Fox Albert J, Kellman Robert M
Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse, NY 13210, USA.
Arch Facial Plast Surg. 2003 Nov-Dec;5(6):464-9. doi: 10.1001/archfaci.5.6.464.
Noncompression monocortical miniplate fixation of the mandibular angle is an accepted and reliable method for providing rigid internal fixation. High complication rates have been reported for internal fixation of angle fractures.
To analyze the outcome and complications in cases in which patients were treated with 2-miniplate fixation at the mandibular angle.
A retrospective analysis of outcomes for a case series.
Treatment performed at a level 1 trauma-rated teaching hospital.
From May 1992 to September 2001, a total of 88 patients with angle fractures of the mandible were treated with 2-miniplate fixation. Sixty-eight of the 88 patients, with 70 angle fractures, were included in the study; 13 were unavailable for follow-up and 7 had less than the minimum follow-up of 6 weeks. The time of trauma to treatment, cause of injury, and associated fractures were recorded. Postoperative complications, including infection, malunion, nonunion, dehiscence, osteomyelitis, and nerve injury due to surgical manipulation, were tabulated. Follow-up examinations were performed up to 12 weeks after surgery, with additional examinations if necessary. Postreduction panoramic radiographs were obtained in most cases.
No patients treated with monocortical 2-miniplate fixation had malunion, nonunion, or osteomyelitis. Twelve (17.6%) of the 68 patients were identified as having at least 1 postoperative complication. Postoperative infection occurred in 2 patients (2.9%). Infection was controlled with oral antibiotic therapy. One patient required removal of miniplates after the acute phase resolved. Occlusal disturbances were noted in 4 patients (5.9%) (2 with a slight anterior open bite, 1 with a crossbite, and 1 with premature contact of a molar) after surgery. Three of the 4 patients had associated midfacial or multiple mandibular fractures. None required further surgery. Wound dehiscence, with exposure of an underlying plate, occurred in 4 patients (5.9%); the wounds were treated conservatively and subsequently resolved. Nerve injury due to surgical manipulation occurred in 3 patients (4.4%).
Monocortical 2-miniplate fixation of the mandibular angle is a reliable and effective technique for providing rigid fixation. The complications were minimal in our study, and the infection rate was 2.9%, which is comparable to or better than the infection rate reported with the use of a single miniplate fixation technique in other studies. Disturbances of occlusion were associated with midfacial or additional mandibular fractures. In view of the contradictory published results, further studies are needed to determine the ideal approach for noncompression monocortical plate fixation of angle fractures.
下颌角非加压单皮质微型钢板固定是一种公认的可靠的坚强内固定方法。已有报道称下颌角骨折内固定的并发症发生率较高。
分析采用下颌角双微型钢板固定治疗患者的疗效及并发症。
对一组病例的疗效进行回顾性分析。
在一所一级创伤评级教学医院进行治疗。
1992年5月至2001年9月，共有88例下颌角骨折患者接受了双微型钢板固定治疗。88例患者中的68例（共70处下颌角骨折）纳入本研究；13例无法进行随访，7例随访时间不足6周的最短随访时间要求。记录受伤至治疗的时间、损伤原因及相关骨折情况。将术后并发症，包括感染、骨愈合不良、骨不连、裂开、骨髓炎及手术操作导致的神经损伤制成表格。术后随访至12周，必要时进行额外检查。多数病例拍摄复位后的全景X线片。
接受单皮质双微型钢板固定治疗的患者均未发生骨愈合不良、骨不连或骨髓炎。68例患者中有12例（17.6%）被确定至少有1种术后并发症。2例患者（2.9%）发生术后感染。通过口服抗生素治疗控制了感染。1例患者在急性期过后需要取出微型钢板。4例患者（5.9%）术后出现咬合紊乱（2例轻度前牙开颌，1例反颌，1例磨牙早接触）。4例患者中有3例伴有面中部或多发性下颌骨骨折。均无需进一步手术。4例患者（5.9%）发生伤口裂开，钢板外露；伤口经保守治疗后愈合。3例患者（4.4%）发生手术操作导致的神经损伤。
下颌角单皮质双微型钢板固定是一种可靠有效的坚强固定技术。在我们的研究中并发症极少，感染率为2.9%，与其他研究中使用单微型钢板固定技术报道的感染率相当或更低。咬合紊乱与面中部或其他下颌骨骨折有关。鉴于已发表的结果相互矛盾，需要进一步研究以确定下颌角骨折非加压单皮质钢板固定的理想方法。
