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Transbuccal versus transoral approach for management of mandibular angle fractures: a prospective, clinical and radiographic study.

Khandeparker PV, Dhupar V, Khandeparker RV, Jain H, Savant K, Berwal V - J Korean Assoc Oral Maxillofac Surg (2016)

Bottom Line: A P-value less than 0.05 was considered significant.Infection was noted in 2 patients in group B compared to 6 patients in group A.There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Hospicio District Hospital, Margao, India.

ABSTRACT

Objectives: We compared the transbuccal and transoral approaches in the management of mandibular angle fractures.

Materials and methods: Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant.

Results: No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up.

Conclusion: The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.

No MeSH data available.


Related in: MedlinePlus

Transoral approach. A. Fracture exposure. B. Fracture reduction and placement of intermaxillary fixation. C. Placement of miniplate. D. Closure. E. Postoperative radiograph.
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Figure 1: Transoral approach. A. Fracture exposure. B. Fracture reduction and placement of intermaxillary fixation. C. Placement of miniplate. D. Closure. E. Postoperative radiograph.

Mentions: All patients were operated under general anesthesia with nasotracheal intubation following a standard surgical protocol by a single oral and maxillofacial surgeon. In group A, following local infiltration of the intraoral site with 2% lignocaine with 1:80,000 adrenaline, an incision was planned extending from the anterior border of the ascending ramus at the level of maxillary occlusal plane. The incision was then carried down just along the lateral portion of the anterior ramus and continued forward approximately 5 mm from the junction of the attached mucosa and vestibule to extend anteriorly to the level of the mandibular first molar. The mucoperiosteal flap was then raised and the fractured site was exposed.(Fig. 1. A) Fractured segments were reduced under direct vision. Satisfactory occlusion was achieved and held in place with intermaxillary fixation.(Fig. 1. B) Fractured segments were stabilized and fixed with a 2.5 mm 4-hole titanium miniplate with a gap, and were secured with monocortical screws that were 2.5-mm in diameter and 6 to 8 mm in length. These screws were threaded in position to the proper depth.(Fig. 1. C) The intermaxillary fixation was then released and occlusion was rechecked. Copious irrigation was performed with betadine and saline. The intraoral wound was closed with 3.0 vicryl sutures (Fig. 1. D) and the throat pack was removed. General anesthesia was reversed and the patient was extubated and shifted to the recovery room.


Transbuccal versus transoral approach for management of mandibular angle fractures: a prospective, clinical and radiographic study.

Khandeparker PV, Dhupar V, Khandeparker RV, Jain H, Savant K, Berwal V - J Korean Assoc Oral Maxillofac Surg (2016)

Transoral approach. A. Fracture exposure. B. Fracture reduction and placement of intermaxillary fixation. C. Placement of miniplate. D. Closure. E. Postoperative radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940199&req=5

Figure 1: Transoral approach. A. Fracture exposure. B. Fracture reduction and placement of intermaxillary fixation. C. Placement of miniplate. D. Closure. E. Postoperative radiograph.
Mentions: All patients were operated under general anesthesia with nasotracheal intubation following a standard surgical protocol by a single oral and maxillofacial surgeon. In group A, following local infiltration of the intraoral site with 2% lignocaine with 1:80,000 adrenaline, an incision was planned extending from the anterior border of the ascending ramus at the level of maxillary occlusal plane. The incision was then carried down just along the lateral portion of the anterior ramus and continued forward approximately 5 mm from the junction of the attached mucosa and vestibule to extend anteriorly to the level of the mandibular first molar. The mucoperiosteal flap was then raised and the fractured site was exposed.(Fig. 1. A) Fractured segments were reduced under direct vision. Satisfactory occlusion was achieved and held in place with intermaxillary fixation.(Fig. 1. B) Fractured segments were stabilized and fixed with a 2.5 mm 4-hole titanium miniplate with a gap, and were secured with monocortical screws that were 2.5-mm in diameter and 6 to 8 mm in length. These screws were threaded in position to the proper depth.(Fig. 1. C) The intermaxillary fixation was then released and occlusion was rechecked. Copious irrigation was performed with betadine and saline. The intraoral wound was closed with 3.0 vicryl sutures (Fig. 1. D) and the throat pack was removed. General anesthesia was reversed and the patient was extubated and shifted to the recovery room.

Bottom Line: A P-value less than 0.05 was considered significant.Infection was noted in 2 patients in group B compared to 6 patients in group A.There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral and Maxillofacial Surgery, Hospicio District Hospital, Margao, India.

ABSTRACT

Objectives: We compared the transbuccal and transoral approaches in the management of mandibular angle fractures.

Materials and methods: Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant.

Results: No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up.

Conclusion: The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.

No MeSH data available.


Related in: MedlinePlus