title: Management of bilateral mandibular angle fractures with combined rigid and nonrigid fixation.
abstract: OBJECTIVE
  There is very limited evaluation of the management of fractures of the bilateral mandibular angles. The purpose of this study was to determine the incidence, etiology, and outcomes of bilateral mandibular angle fractures treated with the transoral application of rigid fixation on one side and nonrigid fixation on the other.
  
  
  METHODS
  Patients 18 years of age or older with isolated, noncomminuted fractures through the right and left mandibular angles and treated solely with 2.0-mm miniplates through intraoral incisions (and trocar) were collected from 2 sources. Patients treated at Allegheny General Hospital (Pittsburgh, PA) were prospectively collected from August 1, 2006 through December 31, 2012. Patients treated at Parkland Memorial Hospital (Dallas, TX) and University Hospital in San Antonio (San Antonio, TX) from January 1, 1992 through December 31, 2012 were retrospectively added to the sample. Data collected included age, gender, race, cause of fracture, presence or absence of mandibular third molars, occlusal relation documented at last visit, and occurrence and management of complications. Standard descriptive statistics were used and the relation between initial displacement and adequacy of reduction was evaluated with the Fisher exact test.
  
  
  RESULTS
  Of 1,565 patients with 2,195 mandibular fractures, 33 (2.1%) presented with bilateral mandibular angle fractures. The average age of the cohort was 25.2 ± 1.8 years (range, 18 to 48 yr). The mechanisms of injury were assaults (30 of 33, 90.9%), motor vehicle collisions (2 of 33, 6%), and a fall (1 of 33, 3%). Twenty-seven patients (81.8%) had at least 1 mandibular third molar at the time of injury. Three patients (9.1%) had minor postoperative wound problems, with 1 incident (3.0%) of malocclusion. There was no statistically significant relation between the initial displacement and the adequacy of reduction.
  
  
  CONCLUSIONS
  Bilateral mandibular angle fractures are a rare traumatic event that may be successfully treated with transoral rigid and nonrigid fixation with 2.0-mm miniplates.
authors.affiliation: Program Director and Assistant Professor, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA. Electronic address: jecdna@aol.com.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Cillo
authors.affiliation: Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Edward
authors.initials: E
authors.lastname: Ellis
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019248:Jaw Fixation Techniques; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008310:Malocclusion / Q000209:etiology; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged; D008904:Miniaturization; D008964:Molar, Third / Q000473:pathology; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D014754:Violence / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult