Comparative Efficacy of Lag Screw and 3D Plate in Fixation of Symphysis and Parasymphysis Fractures of Mandible- A Prospective Interventional Study

Abstract

Introduction: Mandible is well known for its unique anatomy and is the second most prevalent facial bone to fracture followed by fracture of nasal bone. Fracture of the mandible causes deranged occlusion, trismus, mobility of fractured fragments, pain, oedema and results in functional as well as aesthetic deformity. Therefore, the fixation of mandibular fracture plays a major role in rehabilitation of the jaw. The goal of management is to restore the premorbid occlusion and function. Aim: To compare the efficacy of osteosynthesis of mandibular anterior fracture by two different methods of open reduction, i.e, titanium lag screw and titanium 3 Dimensional miniplate. Materials and Methods: This prospective interventional study was conducted in the Department of Oral and Maxillofacial Surgery of Navodaya Dental College and Hospital, Raichur, Karanataka, India from January 2019 to February 2021. A total of 10 patients with symphysis and parasymphysis fracture were included in this study and were divided into two groups, five patients for Group A (osteosynthesis by titanium lag screw fixation) and five patients for Group B (osteosynthesis by titanium 3D plate fixation) and were treated accordingly. Parameters such as occlusion, mobility of fracture segments, interincisal mouth opening, facial oedema, pain, approximation of the lower border and lingual cortex and hardware failure were assessed clinically and radiographically, and the patients were followed up for three months. Recorded data was compared and was analysed using Statistical Package for Social Sciences (SPSS) version 26.0. Independent sample t-test was used for comparison between the groups. Chi-square test and Fisher exact test were used for qualitative data and p-value was set at 0.05. Results: There was no significant difference noted between two groups when assessed radiographically on 1st day, one and a half month later and after three months. There was no significant difference noted in occlusion as well as in pain when measured postoperatively between the groups, but lag screw fixation provided normal immediate postoperative occlusion in all the cases. A significant improvement in the postoperative mouth opening was noted with lag screw group when compared to 3 Dplates with a p-value of 0.015 when measured after a week postoperatively. When oedema was measured in transverse direction, it was statistically significantly less in 3D plates group postoperatively first day with a p-value of 0.028 and after a week with a p-value of 0.044. Oedema when measured in vertical direction revealed no statistically significant difference between two groups. Conclusion: In the present study a significant improvement in the mouth opening as well as in terms of reduction in pain and oedema was noted with lag screw osteosynthesis group. Immediate postoperative occlusion was better with titanium lag screw osteosynthesis when compared to titanium 3D plates. Based on our study we conclude that both the osteosynthesis materials provide good interfragmentary stability in the management of anterior mandibular fractures and can be used satisfactorily for the fixation of mandibular fractures.

Keywords

• anterior mandibular fractures
• lingual cortex
• mandibular lower border approximation
• occlusion
• osteosynthesis