Resident, Department of Oral and Maxillofacial Surgery SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
Professor, Department of Oral and Maxillofacial Surgery SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
J Oral Maxillofac Surg. 2023 Aug;81(8):1001-1010. doi: 10.1016/j.joms.2023.04.005. Epub 2023 Apr 20.
The treatment of mandibular angle fractures ranges from observation to closed reduction with maxillomandibular fixation to open reduction and internal fixation. The study aims to compare the effectiveness of three different techniques (transoral, transbuccal, and right-angled fixation technique) for single adaptational monocortical upper border plating in mandibular angle fracture.
The study conducted at our center was a prospective randomized study. The study duration was from November 2019 to August 2021. The three groups included in our study were transoral, transbuccal, and transoral approach using the right-angled drill. Patients who required open reduction and internal fixation of mandibular angle fracture were included in the study. Computer-generated randomization method was used to assign the participants among the 3 groups, ie, transoral, transbuccal, or right-angled fixation technique. The primary outcome clinical variables were mouth opening (MO), occlusion stability, scar or laceration, facial nerve weakness, infection, and the radiological variables were gap between the fracture segments and displacement of the fracture segment. The secondary outcome of our study is a comparison of the perioperative complications including plate exposure during the entire fracture healing period. The covariates of the study were age, sex, etiology, and tooth in line of fracture. Statistical analysis was done using ANOVA, post hoc Tukey test, and Pearson χ test. A P value less than 0.05 was considered statistically significant.
A total of 48 patients were included in our study. According to randomization, each group was allotted 16 patients. In the study, 66.7% of the study population were male and 33.3% were female; 75% of the study population were victims of road traffic accidents, and 25% were injured due to assault. The mean and standard deviation for MO at 1 month were 31.3 ± 2.9 for the transoral group, 35.8 ± 1.7 for the transbuccal group, and 35.5 ± 1.3 for the right-angled fixation group. On intergroup comparison, statistically significant results were seen at the 1-month postoperative MO clinical parameter. The P value here was 0.02 which was statistically significant.
The comparison of the right-angled fixation technique to transoral and transbuccal fixation methods have not been documented. Our study is the first of its kind to compare the right-angled fixation technique to various other approaches. Our study showed that the MO was better postoperatively with the transbuccal approach. The other variables showed no difference among the three techniques.
下颌角骨折的治疗范围从观察到经颌骨固定的闭合复位，再到切开复位和内固定。本研究旨在比较三种不同技术（经口内、经颊和直角固定技术）在单一适应性单皮质下颌角骨折上板的效果。
本研究在我们中心进行，是一项前瞻性随机研究。研究时间为 2019 年 11 月至 2021 年 8 月。我们的研究包括三组：经口内、经颊和经口内使用直角钻头。纳入需要切开复位和内固定下颌角骨折的患者。使用计算机生成的随机化方法将参与者分配到 3 组，即经口内、经颊或直角固定技术组。主要临床结局变量为张口度（MO）、咬合稳定性、疤痕或裂伤、面神经无力、感染和影像学变量包括骨折段之间的间隙和骨折段的移位。我们研究的次要结局是比较围手术期并发症，包括整个骨折愈合期间的钢板暴露。研究的协变量为年龄、性别、病因和骨折线上的牙齿。使用方差分析（ANOVA）、事后 Tukey 检验和 Pearson χ 检验进行统计分析。P 值小于 0.05 被认为具有统计学意义。
共有 48 名患者纳入本研究。根据随机分组，每组分配 16 名患者。在研究中，66.7%的研究人群为男性，33.3%为女性；75%的研究人群为道路交通事故受害者，25%为因袭击受伤。1 个月时 MO 的平均值和标准差为经口内组 31.3±2.9，经颊组 35.8±1.7，直角固定组 35.5±1.3。组间比较，术后 1 个月 MO 临床参数有统计学意义。这里的 P 值为 0.02，具有统计学意义。
直角固定技术与经口内和经颊固定方法的比较尚未有文献记载。我们的研究是首次将直角固定技术与其他各种方法进行比较。我们的研究表明，经颊入路术后张口度更好。其他变量在三种技术之间没有差异。
