Abstract
This study aimed at proposing a new treatment-oriented classification and treatment algorithm of comminuted mandibular fractures which has a guidance effect on choosing management methods. Patients with comminuted mandibular fractures were retrospectively reviewed in the study and all the patients were classified as follows: Type I: mandibular morphology is sound without bone defect and treated conservatively with intermaxillary fixation (IMF); Type II: mandibular morphology is damaged while the degree of comminution is low and treated by open reduction internal fixation (ORIF) with miniplates; Type III: mandibular morphology is also damaged, but with a higher comminution degree and mass of comminuted. The occlusal relationship can be effectively regained by IMF and was done in the primary debridement. 7-10 days after that, ORIF with titanium meshes was performed in the staged operation; Type IV: comparing to the type III fracture, the occlusal relationship is unable to be regained only by IMF and reconstruction plates were used in ORIF; Type V: the occlusal relationship and mandibular morphology are both damaged with segmental bone defect and mandibular continuity losing and bone flap transplantation was performed for reconstruction; 75 patients were included in the study. Type II fractures are the most common type, followed by type III fractures. 44 of the patients were treated according to the classification and algorithm, and 2 patients of type I and IV manifested infection, 1 patient of type III showed malocclusion in the group of patients who were managed according to our treatment algorithm. Of those who were not in the treatment algorithm, 2 patients of type II and 2 of type III manifested infection, 2 patients of type 3 manifested bone un-union, 2 patients of type II and IV displayed malocclusion and 1 patient of type IV showed mandibular asymmetry. The results of this study suggest the treatment-oriented classification and algorithm for comminuted mandibular fractures has a certain guiding effect on the choice of treatment methods and is able to decrease the complication rate.