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

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

Mandible - Symphysis and parasymphysis, simple

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Glossary

General considerations

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

It is recommended in all unstable fractures and noncompliant patients.

Closed treatment of simple fractures is still well accepted as an alternative to open treatment.

Closed treatment (MMF)
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, two lag screw fixation
Main indication Skill Equipment
Oblique or sagittal fractures where two lag screws can be placed from the buccal or lingual cortices. Some specialized surgical experience Full specialized surgical and imaging resources

Advantages

  • Rapid application with a high level of stability
  • Perfect bony reduction after interfragmentary compression
  • Lower cost compared to plate and screw fixation
  • Intraosseous location avoiding palpability

Disadvantages

  • Technically demanding (only one chance to get it right)
  • Difficult implant removal (if needed)
ORIF, lag screw and plate
Main indication Skill Equipment
Oblique or sagittal fractures where only one lag screw is possible. The plate is used to supplement the fixation. Some specialized surgical experience Full specialized surgical and imaging resources

This technique is a backup procedure for two lag screw procedure where only one lag screw could be inserted due to anatomical or technical reasons.

Note: these fractures could also be treated with two miniplates.

ORIF, one plate and arch bar
Main indication Skill Equipment
Simple fractures when used in combination with a stable arch bar. Basic surgical experience, no specialized skills Basic equipment only

Further indication

  • Anatomical and technical limitation for the placement of two plates

Advantage

  • easy to place and less expensive relative to two plates
ORIF, two plates
Main indication Skill Equipment
Cases where an arch bar is not possible because of missing teeth, loose teeth, or the objection to using an arch bar, or distal trailing fractures not amenable to the other treatments. Basic surgical experience, no specialized skills Basic equipment only

Advantages

  • Easy to contour and to secure to the mandible using monocortical screws
  • Rapidly applied and provide stable fixation
  • Readily available in most operating rooms
*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