A prospective study for the effectiveness of 3-dimensional curved strut plates for the treatment of mandibular angle fractures

Background: The treatment for mandibular angle fractures has evolved over the years, from old methods of bandaging, splinting, extra-oral pin fixation, circum-mandibular wiring, semi rigid fixation with transosseous wiring to various methods of open reduction and internal fixation (ORIF). Open reduction and internal fixation can be performed by intraoral, extraoral or combined intraoral and transbuccal approach. During the last decade, significant attention has been placed on fixation of mandibular angle fractures using a variety and combination of transorally placed small plates secured with monocortical screws. Fixation with these plates has shown to simplify surgery and reduce surgical morbidity. One of the various methods of fixation is using a 3-dimensional strut plate. The 3-D curved angle strut plate is a single plate composed of two 4-hole miniplates with interconnecting crossbars or struts. Its geometry with an increased number of screws allows for stability in 3-dimensions, malleability and also provides increased torsional stability. The fixation of a single miniplate at the superior border, as in Champy technique can cause lower border splaying due to molar loading. This complication is prevented by the 3-D strut plate due to its action like 2 miniplates. The purpose of this study is to evaluate the effectiveness of the 3-dimensional curved strut plate in the management of mandibular angle fractures. Materials and Methods: Patients who reported to the Department of Oral and Maxillofacial Surgery, A.J Institute of Dental Sciences, Mangalore diagnosed clinically and radiographically with mandibular angle fractures were selected for the study with their informed consent. A total of 10 patients were selected after fulfilling the inclusion and exclusion criteria. All patients were operated under general anesthesia for open reduction and internal fixation. The fractures were exposed by an extraoral approach using Risdon's incision. After reducing the fracture anatomically, the 3-D strut plate was placed across the fracture site and secured with monocortical screws. After fixation, the occlusion was assessed and layered suturing was done. Patient was evaluated preoperatively, intraoperatively and postoperatively on various parameters by a prosthodontist and an oral and maxillofacial surgeon. Results: Ten patients fulfilling the inclusion and exclusion criteria were selected for repair using 3-dimensional strut plates in the mandibular angle region. 80% of the cases were found to be caused due to Road traffic accidents while remaining 20% were due to self-fall. Nine of the patients were associated with other fractures. Five patients were found to have minor occlusal disturbances preoperatively and five had severe occlusal disturbances. Intraoperatively, 30% cases were found to be easy for plate fixation. Postoperatively, evaluation was done immediately, at 3 months and months using a panoramic radiograph. Anatomic reduction was excellent in all patients at the end of 6 months. All patients showed stability during each evaluation. No occlusal disturbances were seen in any patient at the end of 6 months. Three patients complained of paresthesia postoperatively, which reduced to one in the second follow-up. One of the patients had to undergo plate removal due to a swelling which did not subside even after a course of antibiotics. Conclusion: Based on our study and its findings, we can conclude that a 3-dimensional curved strut plate is an effective modality of treatment for mandibular angle fractures.