Management of fractured mandibles without the use of intermaxillary wire fixation.
OBJECTIVE
The aims of this retrospective clinical study were to compare the management of unilateral angle fractures of the mandible using the traditional approach of open reduction with internal fixation (ORIF) and intermaxillary wire fixation (IMF) with the technique of ORIF without IMF.


METHODS
Thirty-one patients who presented with isolated unilateral angle fractures of the mandible were randomly divided into 2 treatment groups. Both groups underwent open reduction with a single upper border miniplate and screw fixation (ORIF). Eleven of the 31 patients in the study had IMF to aid in the fracture reduction, and 20 patients had no IMF so the fracture was reduced by hand manipulation. Records of operating and discharge times, postreduction radiographs, and occlusal outcomes were examined and tabulated.


RESULTS
Patients in both treatment groups were closely matched in terms of age, gender, site of injury (ie, isolated angle fracture of mandible), and incidence of teeth in the fracture line. The mean operating time for traditional ORIF with IMF of angle fractures of the mandible was 98.5 minutes, and these patients were discharged an average of 1.82 days after surgery. The mean operating time for ORIF of angle fractures of the mandible without the use of IMF was 40.2 minutes, and these patients were discharged an average of 1.35 days after surgery. Postoperative outcomes in terms of the postreduction anatomic alignment of the fractures and functional occlusion at 6 weeks were similar in the 2 treatment groups.


CONCLUSIONS
We found that the use of IMF for the management of angle fractures of the mandible is unnecessary provided there is a skilled assistant present to help manually reduce the fracture site for plating. Discarding the use of IMF not only helps improve patient comfort but also reduces the operating time by up to 1 hour and accelerates discharge times by up to half a day.
Dimitroulis
George
G
Consultant Oral and Maxillofacial Surgeon, Plastics and Maxillofacial Surgery Unit, St Vincents Hospital Melbourne, University of Melbourne, Australia. geodim@netspace.net.au
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007103:Immobilization; D019248:Jaw Fixation Techniques; D007902:Length of Stay; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome