Treatment of a Mandibular Fracture by Two Perpendicular Mini-Plates

Document Type: Original


1 Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.


In open reduction and internal fixation for the treatment of mandibular fracture, the fixation technique used is very important in reducing post-operative complications and promoting the healing process. This study assessed the results of fixation of the mandible using two mini-plates perpendicular to each other in the lower border of the mandible for fracture treatment. 
Materials and Methods:
Access to the fractures was via an extraoral approach (through existing scars or incisions). After reductions of mandibular fractures, the fracture line fixation was accomplished using two mini-plates perpendicular to each other. One-week intermaxillary fixation (IMF) was applied and 3 weeks of soft diet was recommended in the post-operative period. All patients were followed up for at least 1 year regarding infection and malocclusion.
Twenty-five patients (28 fracture lines) underwent this technique. Most (81.8%) patients were male and the mean age was 41.3±7.59 years (range, 17–73 years). Symphyseal fracture (frequency, 52%) was the most prevalent followed by angle (32%) and body (16%) fractures. Among the patients who underwent surgery, only one malocclusion and no cases of infection were observed. No cases [Rachel1] of facial nerve weakness or damage were observed in this study.
This method can be used in specific cases to replace treatment with one mini-plate, which necessitates a more intensive fixation or reconstruction plate therapy.    
 [Rachel1]Please confirm


1. Holmes PJ, Koehler J, McGwin G Jr, Frequency of maxillofacial injuries in all-terrain vehicle collisions. J Oral Maxillofac Surg 2004; 62(6): 697–701.

2. Muhonen J, Leikomaa H. Treatment of mandibular fracture. Duodecim 2010; 126(6): 712–6.

3. van den Bergh B, Heymans MW, Duvekot F, Forouzanfar T. Treatment and complications of mandibular fractures: A 10-year analysis. J Craniomaxillofac Surg 2012; 40(4): e108–11.

4. Uglesić V, Virag M, Aljinović N, Macan D. Evaluation of mandibular fracture treatment. J Craniomaxillofac Surg 1993; 21(6): 251–7.

5. Bell RB, Wilson DM. Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures? J Oral Maxillofac Surg 2008; 66(10): 2116–22.

6. Terris DJ, Lalakea ML, Tuffo KM, Shinn JB. Mandible fracture repair: specific indications for newer techniques. Otolaryngol Head Neck Surg 1994; 111(6): 751–7.

7. Blitz M, Notarnicola K. Closed reduction of the mandibular fracture. Atlas Oral Maxillofac Surg Clin North Am 2009; 17(1): 1–13.

8. Renton TF, Wiesenfeld D. Mandibular fracture osteosynthesis: a comparison of three techniques. Br J Oral Maxillofac Surg 1996; 34(2): 166–73.

9. Bolourian R, Lazow S, Berger J. Transoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: a prospective study. J Oral Maxillofac Surg 2002; 60(2): 167–70.

10. Chritah A, Lazow SK, Berger JR. Transoral 2.0-mm locking miniplate fixation of mandibular fractures plus 1 week of maxillomandibular fixation: a prospective study. J Oral Maxillofac Surg 2005; 63(12): 1737–41.

11. Rudderman RH, Mullen RL, Phillips JH. The biophysics of mandibular fractures: an evolution toward understanding. Plast Reconstr Surg 2008; 121(2): 596–607.

12. Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery. J Maxillofac Surg 1973; 1(2): 79–84.

13. Rajchel J, Ellis E, Fonseca RJ. The anatomical location of the mandibular canal: its relationship to the sagittal ramus osteotomy. Int J Adult Orthodon Orthognath Surg 1986; 1(1): 37–47.

14. Nakamura S, Takenoshita Y, Oka M. Complications of miniplate osteosynthesis for mandibular fractures. J Oral Maxillofac Surg 1994; 52(3): 233–8.

15. Zachariades N, Papademetriou I. Complications of treatment of mandibular fractures with compression plates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 79(2): 150–3.

16. Williams MD, Pearson MH, Milner SM. Complications in the use of compression plates in the treatment of mandibular fractures. Oral Surg Oral Med Oral Pathol 1991; 72(2): 159–61.

17. Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: a review of 466 cases. Literature review, reflections on treatment and proposals. J Craniomaxillofac Surg 2006; 34(7): 421–32.

18. Wagner A, Krach W, Schicho K, Undt G, Ploder O, Ewers R. A 3-dimensional finite-element analysis investigating the biomechanical behavior of the mandible and plate osteosynthesis in cases of fractures of the condylar process. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94(6): 678–86.

19. Fonseca RJ,Waker RV,Betts NJ,Barber HD,Powers MP. Oral and maxillofacial trauma. 3th ed. Louis: Saunders Elsevier;2005. p. 1139.

20. Ellis E 3rd, Dechow PC, Carlson DS. A comparison of stimulated bite force after mandibular advancement using rigid and nonrigid fixation. J Oral Maxillofac Surg 1988;46(1):26–32.

21. Rosenquist BE. Nerve transpositioning to facilitate implant placement. Dent Econ 1995; 85(10): 92–3.

22. Dharmar S. Locating the mandibular canal in panoramic radiographs. Int J Oral Maxillofac Implants1997; 12(1): 113–7.