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.
|Seldom indicated for non-displaced non-mobile fractures in a compliant patient with normal occlusion.|
- When fracture topography and muscular forces (favorable fracture) allow a stable environment of undisturbed healing
- 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.
|Non- or minimally displaced favorable fractures of the angle in compliant patients with good dentition amenable to MMF.|
- 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.
|In unfavorable fractures when plate/screw fixation is not available.|
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|
|Standard method of treatment of isolated simple mandibular angle fractures.|
|ORIF, two miniplates|
|Conditions when use of a secondary plate improves bone buttressing and fracture alignment.|
|ORIF, reconstruction plate|
|Reduced bone buttressing requiring load bearing fixation.|
- Delayed fracture treatment
- If more stability is required
Note: To consider when tooth removal in the line of fracture leads to decreased bone buttressing.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|