J Korean Assoc Oral Maxillofac Surg.  2016 Jun;42(3):144-150. 10.5125/jkaoms.2016.42.3.144.

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

• Khandeparker PVS
• Dhupar V
• Khandeparker RVS
• Jain H
• Savant K
• Berwal V

• KMID: 2309256
• DOI: http://doi.org/10.5125/jkaoms.2016.42.3.144

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.

Keyword

Mandibular angle fracture; Transoral approach; Transbuccal approach; Single miniplate

MeSH Terms

Cicatrix
Cicatrix, Hypertrophic
Follow-Up Studies
Humans
Mandible
Operative Time
Postoperative Complications
Prospective Studies*

Figure

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  Fig. 1 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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  Fig. 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.

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  Fig. 3 Postoperative radiographic interpretation of fracture reduction (group A).

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  Fig. 4 Postoperative radiographic interpretation of fracture reduction (group B).

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