Treatment of atrophic mandibular fractures based on the degree of atrophy--experience with different plating systems: a retrospective study.

PURPOSE: The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems.

PATIENTS AND

METHODS

Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach.

RESULTS

In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively.

CONCLUSIONS

Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height.