Fixation of Mandibular angle fractures with a 3 dimensional strut plate a prospective study
INTRODUCTIONMandibular angle is one of the most common site for the fracture (20 30 that may result from sports injury, road traffic accidents, sports injury, pathology or falls. Various techniques have been described in the past like internal fixation or open reduction to treat these conditions but the major disadvantage with these was restricted dietary intake. This prospective study uses 3 D strut plates to overcome these problems. AIMS AND OBJECTIVESTo evaluate the efficacy of 8 holed 3D strut plate in the management of patients with mandibular angle fracture. MATERIALS AND METHODThis prospective study was conducted on 10 patients sustaining mandibular angle fracture. The transbuccal trocar was inserted through a stab incision in the safe zone. On removing trocar, cheek sleeve was placed. Transbuccal holes were drilled and 8 monocortical screws were inserted to secure the 3D strut plate. Follow up was done on 3 rd day, 1 st 3 rd week, 1 st 3 rd month to evaluate the efficacy of 3 D strut plates. RESULTadequate anatomical reduction, with no signs of inflammation, swelling or malunion of fractured fragments was seen 3 months post operatively in all patients thus demonstrating the efficacy of 3 D strut plates in treatment of Mandibular angle fracture. CONCLUSIONwithin the limitations our study suggests that 3 D strut plates can be effectively used for the treatment of Mandibular angle fracture. Introduction Angle fracture accounts for 20% 36% of all mandibular fractures which may be due to interpersonal violence, motor vehicle accidents, falls, sports injury, occupational accidents, and pathology. Different techniques have been described to treat these conditions with major disadvantage being restricted dietary intake. This has forced surgeons to look for different methods like open reduction and internal fixation (ORIF) Despite many advances in internal fixation, angle fractures remains most difficult and unpredictable to treat. During the last decade significant attention has been placed on fixation using mini plates secured with monocortical screws that had simplified surgery and reduced surgical morbidity but it failed to surpass the predictability of rigid fixation. Primary aim of fracture management is to make patient return to function and to attain anatomic reduction. Placement of large plates through extraoral approach or use of Champy's mini plates is relatively less successful in displaced mandibular angle fractures and can not overcome torsional and occlusal forces. To overcome these shortcomings, 3D strut plates are used that has increased resistance against torque forces. In this study, curved strut plates were used as being anatomically similar to the Mandibular angle region. Fixation of Mandibular angle fractures3(2);2017 34 Journal Of Applied Dental and Medical Sciences 3(2);2017 Here 10 patients with mandibular angle fractures were treated by fixation with 3D strut plate hypothesizing that it is one of the easier best option AIM AND OBJECTIVE: To evaluate the efficacy of 8 holed 3D strut plate in the management of patients with mandibular angle fracture. MATERIALS AND METHODOLOGYThis prospective study was conducted on 10 patients sustaining mandibular angle fracture visiting Department of Oral Surgery, in a Dental College and Hospital of south India. PATIENT SELECTION CRITERIA: Ethical clearance was obtained from the institute and patients who gave their consent for the study were included. While those with infected fractures, medically compromised patients Age below 18 and above 60 years, patients with significant bone/ soft tissue loss or severly comminuted fracture(i.e. gunshot wound) and those who did not give consent for the study were excluded. METHODOLOGYafter obtaining demographic details, informed consent, blood investigations and pre operative radiographs, Erich arch bar or eye let wiring was applied and occlusion was achieved. Along with regular titanium trauma kit additional armamentarium used were 8 holed 2mm curved titanium strut plate along with 2mmx6mm 8mm screws. Transbuccal trocar was used in all cases. Post operatively IMF was applied to those with Occlusal derangement. A pressure dressing was applied for 24 48 hours. No drains were used. IV antibiotics and analgesics were administered. Soft diet was prescribed for a period of 3 4 weeks. SURGICAL TECHNIQUE: After achieving general anesthesia and patient preparation, sub mandibular and buccal region of the affected side were exposed. Fracture fragments were anatomically reduced, occlusion was achieved I.M.F. was placed. The 3D curved strut plate was adapted approximately to the underlying bone on the lateral surface of mandible such that horizontal cross bars were perpendicular to the fracture line and vertical cross bars were parallel to fracture line. Mono cortical screws were placed perpendicular to the bone by percutaneous transbuccal approach. The transbuccal trocar was inserted through a stab incision in the safe zone (figure II) and transbuccal tunnel established. On removing trocar, cheek sleeve was placed Transbuccal holes were drilled using 1.5 mm drill bit. Eight monocortical screws of size 2 x 6 or 2 x 8 mm screws were inserted to secure the 3D strut plate. IMF was removed, leaving arch bars in place and occlusion was checked. The fixed fracture fragments were checked for adequate reduction. After achieving hemostasis, incision was closed and pressure bandage was placed for 24 48 hours. I.V antibiotics were administered thrice daily for five days, along with analgesic. Liquid diet was prescribed for 3 4 weeks. Follow up was done on 3 rd day, 1 st 3 rd week, 1 st 3 rd month. Preoperatively, oedema, occlusion, step deformity, paresthesia, presence of infection were assessed. Intraoperativelyanatomical reduction, occlusion, no of screws placed and immediate post operatively, reduction of fracture fragment, Position/ proximity of plate and screws to neurovascular structure, root injuries were assessed. Fixation of Mandibular angle fractures3(2);2017 35 Journal Of Applied Dental and Medical Sciences 3(2);2017 S.N O AG E SE X ETIOLO GY FRACTURE SITE DISPLA CE MENT SOFT TISSUE INJURY OEDE MA PARESTH ESIA OCCLUSI ON STEP DEFO RMIT Y TEETH IN LINE OF FRACTU RE 1 25 M RTA Right angle with left para symphasis Displaced Present Present Present Deranged Presen t Present 2 20 M FALL Left angle with right body fracture Not Displaced Absent Present Present Deranged Presen t Present 3 26 M FALL Left angle fracture Displaced Absent Present Absent Deranged Presen t Present 4 21 M ASSAU LT Left angle with right parasymphasi s Displaced Present Present Present Deranged Presen t Present 5 29 M FALL Left angle fracture Not Displaced Absent Present Absent Deranged Presen t Present 6 29 M ASSAU LT Right angle fracture Not Displaced Absent Present Present Deranged Presen t Present 7 25 M RTA Right angle with left para symphasis Displaced Absent Present Present Deranged Presen t Present 8 27 M RTA Left angle with right parasymphasi s Not Displaced Absent Present Present Deranged Presen t Present 9 40 M ASSAU LT Left angle fracture Displaced Absent Present Present Deranged Presen t Present 10 22 M RTA Right angle with left para symphasis Displaced Present Present Present Deranged Presen t Present Table I: SHOWS DIFFERENT PRE OPERATIVE FEATURES. RESULTS: 10 patients with Mandibular angle fracture were evaluated for the efficacy of 3D strut plate. Intra operative and post operative parameters evaluated were signs of infection, mobility of the fracture fragments, paresthesia, and intra operative hardware failure. All the cases were evaluated intraoperatively, 3 rd day, 1 st week, 3 rd week, 1 st month and 3 rd month postoperatively. Infection was evaluated intra operatively, 3 rd day, 1st week, 3 rd week, 1st month and 3rd month. No patient presented with pus formation or discharging sinus or any other signs of infection. All other fracture sites healed uneventfully (table 2) Occlusal discrepancies were assessed intra operatively, immediate post operatively, 1 st and 3 rd weeks of operation, 1 st and 3 rd months post operatively based on Fixation of Mandibular angle fractures3(2);2017 36 Journal Of Applied Dental and Medical Sciences 3(2);2017 0 2 4 6 8 10 12