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, simple

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Glossary

General considerations

Treatment of angle fractures remains controversial.

Open reduction internal fixation (ORIF) is usually the method of choice for unfavorable simple angle fractures to avoid postreduction displacement of the fragments and inconvenience of MMF.

Observation
Main indication Skill Equipment
Seldom indicated for non-displaced non-mobile fractures in a compliant patient with normal occlusion. Basic surgical experience, no specialized skills Basic equipment only

Further indication

  • When fracture topography and muscular forces (favorable fracture) allow a stable environment of undisturbed healing

Requirements

  • Fully compliant individual who is willing to adhere to a non-chew diet and avoid physical exercise and sports for a period of 6 weeks
  • Patient must be advised that additional treatment may be required if complications arise during the observation period.
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, wire
Main indication Skill Equipment
In unfavorable fractures when plate/screw fixation is not available. Some specialized surgical experience Basic equipment only

Note: Intraosseous wire fixation of angle fractures is a nonrigid technique that requires 5-6 weeks of postoperative MMF.

ORIF, miniplate fixation to the oblique ridge
Main indication Skill Equipment
Standard method of treatment of isolated simple mandibular angle fractures. Some specialized surgical experience Simple surgical and imaging resources
ORIF, two miniplates
Main indication Skill Equipment
Conditions when use of a secondary plate improves bone buttressing and fracture alignment. Some specialized surgical experience Simple surgical and imaging resources
ORIF, reconstruction plate
Main indication Skill Equipment
Reduced bone buttressing requiring load bearing fixation. Some specialized surgical experience Full specialized surgical and imaging resources

Further indications

  • Delayed fracture treatment
  • Infection
  • Pseudarthrosis
  • Nonunion
  • If more stability is required

Note: To consider when tooth removal in the line of fracture leads to decreased bone buttressing.

*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