A Comparative Analysis of Outcome of Open Reduction and Internal Fixation of Mandibular Fracture With or Without Intermaxillary Fixation

Aim: To evaluate the difference and functional outcome between open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) in mandibular fractures. Study Design: Retrospective study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Faryal Dental College, Sheikhupura, Lahore from 1st February 2019 to 31st January 2021. Methodology: One hundred and fifty seven patients treated for fractures of mandible and reviewed their prognosis based on use of intermaxillary fixation after reduction of fracture. The patients were divided into two groups; Manual reduction group without the intermaxillary fixation and the intermaxillary fixation group. Results: Good results have been obtained in most patients after mandible fracture reduction. However, complications occurred in 19 (27.5%) patients in group 2 after surgery. 6 patients had an infection, 4 patients had a wound dehiscence, and 4 patients had osteomyelitis. No loosening of the mounting bolts and/or crack of the mounting plates was observed. Correct occlusion was achieved using posterior arch wires and elastic rings in 2 malocclusion patients. Occlusion failed in two patients in Group 1 due to osteomyelitis, and the second operation was performed under general anaesthesia. The mean complication severity scores for Group 1 and Group 2 were 1.37 and 1.38, respectively, with no significant difference. Conclusion: Among the patients treated with manual reduction, 2 patients had malocclusion and 1 patient required a new surgery. Such a simple mandible fracture can give good results even with manual reduction without intermaxillary fixation. For a simple mandible fracture, only manual reduction without intermaxillary fixation or intermaxillary fixation was recommended for a short time. Key words: Complication, Fracture, Internal fixation, Mandible

Prevention of Mandible Fractures in Medication-Related Osteonecrosis of the Jaws: The Role of Virtual Surgical Planning and Computer-Aided Design and Manufacturing in Two Clinical Case Reports

Background: Marginal mandible resection is required to achieve healing in some cases of medication-related osteonecrosis of the jaws (MRONJ). Despite the sparsity of the literature, computer-aided design/computer-aided manufacturing (CAD/CAM) materials may provide superior outcomes for patients with an increased risk of mandible fracture. The aim of this study was to report a digital workflow for surgical interventions to prevent mandible fracture in MRONJ patients. Methods: We present two cases in which virtual surgical planning (VSP) and CAD/CAM surgical guides and reconstruction plates were used to prevent mandible fractures in elderly MRONJ patients submitted for marginal resection. Two osteoporotic patients, aged 73 and 84 years, presented with stage 3 MRONJ of the right mandibular body with inferior alveolar nerve involvement. The unaffected bone height was 6 mm in both cases, implying a high risk of mandible fracture. After preoperative VSP, surgery was performed through a combined intraoral–transbuccal approach. CAD/CAM-customized cutting guides and reconstruction plates were used for the marginal resection of necrotic bone and internal fixation. Results: Complete healing was achieved and the patients remained asymptomatic up to 1 year post-surgery. Conclusions: VSP and CAD/CAM-customized materials facilitated the complete resection of necrotic bone and rigid fixation in MRONJ patients, allowing a simplified approach with shorter operative times, reduced morbidity, and predictable results.

Mandible Fractures

Mandible fractures are often caused by blunt or penetrating trauma and are one of the most common facial fractures. It is critical to understand facial and mandibular anatomy to best evaluate, classify, and treat mandible fractures. The primary goal of treatment is to restore the jaw to the preinjury occlusion. This can be achieved through open reduction with internal fixation or closed reduction with maxillomandibular fixation (MMF) in conjunction with dietary changes and/or physiotherapy. The main risks and concerns in mandible fracture management are infection, malunion, airway compromise, pain, and temporomandibular joint (TMJ) dysfunction. This chapter will provide a brief overview of facial and mandibular anatomy as well as common treatment methods and surgical interventions. This review contains 17 figures, 2 tables, and 43 references Key words: Mandibular fracture, maxillomandibular fixation, occlusion, malunion, closed reduction, open reduction, TMJ dysfunction