Risk Factors Associated With Poor Outcomes Following Temporomandibular Joint Discectomy and Fat Graft.

PURPOSE: Temporomandibular joint (TMJ) discectomy is performed for patients with degenerative joint disease with an unsalvageable disc, but with a salvageable condylar head and glenoid fossa. The purpose of this study was to estimate the incidence and risk factors associated with poor postoperative outcomes following TMJ discectomy and abdominal fat grafting. METHODS: A retrospective cohort study was conducted on patients who underwent TMJ discectomy. Included in this study were patients who had complete data sets with a minimum of 1-year follow-up. Potential risk factors included demographics, preoperative findings (mouth opening, pain levels, previous TMJ surgery), operative findings (disc degeneration, state of TMJ components), and postoperative outcomes (pain levels, mouth opening). Failed outcomes were those who had return of pain postoperatively, no improvement in mouth opening following TMJ discectomy, and/or those who progressed to TMJ total joint replacement (TJR). Statistical methods included Kaplan-Meier curves and Cox proportional hazards regression time to event analyses. RESULTS: This study included 129 patients who had undergone 132 TMJ discectomies. Most patients were female (89.9%), with a mean age of 43.2 years, standard deviation 14.2. The success rate for discectomy was 75.2% and the conversion rate of TMJ discectomy to TJR was 11.7%. A total of 32 patients (24.8%) experienced return of pain. The median time to return of pain or second surgery was 94.4 months (95% CI = 88.3 to 101.8). No risk factors were statistically significant, although mouth opening improvement of less than 10% was associated with higher risk of poor outcome (P = .77). CONCLUSION: The findings of this study suggest that lower improvement in mouth opening at 1 year following surgery is likely to result in failure of the TMJ discectomy procedure although the result was not statistically significant. This outcome may ultimately necessitate a TJR.

Prosthesis loading after temporomandibular joint replacement surgery: a musculoskeletal modeling study.

One of the most widely reported complications associated with temporomandibular joint (TMJ) prosthetic total joint replacement (TJR) surgery is condylar component screw loosening and instability. The objective of this study was to develop a musculoskeletal model of the human jaw to assess the influence of prosthetic condylar component orientation and screw placement on condylar component loading during mastication. A three-dimensional model of the jaw comprising the maxilla, mandible, masticatory muscles, articular cartilage, and articular disks was developed. Simulations of mastication and a maximum force bite were performed for the natural TMJ and the TMJ after prosthetic TJR surgery, including cases for mastication where the condylar component was rotated anteriorly by 0 deg, 5 deg, 10 deg, and 15 deg. Three clinically significant screw configurations were investigated: a complete, posterior, and minimal-posterior screw (MPS) configuration. Increases in condylar anterior rotation led to an increase in prosthetic condylar component contact stresses and substantial increases in condylar component screw stresses. The use of more screws in condylar fixation reduced screw stress magnitudes and maximum condylar component stresses. Screws placed superiorly experienced higher stresses than those of all other condylar fixation screws. The results of the present study have important implication for the way in which prosthetic components are placed during TMJ prosthetic TJR surgery.

A five-year review of the OMX temporomandibular prosthetic total joint replacement system.

PURPOSE: The aim of this study was to undertake a 5-year review of the OMX temporomandibular prosthetic total joint replacement system (OMX-TMJ). METHODS: Data was collected from patients who had an OMX-TMJ implanted between May 2015 and November 2020 at Epworth-Freemasons and St. Vincent's hospitals in Melbourne, Australia. The data points included patient demographics, primary diagnosis, and clinical outcomes in terms of visual analogue scale (VAS) for pain, maximum inter-incisal mouth opening, and complication events. RESULTS: There were 206 OMX-TMJ devices implanted in 151 patients over the 5-year study period. The vast majority were female patients (n = 137, 90.7%) with a mean age of 44.8 years (range 20-76 years) at the time of surgery. Most patients presented with primary (idiopathic) osteoarthritis (119 joints-57.8%) that failed to respond to conservative measures. Based on a mean follow-up period of 36 months (range 12 months to 73 months), the average mouth opening improved from 30.8 mm pre-surgery to an average of 39.1 mm following OMX-TMJ surgery (p < 0.05). Joint pain (VAS: 0-10) significantly improved from 6.14 pre-surgery to 0.87 following OMX-TMJ surgery (p < 0.001). Twenty-one patients (13.9%) experienced device-related complications which resulted in explantation of 7 (3.4%) OMX-TMJ devices over the 5-year period. CONCLUSION: This study shows that the OMX-TMJ prosthetic total joint replacement system is a reasonably safe, versatile, and reliable implant that effectively improves mandibular opening and reduces joint pain across a broad range of end-stage TMJ disorders.

The atrophic edentulous alveolus. A preliminary study on a new generation of subperiosteal implants.

The aim of this cohort case series is to present a new subperiosteal implant device that uses CAD-CAM technologies together with 3D metal printing capabilities to produce direct bone-anchored dental prosthetic solutions for the management of atrophic edentulous alveolus and jaws. The clinical experience of 21 subperiosteal devices implanted over a 4-year period is presented. The results of this study showed 14 of the 21 cases were successful (66.7%), while 7 cases had complications including exposure of the metal frame (5 cases), mobility of the device (1 case) and 1 case failed for reasons unrelated to the device. Four of the 7 cases were successfully salvaged resulting in an overall success rate of 85.7% (18 /21 cases). This study supports the use of fully customized subperiosteal jaw implants as a simple and reliable alternative for dental rehabilitation of atrophic edentulous cases which would otherwise require bone grafts for conventional fixed dental implant solutions. With more research, the clinical potential for this device is significant as it not only avoids the need for complex and lengthy reconstructive jaw surgery but also allows for the placement of immediate prosthetic teeth at the time of implantation.

Condylar morphology after temporomandibular joint discectomy with interpositional abdominal dermis-fat graft.

PURPOSE: The purpose of this study was to look at the morphology of the condylar head after temporomandibular joint (TMJ) discectomy with interpositional abdominal dermis-fat grafts by using the orthopantograph (OPG) as the basis for investigation. PATIENTS AND METHODS: This retrospective study involved 28 patients (1 male patient) who had undergone TMJ discectomy with an interpositional abdominal dermis-fat graft for the management of severe internal derangement. The age range of the patients was 15 to 68 years, with a mean age of 51.5 years at the time of their TMJ surgery. A total of 33 operated joints were examined, including 5 cases of bilateral TMJ discectomy with dermis-fat grafts. Sixteen joints underwent additional surgery to the condylar head, whereas the remaining 17 joints had no condylar surgery. OPG radiographs were taken from 12 months up to 7 years after surgery, with a mean follow-up period of 32 months. The condyles of the operated joints were visually assessed on OPG and graded according to the condylar morphology scale (CMS), where 0 indicates normal, 1 indicates remodeling, and 2 indicates resorption of the condylar head. RESULTS: By use of the CMS grading system, 9 of 33 joints (27.3%) were found to be normal (CMS = 0). Remodeling (CMS = 1) was found in 14 joints (42.4%) after TMJ discectomy with dermis-fat graft. Radiologic evidence of resorption was present in 10 joints (30.3%) with a CMS score of 2. Remodeling (CMS = 1) was found in 3 joints (17.6%) where no condylar surgery was performed compared with 11 joints (68.8%) where condylar surgery was undertaken. Resorption (CMS = 2) was measured in equal numbers of 5 joints in each group regardless of whether condylar surgery was undertaken (31.2%) or not (29.4%). CONCLUSIONS: The findings of this study suggest that in cases where additional condylar surgery was undertaken, over two thirds of the joints (68.8%) showed evidence of remodeling on postoperative OPGs. The interpositional dermis-fat graft failed to prevent significant condylar changes (CMS = 2) in about one third of patients who underwent TMJ discectomy, with the youngest (mean, 30.2 years) and the oldest (mean, 55.6 years) patients being most susceptible to condylar resorption.

Accuracy of custom temporomandibular joint replacement surgery using a virtual surgical planning protocol.

BACKGROUND: Accurate placement of TMJ implant components may be facilitated by virtual surgical planning (VSP) technologies. The aim of this study was to assess the accuracy of a typical VSP protocol and describe the pattern of surgical error associated with total alloplastic TMJ replacement. METHODS: A retrospective analysis was undertaken on 40 adult patients who were implanted with a fully customised, 3D printed TMJ prosthesis due to end-stage TMJ disease. Planned TMJ implant position based on preoperative CBCT images was compared with final position on postoperative OPGs using a previously validated linear rescaling method. Translational discrepancy was described in the anterior-posterior direction and superior-inferior direction. Rotational discrepancy was described as anterior or posterior. RESULTS: Lin's concordance between preoperative and postoperative position was 0.97, with no significant differences (p > 0.05). The Bland-Altman analysis showed a 95% limit of agreement between planned and final position of - 5.9 to 5.4 mm. Overall, final implant position was more anterior (0.4 mm), superior (0.4 mm) and posteriorly rotated (2.4°) compared with planned position. CONCLUSION: The use of VSP in TMJ replacement surgery results in accurate implant placement with good agreement between planned and final implant position. Discrepancies in planned and final implant position tended to result in the mandibular component of the implant being translated anterior superiorly and rotated posteriorly, with potential implications for the biomechanical performance of the implant and overall device longevity. These results should be used to assist TMJ surgeons pre- and intraoperatively to facilitating accurate implant positioning and optimal surgical rehabilitation.

Accuracy of orthopantomograms in the assessment of implant position following alloplastic temporomandibular joint replacement.

PURPOSE: The aim of this study was to determine the accuracy of orthopantomograms (OPGs) when assessing post-operative temporomandibular joint (TMJ) implant position, compared with cone beam computerized tomography (CBCT). METHODS: A retrospective analysis was undertaken on six adult patients who were implanted with a custom TMJ prosthesis due to end-stage TMJ disease. Post-operative CBCT was compared with post-operative OPGs. Overall magnification of each OPG was calculated and used to linearly rescale each image. Implant position was assessed by measuring the gonion angle and the distance between each surgical screw and the mandibular gonion (SG length). RESULTS: Mean magnification for OPGs was 24.2%. There were no significant differences (p > 0.05) in the gonion angle on OPGs compared with CBCT images. There was a mean decrease in SG lengths of 0.02 mm on OPGs, corresponding to error level of 5.31%. The 95% limits of agreement between OPGs and CBCT images for SG lengths were 1.65 mm and - 1.73 mm. CONCLUSION: This study presents a clinically applicable and accurate first-line radiographic screening tool to assess TMJ implant position. When combined with clinical assessment, OPGs can help reduce the need for further imaging and radiation exposure post-operatively.

The morphology of the human mandible: A computational modelling study.

Cephalometric methods have been used to evaluate morphometric measurements of the mandible and quantify sex-related anatomical features; however, most studies to date employ a limited set of location-specific measurements without considering the entire three-dimensional anatomy of the mandible. The aims of this study were to develop statistical shape models (SSMs) of partially edentulous male and female mandibles to evaluate inter-subject morphological variability and secondly to assess the effectiveness of discrete clinical morphometric measurements in prediction of complete three-dimensional mandible geometry. Computed tomography images of forty partially edentulous female and twenty-five male subjects were obtained, and SSM developed using mesh fitting, rigid body registration and principal component analysis. Analysis of female and male SSMs showed that the variation along their first principal components was size-related. Sex-differentiating pure shape variations were found along the first principal component of size-normalised SSM and were observed to be most prominent in the symphysis and posterior ramus regions of the mandible. Seven morphometric measurements were found to characterise female and male shape prediction optimally. The capability to rapidly generate accurate patient-specific shape-predictive models of the mandible may be useful for implant development and pre-operative planning, particularly in the absence of bony structures following trauma or tumour resection.

Biomet stock temporomandibular joint prosthesis: Long-term outcomes of the use of titanium condyles secured with four or five condylar fixation screws.

PURPOSE: The aim of this study was to determine the long-term outcomes following TMJ replacement using the stock Zimmer-Biomet TMJ device. In particular, investigated whether the titanium condylar implant and number of screws used to fixate it to the mandibular ramus had any impact on outcomes. METHODS: Subjects who underwent surgical implantation of a stock Zimmer-Biomet TMJ prosthesis were identified for this retrospective study. All patients received a titanium condylar component secured with four or five screws and ultra-high molecular weight polyethylene (UHMWPE) fossa with no metal reinforcement. Pre- and postoperative pain scores (VAS) and maximum interincisal opening (MIO) data were collected. Additional data included patient demographics, as well as operative, postoperative and follow-up details. Data were analysed with IBM SPSS 2.0 through the use of paired t-tests, and ANOVA and ANCOVA analysis. RESULTS: 190 subjects were identified. Following exclusions, the remaining study population (n = 60) consisted of 58 females and two males with a mean age of 53.5 years at time of surgery. Preoperative VAS and MIO values were 6.08 (SD = 2.24) and 31.88 mm (SD = 7.38 mm), respectively. 90% of the cohort required four screws to fix the prosthetic condylar component in place. After a median follow up of 5.2 years (95% CI: 4.73-5.62 years), with a range of 2-9 years, the VAS was 0.91 (SD = 1.89; p < 0.001) and the MIO was 34.8 mm (SD = X; p = 0.015). Only one device failed over the 9-year study period. CONCLUSION: The results of this study demonstrate good VAS and MIO outcomes following the implantation of a stock Zimmer-Biomet TMJ device. Additionally, good long-term outcomes were obtained with a titanium condylar component, fixed to the mandibular ramus with only four or five screws, and a UHMWPE fossa with no metal reinforcement.

A new three-dimensional, print-on-demand temporomandibular prosthetic total joint replacement system: Preliminary outcomes.

PURPOSE: The aim of this study is to present the preliminary clinical data on the OMX Temporomandibular Joint (TMJ) Prosthetic total joint replacement system. MATERIALS AND METHODS: A prospective, cohort, clinical study was undertaken of consecutive adult patients with Category 5 end-stage joint disease who were implanted with the OMX TMJ prosthesis between May 2015 and April 2017. A total of 50 devices were implanted in 38 patients, with 12 patients receiving bilateral prosthetic joints. There were 31 females and 7 males in this cohort, who ranged in age from 20 to 66 years, with a mean of 43.8 years (±14.0 years). Ten of the 50 prosthetic joints (20%) were fully customized, while the remaining were patient matched using virtual planning software. RESULTS: Based on a mean follow-up period of 15.3 months (range 12-24 months) following the TMJ total joint replacement, preliminary results suggest the OMX TMJ prosthesis has made a positive impact on clinical outcomes, with a mean 74.4% reduction in joint pain levels and significant improvements (p < 0.05) in jaw function as measured by the visual analogue scales for mouth opening (30.8%), diet (77.1%), and function (59.2%). No device failures were reported during the study period. CONCLUSION: This study suggests that the print-on-demand OMX TMJ prosthesis, designed for rapid delivery of both patient-matched and fully customize devices, represents a safe, reliable and versatile implantable joint replacement system for the treatment of category 5 end-stage TMJ disease.

Design and clinical outcome of a novel 3D-printed prosthetic joint replacement for the human temporomandibular joint.

BACKGROUND: Stock prosthetic temporomandibular joint replacements come in limited sizes, and do not always encompass the joint anatomy that presents clinically. The aims of this study were twofold. Firstly, to design a personalized prosthetic total joint replacement for the treatment of a patient's end-stage temporomandibular joint osteoarthritis, to implant the prosthesis into the patient, and assess clinical outcome 12-months post-operatively; and secondly, to evaluate the influence of changes in prosthetic condyle geometry on implant load response during mastication. METHODS: A 48-year-old female patient with Grade-5 osteoarthritis to the left temporomandibular joint was recruited, and a prosthesis developed to match the native temporomandibular joint anatomy. The prosthesis was 3D printed, sterilized and implanted into the patient, and pain and function measured 12-months post-operatively. The prosthesis load response during a chewing-bite and maximum-force bite was evaluated using a personalized multi-body musculoskeletal model. Simulations were performed after perturbing condyle thickness, neck length and head sphericity. FINDINGS: Increases in prosthetic condyle neck length malaligned the mandible and perturbed temporomandibular joint force. Changes in condylar component thickness greatly influenced fixation screw stress response, while a more eccentric condylar head increased prosthetic joint-contact loading. Post-operatively, the prosthetic temporomandibular joint surgery reduced patient pain from 7/10 to 1/10 on a visual analog scale, and increased intercisal opening distance from 22 mm to 38 mm. INTERPRETATION: This study demonstrates effectiveness of a personalized prosthesis that may ultimately be adapted to treat a wide-range of end-stage temporomandibular joint conditions, and highlights sensitivity of prosthesis load response to changes in condylar geometry.

A personalized 3D-printed prosthetic joint replacement for the human temporomandibular joint: From implant design to implantation.

Personalized prosthetic joint replacements have important applications in cases of complex bone and joint conditions where the shape and size of off-the-shelf components may not be adequate. The objective of this study was to design, test and fabricate a personalized 3D-printed prosthesis for a patient requiring total joint replacement surgery of the temporomandibular joint (TMJ). The new 'Melbourne' prosthetic TMJ design featured a condylar component sized specifically to the patient and fixation screw positions that avoid potential intra-operative damage to the mandibular nerve. The Melbourne prosthetic TMJ was developed for a 58-year-old female recipient with end-stage osteoarthritis of the TMJ. The load response of the prosthesis during chewing and a maximum-force bite was quantified using a personalized musculoskeletal model of the patient's masticatory system developed using medical images. The simulations were then repeated after implantation of the Biomet Microfixation prosthetic TMJ, an established stock device. The maximum condylar stresses, screw stress and mandibular stress at the screw-bone interface were lower in the Melbourne prosthetic TMJ (259.6MPa, 312.9MPa and 198.4MPa, respectively) than those in the Biomet Microfixation device (284.0MPa, 416.0MPa and 262.2MPa, respectively) during the maximum-force bite, with similar trends also observed during the chewing bite. After trialing surgical placement and evaluating prosthetic TMJ stability using cadaveric specimens, the prosthesis was fabricated using 3D printing, sterilized, and implanted into the female recipient. Six months post-operatively, the prosthesis recipient had a normal jaw opening distance (40.0 mm), with no complications identified. The new design features and immediate load response of the Melbourne prosthetic TMJ suggests that it may provide improved clinical and biomechanical joint function compared to a commonly used stock device, and reduce risk of intra-operative nerve damage during placement. The framework presented may be useful for designing and testing customized devices for the treatment of debilitating bone and joint conditions.

Oral focal mucinosis: report of 15 cases and review of the literature.

AIMS: To describe 15 cases of oral focal mucinosis (OFM) and compare these to previously reported cases. METHODS: Cases diagnosed as OFM in the period 1981-2003-were reviewed. Clinical information provided at the time of submission of each specimen was retrieved and supplemented by additional clinical details provided by the respective clinician at the time of compilation of this paper. The literature was reviewed. RESULTS: OFM presented as an innocuous soft tissue swelling that may be either pedunculated or sessile. The gingiva was confirmed as the most common site for OFM, with a predominance of females affected. Microscopically, OFM is characterised by an area of myxoid tissue which is usually well-defined. The lesion is periodic acid-Schiff (PAS)-negative and alcian blue-positive, with pre-digestion with hyaluronidase preventing the alcian blue staining. As the differential diagnosis includes myxoid neural lesions, S100 staining is important in establishing the diagnosis, with cases of OFM being negative. CONCLUSIONS: The cause of OFM remains unknown. The cases presented in this paper bring OFM to the attention of anatomical pathologists when considering the differential diagnosis of myxoid lesions of the oral cavity.

A case of recurrence of synovial chondromatosis of the temporomandibular joint.

This is a case study of a patient with recurrent synovial chondromatosis. It shows some relevant images. It also provides possibilities for why this patient may have had a recurrence and how this was managed.

The effects of unilateral discectomy and condylectomy on the contralateral intact rabbit craniomandibular joint.

PURPOSE: The purpose of this study is to determine the effects of unilateral discectomy and condylectomy on the contralateral intact rabbit craniomandibular joint at the histological level. MATERIALS AND METHODS: Fifteen New Zealand white rabbits were used and divided into 3 groups. Three rabbits were used as controls (group A) whereby a sham operation was undertaken without breaching the joint space of the left craniomandibular joint (CMJ). In 6 rabbits (group B), the articular disc of the left CMJ was excised. The remaining 6 rabbits (group C) underwent surgical resection of the left condylar head at the level of the condylar neck. The resultant surgical defects were left to heal without any grafting and the incisions were closed with resorbable sutures. The rabbits were sacrificed at 4, 12, and 20 weeks after surgery and both the left and right CMJs were histologically prepared and examined under light microscopy. RESULTS: In the 4-week group, unilateral discectomy and condylectomy resulted in remodeling of the unoperated right CMJ with histological evidence of flattening of the condylar head which was more pronounced in the condylectomy group. In the 12-week group, the remodeling process in the unoperated right CMJ was less pronounced with most of the activity concentrated in the medial pole, especially in the condylectomy group. The 20-week group showed no obvious signs of remodeling in the unoperated right CMJs in both the discectomy and condylectomy groups. Evidence of condylar regeneration was seen in all groups in the left CMJ which had undergone condylectomy. No evidence of disc regeneration in the operated left CMJ was seen in any of the discectomy groups. CONCLUSIONS: Unilateral discectomy and condylectomy have an early adverse effect on the structural integrity of the contralateral unoperated CMJ which appears to be short lived. The early remodeling effects on the unoperated right CMJ appear to be reversible as the operated left CMJ heals.

The use of dermis grafts after discectomy for internal derangement of the temporomandibular joint.

PURPOSE: The aim of this retrospective clinical study was to review the outcomes of temporomandibular joint (TMJ) discectomy with autogenous dermis used as an immediate interpositional graft in patients with advanced internal derangement of the TMJ. PATIENTS AND METHODS: Thirty-five joints in 29 patients who presented with advanced internal derangement of the TMJ with degenerate and irreparable discs were identified and included in the study. All patients underwent a TMJ arthrotomy (including 6 bilateral TMJ procedures) that involved removal of the disc (discectomy) and immediate replacement with autogenous dermis graft. Patients were followed up for an average of 2 years. RESULTS: There was a mean +6.7-mm improvement in maximum interincisal opening, a 66% mean improvement in pain ( P < .001), and a 42% mean improvement in function ( P < .05) after TMJ discectomy with immediate dermis graft replacement. After an average follow-up period of 24.6 months, patients reported good to excellent improvement in their TMJ symptoms in 30 of the 35 joints (85.7%). All patients showed radiologic evidence of varying degrees of condylar remodeling at 6 months or later after surgery. Of the 7 patients who had magnetic resonance imaging (MRI) performed at 6 months or later after surgery, none showed any radiologic evidence of the dermis graft. No clinical evidence of joint sounds such as crepitus was found in 33 of the 35 operated joints. CONCLUSIONS: This study found that TMJ discectomy can have a significant positive effect on the management of patients with advanced internal derangement of the TMJ who fail to respond to less invasive measures such as splint therapy and TMJ arthroscopy. However, the only advantage of dermis grafts over no grafts seems to be that it can minimize or eliminate joint sounds such as crepitus in the discectomized TMJ. In this study, the dermis grafts did not prevent regressive remodeling of the mandibular condyles.

A review of 56 cases of chronic closed lock treated with temporomandibular joint arthroscopy.

PURPOSE: The aims of this prospective clinical study were to look at the features that constitute chronic closed lock of the temporomandibular joint (TMJ) and to assess the effectiveness of TMJ arthroscopic lavage and lysis in the management of this condition. PATIENTS AND MATERIALS: Sixty joints in 56 patients who presented with mandibular hypomobility suggestive of chronic closed lock were prospectively examined and treated with TMJ arthroscopic lavage and lysis during a 3-year period from 1996 to 1999. RESULTS: Eighty-seven percent (49 of 56) of patients were found to have chronic closed lock of the TMJ. The most common intra-articular findings were fibrillation (76%) and synovitis (54%). TMJ arthroscopic lavage and lysis were found to be effective in the management of chronic closed lock in 84% (47 of 56) of patients, with an average 66% reduction in pain levels and a mean improvement of 9.8 mm in interincisal mouth opening up to 6 weeks after the procedure. CONCLUSIONS: Chronic mandibular hypomobility is a clinical sign that is often but not always caused by chronic closed lock of the TMJ. The intra-articular findings of this study suggest that cartilage degradation and synovial inflammation are important components of chronic closed lock of the TMJ that respond well to arthroscopic lavage. Patients with mandibular hypomobility not caused by closed lock of the TMJ (ie, myofascial pain and dysfunction, osteoarthrosis, and others) are less likely to derive benefit from arthroscopic lavage and lysis, so other treatment methods should be considered.

Management of fractured mandibles without the use of intermaxillary wire fixation.

PURPOSE: The aims of this retrospective clinical study were to compare the management of unilateral angle fractures of the mandible using the traditional approach of open reduction with internal fixation (ORIF) and intermaxillary wire fixation (IMF) with the technique of ORIF without IMF. PATIENTS AND MATERIALS: Thirty-one patients who presented with isolated unilateral angle fractures of the mandible were randomly divided into 2 treatment groups. Both groups underwent open reduction with a single upper border miniplate and screw fixation (ORIF). Eleven of the 31 patients in the study had IMF to aid in the fracture reduction, and 20 patients had no IMF so the fracture was reduced by hand manipulation. Records of operating and discharge times, postreduction radiographs, and occlusal outcomes were examined and tabulated. RESULTS: Patients in both treatment groups were closely matched in terms of age, gender, site of injury (ie, isolated angle fracture of mandible), and incidence of teeth in the fracture line. The mean operating time for traditional ORIF with IMF of angle fractures of the mandible was 98.5 minutes, and these patients were discharged an average of 1.82 days after surgery. The mean operating time for ORIF of angle fractures of the mandible without the use of IMF was 40.2 minutes, and these patients were discharged an average of 1.35 days after surgery. Postoperative outcomes in terms of the postreduction anatomic alignment of the fractures and functional occlusion at 6 weeks were similar in the 2 treatment groups. CONCLUSIONS: We found that the use of IMF for the management of angle fractures of the mandible is unnecessary provided there is a skilled assistant present to help manually reduce the fracture site for plating. Discarding the use of IMF not only helps improve patient comfort but also reduces the operating time by up to 1 hour and accelerates discharge times by up to half a day.