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Original Investigation
May 23, 2019

Evaluation of a Vertical Box Plating Technique for Mandibular Body Fractures and Retrospective Analysis of Patient Outcomes

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • 2Albert Einstein College of Medicine, Bronx, New York
  • 3Department of Epidemiology & Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • 4Department of Oral and Maxillofacial Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
  • 5Department of Otolaryngology–Head and Neck Surgery, University Hospital, Rutgers New Jersey Medical School, Newark
  • 6Department of Otorhinolaryngology–Head and Neck Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
JAMA Facial Plast Surg. Published online May 23, 2019. doi:10.1001/jamafacial.2019.0057
Key Points

Question  Does a vertically oriented box plate increase resistance to torsional forces and reduce complications in the treatment of mandibular body fractures?

Findings  In this comparative study and retrospective medical record review of 84 patients, it was demonstrated that box plating for mandibular body fractures was associated with reduced neurosensory complications and operative time compared with traditional rigid internal fixation plating techniques.

Meaning  Vertically oriented box plates may be a superior treatment option for the open reduction and internal fixation of mandibular body fractures.

Abstract

Importance  Despite advancements, treatment of mandibular body fractures is plagued by complications. Evaluation of a new plating system is needed with the goal of reducing complication rates.

Objectives  To evaluate the biomechanical behavior of a vertically oriented box plate vs traditional rigid internal fixation plating techniques for mandibular body fractures and to test if placement of the 3-dimensional plate oriented parallel to the fracture line provides improved rigidity and greater resistance to torsion, resulting in improved outcomes.

Design, Setting, and Participants  A mandible fracture model with synthetic replicas was used to compare resistance to torsional forces of different plating configurations. Additionally, a retrospective comparative review of the medical records of 84 patients with mandibular body fractures treated from 2005 to 2018 at Jacobi Medical Center, a level-1 trauma hospital in Bronx, New York, was completed.

Exposures  Patients sustained a mandibular body fracture and were treated with open reduction and internal fixation using metal plating.

Main Outcomes and Measures  In the comparative study of biomechanical behavior of various plating configurations, maximum torque sustained prior to deformation and loss of alignment was measured. Medical records were reviewed for surgical approach, plating techniques, operative time, length of admission, and rate of complications, including malocclusion, nonunion, infection, neurosensory disturbance, and wound dehiscence.

Results  Of the 84 patients included in the retrospective review, 76 (91%) were men, and the mean (SD) age was 29.7 (12.0) years. During biomechanical analysis, the vertical box plate provided greater stability and 150% of the resistance against torsional forces when compared with traditional linear plating. In the retrospective review, analysis showed vertical plating was associated with a lower incidence of postoperative neurosensory disturbance (25 [38%] patients treated with vertical plating vs 0 patients treated with box plating; P = .002) and a lower risk of any complication (41 [62%] vs 6 [33%], respectively; relative risk, 0.54; 95% CI, 0.27-1.06; P = .03). Vertical plating was associated with reduced operative time (134 minutes vs 70 minutes, respectively; P < .001).

Conclusions and Relevance  This investigation suggests that vertical box plating is associated with a lower incidence of postoperative complications and reduced operative time compared with traditional plating techniques. The comparative biomechanical component demonstrated that the vertical box plate offered equal or greater resistance to torsional forces. Further studies of greater power and level of evidence are needed to more robustly demonstrate these benefits.

Level of Evidence  3.

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