Intraoral extra-mucosal fixation of fractures in the atrophic edentulous mandible

Abstract

Atrophy of the mandible leads to a decrease in the bone mass, making it more vulnerable to fractures. A direct relationship has been demonstrated between the height of the bone in the area of the fracture and the incidence of postoperative complications of bone healing. Basic principles of fracture management in both edentulous and non edentulous patients are open reduction and internal fixation with osteosynthesis of the fracture to achieve restoration in terms of aesthetics and functionality. Several authors have discussed the advantages and disadvantages of the transoral and extraoral approaches. Between January 2007 and June 2011, 13 patients affected by bilateral fractures of atrophic mandibles were treated by extra-mucosal intraoral stabilization with satisfactory results. This approach reduces the risks of damage of the marginalis mandibulae nerve with low operation time, while avoiding unsightly scars.

Atrophy of the mandible leads to a decrease in the bone mass, making it more vulnerable to fractures. Maxillary atrophy can be considered as the end stage of edentulism (total teeth loss). Treatment of fractures in old patients with bone atrophy are characterized by high morbidity due to local and general factors. A direct relationship between the height of the bone in the area of the fracture and the incidence of postoperative complications of bone healing has been demonstrated.

The most common site of fracture in the edentulous mandibles is the mandibular body. Fibrous union or non union occurs most frequently at this site, especially when the amount of the residual mandible is less than 20 mm (particularly <10 mm).

Basic principles of fracture management in both edentulous and non edentulous patients are open reduction and internal fixation with osteosynthesis of the fracture to achieve restoration in terms of aesthetics and functionality. Several authors have discussed the advantages and disadvantages of the transoral and extraoral approaches. The purpose of this study was to introduce the authors’ approach to fractures occurring in atrophic mandibles. Their preoperative hypothesis was that extra-mucosal intraoral osteosynthesis can achieve adequate mandibular restoration in terms of aesthetics and functionality. The specific aims were to review the surgical outcomes of this approach.

Materials and methods

A case series study was designed and a sample of patients affected by fractures of the atrophic mandible was enrolled. Inclusion criteria were bilateral fracture of atrophic mandibular body, edentulism, and bone height less than 20 mm. Patients were excluded if they had previously treated or untreated mandibular fractures.

Causes of fractures included accidental falls in six cases; three patients had fallen to the ground after a syncope; and four patients had been involved in a motor vehicle accident. Two patients had no associated systemic comorbidities, eight had hypertension, two had diabetes associated with hypertension, and one patient reported hypertension and a previous transient ischaemic attack. Despite these comorbidities, all patients were able to undergo general anaesthesia ( Table 1 ).

Table 1
Characteristics of the patients who underwent extra-mucosal intraoral osteosynthesis.
Patients Gender Age Causes of fractures Comorbidities Complications
A.P. M 78 Accidental fall No None
B.B. F 80 Motor accident Hypertension plus diabetes None
D.V. M 84 Accidental fall Hypertension Pseudarthrosis
F.A. M 74 Syncope No None
B.F. F 79 Motor accident Hypertension. None
B.C. M 82 Accidental fall Hypertension None
C.N. F 76 Accidental fall Hypertension None
L.P. M 72 Motor accident Hypertension None
O.D. F 86 Motor accident Hypertension None
G.Z M 82 Accidental fall Hypertension None
D.U. F 76 Accidental fall Diabetes None

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Jan 24, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Intraoral extra-mucosal fixation of fractures in the atrophic edentulous mandible
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