Surgical sequence of reduction in double mandibular fractures treatment

Abstract

AIM: This study aims to clarify, according to our experience, the correct surgical sequence which should be followed in order to treat double mandibular fractures.

MATERIAL OF STUDY: From January 2007 to January 2010, we have conducted a retrospective study on a sample of patients operated on in our department. We include only those cases in which the jaw was fractured in 2 places, in particular patients who suffer a fracture in tooth-bearing areas (symphysis, parasymphysis, and anterior body) and also contralaterally in non tooth-bearing areas (posterior body, angle, ramus, and condyle). The sample was divided into 2 groups based on the fracture sequence of reduction.

RESULTS: At 1-year follow-up, the group of patients who received first the tooth-bearing fractured areas treatment, followed by treatment of non tooth-bearing fractured area on bifocal mandibular fracture (Group A), showed less postoperative complications and reduced surgical time and costs.

DISCUSSION: In patients of group B, the non-execution of rigid IMF for the non tooth-bearing fractures made bone segments more free to move. Thus, reduction and fixation of non tooth-bearing fractures is facilitated, but poses a greater risk of complications. The surgeon in this case does not have the occlusal help guide; thus, the tooth-bearing fracture reduction and the subsequent fixation may be imperfect.

CONCLUSION: It is recommended from this study that reduction of the tooth-bearing fragment be prior to that of the tooth-free fragment for the double mandibular fracture.