Which Factors Affect the Reduction Quality of Open Reduction Internal Fixation of Mandibular Subcondylar Fractures? 2023

Preston Dekker, and Nicholas F Callahan, and Michael Miloro, and Michael D Han
Private Practice, Las Vegas, NV.

Open reduction internal fixation (ORIF) of mandibular subcondylar fractures (MSF) involves several variables that could affect decision making. There is insufficient data regarding factors influencing the outcomes of MSF ORIF. The purpose of this study was to investigate factors associated with quality of bony reduction of MSF and occlusion, after ORIF. We designed a retrospective cohort study of consecutively treated subjects for MSF ORIF, ages 18 to 64 years, by University of Illinois' Department of Oral and Maxillofacial Surgery, between January 1, 2013, and January 26, 2021. The primary predictor variable was the vertical level of MSF from the gonial angle. Secondary predictor variables included surgeon, fixation scheme (number and configuration of miniplate), surgical approach, time to surgery, mechanism of injury, vertical fragment overlap, overlying soft tissue thickness, presence of other mandibular fractures, and severity and direction of displacement. The primary outcome variable was the mean radiographic reduction score (RRS), rated by 2 blinded observers on a 1 to 5 scale. The secondary outcome variable was presence of postoperative malocclusion as documented in the medical records. Covariates were age and sex. Descriptive statistics were computed. To investigate the influence of the predictor variables on reduction quality, multifactorial analysis of variance with post hoc Tukey test was performed. For malocclusion, χ2 test was performed. The level of significance was set at P < .05. Thirty-eight MSF in 37 subjects were included. Mean age was 32.7 years (range 18 to 64), and 83.8% were male. Mean RRS was 4.38 (standard deviation 0.77). Fixation scheme was the only variable that showed significant impact on RRS: single-straight miniplate had lower scores than double-straight (-1.50, P = .011), rhomboid (-1.29, P = .036), and ladder miniplates (-1.38, P = .048). There was 1 incidence of malocclusion (2.7%) which resolved without intervention. Favorable reduction (anatomic reduction to mild discrepancies) can be achieved without malocclusion using double-straight, or rhomboid-shaped or ladder-shaped miniplates, without influences from patient or injury-related factors. In contrast, single-straight miniplate fixation resulted in moderate discrepancies in reduction, although it did not lead to malocclusion.

UI MeSH Term Description Entries
D008297 Male Males
D008310 Malocclusion Such malposition and contact of the maxillary and mandibular teeth as to interfere with the highest efficiency during the excursive movements of the jaw that are essential for mastication. (Jablonski, Illustrated Dictionary of Dentistry, 1982) Angle's Classification,Crossbite,Tooth Crowding,Cross Bite,Angle Classification,Angles Classification,Bite, Cross,Bites, Cross,Classification, Angle's,Cross Bites,Crossbites,Crowding, Tooth,Crowdings, Tooth,Malocclusions
D008337 Mandibular Fractures Fractures of the lower jaw. Fracture, Mandibular,Fractures, Mandibular,Mandibular Fracture
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005260 Female Females
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070799 Open Fracture Reduction Restoration of normal alignment of a fractured bone via an OPERATIVE SURGICAL PROCEDURE. Open Reduction, Fracture,Fracture Open Reduction,Fracture Open Reductions,Fracture Reduction, Open,Open Fracture Reductions,Open Reductions, Fracture,Reduction, Fracture Open,Reductions, Fracture Open
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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