MANDIBLE FRACTURE REPAIR - SPECIFIC INDICATIONS FOR NEWER TECHNIQUES

Mandible fracture repair is commonly undertaken by otolaryngologists. Although the essential principles of reduction and immobilization are undisputed, the approach used to obtain these goals varies considerabl y. We performed a critical evaluation of all mandible fractures treate d at the Santa Clara Valley Medical Center by the otolaryngology servi ce between January 1988 and February 1992, with the purpose of better defining the indications for plate fixation and for the use of more tr aditional techniques. One hundred eighty-three fractures in 112 patien ts were evaluable. Thirty-six (32.1%) of these patients had at least o ne plate placed (group A); 39 (34.8%) underwent an open procedure, wit h interosseous wire fixation (group B); and 37 (33.0%) were treated wi th closed techniques (group C). The severity of fracture (indexed by c omminution, presence of infection, teeth in the fracture line, interva l to repair, and whether the fracture was open or closed) was similar in plated and nonplated mandibles. Mean (+/- standard deviation) opera tive times for the three groups were 3.2 +/- 1.6 hours for group A, 3. 0 +/- 0.9 hours for group B, and 1.4 +/- 0.5 hours for group C. The nu mber of follow-up visits required was not statistically different (gro up A, 5.6 +/- 3.8 visits; group B, 5.2 +/- 2.5 visits; and group C, 5. 3 +/- 2.0 visits). The overall incidence of major complications was 14 .3% (16 of 112), including 11 of 36 (30.6%) in group A, 4 of 39 (10.3% ) in group B, and 1 of 37 (2.7%) in group C. The approximate cost of o ne compression plate with four screws is $550, compared with $12 for w ire suitable for fixation (24 gauge). We conclude that plates are more expensive than wire fixation, are associated with a higher incidence of major complications, and should be reserved for situations in which traditional techniques are not feasible.