Evaluation of Titanium Lag Screw Osteosynthesis in the Management of Mandibular Fractures
Authors: Bansal Puneet , Mishra Vijay , Jaiswal Yashmi , Das Gourab 
Published: November 2017

ABSTRACT

Introduction
The management of facial trauma is one of the most important and demanding aspects of maxillofacial surgery. Mandible is the most movable and prominent bone of facial skeleton. The management of the injuries to the maxillofacial complex remains a challenge for oral and maxillofacial surgeons. The aim of mandibular fracture treatment is the restoration of anatomical form and function with particular care to establish occlusion. The lag screw technique was first introduced to maxillo facial surgery by Brons and Boering in 1970, who cautioned that at least two lag screws are necessary to prevent rotational movement of the fragments in oblique fractures of mandible.

Aim
The aim of the study was to evaluate the outcome of lag screw osteosynthesis in the management of mandibular body, symphysis, and parasymphysis fractures.

Materials and methods
About 15 cases presenting with mandibular oblique, sagittally displaced mandibular fractures, and requiring open reduction and internal fixation (ORIF) were selected. Titanium lag screws were placed in such a way that their axes bisect the angle between a perpendicular drawn to the fracture line and perpendicular to the bone surface. About 3 months postoperatively, follow-up was done to evaluate the duration of surgery intraoperatively, stability of fracture segments, occlusion, biting efficiency postoperatively, and record any postoperative complications with lag screw fixation technique.

Results
The maximum intraoperative time was 120 minutes and minimum was 40 minutes. The average intraoperative time was 72 minutes. In postoperative complications, deranged occlusion was seen in two patients; in one patient, it was due to associated condylar fracture and technical error in the placement of lag screw in another patient; but, it was not significant statistically with a p-value of 0.483 and which was managed easily by placing guiding elastics for 2 weeks in both patients. All the patients in the study showed good stability of fixation and significant increase in biting efficiency over a period of time. No postoperative complications, such as lag screw exposure, neurosensory disturbance, and malunion/nonunion were seen in any of the patients.

Conclusion
Titanium lag screw fixation was found to have good stability, rigidity, was inexpensive, and less time consuming in some types of mandibular fractures, though there exist few contraindications regarding its usage. This technique is a very sensitive procedure, requiring strict adherence to the lag screw placement principle and sufficient knowledge about the surgical anatomy of the mandible.

Clinical significance
Fixation of the anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique reduces the chances of infection due to less exposure and promotes the healing process by producing stress in the fracture lines. Lag screw showed faster improvement in terms of biting efficiency and a significant reduction in fracture gap, which is not seen in miniplate fixation.

How to cite this article
Bansal P, Kumar S, Mishra V, Jaiswal Y, Das G. Evaluation of Titanium Lag Screw Osteosynthesis in the Management of Mandibular Fractures. World J Dent 2017;8(4):315-320.