Intraoral Open Reduction for Mandibular Angle Fracture Using an Angulated Screwdriver System

Abstract

Objectives: The optimal surgical technique to treat a mandibular angle fracture remains a subject of debate. The authors introduce a new surgical technique, involving the use of an angulated screwdriver to treat mandibular angle fractures. This renders the intraoral approach both feasible and reliable, with fewer complications than with an external approach. Methods: Between January 2012 and March 2016, the authors used an angulated screwdriver to treat 24 patients with mandibular angle fractures via transoral open reduction and rigid fixation. Patients were divided into 2 groups, a favorable and an unfavorable group, based on the direction of displacement. The average operative times and clinical outcomes including occlusion status, temporomandibular joint function, temporomandibular joint pain, wound infection, nonunion, and plate or screw loosening or exposure, were evaluated. Results: Of the 24 patients, 14 were classified as favorable and 10 as unfavorable. The mean follow-up period was 6 months and no major or minor complication was encountered during either hospitalization or follow-up. The mean operative time was 70 minutes (45-105 minutes) in the favorable group and 102 minutes (55-140 minutes) in the unfavorable group (P < 0.05). Conclusions: Any mandibular angle fracture, irrespective of the direction of displacement, can be treated using an angulated screwdriver via a transoral approach. The operative field is adequate and no complications are encountered.