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

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

Mandible - Body, simple

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Glossary

General considerations

Open reduction internal fixation (ORIF) is usually the method of choice for complete simple body fractures to avoid the drawbacks and inconveniences of MMF in the majority of patients.

It is recommended in all displaced fractures and noncompliant patients.

Observation
Main indication Skill Equipment
Seldom indicated for non-mobile non-displaced fractures with undisturbed 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 simple fractures 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, lag screws
Main indication Skill Equipment
Sagittal/oblique fractures Some specialized surgical experience Simple surgical and imaging resources

Advantages of the lag screws over plate fixations are:

  • Rapid application with a high level of stability
  • Ideal fracture alignment and interfragmentary buttressing
  • Intraosseous location avoiding palpability
  • Less fixation hardware resulting in lower cost

Disadvantages are:

  • Technically demanding
  • Difficult implant removal (if needed)

Lag screws can hardly be used in transverse fractures of the body.

ORIF, one miniplate
Main indication Skill Equipment
Simple fractures in compliant patients with good dentition and buttressing of the segments after reduction. Basic surgical experience, no specialized skills Basic equipment only
ORIF, two plates
Main indication Skill Equipment
Simple fractures in transitional areas of the mandibular body. Some specialized surgical experience Simple surgical and imaging resources
ORIF, one large 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
*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