Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note

Uday Kiran Uppada; Ramen Sinha

doi:10.4103/jdrr.jdrr_131_21

SHORT COMMUNICATION

Year : 2021 | Volume : 8 | Issue : 4 | Page : 325-326

Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note

Uday Kiran Uppada, Ramen Sinha
Department Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India

Date of Submission	28-Jul-2021
Date of Decision	01-Sep-2021
Date of Acceptance	07-Sep-2021
Date of Web Publication	20-Dec-2021

Correspondence Address:
Uday Kiran Uppada
Department oral and Maxillofacial Surgery, Sri Sai College of dental surgery, Vikarabad, Telangana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdrr.jdrr_131_21

Abstract

Numerous studies have evaluated the efficacy, viability, and reliability of various fixation devices for the management of anterior mandibular fractures. Even though these fixation devices have shown identical and satisfactory results in the long term, they have some distinct disadvantages. Hence, an attempt is made to propose a novel technique of using the oblique L plates as a viable alternative fixation device for parasymphysis fracture management.

Keywords: Fixation device, oblique L plate, parasymphysis fracture

How to cite this article:
Uppada UK, Sinha R. Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note. J Dent Res Rev 2021;8:325-6

How to cite this URL:
Uppada UK, Sinha R. Oblique l plates as a viable alternative fixation device for parasymphysis fracture management: A technical note. J Dent Res Rev [serial online] 2021 [cited 2023 Mar 29];8:325-6. Available from: https://www.jdrr.org/text.asp?2021/8/4/325/332919

Introduction

Fractures involving the anatomical region confined between the two mental foramen represent a substantial amount (14%–30%) of mandibular injuries.^[1],[2] The presence of dense cortical bone in addition to the absence of vital structures permits a safe and predictable region for ORIF.^[3] Conversely, due to eccentric forces from the muscular attachments, it can be considered as the most complex anatomic area biomechanically with literature suggesting that fracture segments can undergo nonunion when proper immobilization is not achieved.^[4] The use of oblique L plates is a novel alternative fixation device for parasymphysis fracture management.

Technique

This technique is advocated for simple oblique unilateral parasymphysis fractures [Figure 1]. Following a circumvestibular incision and a subperiosteal dissection, the anterior mandible is exposed up to the lower border a little beyond the foramina on the affected side to visualize the fracture line [Figure 2]. Two genial retractors are used to protect the tissues of the chin at the lower edge and a 10 mm steel malleable retractor is used to protect the mental nerve. The fracture segments are manipulated and reduced. intermaxillary fixation is achieved using E chain to the preoperatively placed upper and lower arch bars. Based on Champy's lines of osteosynthesis, two 2.0 Oblique L plates are place one at the lower border and one 5 mm above the lower border plate using 2.0 mm × 8 mm screws [Figure 3]. Wound toilet done hemostasis achieved and wound closed. [Figure 4] shows the postoperative radiograph.

Figure 1: Preoperative radiograph showing an oblique parasymphysis fracture running close to the mental foramen

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Figure 2: Intraoperative picture showing an oblique parasymphysis fracture running close to the mental foramen

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Figure 3: Intraoperative picture showing the oblique L plates as a viable alternative fixation device for parasymphysis fracture management

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Figure 4: Postoperative radiograph showing the oblique L plates as a viable alternative fixation device for parasymphysis fracture management

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Discussion

Ideal fixation device should provide adequate functional stability and minimize interfragmentary movement.^[5] Few studies have evaluated the efficacy, viability, and reliability of miniplates, three-dimensional (3D) plates, Lag Screws, and Herbert Screws in the management of anterior mandibular fractures.^[1] Though these fixation devices have shown identical and satisfactory results in the long term, they have some distinct disadvantages. Hence, the final choice is governed by the fracture pattern, specific indication, and experience of the operator.

Champy advocates the placement of two 4 hole with gap miniplates for the management of parasymphysis fractures to counter the forces at the tension and compression zones. However, in clinical scenarios where a linear oblique fracture line runs just anterior to the mental foramen, a 4 hole with gap plate cannot be placed due to the unavailability of space for the distal screw at the superior border. Neither a 3D plate nor a lag screw can be placed to avoid damage to the mental nerve. Damage to the mental nerve could be the only potential complication in the management of these fractures and hence avoiding damage to the mental nerve make the surgical intervention devoid of complications.

In such clinical scenarios, the oblique L plate serves as a viable option. Second, the 120° angle of the oblique L plate enables the placement of the vertical arm of the plate along the fracture line with both the screws lying close to the fracture line aiding in enhanced stability. This reduces the surgical access required for the fixation and the operating time, thereby reducing the patient discomfort in the immediate postoperative period. Limitation includes its fixed shape and size hindering its use in comminuted fractures. However, it is a safe and versatile device to treat simple oblique unilateral and bilateral parasymphysis fractures.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Uppada UK, Sinha R, Tiwari P, Vennela S, Khan TA. Evaluation of efficacy of various fixation devices in management of anterior mandibular fractures: A prospective clinical study. J Dent Res Rev 2019;6:72-6.
2.	Uppada UK, Sinha R, Susmitha M, Praseedha B, Ravi Kiran B. Mandibular fracture patterns in a rural setup: A 7-year retrospective study. J Maxillofac Oral Surg 2021.[In Press]
3.	Rai S, Rattan V. Current perspective in the management of mandibular fractures. J Postgrad Med Edu Res 2014;48:63-7.
4.	Mathog RH, Toma V, Clayman L, Wolf S. Nonunion of the mandible: An analysis of contributing factors. J Oral Maxillofac Surg 2000;58:746-52.
5.	Ellis E 3^rd. Is lag screw fixation superior to plate fixation to treat fractures of the mandibular symphysis? J Oral Maxillofac Surg 2012;70:875-82.