Fixation of mandibular angle fractures with a miniplate by intraoral approach and by a combination of transbuccal and intraoral approach -A comparative study

The mandibular angle is a frequent site of fracture and has a high rate of complication. In order to minimise complications a functionally stable fixation is required. Different methods of internal fixation have been advocated with varying degrees of success. The use of mini bone plate helps in immobilising the fractured bony fragments and thereby maintaining quality of life. The objective of this study is to evaluate the effectiveness of mini bone plate to immobilise the fractured fragments in the region of the angle of the mandible by two different approaches-intraoral technique only and transbuccal with intraoral technique. Patients were randomly divided in two groups, A and B. In Group A one non-compression 2.0 mm miniplate was used on the lateral surface of mandible, in the region of the angle approached both intraorally and transbuccal. In Group B one non-compression 2.0 mm miniplate was placed on external oblique ridge of mandible intraorally. Peak incidence of isolated mandibular angle fractures was seen in males within the age group of 21-30 years. Mean age was 29.75 years; males had a higher incidence than females. Most common aetiology of the trauma was RTA (45%) followed by assaults (35%). Stability of fracture fragments; tooth damage, facial nerve weakness and hardware failure have been found with statistically no significant difference. Scar became invisible at the end of 6 months in all patients of Group A. 1 patient of Group B had gross displacement between the fractures fragments for which paresthesia did not recover till the end of 6 months. The intra-operative time was significantly higher in Group A patients compared to Group B. The combined use of transbuccal & intraoral technique produces excellent results as screws are placed perpendicular to stress across the fracture line and the provision for placement of a second plate, if required, still remains. It is possible to maintain better reduction, with minimal or no plate bending with the clinical impression of better stability.