Mandible fracture repair: Specific indications for newer techniques

Mandible fracture repair is commonly undertaken by otolaryngologists. Although the essential principles of reduction and immobilization are undisputed, the approach used to obtain these goals varies considerably. We performed a critical evaluation of all mandible fractures treated at the Santa Clara Valley Medical Center by the otolaryngology service between January 1988 and February 1992, with the purpose of better defining the indications for plate fixation and for the use of more traditional techniques. One hundred eighty-three fractures in 112 patients were evaluable. Thirty-six (32.1%) of these patients had at least one plate placed (group A); 39 (34.8%) underwent an open procedure, with interosseous wire fixation (group B); and 37 (33.0%) were treated with closed techniques (group C). The severity of fracture (indexed by comminution, presence of infection, teeth in the fracture line, interval to repair, and whether the fracture was open or closed) was similar in plated and nonplated mandibles. Mean (± standard deviation) operative times for the three groups were 3.2 ± 1.6 hours for group A, 3.0 ± 0.9 hours for group B, and 1.4 ± 0.5 hours for group C. The number of follow-up visits required was not statistically different (group A, 5.6 ± 3.8 visits; group B, 5.2 ± 2.5 visits; and group C, 5.3 ± 2.0 visits). The overall incidence of major complications was 14.3% (16 of 112), including 11 of 36 (30.6%) in group A, 4 of 39 (10.3%) in group B, and 1 of 37 (2.7%) in group C. The approximate cost of one compression plate with four screws is $550, compared with $12 for wire suitable for fixation (24 gauge). We conclude that plates are more expensive than wire fixation, are associated with a higher incidence of major complications, and should be reserved for situations in which traditional techniques are not feasible.