Hardware removal rates for mandibular angle fractures: comparing the 8-hole strut and champy plates.

OBJECTIVE: To compare the removal rates of 8-hole angle strut plate and Champy line plate in repairing mandibular angle fractures. METHODS: Retrospective chart review at a tertiary care academic center of adults who were at least 18 years old with at least 1 mandibular angle fracture of a traumatic origin who underwent open reduction and internal fixation by using single monocortical miniplate fixation in Champy line or by using 8-hole angle strut plate via transbuccal approach. The outcome measures were hardware removal rates and the reason for removal of the hardware. RESULTS: One hundred four patients with a total of 106 angle fractures met the inclusion criteria for this study. Seventy-three angle fractures were treated with the 8-hole strut, and 33 angle fractures were treated with the Champy line plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8-hole strut plate group and 18.2% in the Champy line group (P = 0.133). Loose hardware was determined to be the cause of plate removal in 2 (2.7%) of the 8-hole strut plate group compared with all 6 (18.2%) of the Champy group (P = 0.005). CONCLUSIONS: Overall, removal rates between Champy line and 8-hole strut plates are not different in treating mandibular angle fractures, although the 8-hole strut plate has a lower rate of loose hardware-related plate removal compared with the Champy line plate.

The effects of molar tooth involvement in mandibular angle fractures treated with rigid fixation.

OBJECTIVE: To determine whether the presence of a tooth in the line of mandibular angle fracture increases the incidence of complications and whether removing these teeth has an effect on complication rates. DESIGN: Case series with chart review. SUBJECTS AND METHODS: The analysis was performed on 83 patients who underwent open reduction and internal fixation for mandibular angle fractures. Lower molar teeth involved in the fracture line were extracted if they were loose, fractured, or grossly infected or prevented satisfactory reduction. Data regarding demographics, involvement of a molar tooth, management of the involved tooth, and postoperative outcome were analyzed. Statistical analysis was performed by using likelihood ratio chi(2) and logistic regression. RESULTS: The revision surgery in fractures with molar tooth involvement was 28.9 percent, compared to 12.9 percent when no tooth was involved (P = 0.084). When a tooth was involved in the fracture, the revision surgery rate was 25 percent when it was removed and 30% when it was preserved (P = 0.734). CONCLUSION: Postoperative complications, especially the revision surgery rates, may not increase by involvement of lower molar teeth in the fracture line and selective removal of these teeth by using commonly accepted guidelines may not decrease complication rates in angle fractures.

Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures.

OBJECTIVE: To report the occlusal outcomes of manually provided temporary intraoperative maxillomandibular fixation (MMMF) for the open repair of selected mandibular fractures. STUDY DESIGN/SUBJECTS AND METHODS: A retrospective chart review of the patients who underwent open reduction and internal fixation of mandibular fractures with MMMF was performed. RESULTS: Twenty-six patients underwent open reduction and internal fixation with MMMF. Postoperative data were available for only 16 patients who kept their follow-up appointments. With the exception of one patient who experienced minimal cross-bite in the right molar region, all of the patients had their original normocclusion. CONCLUSION: Preliminary results of MMMF suggest that satisfactory postoperative occlusal outcomes may be obtained without the use of wire-based maxillomandibular fixation methods in selected mandibular fractures.

Outcomes of paramedian forehead and nasolabial interpolation flaps in nasal reconstruction.

OBJECTIVE: To determine the factors contributing to failure of interpolation flaps in nasal reconstruction. DESIGN: Retrospective medical chart review. SETTING: Tertiary care academic center. PATIENTS: A total of 107 patients with nasal defects needing reconstruction, performed at the University of Arkansas for Medical Sciences, Little Rock. INTERVENTION: Patients underwent nasal reconstruction with 2-stage paramedian forehead or nasolabial flaps (PMFF and NLF, respectively) from 2002 to 2011. Defect thickness, location, flap type, use of cartilage grafts, and comorbidities, including diabetes mellitus, peripheral vascular or coronary artery disease, and smoking habits, were recorded. MAIN OUTCOME MEASURES: Full success, partial failure, or full failure of the respective flap. RESULTS: Eighty-two of the patients (77%) underwent 2-stage PMFF repair and 25 (23%) underwent 2-stage NLF repair. Fifty-eight defects (54%) were full thickness, in which 46 repairs used PMFF and 12 used NLF for reconstruction. The overall failure rate was 6%. Five PMFF failed (6%); 3 of these were used for full-thickness repairs. There was only 1 NLF failure (4%), which was also performed for the repair of a full-thickness defect. Use of cartilage in the reconstruction did not affect failure rates of the different soft tissue flaps. No single comorbidity was noted to have a statistically significant effect on failure rates, although 83% of failures were observed in smokers. CONCLUSIONS: The overall success rate of interpolation flaps in nasal reconstruction was 94.4%. Defect thickness, use of a cartilage graft, type of flap used, and presence of comorbidities did not affect outcome. Although the comparison was not statistically significant (P  = .21), flap failures were more commonly observed in smokers.