, the nature of their other injuries, or when the fracture had initially been inadequately treated. A total of 139 plates were placed in a distribution indicated in Table 3. Intermaxillary fixation was required post-operatively in 9 cases, usually necessitated by the presence of a displaced condylar or maxillary fracture.
Table 3. Distribution of the 139 plates placed
Position of plates
Angle 45
Body 35
Parasymphysis 51
Symphysis 8
The amount of theatre time required ranged from l to 5 h with 73 % of cases completed in 2 h or less (Flg.4). Longer operative times were associated with cases of multiple facial injuries. The period of hospitalisation ranged from l to 55 days with 2 patients managed as outpatients and 72 % of patients discharged within 5 days (Fig.5). The lengthy inpatient times were associated with cases of multiple injuries.
Five of the 80 patients failed to attend review appointments and could not be contacted. The incidence of complications in the remaining patients is illustrated in Table 4, with only 8% having
persistent complications. During the early post-operative period (< l month) a considerable number of transient complications were in evidence. There were 32 cases of hypoaesthesia of the inferior alveolar nerve, a result of the initial trauma plus manipulation of the nerve during the plating procedure. Only 2 failed to resolve (2.5%), one of which was also the only case of delayed union. Occlusal disturbances were reported by 13 patients in the initial post-operative phase. Minor occlusal adjustment was carried in a few cases; however, the majority of these cases resolved spontaneously. Only 2 cases (2.5%) had residual occlusal complications, one with an anterior open bite and one with a residual occlusal step defect. Both of these cases had associated condylar fractures. Transient weaknss of the mandibular branch of the facial nerve occurred in 3 of the 8 patients where an extraoral approach had been used to place the plates. These all resolved after some months. Two dental complications occurred both involving a tooth in the fracture line. In one case a periodontal defect developed and in the other resorption of the apical portion of the root was detected, although the tooth remained asymptomatic.
Table 4. Incidence of complications
Complications l Month 6 Months
Malocclusion l3 2
Dysaesthesia 32 2
Delayed union - 1
Infection nil nil
Wound dehiscence 2 nil
Facial nerve weakness 3 Nil
Periodontal defect - 1
Resorption of tooth in fracture line - 1
Total complications = 6 patients(8%)
5 patients unable to be reviewed (n= 75)
The incidence of complications in this study compared favourable with that in similar studies on miniplate osteosynthesis (Table 5). These results are also similar to those achieved with traditional methods of fracture treatment disign intermaxillaty fixations.
Table 5. Comparison of results with other studies.
Complication Cawood
1985
n = 5 Champy
1978
n =100 Ikemura
1988
n = 66 Wald
1988
n = 61 Sydney
n = 75
Maloccluson 8 4.8 3 1.9 2.6
Infection 6 3.8 3 7.4 nil
Dehiscence 12 - 7.6 - 2.6
Delayed union - 0.5 - - 1.3
Sensory disturbance 8 - - 3.7 2.6
Figures expressed as percentages
Discussion
During the last 10 years there have been a number of papers published on th
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