Purpose: To compare the intra-oral approach using a contra-angled hand piece with the standard transbuccal approach in the treatment of mandibular angle fractures.

Patients and methods: Thirty patients with isolated fractures of the mandibular angle were treated by open reduction and internal fixation using one three-dimensional “strut” or “geometric” Synthes ^® angle plate. Patients were selected randomly for placement of two-millimeter self-threading screws, either through the standard transbuccal technique or with an intra-oral approach using a contra-angle hand piece. None of the patients were placed into post-surgical maxillomandibular fixation (MMF). Swelling and pain were measured pre-operatively and again 24 h after surgery. The actual cutting time from first incision to placement of last suture was documented, as well as the perception of difficulty of the specific case by a single operating surgeon.

Results: No statistically significant difference in perception of pain was experienced between the two groups of patients during the first 24 h after surgery. There was also no statistically relevant difference in cutting time between the two placement techniques. A small statistically relevant difference ( p -value = 0.089) was found in the amount of swelling post-operatively between the two groups, with more swelling in the control group.

Conclusion: The use of a contra-angle hand piece to place screws in the compression band area in a mandible angle fracture is an acceptable alternative to the transbuccal approach.

Conflict of interest: None declared.