title: The need for rigid fixation of combined parasymphyseal and bilateral subcondylar fractures.
abstract: Both miniplate and larger fracture plate fixation techniques have been utilized successfully in the treatment of mandibular fractures. Parasymphyseal fractures which occur in conjunction with bilateral subcondylar fractures, however, represent a special fracture pattern that is not well managed with miniplate fixation. Miniplates do not have the tensile strength to resist the strong, muscular-deforming forces that act on these fractures. This fracture pattern is best managed with anatomic symphyseal reduction and internal fixation with a 2.7 mm mandibular fracture plate and a 2.0 mm tension band plate. The subcondylar fractures can then be managed with either intermaxillary fixation or open reduction. This approach provides good functional results and can prevent late complications.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Oregon Health Sciences University, Portland Veterans Administration Medical Center, Portland, Oregon, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wheatley
authors.forename: T R
authors.initials: TR
authors.lastname: Meltzer
mesh_terms: D000293:Adolescent; D001860:Bone Plates; D001863:Bone Screws; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D019248:Jaw Fixation Techniques; D008335:Mandibular Condyle / Q000293:injuries*; D008337:Mandibular Fractures / Q000145:classification / Q000601:surgery*; D009119:Muscle Contraction / Q000502:physiology; D009334:Neck Muscles / Q000503:physiopathology; D010027:Osteotomy; D011183:Postoperative Complications / Q000517:prevention & control; D013718:Tensile Strength