Limits...
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

Transbuccal approach. A. Fracture exposure. B. Transfacial stab incision. C. Placement of the transbuccal trocar and placement of intermaxillary fixation. D. Plate fixation. E. Plate on the lateral aspect of the ramus. F. Intraoral closure. G. Stab incision closure. H. Postoperative radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4940199&req=5

Figure 2: Transbuccal approach. A. Fracture exposure. B. Transfacial stab incision. C. Placement of the transbuccal trocar and placement of intermaxillary fixation. D. Plate fixation. E. Plate on the lateral aspect of the ramus. F. Intraoral closure. G. Stab incision closure. H. Postoperative radiograph.

Mentions: In group B, in addition to the transoral incision, a small extraoral stab incision was given to permit the insertion of the transbuccal cannula.(Fig. 2. A, 2. B) The location of the extraoral stab incision was guided by the location of the fracture line and the position of the facial vessels. The trocar was advanced into the operative site with blunt dissection through the stab incision, perforating the periosteum in the area planned for plate fixation.(Fig. 2. C) The cheek retractor was applied to stabilize the trocar assembly during movement towards and away from the fracture site. A drill bit that was 11.5 cm in length and 2.3 mm in diameter was inserted through the drill guide to drill the holes. The procedure followed for fracture reduction was similar to that of the transoral approach, except that after fracture reduction, the trocar assembly was removed and the extraoral skin incision was sutured with 5.0 ethilon (Johnson & Johnson, New Brunswick, NJ, USA) suture.(Fig. 2. D-H) All patients were hospitalized for 5 days and were placed on a liquid diet for 2 weeks, followed by a soft diet for another 4 weeks. Patients were followed at 1 week, 3 months, and 6 months.


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)

Transbuccal approach. A. Fracture exposure. B. Transfacial stab incision. C. Placement of the transbuccal trocar and placement of intermaxillary fixation. D. Plate fixation. E. Plate on the lateral aspect of the ramus. F. Intraoral closure. G. Stab incision closure. H. Postoperative radiograph.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Transbuccal approach. A. Fracture exposure. B. Transfacial stab incision. C. Placement of the transbuccal trocar and placement of intermaxillary fixation. D. Plate fixation. E. Plate on the lateral aspect of the ramus. F. Intraoral closure. G. Stab incision closure. H. Postoperative radiograph.
Mentions: In group B, in addition to the transoral incision, a small extraoral stab incision was given to permit the insertion of the transbuccal cannula.(Fig. 2. A, 2. B) The location of the extraoral stab incision was guided by the location of the fracture line and the position of the facial vessels. The trocar was advanced into the operative site with blunt dissection through the stab incision, perforating the periosteum in the area planned for plate fixation.(Fig. 2. C) The cheek retractor was applied to stabilize the trocar assembly during movement towards and away from the fracture site. A drill bit that was 11.5 cm in length and 2.3 mm in diameter was inserted through the drill guide to drill the holes. The procedure followed for fracture reduction was similar to that of the transoral approach, except that after fracture reduction, the trocar assembly was removed and the extraoral skin incision was sutured with 5.0 ethilon (Johnson & Johnson, New Brunswick, NJ, USA) suture.(Fig. 2. D-H) All patients were hospitalized for 5 days and were placed on a liquid diet for 2 weeks, followed by a soft diet for another 4 weeks. Patients were followed at 1 week, 3 months, and 6 months.

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