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Original Article |

Repairing Angle of the Mandible Fractures With a Strut Plate

William Marshall Guy, MD; Nadia Mohyuddin, MD; Daniela Burchhardt, MD; Krista L. Olson, MD; Susan A. Eicher, MD; Anthony E. Brissett, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):592-597. doi:10.1001/jamaoto.2013.3246.
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Importance Despite multiple fixation techniques, the optimal method of repairing mandibular angle fractures remains controversial.

Objective To evaluate the outcomes when using a 3-dimensional, curved strut plate in repair of angle of the mandible fractures.

Design Retrospective cohort study.

Setting Level I trauma center at an academic institution in Harris County, Texas.

Participants Patients with diagnostic codes involving angle of the mandible fractures that were repaired by the otolaryngology–head and neck surgery service from February 1, 2006, through February 28, 2011.

Exposure Open reduction internal fixation using either a 3-dimensional curved strut plate or any other type of repair technique for angle of the mandible fractures.

Main Outcomes and Measures Complication rates, postoperative complaints, and operative characteristics.

Results Ninety patients underwent qualifying procedures during the study period. A total of 68 fractures (76%) were repaired using the 3-dimensional curved strut plate and 22 (24%) were repaired using other methods. The revision surgery rate was 10% for the strut plate group (7 patients) and 14% for the non–strut plate group (3 patients), with no significant differences in rates of infection (3 [4%] vs 2 [9%]), dehiscence (4 [6%] vs 2 [9%]), malunion (1 [1%] vs 2 [9%]), nonunion (3 [4%] vs 0), hardware failure (1 [1%] vs 1 [5%]), malocclusion (2 [3%] vs 2 [9%]), and injury to the inferior alveolar nerve (1 [1%] vs 1 [5%]). The most common postoperative complaints were pain (13 [19%] vs 6 [27%]), followed by numbness (5 [7%] vs 2 [9%]), trismus (4 [6%] vs 3 [14%]), edema (3 [4%] vs 3 [14%]), and bite deformity (2 [3%] vs 2 [9%]), with a mean (range) follow-up time of 54.7 (2-355) days for the strut plate group vs 46.8 (8-308) days for the non–strut plate group.

Conclusions and Relevance The 3-dimensional curved strut plate is an effective treatment modality for angle fractures, with comparable infection rates, low incidence of alveolar nerve injury, and trends for decreased length of operation, complications, and infections compared with other techniques.

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Figure. Methods of repairing angle of the mandible fractures. A, Location of fractures; B, lateral view of the fractures; C, fracture reduction with arch bars; D, percutaneous approach to plating; E, anterior view of percutaneous approach to plating; F, postreduction with arch bars and plates. Illustration by Scott A. Weldon, MA, CMI. Published with permission from Baylor College of Medicine.

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