Comparison of Surgical Approaches in Reducing Mandibular Angle Fracture
Condition: Fractures, Bone; Mandibular Fractures
MeSH terms: Mandibular Fractures; Fractures, Bone
Study type: Interventional

Summary: 
      This study compared the surgical approach to the lower jaw fractures, an approach from the
      face and an approach from inside the mouth were used and compared for the outcomes.
    

Detailed description: 
      Mandibular factures tend to be more common than those of the middle third of the face.1 They
      occur alone or in combination with other facial bone fractures resulting in severe loss of
      function and disfigurement.2,3 Mandibular factures tend to be more common than those of the
      middle third of the face.1 They occur alone or in combination with other facial bone
      fractures resulting in severe loss of function and disfigurement.2,3 The pattern of
      mandibular fractures varies with geographic location, physical activity, social, cultural and
      environmental factors. The main causes 4,5 of mandibular fracture are; Road traffic
      accidents, interpersonal violence, falls, sports injuries, industrial trauma, pathological
      fractures etc. In developing countries road traffic accident 6 is the common cause of
      mandibular fractures due to lack of implementation of traffic laws while in developing
      countries alcohol related7 interpersonal violence is the leading cause. Any age and sex group
      may sustain trauma to the lower jaw but children below the age of 12 years are less
      susceptible to fracture because their bones are more resilient.5,6 Different modalities
      available for the treatment of mandibular fractures are: Maxillo mandibular fixation (MMF)
      alone e.g. dental wiring, arch bar etc.8 Previously traditional methods i.e.
      maxillomandibular fixation and transosseous wiring were the most popular methods used for
      mandibular fracture fixation. These are still commonly used methods9 and have got various
      disadvantages such as preventing normal jaw function, weight loss due to restriction of food
      to liquid consistency, oral hygiene problem and reduction of ventilatory volume.,10
      Currently, fixation with one or two mini- plates has become a widely acceptable method of
      providing internal fixation and eliminating the need for post-operative maxillo mandibular
      fixation. The fixation of mandibular angle can be carried out by two methods i.e. Intra oral
      approach8, and Extra oral approach. For intra oral approach buccal sulcus incision while for
      extra oral approach sub-mandibular (Risdon),11 incision is given. Postoperative complications
      related to both types of treatment modalities were observed in intra oral approach 13.3 % and
      extra oral approach 16.6% infection and limited opening were observed in intra oral approach
      6.6% and extra oral approach 16.6%.12 Rationale of this study is to compare post-operative
      complication of intra oral approach and extra oral approach in reduction of mandibular angle
      fracture in terms of infection and limited mouth opening. In our study, if we find less
      complication of intra-oral approach in significant number of patients, we will strongly
      recommend its routine use in the reduction of pain and limited mouth opening.
    

Intervention name(s): Maxillofacial surgery
Intervention type(s): Procedure
Intervention description(s): An incision on the skin over the mandible versus incision on the gingivae inside the mouth
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomised controlled trial with non-probability consecutive sampling.
Masking: None (Open Label)
Primary purpose: Treatment