Manual reduction of mandibular fractures before internal fixation leads to shorter operative duration and equivalent outcomes when compared with reduction with intermaxillary fixation.

ABSTRACT

PURPOSE: Open reduction of mandibular fractures before internal fixation is most commonly performed by 1 of 2 methods: intermaxillary fixation (IMF) or manual reduction. There are risks to both patient and clinician associated with using IMF. Furthermore, previous retrospective studies have failed to show any advantage in its use. The purpose of this study was to directly compare the use of manual reduction (experimental group) and IMF (control group) in open reduction-internal fixation of mandibular fractures. MATERIALS AND METHODS: Patients who presented with isolated mandibular fractures at 2 hospitals in Queensland, Australia, from May 2009 to June 2010 were enrolled in a prospective controlled trial comparing IMF and manual reduction. The outcome measures were operative duration (primary outcome), as well as radiographic outcome, occlusal outcome, and complications (secondary outcomes). The patient and assessor were blinded to the type of reduction used before fixation. The study hypothesis is that manual reduction allows internal fixation in a shorter time than IMF with an equivalent outcome. RESULTS: We recruited 50 patients, 26 allocated to IMF and 24 allocated to manual reduction before internal fixation of mandibular fractures. IMF was associated with an increased duration of procedure (P < .001) and increased complication rate (P = .063), without any observable benefit with regard to either radiographic outcome or occlusal outcome. CONCLUSIONS: IMF is not required in open reduction-internal fixation of mandibular fractures that met our inclusion criteria. IMF is associated with increased costs to the health service and risks to both the patient and clinician.