Executive Editor: Marcelo Figari, Gregorio Sánchez Aniceto General Editor: Daniel Buchbinder

Authors: Ricardo Cienfuegos, Carl-Peter Cornelius, Edward Ellis III, George Kushner

Mandible - Angle and ramus, complex

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Glossary

General considerations

Open reduction internal fixation (ORIF) is the recommended method for complex angle fractures to assure adequate stability in the fracture site, thus preventing complications.

Angular fractures are more likely to result in postoperative complications such as infection.

Closed treatment
Main indication Skill Equipment
Non- or minimally displaced favorable fractures of the angle in compliant patients with good dentition amenable to MMF. Basic surgical experience, no specialized skills Basic equipment only

Further indications

  • Premorbid or unstable medical condition preventing general anesthetic
  • Conditions making open reduction and internal fixation difficult
  • Patient refusal of operative treatment
  • Unavailability of plates and screws

Special consideration: MMF may be contraindicated in patients with psychiatric disorders, seizure disorders, and alcoholics.

ORIF, two plates (basal triangle)
Main indication Skill Equipment
If control of the top of the basal triangle is required, the use of two plates provides this control. Some specialized surgical experience Simple surgical and imaging resources

Advantage

When application of two plates is simpler than a single load bearing reconstruction plate (when a transoral approach is selected).

ORIF, reconstruction plate (basal triangle)
Main indication Skill Equipment
Maximum stability under load bearing conditions. Some specialized surgical experience Simple surgical and imaging resources

The reconstruction plate is considered the most predictable method of treatment.

ORIF, reconstruction plate (comminuted fracture)
Main indication Skill Equipment
Standard method of treatment for comminuted fractures requiring load-bearing fixation. Some specialized surgical experience Full specialized surgical and imaging resources
External fixator
Main indication Skill Equipment
Temporary stabilization of complex fractures simultaneously affecting several anatomic mandibular subunits. Some specialized surgical experience Full specialized surgical and imaging resources

Advantages

  • Maintain fragment position without disrupting the blood supply
  • Rapid application
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2008-12-01