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L. Rix A. R. L Stevenson, A. Punnia-Moorthy: An analysis of 80 cases of mandibular fractures treated with miniplate osteosynthesis. Int. J. Oral Maxillofal. Surg. 1991; 20: 337-341
Abstract. A study of 80 consecutive cases of mandibular fractures treated utilizing miniplate osteosynthesis is reported. Analysis of the data collected from 2 inner city hospitals revealed a high incidence of males (90%), alcohol abusers (44%), smokers (77%) and unemployed (36%). Assault was the aetiological factor in 72.5% of cases, with alcohol implicated in 58%. The injuries were predominantly noncomplex in nature, 94 % having one or 2 mandibular fractures and only 11% having additional facial fractures. The results compared favourably with those found in previous studies with 8% having complications. The efficacy and advantages of miniplate osteosynthesis as a method of treatment of mandibular fractures is discussed.
Osteosynthesis of mandibular fractures utilising npm-compression monocortical miniplates was introduced by MICHELET et al. and developed and refined by CHAMPY et al. This system is now well recognised and practiced in many countries. However its introduction into Australia has been recent and as yet no results have been reported. The aim of this study was to analyze data collected from patients suffering manclibular fractures who presented to the University of Sydney Department of Oral Surgery. The nature of their injuries was assessed and the effectiveness or this technique in treating these fractures was examined.
Material and methods
Eighty consecutive cases of mandibular fractures treated during the period July 1987 to march 1991 were included in this study. The patients were treated at Sydney Hospital and United Dental Hospital, both of which are located in the inner city area of Sydney. Data was collated from the patient records, radiographs and from clinical examination whenever possible. The operative techniques employed followed that described by CHAMPY et al. with some minor modifications. The patients were treated under general anesthesia in all but 4 cases. An intra-oral approach was used in 90% of cases with the occasional need to place screws transbuccally. Intermaxillary fixation, in the form of eyelet wires or archbars was usually applied intra-operatively in order to stabilise the fracture whilst the plated were adapted and screwed into position. Two plates were used for fractured anterior to the mental foramen and one plate for fractures at other sites except for condylar fractured which were managed conservatively. A modification was occasionally used for fractures in close proximity to the mental foramen to avoid trauma to the nerve. Instead of the customary 2 plates, only one plate was placed, above the foramen, and supplemented with loop wiring which included 2 or more teeth on either side of the fracture line. The loop wire was left in place for approximately 4-6 weeks. Stainles steel plates (Champy plates. Gebruder Martin Co.) were used in all but 7 cases where titanium plates were used. The operators ranged from specialists to trainees with varying levels of experience.
Prophylactic antibiotics (predominantly penicillin and/or metronidazole) were administered either intravenously or orally from the time of presentation until the 7th post-operative day 8 mg of dexamethasone was administered intra-operatively, with 2 further doses the following day in certain cases