Surgical treatment of mandibular fractures

Abstract

Introduction. Due to its position, shape and function, the mandible is most often exposed to trauma across the whole oro-maxilo-facial area. The mandible fractures take the first place in facial trauma, so their treatment requires a comparative analysis of all treatment methods and the choice of the optimal variant. The most common used method is conservative-orthopedic treatment, used on average in 60.86% cases. In situations when it is impossible to reduce and fix fractured fragments with orthopedic devices, the surgical method of treatment is used. As a rule, the exooral approach is used being the best visibility method, but it also has disadvatages, such as excessive trauma to tissues adjacent to fracture and prolonged healing time. To remedy these disadvatages, the method of osteosynthesis is used by endooral access, but as a treatment method it continues to be used much less frequently. Aim of the study. To perform a comparative analysis of several sources of information on the methods of surgical treatment of mandibular fractures and their effectiveness. Materials and methods. The research material of the statistical study comprised a group of 580 patients with mandibular fractures, female and male, aged between 20 and 89 years, which is 70.55% of viscerocranial fractures. Clinical cases were selected from 5523 records for the last three years during 2015-2017, examined, operated and treated in the Oral and Maxillofacial Surgery Department of the Emergency Medicine Institution (EMI) in Chisinau. Clinical case data have been taken from patient records in the archives (EMI) and examined using Microsoft Excel. Results. Surgical methods were used in 227 patients, 123 surgical interventions were performed by osteosynthesis with miniplates, with exobuccal access - 69.1% and endobuccal access - 30.9%). Osteosynthesis with metallic wire was performed in 76 patients, with exobuccal approach - 73, 68% and endobuccal approach - 26.32%. In other 38 interventions, fractures were managed by combined method. Conclusions. The mandibular fractures occupy the leading position in facial trauma due to mandible position, shape, and function. Surgical treatment using various methods of osteosynthesis was applied in 39.14% of patients with mandible fractures.