensive electronic search was conducted without date but with restriction to articles written in English. Studies in humans, including randomized or quasi-randomized controlled trials and retrospective studies, were included. The outcome parameters measured were number of patients, fracture classification, results, follow-up period, postoperative complications, and mean age of patients. Major complications were defined as those needing additional surgical intervention, for example, malocclusion, infection or plate fracture. Accordingly, complications not needing additional surgical intervention were defined as minor (ie, dehiscence, trismus).

RESULTS

Guided by the PRISMA statement and the Cochrane Handbook for Systematic Reviews of Interventions, the authors identified 44 publications with a total of 1790 patients. Among the articles selected for the final review, there were 32 reported prospective studies, 12 reported retrospective studies. Regarding the evaluation of quality, 8 studies showed a low value of the risk of bias, 17 a moderate risk, and 19 a high risk. There were statistically significant advantages for 3D plates in mandibular fractures in terms of postoperative complications, for example, wound dehiscences or plate fracture.

CONCLUSIONS

The 3D plate is an effective treatment modality for mandibular fractures, with low incidence of major complications, decreased length of operation time, and increased stability of osteosynthesis.

Miniplate Fixation to an Edentulous Mandibular Fracture in Panfacial Trauma

A 70-year-old edentulous male presented with bilateral mandible and left midface fractures following an assault. Imaging confirmed fractures and showed mandible thickness greater than 20 millimeters. The patient was treated by open reduction internal fixation with miniplates via an intra-oral approach and recovered without deficit. While miniplate fixation and an intra-oral approach is typically reserved for the dentulous patient, this case illustrates that in select edentulous patients with sufficient bone thickness and amenable midface fractures this technique may be successfully utilized.

Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital Münster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.

Management of Angle Mandible Fractures by 3D Rectangular Grid Plate: A Prospective Study

Aim

This study aims to evaluate the clinical outcomes of treatment of mandibular angle fractures using 3D rectangular grid plate.

Materials and Methods

A total of 10 patients with mandibular angle fractures with or without associated facial fractures requiring open reduction and internal fixation were included in the study. Fixation was done using 3D rectangular grid plate.

Results

The mean age of the patients in the study is 34.7 years. In all the cases, fracture was adequately reduced (100%) intraoperatively and confirmed through postoperative radiographs. The mean mouth opening by the end of 3 months is 38.60 mm. Four patients had paresthesia of inferior alveolar nerve pre- and postoperatively, and normal sensation was regained by the end of the third month. There were no reported cases of infection and hardware failure during the 9-month follow-up period.

Conclusion

The results of the study suggest that 3D rectangular grid plate is a feasible alternative to conventional miniplate systems with good clinical outcome and fewer complications related to paresthesia, infection and hardware failure.

3-D Miniplates Versus Conventional Miniplates in Treatment of Mandible Fractures

AIM

To study whether the use of 3-D miniplate, when compared with conventional miniplate, gives better clinical outcomes with fewer complications in patients with fracture mandible.

MATERIALS AND METHODS

A prospective study was conducted in the Department of Oral and Maxillofacial Surgery, Trauma Care Centre, on 40 patients. They were randomly divided into Group-I and Group-II with 20 patients in each group. In Group-I, 3-D miniplate was used and in Group-II, conventional miniplate was used. Parameters such as fracture stability, occlusal status, mouth opening, nerve paresthesia, infection, pain, swelling, and complications were evaluated on 1st, 7th postoperative day, 1st month and 3rd month.

RESULTS

Fracture stability and occlusion were clinically better in Group-I than in Group-II on each follow-up; however, it was not statistically significant. Infection rate was lesser in Group-I than in Group-II (p = 0.003). Mouth opening was more in Group-II than in Group-I on immediate (p = 0.001) and 7th post-op day (p = 0.002). Overall complications were lesser in Group-I than in Group-II (p > 0.005).

CONCLUSION

There is no major difference observed in clinical outcomes between 3-D miniplate and conventional miniplate. Either method of fixation can be used successfully in treatment of mandible fractures with comparable rates of complications.

Three-dimensional strut plate for the treatment of mandibular fractures: a systematic review

The treatment of mandibular fractures by open reduction and internal fixation is very variable. Thus, there are many controversies about the best fixation system in terms of stability, functional recovery, and postoperative complications. This systematic review sought scientific evidence regarding the best indication for the use of three-dimensional (3D) plates in the treatment of mandibular fractures. A systematic search of the PubMed/MEDLINE, Elsevier/Scopus, and Cochrane Library databases was conducted to include articles published up until November 2016. Following the application of the inclusion criteria, 25 scientific articles were selected for detailed analysis. These studies included a total of 1036 patients (mean age 29 years), with a higher prevalence of males. The anatomical location most involved was the mandibular angle. The success rate of 3D plates was high at this location compared to other methods of fixation. In conclusion, the use of 3D plates for the treatment of mandibular fractures is recommended, since they result in little or no displacement between bone fragments.

The 3-dimensional miniplate is more effective than the standard miniplate for the management of mandibular fractures: a meta-analysis

PURPOSE

The study aimed to determine the superiority between 3-dimensional (3D) miniplate and standard miniplate for mandibular fractures (MFs) treatment.

BACKGROUND

Controversial results on the use of standard miniplate and 3D miniplate have remained for management of MFs.

METHODS

Several electronic databases were retrieved up to September 2014 to identify eligible studies. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Subgroup analyses by different fracture regions and different 3D miniplate sizes were performed. Publication bias was measured by a funnel plot.

RESULTS

There were 13 studies included for the meta-analysis, consisting of 593 participants. The 3D miniplate achieved significant lower incidences of malocclusion (RR 0.43, 95% CI 0.24-0.77, P = 0.004) and hardware failure (RR 0.31, 95% CI 0.13-0.74, P = 0.008) than the standard miniplate. There were no significant differences between the two miniplates on the incidence of the remaining outcomes: wound dehiscence, infection, paresthesia, and nonunion/malunion. Subgroup analyses indicated that 3D miniplate caused a lower hardware failure than standard with the size of 8 or 10 holes (RR 0.23, 95% CI 0.08-0.66, P = 0.006). Besides, publication bias was not detected.

CONCLUSION

The 3D miniplate is superior to the standard miniplate on the reduction of postoperative complication rates for the management of MFs. More holes in the 3D miniplate might contribute to a successful treatment.

Evaluation of in vitro resistance of different 2.0-mm titanium plates on the mandibular angle sectioning

OBJECTIVE

The purpose of this study was to compare, by mechanical in vitro testing, a regular 5-hole plate and a long 4-hole plate with a regular 4-hole plate, applied to stabilize a simulated mandibular angle fracture.

STUDY DESIGN

The plates from the 2.0-mm titanium-based system were adapted and stabilized passively in the same site in both groups using four screws, 6 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side, first molar at the contralateral side, and between the central incisors.

RESULTS

The regular 5-hole plates and longer 4-hole plates were superior to the regular 4-hole plates. Furthermore, no statistically significant difference was found between the regular 5-hole plates and long 4-hole plate.

CONCLUSIONS

The length and shape of plates did not interfere with the effectiveness to stabilize the fragments.

OBJECTIVE

The purpose of this study was to compare, by mechanical in vitro testing, a regular 5-hole plate and a long 4-hole plate with a regular 4-hole plate, applied to stabilize a simulated mandibular angle fracture.Study design The plates from the 2.0-mm titanium-based system were adapted and stabilized passively in the same site in both groups using four screws, 6 mm long. During the resistance-to-load test, the force was applied perpendicular to the occlusal plane at three different points: first molar at the plated side, first molar at the contralateral side, and between the central incisors.

RESULTS

The regular 5-hole plates and longer 4-hole plates were superior to the regular 4-hole plates. Furthermore, no statistically significant difference was found between the regular 5-hole plates and long 4-hole plate.Conclusions The length and shape of plates did not interfere with the effectiveness to stabilize the fragments.

In vitro evaluation of the resistance of three types of fixation to treat fractures of the mandibular angle

The purpose of this study was to compare the mechanical resistance of three different plates used to treat fractures of the mandibular angle: a regular 4-hole plate, a longer 4-hole plate (both positioned using the Champy technique), and a 3-dimensional plate positioned over the oblique line. Three equal groups of replicas of human dentate mandibles made out of polyurethane resin were used (n=21 in each group). The force was applied perpendicular to the occlusal plane at a rate of 2mm/minute at three different points: the first molar on the sectioned side; the first molar on the contralateral side; and between the central incisors. This was followed by a resistance-to-load test. The two varying factors (type of plate and site-of-load application) were tested by analysis of variance, and probabilities of less than 0.05 were accepted as significant. There were no significant differences between the subgroups, or between the mean values of the different types of plates (p=0.925). The three types of plates showed similar mechanical behaviour, which showed that the 3-dimensional plates positioned over the oblique line can produce mechanical scores similar to those of conventional plates.

Evaluation of Three Different Osteosynthesis Methods for Mandibular Angle Fractures: Vertical Load Test

The aim of this study was to evaluate the mechanical behavior of different rigid fixation methods in mandible angle fractures. Three different plates were tested: one 4-hole grid miniplate, one 8-hole curved grid miniplate, and one 4-hole straight miniplate.For the loading tests, 30 polyurethane hemimandibles sectioned at the angle area to simulate a simple angle fracture were used: 10 hemimandibles for each group. The mechanical evaluation revealed that the straight plate positioned at the tension zone presented the best results in supporting vertical loading in the predefined displacement moments of 1, 3, and 5 mm. Regarding the grid plates, there was no statistically significant difference between the smaller and the larger plate.According to this sample, the straight plate positioned in the tension zone presented better results than the other 2 different grid plates positioned at the neutral zone.

Management of Mandibular Angle Fractures: Single Stainless Steel Linear Miniplate Versus Rectangular Grid Plate-A Prospective Randomised Study

PURPOSE

This prospective study was conducted to evaluate the efficacy of stainless steel single linear miniplate with rectangular grid plate in the treatment of mandibular angle fractures.

METHODS

This study included 30 patients who were allocated randomly into two groups of each. Group 1 patients were treated with single 2 mm × 4 hole linear stainless steel miniplate and group 2 patients with 2 mm × 4 hole rectangular grid plate. Patients were evaluated for fracture stability, occlusion, mouth opening, and complications at 1st week, 1 and 3 months post operatively.

RESULTS

There were no significant differences between the two groups with respective variables statistically. In group 1 20 % (n = 3) had mild occlussal derangement 6.66 % (n = 1) patient had deranged occlusion at 1 week post operatively and 13.3 % (n = 2) had mild derangement at 1 month post operatively. In group 2 6.66 % (n = 1) had mild derangement at 1 week postoperatively. 20 % (n = 3) had limited mouth opening at 1 week in group 1 and 13.3 % (n = 2) in group 2. All patients in both groups achieved adequate mouth opening by the end of 3 month. None of the patients in both groups had plate fracture, screw loosening, non union or mal-union.

CONCLUSION

Within the limits of the study, use of rectangular grid plates for fixation of mandibular angle fractures was reliable with low complication rates, easy adaptation and an effective alternative to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.

Biomechanical comparison of four mandibular angle fracture fixation techniques

The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested.

Fixation of mandibular angle fractures: clinical studies

PURPOSE

The purpose of this study was to review the literature regarding the evolution of current thoughts on fixation of mandibular angle fractures (MAFs).

METHODS

An electronic search in PubMed was undertaken in August 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies from the last 30 years (from 1983 onwards) reporting clinical studies of MAFs.

RESULTS

The search strategy initially identified 767 studies. The references from 1983 onwards totaled 727 articles. Fifty-four studies were identified without repetition within the selection criteria. Two articles showing significance in the development of treatment techniques were included. Additional hand-searching yielded 13 additional papers. Thus, a total of 69 studies were included.

CONCLUSIONS

Prospective randomized controlled studies of MAFs repair techniques are scarce. The available data at best predict that complications are associated with all kinds of fixation techniques. The similar results of complications in studies using different methods of fixation indicate that biomechanics are only one factor to be considered when treating MAFs. A second fracture in the mandible (which was observed in the majority of the studies' population) can confound the outcome data because the fixation requirements of a double fracture are often different from those for an isolated fracture. It can be necessary additional effort intended for increase of stability when using biodegradable plate system to fixate MAFs. The use of 1.3 mm malleable miniplates was associated with an unacceptable incidence of plate fracture, suggesting that this is not the most adequate system to treat MAFs. The use of the 3D grid plates has shown good clinical results. The efficiency of locking miniplate system is yet to be proven because there are few clinical studies with its use to fixate MAFs, although they have shown good results. When considering the use of semirigid or rigid fixation systems, the use of two miniplates outweigh the advantages of the use of one reconstruction plate, although the use of miniplates is not recommended for displaced comminuted MAFs. Although it has been shown that absolute rigid fixation is not necessary for fracture healing, any system that provides superior stability without impacting negatively on other aspects of the procedure, i.e., time, exposure, and cost, should be favored. MAFs can be treated in a highly effective way and with a relatively low rate of complications with monocortical miniplate fixation. The large number of studies on the treatment of MAF reflects the fact that a consensus has not been reached for a single, ideal treatment method.

Matrix miniplate versus locking miniplate in the management of displaced mandibular angle fractures

Aim:

The purpose of this study was to determine and compare various postoperative parameters like ease of operability, plate adaptability, stability etc., associated with use of matrix miniplate versus locking miniplate in the treatment of displaced mandibular angle fractures.

Materials and Methods:

The study was carried out in the Department of Oral and Maxillofacial surgery, King George's Medical College, GM and Associated Hospital, Lucknow. Total 50 patients were treated and included in the study. These were divided into two groups of 25 each and were treated with two of the standard techniques, i.e., one is matrix miniplate osteosynthesis and other is locking miniplate osteosynthesis. These patients were evaluated for postoperative complications and the differences between the two Groups were assessed.

Results:

Patients treated by matrix miniplate showed better recovery phase postoperatively as compared to locking miniplate group.

Conclusion:

Based on this study matrix mini plate osteosynthesis may be considered as the better alternative method available for the treatment of displaced mandibular angle fractures.

Use of 3-d plate in displaced angle fracture of mandible

Introduction Mandibular angle fractures can be treated by various methods, but even the most popular methods may not be able to give satisfactory results, as the pterygomasseteric sling and masticatory forces can result in displaced angle fracture. These displaced fragments cannot be satisfactorily retained by single miniplate fixation. The aim of this study is to assess treatment of displaced angle fracture with 3-D miniplate fixation. This study can also be considered as a therapeutic study with level V evidence. Materials and Methods This study was designed to assess the feasibility of 3-D matrix miniplate fixation in displaced angle fractures. Eighteen patients with displaced angle fractures were included in this study. Matrix miniplate fixation was done transorally under general anesthesia. Results All these cases were treated successfully, and common complications like infection (5.5% of patients), wound dehiscence (11%), paresthesia (16.7%), and malocclusion (11%) were observed in our study. Conclusions Three-dimensional miniplate fixation in displaced angle fractures provides better stability and function.

Comparison of compressive strength between three different plates for mandibular angle fractures fixation

The present study aims to compare three types of internal fixation for fractures of the mandibular angle. Mechanical testing was performed on replicas of polyurethane hemimandibles sectioned at the angle region to simulate a fracture and fixed with three different hardwares. Fixation devices enrolled on this survey included the grid plates with and without an intermediate bar and the method described by Champy and colleagues in 1978 and the sample consisted of 10 hemimandibles for each group. Vertical loadings were applied on each hemimandible and recorded after a vertical displacement of 3 and 5 mm. Statistical analysis was made by means of the variance analysis (ANOVA) and the Duncan test with a significance level of 5%. The Champy technique showed a statistically significant increased resistance when compared to the grid plates after vertical displacements of 3 and 5 mm. The results of this survey suggest that the Champy technique, when compared to the grid plate positioned at the middle of the mandibular bone (placement site selected for this study), is more resistant than the grid plate and that the inclusion or not of an intermediate bar to the grid plates does not improve its resistance after linear vertical loadings.

The 7-hole angle plate for mandibular angle fractures

PURPOSE

To evaluate the 7-hole angle plate for open reduction, internal fixation of mandibular angle fractures when the Champy technique is inadequate and more rigid or semirigid fixation is beneficial and to provide rational indications for the choice of the 7-hole angle plate.

PATIENTS AND METHODS

Retrospective evaluation of 10 patients selected at Parkland Memorial Hospital over a 2-year period when the 7-hole angle plate stabilized their angle fracture. Patients were evaluated for postoperative complications including pain, malocclusion, and infection.

RESULTS

All 10 patients had sufficient follow-up for inclusion in this retrospective study. Correct placement of the 7-hole angle plate, easily accomplished with adequate assistance, produced no reportable postoperative complications.

CONCLUSION

The 7-hole angle plate is a good first option when more rigid or semirigid fixation is required, and the best fallback when the Champy technique is ineffective.