title: Open reduction and internal fixation of mandibular angle fractures: does the transbuccal technique produce fewer complications after treatment than the transoral technique?
abstract: OBJECTIVE
  The study's purpose was to answer the following clinical question: in patients with mandibular angle fractures requiring open reduction and internal fixation, do those who have fixation screws inserted using a transbuccal approach compared with those with fixation screws inserted using a transoral approach have fewer complications after treatment? The investigators hypothesized that the transoral approach was associated with a higher risk of complications.
  
  
  METHODS
  A multicenter retrospective cohort study was performed in patients who had open reduction and internal fixation of mandibular angle fractures from 2008 to 2010 within Western Australia. Patients were divided into transbuccal and transoral groups and then further subdivided into groups with and without fixation failures (primary outcome variable) and statistically compared. Binary logistic regression was used to control for possible confounders, which included patient gender, age, a wisdom tooth within the fracture not extracted, dental caries, partial dentition, bilateral/unilateral fractures, and smoking.
  
  
  RESULTS
  In total 597 patients were in the study. Sixteen percent of patients in the transoral group had complications after treatment versus 10% in the transbuccal group. For the transoral technique, the odds of having fixation failure was 1.71 times greater than with the transbuccal technique (95% confidence interval, 1.02 to 2.93; P = .04). Incidences of all complication variables (hardware loosening/fracturing, wound dehiscence, secondary infection, surgery redo, nonunion/malunion of fracture, and removal of plate) were lower in the transbuccal group apart from plate fracture.
  
  
  CONCLUSIONS
  The transbuccal technique was associated with fewer complications after treatment compared with the transoral technique.
authors.affiliation: Oral-Maxillofacial Surgical Registrar, Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth, WA, Australia. kenw238@yahoo.com.au
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wan
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Williamson
authors.forename: Dieter
authors.initials: D
authors.lastname: Gebauer
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hird
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D004868:Equipment Failure; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D019248:Jaw Fixation Techniques / Q000295:instrumentation*; D016015:Logistic Models; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult