Treatment of Atrophic Mandibular Fractures Based on the Degree of Atrophy—Experience With Different Plating Systems: A Retrospective Study

Wittwer, Gert; Adeyemo, Wasiu Lanre; Turhani, Dritan; Ploder, Oliver

doi:10.1016/j.joms.2005.10.025

« Previous Next »Journal of Oral and Maxillofacial Surgery
Volume 64, Issue 2 , Pages 230-234, February 2006

Treatment of Atrophic Mandibular Fractures Based on the Degree of Atrophy—Experience With Different Plating Systems: A Retrospective Study

Gert Wittwer, DDS, MD
- Resident, Clinic for Cranio and Maxillofacial Surgery, University of Vienna Medical School, General Hospital, Vienna, Austria.
- Address correspondence and reprint requests to Dr Wittwer: Clinic for Cranio and Maxillofacial Surgery, University of Vienna Medical School, General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
Wasiu Lanre Adeyemo, DDS
- Resident, Clinic for Cranio and Maxillofacial Surgery, University of Vienna Medical School, General Hospital, Vienna, Austria.
Dritan Turhani, MD
- Resident, Clinic for Cranio and Maxillofacial Surgery, University of Vienna Medical School, General Hospital, Vienna, Austria.
Oliver Ploder, DDS, MD, PhD
- Professor, Clinic for Cranio and Maxillofacial Surgery, University of Vienna Medical School, General Hospital, Vienna, Austria.

Purpose

The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems.

Patients and Methods

Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach.

Results

In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively.

Conclusions

Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height.