J Korean Assoc Oral Maxillofac Surg.  2011 Aug;37(4):255-263. 10.5125/jkaoms.2011.37.4.255.

Open reduction of mandibular fracture without maxillomandibular fixation: retrospective study

• Lee CH
• Kim CH

• KMID: 1449057
• DOI: http://doi.org/10.5125/jkaoms.2011.37.4.255

Abstract

INTRODUCTION
Maxillomandibular fixation (MMF) is essential before surgery under general anesthesia in maxillofacial trauma patients. MMF is used basically to reconstruct the occlusion and occlusal stability to recover the facial shape and oral functions. The arch bar and wire is a traditional method for MMF, but it can not only bring pressure to the periodontal ligaments and teeth but also cause a penetrating injury to the surgeons.
MATERIALS AND METHODS
In this study, 198 patients with an open reduction using a manual reduction without MMF from September 2005 to May 2010 in Dankook University Dental Hospital were subjected to a follow-up evaluation during the postoperative 4 months periods. This study evaluated the incidence of complications according to the condition of the patient (gender, age), the state of bony union of the fracture sites and a numeric rating scale evaluation for postoperative pain scoring.
RESULTS
1. The complications were classified into major and minor according to the seriousness, and the major complication rate was as low as 2.02%. Only 2 cases of re-operations (1.01%) were encountered. In the classification according to the fracture line, plate fracture was observed in both cases of mandibular symphysis fracture, and angle fractures and loosening of two screws were noted in the case of mandibular angle fracture.
CONCLUSION
The use of MMF is not always necessary if a skilled assistant is provided to help manually reduce the fracture site. Compared to other studies of mandibular fracture surgery using MMF, the complication rate was similar using only manual reduction and the patients' discomfort was reduced without MMF.

Keyword

Mandibular fracture; Maxillomandibular fixation; Postoperative complication

MeSH Terms

Anesthesia, General
Follow-Up Studies
Humans
Incidence
Jaw Fixation Techniques
Mandibular Fractures
Pain, Postoperative
Periodontal Ligament
Postoperative Complications
Retrospective Studies
Tooth

Figure

• 

  Fig. 1. Open reduction of mandibular symphysis fracture using manual reduction without arch bar. A. Preoperative occlusion B. Preoperative computed tomography, C. Intraoperative photograph showing repair of fracture, D. Postoperative radiograp after fixation.

• 

  Fig. 2. Plate fracture in panorama radiograph.

• 

  Fig. 3. A case of delayed union after operation. A. Delayed union in panorama radiograph after 4 months, B. Partially bony union after 1 year without re-operation.

• 

  Fig. 4. Re-operation in a case of osteomyelitis. A. Panorama radiograph after 3 months, B. Re-operation by using reconstruction plate.

Reference

1. Turvey TA. Midfacial fractures: a retrospective analysis of 593 cases. J Oral Surg. 1977; 35:887–91.

2. Ugboko VI, Oginni FO, Owotade FJ. An investigation into the relationship between mandibular third molars and angle fractures in Nigerians. Br J Oral Maxillofac Surg. 2000; 38:427–9.

3. Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with mandibular fractures: a review of 1,067 cases. J Oral Maxillofac Surg. 1992; 50:586–9.

4. Kawai T, Murakami S, Hiranuma H, Sakuda M. Radiographic changes during bone healing after mandibular fractures. Br J Oral Maxillofac Surg. 1997; 35:312–8.

5. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992; 13:606–8.

6. Fordyce AM, Lalani Z, Songra AK, Hildreth AJ, Carton AT, Hawkesford JE. Intermaxillary fixation is not usually necessary to reduce mandibular fractures. Br J Oral Maxillofac Surg. 1999; 37:52–7.

7. Bell RB, Wilson DM. Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures? J Oral Maxillofac Surg. 2008; 66:2116–22.

8. Coletti DP, Salama A, Caccamese JF Jr. Application of intermaxillary fixation screws in maxillofacial trauma. J Oral Maxillofac Surg. 2007; 65:1746–50.

9. Gaujac C, Ceccheti MM, Yonezaki F, Garcia IR Jr, Peres MP. Comparative analysis of 2 techniques of double-gloving protection during arch bar placement for intermaxillary fixation. J Oral Maxillofac Surg. 2007; 65:1922–5.

10. Williams JG, Cawood JI. Effect of intermaxillary fixation on pulmonary function. Int J Oral Maxillofac Surg. 1990; 19:76–8.

11. Roccia F, Tavolaccini A, Dell'Acqua A, Fasolis M. An audit of mandibular fractures treated by intermaxillary fixation using intraoral cortical bone screws. J Craniomaxillofac Surg. 2005; 33:251–4.

12. Gordon KF, Reed JM, Anand VK. Results of intraoral cortical bone screw fixation technique for mandibular fractures. Otolaryngol Head Neck Surg. 1995; 113:248–52.

13. Coburn DG, Kennedy DW, Hodder SC. Complications with intermaxillary fixation screws in the management of fractured mandibles. Br J Oral Maxillofac Surg. 2002; 40:241–3.

14. Ellis E 3rd, Walker LR. Treatment of mandibular angle fractures using one noncompression miniplate. J Oral Maxillofac Surg. 1996; 54:864–71.

15. Dimitroulis G. Management of fractured mandibles without the use of intermaxillary wire fixation. J Oral Maxillofac Surg. 2002; 60:1435–8.

16. Laurentjoye M, Majoufre-Lefebvre C, Caix P, Siberchicot F, Ricard AS. Treatment of mandibular fractures with Michelet technique: manual fracture reduction without arch bars. J Oral Maxillofac Surg. 2009; 67:2374–9.

17. Jeong CH, Jeong JW, Kwon ST. The siginificance of radiographic followup of mandibular fractures. J Korean Soc Plast Reconstr Surg. 1998; 25(5):860–865.

18. Durham JA, Paterson AW, Pierse P, Adams JR, Clark M, Hierons R, et al. Postoperative radiographs after open reduction and internal fixation of the mandible: are they useful? Br J Oral Maxillofac Surg. 2006; 44:279–82.

19. Sim SY, Park HJ, Lee JM, Lee HS. An overview of pain measurements. Korean J. Meridian Acu. 2007; 24:77–97.

20. White A. Measuring pain. Acupunct Med. 1998; 16:83–7.

21. Maloney PL, Lincoln RE, Coyne CP. A protocol for the management of compound mandibular fractures based on the time from injury to treatment. J Oral Maxillofac Surg. 2001; 59:879–84.

22. Anderson T, Alpert B. Experience with rigid fixation of mandibular fractures and immediate function. J Oral Maxillofac Surg. 1992; 50:555–60.

23. The Korean Association of Oral and Maxillofacial Surgeons. Textbook of oral and maxillofacial surgery. 2nd ed.Seoul: Dental & Medical Publishing Co.;2005.