Treatment of mandibular fractures with Michelet technique: manual fracture reduction without arch bars.
OBJECTIVE
In our Bordeaux maxillofacial surgery unit, we have used the Michelet technique described for 40 years: manual fracture reduction and semi-rigid miniplate osteosynthesis fixation. No maxillomandibular fixation (MMF) with arch bars or with screws was used for reduction during osteosynthesis. The aim of this work was to evaluate results of this unknown manual reduction method.


METHODS
A total of 184 patients were reviewed. We recorded epidemiology of mandible fracture, clinical and radiologic evaluation before and after surgery, and treatment. Anatomic and functional manual reductions were the basic principle: manual maxillomandibular immobilization (functional) and manual fracture reduction (anatomic). In cases of condylar fractures without severe displacement, MMF with cortical bone screws was indicated (orthopedic treatment). Physiotherapy was also possible (functional treatment).


RESULTS
In all, 315 mandible fractures sustained by 184 patients were reviewed into the study. Of the patients, 80% were treated by osteosynthesis: 54% by osteosynthesis treatment alone, 26% by osteosynthesis and orthopedic treatments. The average time required for osteosynthesis or osteosynthesis and orthopedic treatment was 56 minutes. We observed 0.67% of disturbed occlusion, 0.67% of pseudarthrosis, and 0.67% of bilateral temporomandibular joint internal derangement.


CONCLUSIONS
Manual fracture reduction suppresses systematic MMF using arch bars during osteosynthesis of mandible fractures. Operating time and risk of complications are reduced. Functional results seem to be similar to that reported in the literature.
Laurentjoye
Mathieu
M
Department of Maxillofacial Surgery, Centre Hospitalier Universitaire, Bordeaux, France. Mathieu.laurentjoye@yahoo.fr
Majoufre-Lefebvre
Claire
C
Caix
Philippe
P
Siberchicot
François
F
Ricard
Anne-Sophie
AS
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008337:Mandibular Fractures / Q000628:therapy*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult