Muhammad Anwar, Zishan Haider, Nasir-u Din Khan, Abdullah El-muttaqi.
Surgical management of mandibular fractures by diff erent treatment modalities: a prospective study.
Pak J Surg Jan ;30(1):95-102.

Background: Treatment of mandibular fractures is basic to the treatment of maxillofacial trauma. As the principles of internal fi xation and compression osteosynthesis were adopted by maxillofacial surgeons during recent years the time-honoured methods of intermaxillary fi xation and transosseous wiring has gradually become less favoured method of treatment in most of the cases. Objectives: Th e objectives of this study was to evaluate the results achieved in the surgical treatment of mandibular fractures by diff erent techniques and to propose a simple, effi cient, and cost-eff ective technique for mandibular fractures. Materials and Methods: Th is prospective study was conducted in the oral & maxillofacial surgery department of Nishtar Hospital, Multan and plastic surgery department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan during 2 ½ -year period from July 2007 to December 2009. 105 cases of mandibular fractures were included in this study and a total of 174 fractures were treated by diff erent surgical techniques. Th e mean age was 27.3 years and male to female ratio of 6:1. Th e patients were assigned into three groups according to the type of surgical technique used. Outcome was measured by preoperative variables (age, gender, mechanism of fracture, site and number of fractures, nerve function, associated injuries and delay in treatment) and postoperative variables, duration of intermaxillary fi xation (IMF), duration of admission, malunion, nonunion, infection, and nerve function), which were assessed during the follow up period. Results: Th e results showed that the preoperative variables and demographic features were similar in all groups. All the three treatment modalities were successful in restoring functional occlusion. Ten patients required reoperation or readmission and a total of 25 complications were noted. Th ese complications included 05 soft tissue infection (4.8%), 09 malocclusion (8.5%), 04 malunion (3.8%), 05 mental nerve dysfunction (4.7%), and 02 cases of facial nerve (mandibular branch) damage (1.9%). Th ere was no incidence of non-union or osteomyelitis. Bone healing was satisfactory in 100% of cases. Conclusion: Based on the results of this study we concluded that all the three surgical techniques were successful in restoring functional occlusion. Overall closed reduction plus intermaxillary fi xation with 2.7-mm cortical bone screws is the simplest, less invasive, effi cient, and cost-eff ective technique.

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