Basic and patient-oriented research
A Prospective Study of 3 Treatment Methods for Isolated Fractures of the Mandibular Angle

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Purpose

The purpose of this investigation was to evaluate treatment outcomes prospectively when isolated fractures of the mandibular angle are treated by 1) nonrigid fixation that includes 5 to 6 weeks of maxillomandibular fixation, 2) nonrigid but functionally stable fixation using a single miniplate, and 3) rigid fixation using 2 miniplates.

Patients and Methods

All patients treated for isolated fractures of the mandibular angle at Parkland Hospital over a 12-year period were treated by 1 of the 3 methods sequentially assigned. Demographic, fracture characteristic, and treatment and outcome data were prospectively collected and statistically analyzed to determine whether the 3 treatments produced different outcomes.

Results

One hundred eighty-five patients had sufficient follow-up for inclusion in this study. There were no significant differences in demographic data for the 3 groups. There were significant differences in treatment outcomes for several variables, including the amount of time it took to perform the surgery and postoperative wound problems.

Conclusion

The use of single miniplate was the easiest to perform and was associated with the lowest number of complications.

Section snippets

Patients and Methods

All dentate patients 13 years or older with isolated (ie, no other mandibular or maxillary), noncomminuted fractures through the mandibular angle who presented for treatment at Parkland Hospital between April 1997 and July 2009 were included in this institutional review board–approved study. To be included, they must have had sufficient dentition to determine proper occlusion. Exclusion criteria included 1) the fracture was infected at the time of treatment, 2) medical conditions that could

Results

Two hundred twenty-eight patients were enrolled in the study, but 43 were not operated on with the author available, were lost during the follow-up period, or never returned for an evaluation at the 6-week period or later. The final study sample included 185 patients with 60 in group 1, 62 in group 2, and 63 in group 3. The demographics of the population are presented in Table 2. Not surprisingly, males greatly outnumbered females (161 vs 24), and the mean age was in the 20- to 30-year-old

Discussion

Over the course of several years, we performed various treatment schemes for fractures of the mandibular angle on a consecutive series of patients.5, 10, 11, 12, 13, 14, 31, 32, 33, 34, 35 In one of those studies, we showed that treatment of angle fractures even using traditional methods—closed reduction and/or open reduction and internal wire fixation—produced a high rate of complication (17%) in our patient population.5 The most useful techniques in our population were either an extraoral

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    Supported by a grant from AO North America.

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