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Intraoral approach to the angle

The two surgical approaches: A: Without third molar present, B: third molar is to be removed

Principles

Vestibular incisions
The intraoral approach is used for the majority of simple angle fractures.
Depending on whether or not a third molar is to be extracted (Click here for more information on teeth in the line of the fracture), there are two surgical approaches. Where there is no third molar present, or where one is present but is to be left in place, a purely vestibular incision approximately 5 mm away from the attached gingiva is made (A). When an erupted third molar is to be removed, the incision must incorporate the attached gingiva around the buccal side of the tooth (B, combination of vestibular and envelope incisions).

Oral contamination is not a contraindication for an intraoral incision.

Restricted access and contamination
In complex fractures including comminuted, edentulous, and avulsive fractures that will require the placement of load-bearing reconstruction plates, a transfacial/extraoral approach can provide better access to treat the injury.