• Users Online: 215
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
SHORT COMMUNICATION
Year : 2021  |  Volume : 8  |  Issue : 4  |  Page : 325-326

Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note


Department Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Submission28-Jul-2021
Date of Decision01-Sep-2021
Date of Acceptance07-Sep-2021
Date of Web Publication20-Dec-2021

Correspondence Address:
Uday Kiran Uppada
Department oral and Maxillofacial Surgery, Sri Sai College of dental surgery, Vikarabad, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_131_21

Rights and Permissions
  Abstract 


Numerous studies have evaluated the efficacy, viability, and reliability of various fixation devices for the management of anterior mandibular fractures. Even though these fixation devices have shown identical and satisfactory results in the long term, they have some distinct disadvantages. Hence, an attempt is made to propose a novel technique of using the oblique L plates as a viable alternative fixation device for parasymphysis fracture management.

Keywords: Fixation device, oblique L plate, parasymphysis fracture


How to cite this article:
Uppada UK, Sinha R. Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note. J Dent Res Rev 2021;8:325-6

How to cite this URL:
Uppada UK, Sinha R. Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note. J Dent Res Rev [serial online] 2021 [cited 2022 Jan 18];8:325-6. Available from: https://www.jdrr.org/text.asp?2021/8/4/325/332919




  Introduction Top


Fractures involving the anatomical region confined between the two mental foramen represent a substantial amount (14%–30%) of mandibular injuries.[1],[2] The presence of dense cortical bone in addition to the absence of vital structures permits a safe and predictable region for ORIF.[3] Conversely, due to eccentric forces from the muscular attachments, it can be considered as the most complex anatomic area biomechanically with literature suggesting that fracture segments can undergo nonunion when proper immobilization is not achieved.[4] The use of oblique L plates is a novel alternative fixation device for parasymphysis fracture management.


  Technique Top


This technique is advocated for simple oblique unilateral parasymphysis fractures [Figure 1]. Following a circumvestibular incision and a subperiosteal dissection, the anterior mandible is exposed up to the lower border a little beyond the foramina on the affected side to visualize the fracture line [Figure 2]. Two genial retractors are used to protect the tissues of the chin at the lower edge and a 10 mm steel malleable retractor is used to protect the mental nerve. The fracture segments are manipulated and reduced. intermaxillary fixation is achieved using E chain to the preoperatively placed upper and lower arch bars. Based on Champy's lines of osteosynthesis, two 2.0 Oblique L plates are place one at the lower border and one 5 mm above the lower border plate using 2.0 mm × 8 mm screws [Figure 3]. Wound toilet done hemostasis achieved and wound closed. [Figure 4] shows the postoperative radiograph.
Figure 1: Preoperative radiograph showing an oblique parasymphysis fracture running close to the mental foramen

Click here to view
Figure 2: Intraoperative picture showing an oblique parasymphysis fracture running close to the mental foramen

Click here to view
Figure 3: Intraoperative picture showing the oblique L plates as a viable alternative fixation device for parasymphysis fracture management

Click here to view
Figure 4: Postoperative radiograph showing the oblique L plates as a viable alternative fixation device for parasymphysis fracture management

Click here to view



  Discussion Top


Ideal fixation device should provide adequate functional stability and minimize interfragmentary movement.[5] Few studies have evaluated the efficacy, viability, and reliability of miniplates, three-dimensional (3D) plates, Lag Screws, and Herbert Screws in the management of anterior mandibular fractures.[1] Though these fixation devices have shown identical and satisfactory results in the long term, they have some distinct disadvantages. Hence, the final choice is governed by the fracture pattern, specific indication, and experience of the operator.

Champy advocates the placement of two 4 hole with gap miniplates for the management of parasymphysis fractures to counter the forces at the tension and compression zones. However, in clinical scenarios where a linear oblique fracture line runs just anterior to the mental foramen, a 4 hole with gap plate cannot be placed due to the unavailability of space for the distal screw at the superior border. Neither a 3D plate nor a lag screw can be placed to avoid damage to the mental nerve. Damage to the mental nerve could be the only potential complication in the management of these fractures and hence avoiding damage to the mental nerve make the surgical intervention devoid of complications.

In such clinical scenarios, the oblique L plate serves as a viable option. Second, the 120° angle of the oblique L plate enables the placement of the vertical arm of the plate along the fracture line with both the screws lying close to the fracture line aiding in enhanced stability. This reduces the surgical access required for the fixation and the operating time, thereby reducing the patient discomfort in the immediate postoperative period. Limitation includes its fixed shape and size hindering its use in comminuted fractures. However, it is a safe and versatile device to treat simple oblique unilateral and bilateral parasymphysis fractures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Uppada UK, Sinha R, Tiwari P, Vennela S, Khan TA. Evaluation of efficacy of various fixation devices in management of anterior mandibular fractures: A prospective clinical study. J Dent Res Rev 2019;6:72-6.  Back to cited text no. 1
    
2.
Uppada UK, Sinha R, Susmitha M, Praseedha B, Ravi Kiran B. Mandibular fracture patterns in a rural setup: A 7-year retrospective study. J Maxillofac Oral Surg 2021.[In Press]  Back to cited text no. 2
    
3.
Rai S, Rattan V. Current perspective in the management of mandibular fractures. J Postgrad Med Edu Res 2014;48:63-7.  Back to cited text no. 3
    
4.
Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: An analysis of contributing factors. J Oral Maxillofac Surg 2000;58:746-52.  Back to cited text no. 4
    
5.
Ellis E 3rd. Is lag screw fixation superior to plate fixation to treat fractures of the mandibular symphysis? J Oral Maxillofac Surg 2012;70:875-82.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Technique
Discussion
References
Article Figures

 Article Access Statistics
    Viewed56    
    Printed0    
    Emailed0    
    PDF Downloaded8    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]