The Use of Microplates for Internal Fixation of Comminuted Mandibular Fractures

BACKGROUNDAlthough clinical trials have successfully applied microplates for the internal fixation of single or double isolated mandibular fractures, the use of microplate systems in comminuted mandibular fractures is not widely accepted. This study aimed to evaluate the use of microplates for internal fixation of comminuted mandible fractures and to discuss their applicability. METHODSFourteen patients with comminuted mandibular fractures (10 at a single region, 3 at 2 regions, and 1 at 4 regions) were treated with open reduction and internal fixation using 0.5- or 0.6-mm-thick titanium microplates and 1.0-, 1.2-, or 1.3-mm monocortical microscrews. Three-level fixation at the lower border, upper border (as interdental wiring), and middle of the mandible was performed. Maxillomandibular fixation was applied only when premature occlusal contact was observed after fracture fixation. RESULTSDuring the follow-up period (3–55 months), all fractures showed favorable and complete bone healing. Six patients experienced minor complications, including minimal malocclusion (n = 5) and a localized infection (n = 1). Most of these complications were managed with conservative treatment. No major complications that required further orthodontic treatment or reoperation occurred. CONCLUSIONSThese results suggest that 3-level fixation using microplates is appropriate for the reconstruction of comminuted mandibular fractures without bony defects. The small size and malleability of these devices facilitate accurate anatomical reduction for complete contact of the comminuted bony segments by multiple fixation. Furthermore, microplates allow for preservation of sufficient periosteal blood supply and restoration of premorbid occlusion (by occlusal self-adjustment) while providing sufficient stability.