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Jawa S, Prathibha G, Prasad K, Ranganath K, Sagar P, Chandra S. Comparative evaluation of lag screws and miniplates in the fixation of anterior mandibular fractures- a prospective study. Oral Maxillofac Surg 2025; 29:112. [PMID: 40434513 DOI: 10.1007/s10006-025-01406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2025] [Accepted: 05/17/2025] [Indexed: 05/29/2025]
Abstract
INTRODUCTION Mandibular fractures are among the commonest fractures of maxillofacial region with anterior-mandibular fractures accounting for 8-15%. Mini-plates with or without arch bar is the most commonly used fixation method to achieve ORIF. However, the mandible symphysis is uniquely shaped for the application of lag-screws. AIM This study aims at evaluating the effectiveness of lag-screws in comparison with mini-plates in fixation of anterior mandibular fractures. METHODOLOGY 20 patients diagnosed with anterior mandibular fractures were divided into 2 equal groups. Group-A was treated using lag-screws and Group-B was treated using mini-plates. Radiographs were taken for evaluation of fracture site. The results were assessed for mobility of fracture segments, stability of occlusion, paresthesia, and pre-operative, intra-operative and post-operative distances between fracture segments. RESULTS There was a significant reduction in clinical distance between the reduced fracture fragments in the lag-screw group. A substantial reduction of radiographic distance between fracture segments was observed post-operatively in the lag-screw group, unlike the mini-plate group. A lesser interfragmentary distance was observed in patients treated with the lag-screw technique. CONCLUSION While lag screws and miniplate techniques are both stable forms of fixation, there is more interfragmentary bony contact with lag-screws, thus ideal for fixation of anterior mandibular fractures.
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Affiliation(s)
- Sonal Jawa
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, 560054, India
| | - G Prathibha
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, 560054, India
| | - Kavitha Prasad
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, 560054, India
| | - K Ranganath
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, 560054, India
| | - Parimala Sagar
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, 560054, India
| | - Surabhi Chandra
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bangalore, 560054, India.
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Ahemad AZ, Rattan V, Jolly SS, Kalra P, Sharma S. Biomechanical comparison of magnesium bioresorbable and titanium lag screws for mandibular symphysis fracture fixation: A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2025:102383. [PMID: 40254221 DOI: 10.1016/j.jormas.2025.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/12/2025] [Accepted: 04/17/2025] [Indexed: 04/22/2025]
Abstract
OBJECTIVE This study evaluates the biomechanical performance of magnesium bioresorbable lag screws compared to conventional titanium screws for mandibular symphysis fracture fixation using finite element analysis (FEA). MATERIAL & METHODS A 3D mandible model was created using MIMICS software from high-resolution CT data. Fracture lines were simulated, and Mg and titanium screws were designed in SolidWorks and virtually implanted. Meshing was performed using 3-matic software to represent geometry accurately. FEA was conducted using ABAQUS under masticatory forces of 150 N (incisor load) and 550 N (molar load). Stress distribution, displacement, and fracture stability were assessed, with material properties derived from established data. RESULTS Mg screws exhibited lower von Mises stress (VMS) compared to titanium screws under both loading conditions. For incisor loading, Mg screws recorded 44.71 MPa compared to 56.94 MPa for titanium, with the lowest stress in Mg screws (25.73 MPa). Similarly, under molar loading, Mg screws showed reduced stress (48.35 MPa vs. 61.53 MPa for titanium). Mandibular stress (22.158-23.14 MPa), screw deformation (0.230-0.255 mm), and fracture displacement (0.278-0.310 mm) were comparable across materials. DISCUSSION Mg screws demonstrated comparable biomechanical stability to titanium screws while significantly reducing stress concentrations, effectively transmitting loads within bone healing limits. Their bioresorbable nature eliminates the need for secondary surgeries, offering a promising alternative for mandibular fracture fixation and enhancing clinical outcomes.
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Affiliation(s)
- Amanurrahman Zubair Ahemad
- Unit of Oral and Maxillofacial Surgery, Oral Health and Sciences Centre (OHSC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Vidya Rattan
- Unit of Oral and Maxillofacial Surgery, Oral Health and Sciences Centre (OHSC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Satnam Singh Jolly
- Unit of Oral and Maxillofacial Surgery, Oral Health and Sciences Centre (OHSC), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Parveen Kalra
- Production and Industrial Engineering Department, Punjab Engineering College, Chandigarh 160012, India
| | - Shagun Sharma
- Production and Industrial Engineering Department, Punjab Engineering College, Chandigarh 160012, India
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Shah A, Perez-Otero S, Tran D, Aponte HA, Oh C, Agrawal N. Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2024; 82:449-460. [PMID: 38336352 DOI: 10.1016/j.joms.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, potentially offering an opportunity to reduce health-care costs, and aiming to guide effective clinical practice. METHODS In this systematic review with meta-analyses, a review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was conducted using Embase and PubMed for articles published between 1989 and 2023. Inclusion criteria targeted studies on open reduction and internal fixation mandibular fractures comparing intraoral and extraoral approaches and reporting infection rates. Exclusion criteria eliminated non-English articles, case reports, and studies with insufficient approach-specific data. The primary outcome was the postoperative infection rate, with surgical approach as the predictor. Covariates such as age, sex, diabetes, and smoking status were included when reported. Data were analyzed using R software, employing random-effects models due to anticipated heterogeneity (I2 statistics). RESULTS From 61 studies, 11 provided direct comparisons involving 1,317 patients-937 intraoral and 380 extraoral. Infection rates were 5.9% for intraoral and 10% for extraoral approaches. Pooled relative risk was 0.94 [95% confidence interval, 0.63, 1.39], suggesting no significant risk difference. Prevalence of infections was estimated at 9% for intraoral and 6.1% for extraoral procedures, with significant heterogeneity (I2 = 84% for intraoral and 56% for extraoral). CONCLUSION Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.
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Affiliation(s)
- Alay Shah
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.
| | - Sofia Perez-Otero
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - David Tran
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Hermes A Aponte
- Post-Doctoral Research Assistant, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR
| | - Cheongeun Oh
- Clinical Assistant Professor, Biostatistics Division, Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY
| | - Nikhil Agrawal
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis. Sci Rep 2023; 13:11174. [PMID: 37430033 DOI: 10.1038/s41598-023-37652-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023] Open
Abstract
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
| | - Georgia Kostare
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
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Correction of Traumatic Transverse Mandibular Widening With Interdental Wiring. J Craniofac Surg 2021; 33:1214-1217. [PMID: 34759250 DOI: 10.1097/scs.0000000000008332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Mandibular symphysis fractures pose several technical challenges for the craniomaxillofacial surgeon. One classic challenge is restoration of the transverse dimension when the mandible is widened secondary to splaying of the lingual cortex. Failure to diagnose or correct this problem can result in widening of the lower facial third, inadequate fracture reduction, and/or a malocclusion. Surgeons have traditionally utilized techniques such as manual pressure to the rami or lingual splint application to address transverse defects intraoperatively. However, these methods may be inadequate in situations with significant widening, such as in the case of concomitant subcondylar fractures. More recently, virtual surgical planning and custom hardware have been utilized to address mandibular widening, though this method also has various shortcomings. In this technical note, the authors present a simple technique using interdental wiring to precisely control mandibular width intraoperatively. The technique is cost effective, does not require an assistant, and can be used in conjunction with any of the above methods. The authors also present a case of secondary reconstruction in which use of this technique was necessary given a large degree of mandibular widening not amenable to reduction and fixation with manual pressure alone.
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Melek L. Comparison of lag screws and double Y-shaped miniplates in the fixation of anterior mandibular fractures. World J Methodol 2021; 11:88-94. [PMID: 34026582 PMCID: PMC8127419 DOI: 10.5662/wjm.v11.i3.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/02/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mandibular fractures constitute about 80.79% of maxillofacial injuries in Alexandria University, either as isolated mandibular fractures or as a part of panfacial fractures. The combination of symphyseal and parasymphyseal fractures represent 47.09% of the total mandibular fractures.
AIM To compare the effectiveness of lag screws vs double Y-shaped miniplates in the fixation of anterior mandibular fractures.
METHODS This study is a prospective randomized controlled clinical trial, performed on sixteen patients with anterior mandibular fractures. Patients were divided equally into two groups, each consisting of eight patients. Group 1: Underwent open reduction and internal fixation using two lag screws. Group 2: Underwent open reduction and internal fixation using double Y-shaped plates. The following parameters were assessed: operating time in minutes, pain using a visual analog scale, edema, surgical wound healing for signs and symptoms of infection, occlusion status and stability, maximal mouth opening, and sensory nerve function. Cone beam computed tomography was performed at 3 and 6 mo to measure bone density and assess the progression of fracture healing.
RESULTS The study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years (mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidents in 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and other causes in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures (62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except for the mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).
CONCLUSION Both lag screws and double Y-shaped miniplates provide favorable means of fixation for mandibular fractures in the anterior region. Fractures fixed with lag screws show greater mean bone density at 3 mo post-operation, indicative of higher primary stability and faster early bone healing. Further studies with larger sample sizes are required to verify these conclusions.
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Affiliation(s)
- Lydia Melek
- Department of Oral and Maxillofacial Surgery, Alexandria University, Alexandria 21411, Egypt
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Shakilur Rahman AFM, Haider I. Treatment of anterior mandibular fractures by lag screw - A systematic review. JOURNAL OF DENTAL RESEARCH AND REVIEW 2021. [DOI: 10.4103/jdrr.jdrr_26_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Elsayed SAH. Cortical lag screw fixation for the management of mandibular injuries. J Korean Assoc Oral Maxillofac Surg 2020; 46:393-402. [PMID: 33377464 PMCID: PMC7783183 DOI: 10.5125/jkaoms.2020.46.6.393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites. Materials and Methods This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05. Results Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035). Conclusion We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.
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Affiliation(s)
- Shadia Abdel-Hameed Elsayed
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Girls, Al-Azhar University, Cairo, Egypt.,Department of Oral and Maxillofacial Surgery, Taibah University Dental College & Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia
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Elsayed SAH, Elsayed EH, Altaweel AA. Stabilization of anterior mandibular fracture using different osteosynthesis devices: perioperative clinical notes. Oral Maxillofac Surg 2020; 25:303-311. [PMID: 33111232 DOI: 10.1007/s10006-020-00917-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures. METHODS This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema. RESULTS Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152 min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation. CONCLUSION The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.
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Affiliation(s)
- Shadia Abdel-Hameed Elsayed
- Oral and Maxillofacial Surgery, Faculty of Dental Medicine, for Girls, Al-Azhar University, Cairo, 11727, Egypt
- Oral and Maxillofacial Surgery, Taibah University Dental College & Hospital, Al-Madinah Al-Munawwrah, 42353, Saudi Arabia
| | - Emad Hussein Elsayed
- Plastic Surgery, Faculty of Medicine (Girls Branch), Al Azhar University, Cairo, Egypt
| | - Alaa Abdelqader Altaweel
- Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Boys, Al-Azhar University, Cairo, 11727, Egypt.
- Oral and Maxillofacial Surgery, Alfarabi Private College for Dentistry and Nursing, Jeddah, Saudi Arabia.
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Sharma A, Rastogi S, Shukla M, Choudhury R, Tripathi S, Iqbal J. Use of Transgingival Lag Screw Osteosynthesis in the Management of Alveolar Process Fracture. Craniomaxillofac Trauma Reconstr 2019; 12:27-33. [PMID: 30815212 DOI: 10.1055/s-0038-1629906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study is to check the efficacy of transgingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single-arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this study, 20 mixed age group patients with alveolar process fracture were included. All the patients were treated by a 2.0-mm transgingival screw fixation under local or general anesthesia. All the patients were evaluated for fracture stability, anatomical reduction, bone loss and bone resorption of alveolar process, tooth loss, and wound infection at 3 months of follow-up. A simple descriptive statistical analysis was done to evaluate the parameters and it was shown that the treatment of alveolar process fracture with two or three lag screws provides adequate fracture stability and anatomical reduction with no signs of bone loss and tooth loss, and wound infections were noted post lag screw fixation. The study concludes that transgingival lag screw fixation is a suitable alternative for alveolar process fractures in all the age groups and two to three lag screws are generally sufficient to fix fractured alveolar process either under local anesthesia or general anesthesia.
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Affiliation(s)
- Ashish Sharma
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Manish Shukla
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India
| | - Siddhi Tripathi
- Department of Prosthodontics, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Jawed Iqbal
- Department of Oral and Maxillofacial Surgery, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India
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Titanium Lag Screw Versus Miniplate Fixation in the Treatment of Anterior Mandibular Fractures. J Oral Maxillofac Surg 2019; 77:1031-1039. [PMID: 30763527 DOI: 10.1016/j.joms.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/05/2019] [Accepted: 01/05/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE The use of plates for open reduction and internal fixation of mandibular fractures has become a widely accepted method in the past 3 decades. However, the anterior mandible is well suited to lag screw fixation owing to the thickness of its bony cortices. Hence, the purpose of the present study was to comparatively evaluate clinical outcomes of fixation using lag screws and miniplates in anterior mandibular fractures. PATIENTS AND METHODS Fifty patients reporting to the department of oral and maxillofacial surgery with noncomminuted anterior mandibular fractures were randomly divided into 2 groups of 25 patients each. Patients in group A were treated with 2.5-mm lag screws 22 to 26 mm in length and those in group B were treated with 2.0-mm 4-hole miniplates with a gap using monocortical screws. Subsequent follow-up was performed at 3, 6, 12, and 24 weeks postoperatively. The primary determinants included radiographic analysis of the fracture gap and biting efficiency of the patients in groups A and B. The secondary determinants included evaluation of duration of surgery, occlusion before and after injury, and postoperative complications. Results were evaluated using χ2 and unpaired t tests. RESULTS The mean age of the patients in this study was 29.1 ± 8.32 years (range, 18 to 67 yr). The mean postoperative fracture gap was considerably larger in group B. The mean duration of surgery (minutes) was 37.60 ± 9.30 for group A and 47 ± 6.55 for group B. The difference was statistically significant (P = .001). The lag screw group showed faster improvement in biting efficiency compared with the miniplate group. CONCLUSIONS Lag screw fixation was found to have good stability and rigidity, was inexpensive, and was less time consuming in treating anterior mandibular fractures compared with miniplates.
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Mittal G, Aggrawal A, Garg R, Sharma S, Rathi A, Sharma V. A clinical prospective randomized comparative study on ostyeosynthesis of mandibular anterior fractures following open reduction using lag screws and miniplates. Natl J Maxillofac Surg 2018; 8:110-116. [PMID: 29386813 PMCID: PMC5773984 DOI: 10.4103/njms.njms_38_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The aim of the present study was to compare fixation of mandibular anterior fractures following open reduction using lag screws or miniplates. Materials and Methods This prospective study was conducted on 20 patients diagnosed with cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups - Group A: two 2.5 mm stainless steel lag screws were placed in 10 patients. Group B: two 2.5 mm miniplates were placed in 10 patients for the fixation of fractures. Subsequent follow-up was done on the 1st day, 1st, 4th, and 36th week postoperatively. During every follow-up, patient was assessed clinically for infection, malocclusion, loosening of plate/screw, malunion/nonunion, and masticatory efficiency. Radiographs (orthopantogram) were taken preoperative, 1st, 4th, and 36th postoperative week to compare the osteosynthesis between the two groups. Pain was objectively measured using a visual analog scale. The data collected was subjected to unpaired t-test and paired t-test for statistical analysis. Result It was found that lag screw placement was rapid in comparison of miniplate placement. 3rd month postoperative assessment revealed Lag screw group to have better biting efficiency, and better bone healing which was statistically significant when compared with miniplate group. Conculsion Our study suggests that lag screw osteosynthesis can be advocated as a valid treatment modality in the management of mandibular symphysis and parasymphysis fractures.
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Affiliation(s)
- Gaurav Mittal
- Department of OMFS, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Anmol Aggrawal
- Department of OMFS, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Ritesh Garg
- Department of OMFS, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Siddharth Sharma
- Department of OMFS, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Abhishek Rathi
- Department of OMFS, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Vishnu Sharma
- Department of OMFS, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
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Pedemonte C, Carmona A, González E, Vargas I, Lopetegui F, Rojas E. Correlation Between the Posterior Mandibular Width and the Lingual Gap Caused by Symphyseal Fractures Using a Virtual Model. J Oral Maxillofac Surg 2017; 76:832.e1-832.e8. [PMID: 29274951 DOI: 10.1016/j.joms.2017.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The objective was to determine the dimensional impact, on the occlusal and articular level, of the gap produced in the lingual plate from symphyseal fractures, correlated with the dimensional change in the posterior mandibular width. MATERIALS AND METHODS We performed an observational experimental study based on 30 computed tomography scans of patients treated by the Maxillofacial Surgery Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile, between 2012 and 2016. The inclusion criteria were jaws without evidence of fractures or pathology, with an absence of orthodontic appliances, and with complete dentition to the first mandibular molar. By use of Digital Dental Service 3-dimensional planning software (DDS-Pro; Digital Dental Service, London, UK), a vertical mandibular fracture was made, leaving lingual gaps of 1, 2, and 3 mm, and the dimensional changes were recorded with regard to the posterior facial width. RESULTS The mandibular height did not vary with regard to the lingual gap; the mandibular length was inversely proportional to the lingual gap; and the intermolar, intergonial, and intercondylar distances were directly proportional to increases in the lingual gap. CONCLUSIONS The larger the lingual gap, the shorter the mandibular length and the larger the mandibular transverse dimensions. Special attention must be paid to the occlusal and articular level.
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Affiliation(s)
- Christian Pedemonte
- Staff, Maxillofacial Surgery and Traumatology Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile.
| | - Andrea Carmona
- Intern, Maxillofacial Surgery and Traumatology Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Edgardo González
- Staff, Maxillofacial Surgery and Traumatology Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Ilich Vargas
- Staff, Maxillofacial Surgery and Traumatology Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Francisco Lopetegui
- Intern, Maxillofacial Surgery and Traumatology Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Erick Rojas
- Resident, Maxillofacial Surgery and Traumatology Service, Hospital Clínico Mutual de Seguridad, Santiago, Chile
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García Carricondo AR, Quesada Bravo FJ, Espín Gálvez F, Parrón Carreño T, Alarcón Rodriguez R. A comparative study between traditional fixation with miniplates and modified lag screws for the treatment of mandibular fractures. Clin Oral Investig 2017; 22:1503-1511. [PMID: 29038962 DOI: 10.1007/s00784-017-2243-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study is to investigate two internal fixation surgical techniques for mandibular fractures in order to compare modified lag screw techniques with standard miniplates. MATERIALS AND METHODS This is an observational prospective study. Three hundred eighteen patients were operated on for mandibular fractures. The patients were divided into two groups according to the type of surgical technique used: modified lag screws (155 patients) and traditional miniplates (163 patients). Analyses were made of sociodemographic and preoperative variables, the parameters related to the fracture type and postoperative data. RESULTS There were no differences between the two groups regarding their sociodemographic characteristics. The modified lag screws were primarily used with double fractures, while conventional miniplates were more often used with simple fractures. The number of complications was higher with the miniplate technique. The unfavorable fractures had an OR of 5.75 due to postoperative complications; double fractures had an OR of 8.87 and simple fractures an OR of 19.53, which, in both cases, were lower with conventional miniplates than with modified lag screws. CONCLUSION Modified lag screws provide a rigid fixation system that is as secure as miniplates, but with greater compression between the fragments, less postsurgical gap, faster ossification, and fewer postoperative complications. CLINICAL RELEVANCE The modified screw technique is a safe tool that does not require any specific osteosynthesis materials not found in a basic traumatology kit and has a lower cost, due to the reduced amount of material used.
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Affiliation(s)
- Ana Rocío García Carricondo
- Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital Complex, Avd. Torrecardenas No. 80, 04009, Almeria, Spain.
| | - Francisco Javier Quesada Bravo
- Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital Complex, Avd. Torrecardenas No. 80, 04009, Almeria, Spain
| | - Fernando Espín Gálvez
- Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital Complex, Avd. Torrecardenas No. 80, 04009, Almeria, Spain
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15
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Vieira E Oliveira TR, Kemmoku DT, da Silva JVL, Noritomi PY, Passeri LA. Finite Element Evaluation of Stable Fixation in Combined Mandibular Fractures. J Oral Maxillofac Surg 2017; 75:2399-2410. [PMID: 28732217 DOI: 10.1016/j.joms.2017.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/18/2017] [Accepted: 06/18/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The fixation of combined mandibular fractures, especially symphyseal-condylar fractures, although occurring commonly and having a higher complication rate in the clinic, is rarely investigated regarding predictable therapeutic approaches. Thus this study's aim was to assess different forms of condylar fixation when combined with symphyseal fracture fixation. MATERIALS AND METHODS Using finite element models, we analyzed the stress distribution that occurs when a condylar fracture is fixed with 1 miniplate, 2 miniplates, or a trapezoidal condylar miniplate and when a symphyseal fracture is fixed with 2 parallel plates, 2 perpendicular plates, or 2 lag screws. The null hypothesis was that there would be no differences among the different fixation techniques. RESULTS The results showed a stress concentration in the anterior region of the condyle, close to the sigmoid notch. Moreover, adequate fixation in the symphysis could result in less tension at the condylar region. Therefore, when the symphysis was fixed with a lag-screw technique, condylar fixation was less required, showing a more adequate stress distribution when the condyle was fixed with 1 or 2 plates. Conversely, when the symphyseal fixation was less effective, by use of perpendicular plates, there was a change in the stress distribution at the condylar region, altering fixation behavior and resulting in more tension and displacement in the condyle, especially when a trapezoidal plate was used. CONCLUSIONS A lag screw and parallel double plates appear to be suitable for symphyseal fixation, whereas 2 straightly positioned plates and a trapezoidal plate are suitable for condylar fixation. However, the combination of perpendicular plates in symphyseal fixation and a trapezoidal plate in condylar fixation showed an altered stress distribution.
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Affiliation(s)
| | | | | | | | - Luis Augusto Passeri
- Researcher, School of Medical Sciences, State University of Campinas, Campinas, Brazil
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Ram R, Ahsan R, Bhardwaj Y, Ghezta N, Kumar S. Assessment of Fixation of Mandibular Interforaminal Fractures by Using a Single Second-Generation Headless Compression Screw: A Pilot Study. Craniomaxillofac Trauma Reconstr 2017; 10:138-144. [PMID: 28523087 DOI: 10.1055/s-0036-1594276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/17/2016] [Indexed: 10/19/2022] Open
Abstract
The aim of this article is to evaluate the efficacy of a single second-generation headless compression screw along with a lower arch bar in the fixation of interforaminal mandible fractures. A total of seven patients were included in the study. An open approach was used either intraorally or extraorally. A second-generation 3.0 HCS (headless compression screw), 24 to 32 mm in length, diameter at the head of 3.5 mm, smooth shaft with 2.0 mm and at the leading edge 3.0 mm (Synthes, Paoli, PA) was used for the fixation along with a lower arch bar. Postoperative clinical and radiographic follow-up was performed at 3 weeks, 3 months, 6 months, and 1 year. A single, cannulated HCS was found to be effective in fixation of interforaminal mandible fractures except in one case where a miniplate had to be applied subapically. Clinical and radiographic follow-up revealed accurate reduction and fixation in all cases and no postoperative occlusal disturbances. A single, second-generation HCS along with a lower arch bar provides good results when used for the fixation of interforaminal mandible fractures. Headless compression screw fixation of interforaminal mandible fracture is a simple, quick, economic, and efficient method of rigid fixation with minimum complications.
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Affiliation(s)
- Rangila Ram
- Department of Oral and Maxillofacial Surgery, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Razi Ahsan
- Department of Oral and Maxillofacial Surgery, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Yogesh Bhardwaj
- Department of Oral and Maxillofacial Surgery, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Narotam Ghezta
- Department of Oral and Maxillofacial Surgery, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
| | - Santosh Kumar
- Department of Oral and Maxillofacial Surgery, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
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Kotrashetti SM, Singh AG. Prospective study of treatment outcomes with lag screw versus Herbert screw fixation in mandibular fractures. Int J Oral Maxillofac Surg 2016; 46:54-58. [PMID: 27595489 DOI: 10.1016/j.ijom.2016.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 07/26/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022]
Abstract
The principle of axial compression for better adaptation of fracture segments, with the advantage of increased stability and early function, is a promising means of avoiding the bulky rigid plates used previously. This study was done to compare the treatment outcomes between Herbert screw and lag screw fixation in mandibular fractures. Thirty patients with oblique displaced or undisplaced mandibular fractures requiring open reduction and internal fixation with rigid screw fixation, under general anaesthesia, were included. Herbert screws were used in 15 patients (group 1) and lag screws were used in the other 15 patients (group 2). Patients were followed up at 1 week, 6 weeks, 3 months, and 6 months for postoperative occlusion, inter-fragmentary mobility, pain, nerve sensation, and isodensity values on panoramic radiographs. Postoperative occlusion, inter-fragmentary mobility, pain, and nerve sensation were similar in the two groups. Group 1 patients attained isodensity values similar to the final follow-up value much faster than group 2 patients (P<0.05). This study strongly suggests that the use of Herbert screws results in significantly faster healing as compared to lag screws, in terms of achieving higher isodensity values faster.
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Affiliation(s)
- S M Kotrashetti
- Department of Oral and Maxillofacial Surgery, V.K. Institute of Dental Sciences, KLE University, Belgaum, Karnataka, India
| | - A G Singh
- Department of Oral and Maxillofacial Surgery, V.K. Institute of Dental Sciences, KLE University, Belgaum, Karnataka, India.
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Chen S, Zhang Y, An JG, He Y. Width-Controlling Fixation of Symphyseal/Parasymphyseal Fractures Associated With Bilateral Condylar Fractures With 2 2.0-mm Miniplates: A Retrospective Investigation of 45 Cases. J Oral Maxillofac Surg 2016; 74:315-27. [DOI: 10.1016/j.joms.2015.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/27/2015] [Accepted: 09/27/2015] [Indexed: 11/25/2022]
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Agnihotri A, Prabhu S, Thomas S. A comparative analysis of the efficacy of cortical screws as lag screws and miniplates for internal fixation of mandibular symphyseal region fractures: a randomized prospective study. Int J Oral Maxillofac Surg 2013; 43:22-8. [PMID: 23928155 DOI: 10.1016/j.ijom.2013.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
The management of facial trauma is one of the most rewarding and demanding aspects of oral and maxillofacial surgery. Being the most prominent mobile bone of the facial skeleton, mandible fracture occurs more frequently than any other fracture. In this study, open reduction and internal fixation was performed for isolated mandibular symphyseal region fractures using cortical screws (as lag screws) in 40 patients and using miniplates in 40 patients. Clinical and radiological evaluations were made at 6 months postoperatively. Primary stability of fracture segments, postoperative swelling, restricted lip mobility, infection, wound dehiscence, implant removal, and mal-union or non-union of fracture segments was evaluated. Primary stability was achieved in 100% of cases treated with cortical screws, whereas for patients treated with miniplates, 97.5% attained primary stability, while one case (2.5%) showed persistent clinical mobility. Postoperative complications were noted in 13 (16.25%) of the total 80 patients. The duration of postoperative swelling was less in patients treated with cortical screws compared to patients treated with miniplates. It is concluded that cortical screw fixation is an effective procedure for the treatment of symphyseal region fractures, but the procedure is somewhat technically sensitive.
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Affiliation(s)
- A Agnihotri
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India.
| | - S Prabhu
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
| | - S Thomas
- Department of Oral and Maxillofacial Surgery, People's College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
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Lee T, Sawhney R, Ducic Y. Miniplate Fixation of Fractures of the Symphyseal and Parasymphyseal Regions of the Mandible. JAMA FACIAL PLAST SU 2013; 15:121-5. [DOI: 10.1001/jamafacial.2013.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas Lee
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas (Drs Lee, Sawhney, and Ducic), and Departments of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Sawhney), and University of Texas Southwestern Medical Center, Dallas (Dr Ducic)
| | - Raja Sawhney
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas (Drs Lee, Sawhney, and Ducic), and Departments of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Sawhney), and University of Texas Southwestern Medical Center, Dallas (Dr Ducic)
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas (Drs Lee, Sawhney, and Ducic), and Departments of Otolaryngology–Head and Neck Surgery, University of Florida, Gainesville (Dr Sawhney), and University of Texas Southwestern Medical Center, Dallas (Dr Ducic)
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Kumar V, Mehrotra D, Mohammad S, Singh RK, Singh V, Singh G, Gambhir S. Anchor lag screw vs conventional lag screw in mandibular fractures: A series of 30 cases. J Oral Biol Craniofac Res 2013; 3:15-9. [PMID: 25737874 DOI: 10.1016/j.jobcr.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022] Open
Abstract
UNLABELLED Lag screw osteosynthesis is a well proven technique. Its application is limited by the fact that the spherical head of the screw act as wedge. Combining this screw with a bioconcave washer has broadened the range of applications for lag screw osteosynthesis in the maxillofacial region. PURPOSE The aim of the study was to compare the efficacy of anchor lag screw with conventional lag screw in anterior mandibular fractures. PATIENTS AND METHOD Thirty patients with anterior mandible fractures with no concomitant fractures, infection or extraoral communication, who visited our outpatient Department of Oral and Maxillofacial Surgery, were included in the study after obtaining their informed consent. Patients were randomly divided into two groups; where Group A underwent fixation using conventional lag screw and Group B anchor lag screw. The fixation system used included 2 mm titanium lag screws of sizes 25 mm, 27 mm and 30 mm and 3 mm titanium bioconcave washer. At each follow up visit, clinical data was collected detailing clinical presentation of healing and radiographic findings. RESULTS Radiographic features at post surgery evaluation indicated loss of bone contact around the screw head and bone resorption in five patients of Group A, thus causing loosening of lag screw whereas none of the patient in Group B, was found to have any such complication. CONCLUSIONS The findings support the hypothesis that bioconcave washer aids in holding up the farthest fragment at the interface of the fracture fragment. Application of bioconcave washer provides easy loading of lag screw.
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Affiliation(s)
- Vimlesh Kumar
- Lecturer, Oral and Dental Surgery Department, B. R. D. Medical College, Gorakhpur 273013, Uttar Pradesh, India
| | - Divya Mehrotra
- Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, King George Medical University, Lucknow, India
| | - Shadab Mohammad
- Professor & Head, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, King George Medical University, Lucknow, India
| | - R K Singh
- Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, King George Medical University, Lucknow, India
| | - Vibha Singh
- Associate Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, King George Medical University, Lucknow, India
| | - Geeta Singh
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, King George Medical University, Lucknow, India
| | - Sanjay Gambhir
- Professor and Head, Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute, Lucknow, India
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22
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Bhatnagar A, Bansal V, Kumar S, Mowar A. Comparative analysis of osteosynthesis of mandibular anterior fractures following open reduction using 'stainless steel lag screws and mini plates'. J Maxillofac Oral Surg 2012; 12:133-9. [PMID: 24431830 DOI: 10.1007/s12663-012-0397-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 05/28/2012] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12-45 years) and healthy individuals of poor socioeconomic status. METHOD This prospective study was conducted on 30 patients diagnosed as cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups--Group A: Two 2.5 mm stainless steel lag screws were placed in 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis. RESULTS During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency. CONCLUSION The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick treatment modality to accelerate healing of fresh, displaced mandibular anterior fracture.
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Affiliation(s)
- Aditi Bhatnagar
- Department of Oral and Maxillofacial Surgery, Narsinhbhai Patel Dental College, Kamana Crossing, Visnagar, 384315 Gujrat India
| | - Vishal Bansal
- Department Of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, India
| | - Sanjeev Kumar
- Department Of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, India
| | - Apoorva Mowar
- Department Of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, India
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Goyal M, Jhamb A, Chawla S, Marya K, Dua JS, Yadav S. A Comparative Evaluation of Fixation Techniques in Anterior Mandibular Fractures Using 2.0 mm Monocortical Titanium Miniplates Versus 2.4 mm Cortical Titanium Lag Screws. J Maxillofac Oral Surg 2012; 11:442-50. [PMID: 24293938 DOI: 10.1007/s12663-012-0342-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 01/11/2012] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the efficacy and surgical outcome of treatment of anterior mandibular fracture using either 2.0 mm titanium miniplate or 2.4 mm titanium lag screw technique. MATERIALS AND METHODS A total of 30 patients were managed by open reduction and internal fixation utilizing the miniplate and lag screw technique for fractures of anterior mandible. The patients were randomly divided into two groups. Group I: (15 patients) were treated with Leibinger, 2.0 mm titanium mini plates system with self-tapping screws and Group II: (15 patients) were treated with 2.4 mm cortical lag screw (Synthes). Intraoperatively duration of surgery was measured from the time incision was placed till the closure of wound. Subsequent follow up was done at 3, 6, 12, 24 weeks, postoperatively. During every follow up, patients were assessed clinically for malocclusion, neurosensory deficit, biting efficiency, implant failure, mal-union/non-union. Pre and postoperative radiographs were taken to assess the gap between fracture segments. Results were evaluated using Chi square and the unpaired t test. RESULTS In our study, the mean duration of surgery (hours) was 1.97 ± 0.52 for group I and 1.26 ± 0.55 for group II. The difference was found to be statistically significant (p value 0.001). i.e. more time was taken in case of surgery with mini-plates when compared to the lag screw. Short surgical procedure reduces the incidence of infectious complications, which significantly lowers the financial burden. The mean post-operative radiographic distance between all measuring points were considerably more in case of mini-plate group as compared to lag screw group. Lag screw group showed faster improvement in terms of biting efficiency as compared to mini-plate group which showed a tendency to masticate only medium hard food items by 24 weeks. In both groups, no postoperative malocclusion was noted. In initial weeks, neurosensory deficit was seen more in mini-plate group as compared to lag screw group but after six weeks all patients showed improvement in neurosensory function without any permanent nerve damage. CONCLUSION According to this prospective study, rigid internal fixation provided by lag screw technique for anterior mandibular fracture offers several advantages over conventional bone plating. It is an excellent means of achieving rapid and safe fixation which is followed by primary bone healing in anterior mandibular fractures, without any major complications.
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Affiliation(s)
- Manoj Goyal
- Department of Oral & Maxillofacial Surgery, Santosh Dental & Medical College & Hospital, No.1 Santosh Nagar, Pratap Vihar, Ghaziabad, Delhi NCR, 201001 India
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Vieira e Oliveira TR, Passeri LA. Mechanical Evaluation of Different Techniques for Symphysis Fracture Fixation—An In Vitro Polyurethane Mandible Study. J Oral Maxillofac Surg 2011; 69:e141-6. [PMID: 21398009 DOI: 10.1016/j.joms.2010.11.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 09/21/2010] [Accepted: 11/05/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Thalita Regina Vieira e Oliveira
- Division of Plastic Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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Jadwani S, Bansod S. Lag screw fixation of fracture of the anterior mandible: a new minimal access technique. J Maxillofac Oral Surg 2011; 10:176-80. [PMID: 22654375 DOI: 10.1007/s12663-011-0176-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 01/24/2011] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Purpose of this study to introduce a new minimal access technique for management of anterior mandible fracture with several advantages over conventional methods. METHOD Four cases of undisplaced anterior mandibular fracture were selected. Tension band was achieved either by arch bar fixation to mandible or placement of interdental wire followed by intermaxillary fixation. With a 1 cm vertical incision was placed adjacent to fractured line. Fractured segment was immobilized with lag screw with minimal stripping. All patients were followed for 6 months. RESULTS All four cases shown good stable segment after 6 months of post operative follow up. OPG revealed well placed lag screw and there were no surgical complications, for example parasthesia, scarring and odema. CONCLUSION Fixation of anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique is simple and easily performed, reducing the surgical time, reduce the chances of infection due to less exposure and promote the healing process by producing stress in the fracture lines.
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Affiliation(s)
- Sanjay Jadwani
- Government Dental College and Hospital, Ayurvedic College Campus, G.E. Road, Raipur, 492001 Chhattisgarh India
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26
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Research on a novel rigid internal fixation system. J Oral Maxillofac Surg 2010; 68:1608-14. [PMID: 20417017 DOI: 10.1016/j.joms.2009.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 10/17/2009] [Accepted: 11/03/2009] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the efficiency of fixation with a novel (bulge core type system) rigid internal fixation system. MATERIALS AND METHODS Mandibular linear fractures were created artificially in dogs and fixed using a bulge core type system or a miniplate system in vitro. A 3-point load cell was used to contrast the fixation strength of the 2 systems in vitro. Histologic sections were used to analyze the healing of mandibular linear fractures and to contrast the efficiency of fixation of the 2 systems in vivo. Tetracycline-fluorescein staining technology was used to evaluate the bone healing speed in the mandibular fracture lines during bone healing. RESULTS In vitro, the 3-point load cell showed that the fixation strength of the bulge core type system was greater than that of the miniplate system (P < .05). In vivo, the histologic sections and tetracycline-fluorescein staining showed that greater and quicker bony healing occurred using the bulge core type system (P < .05) and that the efficiency of fixation of the 2 systems was similar. CONCLUSION Our results have shown that the bulge core type system can provide sufficient strength for mandibular linear fracture healing.
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Gerbino G, Boffano P, Bosco GF. Symphyseal Mandibular Fractures Associated With Bicondylar Fractures: A Retrospective Analysis. J Oral Maxillofac Surg 2009; 67:1656-60. [DOI: 10.1016/j.joms.2009.03.069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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