Download Surgical Treatment of Mandibular Fracture without Intermaxillary

Surgical Treatment of Mandibular Fracture without Intermaxillary Fixation
Hyoung Jin Kim, MD, Jin Sik Burm, MD, Ph.D, Yang Woo Kim, MD, Ph.D, Jay Kyung Pyun, MD
INTRODUCTION: Principles in treating mandibular fractures consist of precise anatomical reduction,
restoration of premorbid occlusion, and rigid fixtation until stable osseointegration achieves (1). Accordingly,
when the dental arch was maintained in such a case like an isolated unilateral angle fracture, open reduction
and internal fixation without intermaxillary fixation (IMF) brought satisfactory results (2-3).
We propose that anatomical reduction and rigid fixation without IMF can provide secure immobilization and
correct occlusion not only in unilateral angle fracture but also in multiple fractures and comminuted fractures
of mandible.
METHOD: A total of 32 patients with various types of madibular fracture were treated with open reduction
and internal fixation without applying IMF. Of them, 22 cases had two or more fracture sites simultaneously,
always involving either symphysis or parasymphysis that resulted in disruption of the dental arch. We used
either 1.2 mm titanium microplates or 1.7 mm low-profile miniplates, and/or a fixtion wire for bony fixation.
In all cases involving symphysis or parasymphysis, an additional simple eyelet method of interdental wiring
that held four teeth together to bring further stability on the dental lining was used. Usually, two or three
points of fixation including interdental wiring were used to correct the fracture site. Pre- and postoperative
photographs of occlusion, radiographs, thin paper bite test, and subjective satisfaction at occlusion were
analyzed in all cases.
RESULTS: Complications such as infection, periodontitis, trismus, loss of weight and non union were not
found. Three cases showed subjectively unnoticeable mild open bite at thin paper bite test, but the patients did
not need further orthodontic treatment.
CONCLUSION: Anatomical reduction and rigid internal fixation itself without IMF can simplify surgical
technique, increase compliance, reduce complications, and result in re-establishment of the patient’s premobid
occlusion. Thus, this method is thought to coincide with the basic principles of all other fracture treatments
while eliminating the need of IMF.
Fig.
1.
(Above left & right) Preoperative frontal occlusal photograph and panoramic view show multiple
fracture sites, involving right parasymphysis and left condyle. (Below left & right) Open reduction and
internal fixation using microplates and wires without intermaxillary fixation brought good occlusal state and
stable union.
Fig.
2.
(Above left & right) Preoperative photograph and panoramic view show severely disrupted dental
lining due to segmental fracture between the symphysis and the left angle. (Below left & right) Postoperative
photograph and panoramic view taken in 13 months after the surgery show completely restored premorbid
occlusion and complete bone union.
REFERENCES
1.Manson PN.
The head and neck, part 2 : Facial fractures,
Mathes S (ed). Plastic surgery second edition.
Philadelphia, Saunders, 2006, Vol 3: 154-161
2.Dimitrtroulis G.
Management of fractured mandibles without the use of intermaxillary wire fixation. J
Oral Maxillofac Surg 60:1435-1438, 2002
3. Fordyce AM, Lalani Z, Songra AK, et al: Intermaxillary fixation is not usually necessary to reduce
mandibular fractures. Br J Oral Maxillofac Surg 37:52-57, 1999