Management of unfavorable displaced mandibular angle fracture with combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches. One year prospective clinical and radiographic study

Purpose:the aim of this prospective study was to evaluate clinical and radiographic outcomes of combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches in the management of unfavorable displaced mandibular angle fracture with opening mouth immediately postoperatively.
Materials and methods:Thirteen patients(age16-58years,9males and4females)with unfavorable displaced mandibular angle fractures were treated by combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches.The following clinical parameters were evaluated; pain,infection,maximum mouth opening,neurosensory disturbance,malocclusion/midline shift,presence of unsightly facial soft tissue scar,muscle trismus,ability to chew hard food,loosening of hardware,and need for alternative treatment.Radiographic evaluation included evaluation of fracture type,any abnormal position of hardware and screws,malunion, displacement if present,and malocclusion using(CBCT)that was done preoperatively and at8weeks postoperative.All parameters were evaluated preoperatively,postoperatively,3,8weeks,6and12months later.
Results:Maximum mouth opening preoperatively(8.52mm)significantly increased postoperatively to30.57mm,then significantly increased at3,8weeksand6months.All cases(13patients)were detected with pain perioperatively which continued to3weeks then significantly decreased at8weeks and disappeared after6months.Seven cases presented with infection preoperatively which significantly decreased to2cases postoperatively and disappeared after3weeks.All cases had trismus which significantly decrease postoperatively and disappeared after6months.Three cases were detected with neurosensory disturbance postoperatively and disappeared after6months.All patients were unable to chew hard food till8weeks.No cases were detected with malocclusion/midline shift,malunion,non-union,unsightly facial soft tissue scare,no need for any alternative treatments or loosening of the hardware was detected postoperatively.
Conclusion:Within the limitation of this study,combined rigid and semi-rigid fixation using trans-oral and trans-buccal approaches in the management of unfavorable displaced mandibular angle fracture is an effective treatment modality as it was associated with favorable clinical and radiographic outcomes with reduced complications after one year.