Traumatic Genial Tubercle Fractures of the Mandible: Airway Concerns and Invasive Management-A Report of 2 Cases.

Traumatic genial tubercle fracture of the mandible is a rare event that may cause airway compromise owing to loss of the support to the base of the tongue. Over the last 70 years, only 7 known cases of traumatic genial tubercle fractures have been reported. We detail the surgical management of 2 traumatically induced genial tubercle fractures that involved varying levels of airway compromise. These 2 cases add to the limited body of knowledge of the surgical management of this rare and potentially fatal mandible fracture pattern.

Neurosensory Recovery Following Mental Nerve Skeletonization in Intraoral Open Reduction and Internal Fixation of Mandible Fractures.

PURPOSE: The purpose of this study was to evaluate neurosensory recovery after mental nerve skeletonization in open reduction and internal fixation (ORIF) of mandible fractures. METHODS: This was a prospective nonrandomized observation study of adult subjects treated at a Level I trauma center between April 1, 2016 and December 31, 2019, with mental nerve skeletonization for ORIF of mandible fractures. Age, sex, and mandibular injury severity score (MISS), and functional sensory recovery (FSR) and subjective neurosensory recovery of skeletonized mental nerve were recorded at preoperative and regularly scheduled follow-up appointments. Uninomial and multinomial logistic regressions were conducted with a significance level of < 0.05. RESULTS: Twenty-six subjects (all male) completed all the postoperative protocol requirements and were included in this study. All subjects had a loss of FSR (S0) and subjective neurosensation immediately after surgery. Half of the subjects achieved FSR (S3) and subjective neurosensory recovery (VAS < 4) an average of 42 days after surgery. All subjects improved FSR (S4) by 57 days and subjective neurosensory recovery by 90 days after surgery. These were independent of MISS but had decreased recovery time with increased age. No incidences of mental nerve neuropathic pain during the trial period were found. CONCLUSIONS: FSR and subjective neurosensory recovery from mental nerve skeletonization in intraoral ORIF of mandible fractures was achieved in all subjects by the end of this study. Neurosensory recovery was independent of MISS but decreased with increased age. Initial inverse correlations between objective and subjective neurosensory assessments were insignificant at study completion. No incidences of neuropathic pain were identified during the time of this study. Mental nerve skeletonization in ORIF of mandible fracture may be performed with an anticipated return of functional and subjective neurosensory recovery within 3 months of surgery.

Rare Oral Presentation of a Mycophenolate Mofetil-Related Other Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder (MMF-OIA-LPD) Lesion: A Case Report and Literature Review.

Oral manifestations of side effects of medications, such as methotrexate (MTX) for management of rheumatoid arthritis (RA) and mycophenolate mofetil (MMF) for solid organ transplant (SOT), are very rare. The known side effects include entities called other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) due to immunosuppression caused by these medications. While there has been an increased incidence of oral cavity LPD reported in the literature associated with MTX, oral presentations that involve MMF are rare. This case report will detail a 74-year-old man with scleroderma treated with MMF who developed Epstein-Barr virus + polymorphic B-cell lymphoproliferative disorder in the right maxillary gingiva presenting as osteonecrosis of the jaw (ONJ). His oral presentation was successfully treated with a combination of surgery and MMF dosage reduction with an oral presentation free of disease at 6 months follow-up. This is the first known case report of an oral manifestation of MMF-related OIIA-LPD.

Edentulism Is Associated With More Severe Obstructive Sleep Apnea Syndrome.

PURPOSE: The relationship between edentulism and the severity of obstructive sleep apnea syndrome (OSAS) is not well established. The purpose of the present study was to evaluate the relationship of edentulism on the severity of OSAS compared with equally at-risk dentate subjects. PATIENTS AND METHODS: We performed a retrospective matched cohort study of edentulous and dentate subjects with OSAS matched by age, gender, and body mass index (BMI). The primary predictor variable was dentate status (dentate vs edentulous) and the primary outcome variable was the OSAS severity measured using apnea hypopnea index (AHI). The secondary outcome variables were the Epworth sleepiness scale (ESS) score and nadir oxygen level. Inferential, univariate, and multivariate statistical analyses were completed. RESULTS: A total of 26 subjects (13 edentulous and 13 dentate) were included in the present study. The edentulous subjects had more severe OSAS compared with the equally at-risk dentate subjects, with statistically significant differences between the 2 groups for AHI (47 ± 25 vs 23 ± 11; P = .0044) and ESS score (16 ± 4.2 vs 11 ± 5.2; P = .0094). A significant multivariate effect for OSAS was only found for the covariates of gender (female vs male; P = .016) and edentulism status (yes vs no; P = .01), with no significant interaction between them (P = .24). CONCLUSIONS: Within the limits of the present study, edentulous subjects, compared with dentate subjects, and controlling for age, gender, and BMI, had more severe OSAS, as evidenced by the significantly increased AHI and ESS. Male gender and edentulism are significant risk factors for more severe OSAS compared with equally at-risk dentate patients.

Maxillomandibular Advancement for Obstructive Sleep Apnea Is Associated With Very Long-Term Overall Sleep-Related Quality-of-Life Improvement.

PURPOSE: We sought to evaluate the effect of maxillomandibular advancement (MMA) on long-term subjective quality of life (QOL) in obstructive sleep apnea (OSA). PATIENTS AND METHODS: This was a retrospective cohort analysis of long-term postoperative QOL issues in patients who underwent MMA for polysomnogram-confirmed severe OSA (apnea-hypopnea index > 30). The inclusion criteria included a history of MMA in the treatment of OSA, willingness to complete the Ottawa Sleep Apnea Questionnaire (OSA-Q) survey, and minimum of 5-year follow-up. The OSA-Q was used to evaluate sleep quality, daytime function, physical health, mental and emotional health, and sexual health. The independent variable was time of follow-up, and the dependent variables were the responses to the OSA-Q. Data collection was completed, and statistical analyses were performed with the 1-sample Wilcoxon signed rank test with a median score of 3 (no change) to evaluate for significant changes in the categories. P < .05 was considered statistically significant. RESULTS: A total of 27 of 51 eligible patients (53% response rate) responded to the questionnaire (15 men and 12 women). The average postoperative age was 59.1 ± 11.7 years, with an average follow-up period of 12.7 ± 3.8 years. Statistically significant long-term QOL improvements from MMA for OSA were found in overall QOL (mode, 4; P < .05) and in the categories of personal satisfaction (mode, 5; P < .01), sleep quality (mode, 4; P < .01), and functional outcomes (mode, 4; P < .05). CONCLUSIONS: MMA for OSA provided significant improvement in overall patient QOL as well as personal satisfaction, sleep quality, and functional outcomes at very long-term follow-up at an average of more than 12 years after surgery. MMA for OSA produces significant very long-term subjective QOL improvement.

Oral Functional Behavior and Neurosensation After Adult Maxillomandibular Advancement for Obstructive Sleep Apnea in the Long-Term.

PURPOSE: We evaluated and correlated the long-term subjective perioral neurosensory deficit intensity and oral functional behavior difficulty after maxillomandibular advancement (MMA) for adult obstructive sleep apnea (OSA). PATIENTS AND METHODS: We implemented a long-term retrospective cohort study of adult subjects who had undergone MMA for OSA, with subjective assessments using 7-point visual analog scales. Adult subjects who had undergone MMA for OSA with a minimum of 5 years of follow-up data available who had agreed to participate were included in the present study. The 1-sample Wilcoxon signed rank test and Spearman correlation coefficients were used to evaluate the data. Statistical significance was set at the P < .05 level. RESULTS: Of the 51 eligible subjects, 27 (53% response rate) were included in the present study. The mean age preoperatively was 59.8 years, with a mean follow-up of 12.7 years. Most subjects (85%) had, overall, reported the long-term subjective perioral neurosensory deficit intensity to be none to very mild (mode, 0; mean, 2.20; P < .05) and oral functional behavior to have none to very mild difficulty (mode, 0; mean, 1.6; P < .05). Statistically significant moderate to strong positive correlations between the subjective assessments of oral functional behavior and perioral neurosensory deficit intensity were found for chewing (r = 0.74), kissing (r = 0.50), eating (r = 0.80), speaking (r = 0.81), and drooling (r = 0.67). CONCLUSIONS: Within the limitations of the present study, more than 12 years after MMA for severe OSA, most subjects (85%) had minimal to no subjective perioral neurosensory deficits and very minimal to no difficulty in the subjective assessment of oral functional behavior. Strong positive correlations between the subjective decreased perioral neurosensory deficit intensity and decreased oral function behavior difficulty suggest that the return of perioral neurosensation might contribute to the return of oral functional behavior.

Maxillomandibular Advancement for Obstructive Sleep Apnea Produces Long-Term Horizontal Advancement of the Maxilla and Mandible.

PURPOSE: Because limited data have been reported, the purpose of the present study was to evaluate the long-term craniofacial cephalometric skeletal changes associated with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA). MATERIALS AND METHODS: We performed a retrospective cephalometric cohort study of craniofacial skeletal changes in patients who had undergone MMA for OSA. The primary predictor and outcome variables were time and the change in SNB over time, respectively. Digitized cephalometric radiographs were analyzed by an independent third-party cloud-based tracing software for 6 skeletal landmarks at 3 points-preoperatively, within 1 month postoperatively, and at the last follow-up evaluation. Post hoc stratification bidimensional analyses by gender and preoperative age and body mass index (BMI) were performed. Clinically significant results were determined as a greater than 2% change from baseline. Univariate and bivariate statistics were computed, and the statistical significance level was set at P < .05. RESULTS: Thirty consecutive subjects with an even gender distribution were included in the present study. The average preoperative age, apnea hypopnea index, and BMI were 43.7 years, 59.8, and 39.3 kg/m2. The average follow-up duration was 10.7 years (range, 5.6 to 18.8). Statistically and clinically significant long-term postoperative changes were found only for SNA (+4.9° or +6.0%; P < .001) and SNB (+3.8° or +4.9%; P < .001). Stratification by gender and median preoperative age and BMI did not find any statistically or clinically significant results. CONCLUSIONS: Within the limitations of the present study, MMA for OSA produced statistically and clinically significant long-term cephalometric skeletal horizontal angular advancement of the maxilla and mandible of 6 and 4.9%, respectively, independently of gender, age, or BMI.

Adalimumab-Related Dental Implant Infection.

We present an adalimumab-related dental implant surgical-site infection. A 55-year-old patient with a history of twice-weekly adalimumab subcutaneous injections for ulcerative colitis underwent mandibular extractions and placement of 5 immediate dental implants. She experienced intraoral purulent drainage from all 5 dental implant sites with submental and submandibular space infections 2 weeks after surgery. Treatment consisted of extraoral incision and drainage of involved fascial spaces, removal of all mandibular dental implants, and debridement of necrotic mandibular bone. She went on to heal uneventfully. In individuals taking adalimumab, severe infection with loss of implants and bone may develop.

Maxillomandibular Advancement for Severe Obstructive Sleep Apnea Is a Highly Skeletally Stable Long-Term Procedure.

PURPOSE: To evaluate long-term clinically significant cephalometric skeletal stability with maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA). MATERIALS AND METHODS: We performed a retrospective cohort analysis of long-term clinically significant skeletal stability in patients who underwent MMA for OSA. The primary predictor and outcome variables were the occurrence of and time to loss of clinically significant skeletal stability, respectively, at sella-nasion-B point (SNB). The inclusion criteria included severe OSA (apnea-hypopnea index > 30), MMA, diagnostic preoperative and postoperative lateral cephalometric radiographs, and a minimum of 5 years of follow-up. Digitized cephalometric radiographs were analyzed at 3 time points: preoperatively, postoperatively, and at last follow-up. Statistical analyses included Kaplan-Meier time-to-loss of clinical stability analysis, the log-rank test, and the Cox proportional hazards model for hazard ratio determination for the influence of the following independent variables on loss of clinical stability: gender, age at the time of surgery, time to follow-up, and amount of surgical movement. Post hoc stratification for bone grafting was completed. Statistical significance was set at the P < .05 level. RESULTS: Thirty consecutive patients with an even gender distribution and average follow-up period of 10.7 years were included in this study. Preoperatively, the average age was 43.7 years; apnea-hypopnea index, 59.8; and body mass index, 39.3. Half of the cohort had clinically significant loss of skeletal stability at sella-nasion-A point (SNA), SNB, and A point-nasion-B point (ANB) approximately 13 years after surgery, with no statistically significant difference between SNA, SNB, and ANB curves (χ2 = 0.12) independent of the independent variables at SNB (χ2 = 1.9), SNA (χ2 = 1.3), or ANB (χ2 = 1.3). The average hazard ratio ranged from 0.89 to 1.02. CONCLUSIONS: Within the limitations of this study, MMA in the treatment of severe OSA is a highly skeletally stable long-term procedure independent of gender, age at the time of surgery, time to follow-up, and amount of surgical movement.

Maxillomandibular Advancement Improves Multiple Health-Related and Functional Outcomes in Patients With Obstructive Sleep Apnea: A Multicenter Study.

PURPOSE: To comprehensively determine the effectiveness and safety of maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA). PATIENTS AND METHODS: We designed and implemented a prospective multicenter cohort study to evaluate OSA patients who underwent MMA. The primary outcome measures and associated instruments included sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (QOL) (Functional Outcomes of Sleep Questionnaire [FOSQ]), sleep-disordered breathing (apnea-hypopnea index), cardiovascular risk (office blood pressure and levels of high-sensitivity C-reactive protein), and neurocognitive performance (psychomotor vigilance testing [PVT]). The outcomes were measured preoperatively and approximately 6 months postoperatively. Other variables were grouped into the following categories: demographic and pre-MMA use of continuous positive airway pressure. Descriptive and bivariate statistics were computed. RESULTS: The sample was composed of 30 adult patients (63% men; mean age, 45.9 ± 9.8 years). The median length of follow-up was 6.7 months (range, 4.3 to 12.7 months). The ESS score decreased from a mean of 13.3 to 4.9 (P < .001). The FOSQ score increased from a mean of 14.1 to 18.3 (P < .001). The apnea-hypopnea index decreased from a mean of 39.6 to 7.9 events per hour (P < .001). Mean diastolic blood pressure decreased from 83 to 79.7 mm Hg (P = .025). PVT response times improved after MMA (P = .04). Few treatment-related adverse events occurred, which had minimal impact on the QOL. Additional improvements in sleepiness (mean ESS score change, -7.6; P < .001), QOL (mean FOSQ score change, 3.9; P < .001), and PVT (mean change, 0.5; P = .004) occurred after MMA for patients using continuous positive airway pressure before surgery. CONCLUSIONS: MMA is a highly effective and safe treatment for OSA, which predictably leads to significant improvements in sleepiness, QOL, sleep-disordered breathing, and neurocognitive performance, as well as a reduction in cardiovascular risk (blood pressure).

Proceedings of the American Association of Oral and Maxillofacial Surgeon's 2017 Clinical and Scientific Innovations in Oral and Maxillofacial Surgery (CSIOMS).

The sixth biennial Clinical and Scientific Innovations in Oral and Maxillofacial Surgery, formerly the Research Summit, of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois from April 28 to 30, 2017. The goal of the symposium is to provide a forum for the latest clinical and scientific advances to be brought to the specialty. It also nurtures collaboration and the development of relationships between oral and maxillofacial surgeons and researchers to bridge the gap between clinical and basic science. The goal is to improve the care of oral and maxillofacial surgical patients through the advancement of translational and clinical research.

Interpersonal Violence Is Associated With Increased Severity of Geriatric Facial Trauma.

PURPOSE: The geriatric population is rapidly increasing in number with increased demand on health care resources including those spent on the treatment of maxillofacial trauma. The purpose of this analysis was to investigate the independent and cumulative associations between potential risk factors (age, gender, mechanism of injury, drug use, and alcohol use) for and the severity of geriatric facial trauma. METHODS: This was a cross-sectional analysis of secondary data of geriatric (individuals aged ≥65 years) facial trauma using the Allegheny General Hospital Trauma Registry database. Data were collected for diagnosis codes that reflected facial trauma (International Classification of Diseases, Ninth Revision codes 802.0 to 802.9, 800.1 to 801.9, and 803.0 to 804.9) and specific mechanisms of injury (E810 to E819, motor vehicle traffic accidents; E880 to E888, accidental falls; and E960 to E969, injury purposely inflicted by other persons). The Facial Injury Severity Scale (FISS) is a validated measurement that was used to determine the severity of the facial trauma and calculated through analysis of the abstracted data obtained from the trauma registry and patient records. Pearson correlations, 2-way independent t test, 1-way analysis of variance, and multiple linear regression were used to test hypotheses for independent and cumulative associations between the risk factors for and the severity of geriatric facial trauma. Statistical significance was set at the P < .05 level. RESULTS: The sample was composed of 229 patients with a mean age of 72.3 ± 4.5 years. A statistically significant association between mechanism of injury and the severity of geriatric facial trauma (P = .019) was found. Specifically, interpersonal violence (assault) was associated with the greatest facial trauma severity (FISS score, 4.2) when compared with motor vehicle collisions (FISS score, 2.2; P = .011) and falls (FISS score, 2.4; P = .016). CONCLUSIONS: Interpersonal violence (assault) is associated with increased severity of geriatric facial trauma compared with other risk factors.

Proceedings of the American Association of Oral and Maxillofacial Surgeons 2015 Research Summit.

The Fifth Biennial Research Summit of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois on May 6 and 7, 2015. The goal of the symposium is to provide a forum for the most recent clinical and scientific advances to be brought to the specialty. The proceedings of the events of that summit are presented in this report.

Early major medical complications after surgical management of obstructive sleep apnea: a retrospective cohort analysis and case series.

PURPOSE: The purpose of this study was to determine the frequency and relative risk (RR) of early postoperative major medical complications after surgery for the management of obstructive sleep apnea. PATIENTS AND METHODS: This was a retrospective cohort analysis of patients who had undergone surgery for the treatment of polysomnogram-confirmed obstructive sleep apnea at 2 hospitals in Pittsburgh, PA, between 1992 and 2013. Early postoperative major medical complications were defined as either a life-threatening complication requiring intensive care unit intervention or death within the immediate hospital course. Standard demographic data, apnea-hypopnea index, Epworth Sleepiness Score, minimum nocturnal oxygen saturation, and body mass index were collected. The 2-tailed independent t test, Fisher exact test, and RR with 95% confidence interval were used. RESULTS: A total of 267 consecutive patients who underwent surgery for obstructive sleep apnea and met the inclusion criteria were included in this study. A total of 6 patients (6 of 267, 2.2%) had early major medical postoperative complications. When stratified by surgical group (intrapharyngeal vs extrapharyngeal), there were 162 intrapharyngeal patients with 2 complications (1.2%) and 105 extrapharyngeal patients with 4 complications (3.8%). We found no statistically significant difference in frequency (2 of 162 intrapharyngeal patients [1.2%] vs 4 of 105 extrapharyngeal patients [3.8%], P = .17) or RR (3.1; 95% confidence interval, 0.58 to 16.55; P = .1885) between the groups. There were statistically significant differences for mean age, apnea-hypopnea index, Epworth Sleepiness Score, minimum nocturnal oxygen saturation, and body mass index between the surgical groups. CONCLUSIONS: The overall frequency of early major medical postoperative complications in upper airway surgery for obstructive sleep apnea is low, with no statistically significant difference in frequency and RR between intrapharyngeal and extrapharyngeal surgery. There may, however, be a clinically significance difference in RR possibly because of associated differences in risk factors between the groups.

Pre-emptive analgesia with pregabalin and celecoxib decreases postsurgical pain following maxillomandibular advancement surgery: a randomized controlled clinical trial.

PURPOSE: The purpose of this study was to determine the efficacy of pre-emptive analgesia with pregabalin and celecoxib on narcotic consumption and perceived pain in adult patients undergoing maxillomandibular advancement surgery for obstructive sleep apnea. PATIENTS AND METHODS: This was a prospective, randomized, double-blinded, placebo-controlled study of adult patients undergoing elective maxillomandibular advancement surgery for obstructive sleep apnea. The groups received a masked 1-time preoperative oral dose of pregabalin 150 mg and celecoxib 400 mg (experimental group) or lactose powder 2 g (placebo group). In the postoperative period, pain management consisted of intravenous morphine patient-controlled analgesia and oral oxycodone 5 mg and acetaminophen 325 mg. Patients completed a daily pain and narcotic log. Statistical significance between group means was determined by the 2-tailed independent t test. RESULTS: There were statistically significant differences between the pregabalin plus celecoxib and placebo groups in average intravenous morphine consumption per 4-hour interval (6.0 ± 5.9 vs 9.3 ± 7.9 mg; P < .05), mean daily narcotic pill consumption (2.9 ± 2.9 vs 6.8 ± 1.8 pills; P < .05), and mean daily visual analog scale scores (4.3 ± 3.5 vs 5.5 ± 5.0; P < .05). CONCLUSION: Within the limitations of this study, a 1-time preoperative oral dose of pregabalin and celecoxib before adult maxillomandibular advancement surgery for obstructive sleep apnea decreased mean intravenous morphine consumption, mean daily narcotic pill consumption, and mean patient perceived pain.

Proceedings from the 2013 American Association of Oral and Maxillofacial Surgeons Research Summit.

The American Association of Oral and Maxillofacial Surgeons, the Oral and Maxillofacial Surgery Foundation, and the International Association of Oral and Maxillofacial Surgeons sponsored the fifth research summit, which convened on May 2 and 3 in Rosemont, Illinois. The Research Summits are convened biennially to facilitate the discussion and collaboration of oral and maxillofacial surgeons with clinical and basic science researchers in fields affecting the specialty. The goal is to advance the field of oral and maxillofacial surgery through exposure and education in topics that ultimately benefit the oral and maxillofacial surgical patient. This edition of the research summit included the topics of robotic surgery and antiresorptive-related osteonecrosis of the jaws (ARONJ). Most importantly, this research summit saw the development of research interest groups (RIGs) in the fields of anesthesia, maxillofacial oncology and reconstructive surgery, obstructive sleep apnea and orthognathic surgery, temporomandibular joint surgery, and trauma. These RIGs developed specific research goals with a plan to continue working on potential projects at the AAOMS Clinical Trials Course on May 7 to 9, 2013 at the University of Michigan in Ann Arbor. The summit program was developed by the AAOMS Committee on Research Planning and Technology Assessment. The charge of the committee is to encourage and promote research within the specialty and to encourage interdisciplinary collaboration. The research summit serves as a platform for oral and maxillofacial surgeons to lead the goal of advancement of research relevant to the specialty. This article provides an overview of the presentations that were made in the sessions on robotic surgery and ARONJ. The research summit keynote address and two additional presentations on patient registries are summarized and updates from the RIGs that were formed at the 2013 research summit are highlighted.

Management of bilateral mandibular angle fractures with combined rigid and nonrigid fixation.

PURPOSE: There is very limited evaluation of the management of fractures of the bilateral mandibular angles. The purpose of this study was to determine the incidence, etiology, and outcomes of bilateral mandibular angle fractures treated with the transoral application of rigid fixation on one side and nonrigid fixation on the other. PATIENTS AND METHODS: Patients 18 years of age or older with isolated, noncomminuted fractures through the right and left mandibular angles and treated solely with 2.0-mm miniplates through intraoral incisions (and trocar) were collected from 2 sources. Patients treated at Allegheny General Hospital (Pittsburgh, PA) were prospectively collected from August 1, 2006 through December 31, 2012. Patients treated at Parkland Memorial Hospital (Dallas, TX) and University Hospital in San Antonio (San Antonio, TX) from January 1, 1992 through December 31, 2012 were retrospectively added to the sample. Data collected included age, gender, race, cause of fracture, presence or absence of mandibular third molars, occlusal relation documented at last visit, and occurrence and management of complications. Standard descriptive statistics were used and the relation between initial displacement and adequacy of reduction was evaluated with the Fisher exact test. RESULTS: Of 1,565 patients with 2,195 mandibular fractures, 33 (2.1%) presented with bilateral mandibular angle fractures. The average age of the cohort was 25.2 ± 1.8 years (range, 18 to 48 yr). The mechanisms of injury were assaults (30 of 33, 90.9%), motor vehicle collisions (2 of 33, 6%), and a fall (1 of 33, 3%). Twenty-seven patients (81.8%) had at least 1 mandibular third molar at the time of injury. Three patients (9.1%) had minor postoperative wound problems, with 1 incident (3.0%) of malocclusion. There was no statistically significant relation between the initial displacement and the adequacy of reduction. CONCLUSIONS: Bilateral mandibular angle fractures are a rare traumatic event that may be successfully treated with transoral rigid and nonrigid fixation with 2.0-mm miniplates.