Tecnica de Champy

YIJOM-2725; No of Pages 7
Int. J. Oral Maxillofac. Surg. 2013; xxx: xxxxxx http://dx.doi.org/10.1016/j.ijom.2013.07.001, available online at http://www.sciencedirect.com
Clinical Paper Trauma
A comparative analysis of the efcacy of cortical screws as lag screws and miniplates for internal xation of mandibular symphyseal region fractures: a randomized prospective study
A. Agnihotri, S. Prabhu, S. Thomas: A comparative analysis of the efcacy of cortical screws as lag screws and miniplates for internal xation of mandibular symphyseal region fractures: a randomized prospective study. Int. J. Oral Maxillofac. Surg. 2013; xxx: xxxxxx. # 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. Abstract. The management of facial trauma is one of the most rewarding and demanding aspects of oral and maxillofacial surgery. Being the most prominent mobile bone of the facial skeleton, mandible fracture occurs more frequently than any other fracture. In this study, open reduction and internal xation was performed for isolated mandibular symphyseal region fractures using cortical screws (as lag screws) in 40 patients and using miniplates in 40 patients. Clinical and radiological evaluations were made at 6 months postoperatively. Primary stability of fracture segments, postoperative swelling, restricted lip mobility, infection, wound dehiscence, implant removal, and mal-union or non-union of fracture segments was evaluated. Primary stability was achieved in 100% of cases treated with cortical screws, whereas for patients treated with miniplates, 97.5% attained primary stability, while one case (2.5%) showed persistent clinical mobility. Postoperative complications were noted in 13 (16.25%) of the total 80 patients. The duration of postoperative swelling was less in patients treated with cortical screws compared to patients treated with miniplates. It is concluded that cortical screw xation is an effective procedure for the treatment of symphyseal region fractures, but the procedure is somewhat technically sensitive.
A. Agnihotri, S. Prabhu, S. Thomas

Department of Oral and Maxillofacial Surgery, Peoples College of Dental Sciences and Research Centre, Bhanpur, Bhopal, Madhya Pradesh, India
Key words: lag screws; miniplates; symphyseal region fractures. Accepted for publication 1 July 2013
Traumatic injuries to the maxillofacial skeleton occur due to a variety of causes, such as road trafc accidents, sports injuries, interpersonal violence, gunshot
0901-5027/000001+07 $36.00/0
injuries, etc. For the surgeon who operates on patients presenting with facial trauma, fractures of the symphyseal region of the mandible are a common entity. The
mandible is the second most commonly fractured bone of the maxillofacial skeleton because of its position and prominence. Although there is wide variance in the
# 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Agnihotri A, et al. A comparative analysis of the efcacy of cortical screws as lag screws and miniplates for internal xation of. . ., Int J Oral Maxillofac Surg (2013), http://dx.doi.org/10.1016/j.ijom.2013.07.001
Agnihotri et al.
previous improper treatment and comminuted fractures were excluded.
Surgical procedure
reported percentage of fracture of the anterior mandible, aggregate analysis places this at approximately 17% of all mandibular fractures.1,2 Internal xation of mandibular fractures with miniplates (in conformity with the tension band principle) was rst introduced by Michelet in 1973 and was later modied by Champy et al.3 The lag screw technique in maxillofacial surgery was rst advocated by Brons and Boering4 in 1970 and was later reintroduced by Niederdellmann et al.,5 who stated that at least two screws were necessary to prevent rotational movement of the fragments in oblique fractures of the mandible. In North America, its use for the management of anterior mandible fractures became popular through the work of Ellis and Ghali.6 However, this modality has not gained popularity in India for unexplained reasons, resulting in the non-availability of essential hardware for lag screw xation. The purpose of this study was to compare the outcomes of treatment using either cortical screws (used as lag screws) or miniplates, in patients who had sustained a fracture in the mandibular symphyseal region. The objectives included comparative assessments of their ability to provide adequate primary stability, the need for any supplemental maxillomandibular xation (MMF), the time required to complete the procedures, occlusal derangement, and the incidence of postoperative complications such as wound dehiscence, wound discharge, infection, postsurgical swelling, and any functional limitation in lower lip function as evidenced by speech articulation.
Patients and methods
Local anaesthesia (lidocaine 2% with 1:200,000 epinephrine) was preferred whenever feasible. Patients with poor verbal communication, extreme anxiety, or who were otherwise uncooperative in nature were elected to be treated under general anaesthesia. Access to the fracture site was generally sought through an intraoral approach except where a coexisting laceration was present over the chin region. The oral cavity was prepared by thorough irrigation with antiseptic povidoneiodine 1% solution. Exposure of the fracture site was obtained by a standard layered dissection through mucosa, mentalis muscle, and the periosteum. After debridement of the fracture line, MMF was applied using arch bars ligated to the dental arches. Fragments were reduced and held in apposition with a reduction forceps (bone clamp) and conrmed visually by verifying the alignment of the buccal cortex and inferior border.
For group A patients, 2.0-mm miniplates were contoured, applied, and xed using monocortical screws, in accordance with Champys principles, along the line of osteosynthesis. A minimum of two screws were placed on either side of the fracture line for each of the bone plates applied (Fig. 1a). For group B patients, two 2.5-mm diameter cortical screws were placed using the lag screw principle, with care taken to ensure co-axial preparation of the gliding and pilot holes, adequate enlargement of the gliding hole using 3mm diameter drills to prevent thread engagement proximally, and preparation of the countersink (Fig. 2a). Upon completion of the procedure, MMF was released and occlusion veried. The incision was then closed in layers and a pressure dressing was applied to the chin. All patients received antibiotics and analgesics postoperatively for a period of 5 days.
Follow-up
The patients were followed up clinically after 24 h, on days 3 and 7 postoperatively, and then at weekly intervals for 6 weeks and at monthly intervals for 6 months.
This study was conducted on 80 patients with clinical and radiological evidence of fracture of the symphyseal region of the mandible. Patients were assigned to one of two groups: group A (n = 40) were treated by open reduction and internal xation using 2.0-mm miniplates, and group B (n = 40) were treated by open reduction and internal xation using 2.5-mm cortical screws applied using the lag screw principle. Cases with discrete, isolated symphyseal/parasymphyseal fractures requiring primary denitive treatment, without any evidence of infection, were included in the study. Cases with uncontrolled systemic disease, multiple mandibular fractures, mal-union/non-union of fracture segments, and those requiring revision of
Fig. 1. Group A: (a) Intraoperative miniplate xation; (b) postoperative orthopantomograph at 6-month follow-up.
Comparison of cortical screws and miniplates
Functional restriction of lip movement was assessed by asking the patient to pronounce words with signicant bilabial consonants, such as bubble, mumble, etc.; difculty in articulation was scored as present or absent by all three authors. In the case of conict, the majority score determined the decision. Observations were recorded on a standardized proforma. Results were evaluated by statistical analysis to meet the aforementioned objectives of the study. Data were analyzed by analysis of variance (ANOVA), paired t-test, and x2 test of signicance between two proportions, with statistical signicance set at P < 0.05.
Results
Fig. 2. Group B: (a) Intraoperative cortical screw placement; (b) postoperative orthopantomograph at 6-month follow-up.
They were followed up radiographically with intraoral peri-apical (IOPA) radiographs, mandibular anterior occlusal radiographs, and orthopantomographs in the immediate postoperative period and after 1 month, 3 months, and 6 months (Figs. 1b and 2b).
Assessment of parameters
Essential demographic data and the time between injury and execution of open reduction and internal xation were recorded for all of the patients. The time required for completion of the procedure, from the incision to the end of closure, was monitored by an independent observer for each patient. Postoperatively, a blinded observer evaluated the patients for stability of xation by manually manipulating the mandible and checking for inter-fragment mobility at the fracture site; any movement was considered indicative of inadequate stability of internal xation. These cases were considered for supplemental MMF.
Other parameters assessed were occlusion, wound dehiscence, wound discharge, swelling, duration and presence of functional restriction of lip movements, malunion, brous union, or non-union, and infection. An attempt was made to determine statistically if any correlation existed between complications such as infection and the time delay between injury and denitive treatment. Postoperative oedema was evaluated by measuring the distance from the mucocutaneous junction on the lower lip to the upper border of the thyroid cartilage in the vertical axis and the distance between the two gonial angles across the chin in the transverse axis using a 2-0 silk thread, transferring the measurements to a ruler. The average of these two postoperative measurements on postoperative day 3 was subtracted from the average preoperative values to determine the magnitude of swelling. Duration was determined as the time required for a return to the average preoperative measurements, as determined on the designated days of follow-up.
The mean age of patients in this study was 33.7 years (range 1870 years), and the male to female ratio was 10:1. The mean time interval between injury and treatment for group A was 9.4 days (range 418 days) and for group B was 9.5 days (range 125 days). For the majority of patients in group A, the time needed to complete the procedure ranged between 90 and 120 min, while for most in group B the time required ranged from 120 to 180 min. The difference in time required for completion of the procedures between the two groups was found to be statistically signicant (Table 1). In group A, the duration of postoperative swelling varied from a minimum of 7 days in 24 patients (60%) to a maximum of 30 days in four patients (10%), with a mean duration of 11.2 days. In group B, swelling was present for a minimum of 4 days in 10 patients (25%) to a maximum of 14 days in ve patients (12.5%), with a mean duration of 7.1 days (Table 2). The difference in duration of postoperative swelling between the two groups was statistically signicant. The mean magnitude of swelling in group B was 4.49 mm (range 45 mm), whereas in group A the mean was 4.36 mm (range 35.9 mm). The difference in magnitude of swelling as assessed by paired t-test was not statistically signicant (Tables 3 and 4). Postoperatively, all 80 patients showed restricted lip mobility that affected articulation of speech. In group A, restricted lip mobility was present for a minimum of 4 days in 24 patients (60%) and to a maximum of 10 days in four patients (10%), with a mean of 5.8 days. In group B, restricted lip mobility was present for a minimum of 4 days in 35 patients (87.5%) and ve patients showed restrictions for 10
Agnihotri et al.
Table 1. Comparison of time required for procedures. Time required for completion of procedure (min) Group A (n = 40)* Procedure under local anaesthesia 30 and <60 60 and <90 90 and <120 120 and <150 150 and <180 180 and <210
* y
Group B (n = 40)y Procedure under general anaesthesia 0 0 20 0 0 4 (0%) (0%) (50%) (0%) (0%) (10%) Procedure under local anaesthesia 5 5 0 15 15 0 (12.5%) (12.5%) (0%) (37.5%) (37.5%) (0%) Procedure under general anaesthesia 0 0 0 0 0 0 (0%) (0%) (0%) (0%) (0%) (0%)
x2 value
P-value
0 8 4 0 4 0
(0%) (20%) (10%) (0%) (10.0%) (0%)
220.30
<0.0001, signicant
Group A were treated by open reduction and internal xation using 2.0-mm miniplates. Group B were treated by open reduction and internal xation using 2.5-mm cortical screws applied using the lag screw principle.
Table 2. Comparison of the duration of postoperative swelling. Swelling Present Present Present Present Total
* y
Group A (n = 40)* 4 days 7 days 14 days 1 month 0 24 12 4 40 (0%) (60%) (30%) (10%) (100%)
Group B (n = 40)y 10 25 5 0 40 (25%) (62.5%) (12.5%) (0%) (100%)
x2 value 42.79
P-value <0.0001, signicant
for for for for
Table 3. Swelling in group A and group B: descriptive statistics. Mean Group A* Group By Pre-treatment Post-treatment Pre-treatment Post-treatment 38.80 43.16 32.58 37.08 n 40 40 40 40 SD 2.92 3.09 1.11 1.10 SEM 0.46 0.48 0.17 0.17
SD, standard deviation; SEM, standard error of the mean. * Group A were treated by open reduction and internal xation using 2.0-mm miniplates. y Group B were treated by open reduction and internal xation using 2.5-mm cortical screws applied using the lag screw principle.
days, with a mean of 4.5 days. The difference between the groups with regard to restriction of lip mobility was statistically signicant (Table 5). Clinically stable xation (as determined by manual testing for inter-fragmentary mobility) was obtained for all patients in group B and all but two patients in group A when examined on the rst postoperative day. Supplemental immobilization with MMF for 6 weeks was advised for the two patients in group A with unstable internal xation. However, satisfactory
radiographic alignment of the fractured segments and satisfactory occlusion was obtained in all patients at the conclusion of treatment and remained so throughout the observation and follow-up period (Figs. 1b and 2b). Postoperative complications were noted in 13 out of the total 80 patients (16.25%). Complications were divided into two categories: major and minor. Major complications included infection with or without implant loosening, whereas minor complications included wound dehiscence with
or without discharge. Patients with major complications underwent implant removal and antibiotic therapy, whereas those with minor complications were placed on local irrigation with or without antibiotics. Eight patients in group A (20%) suffered complications. Four (10%) patients had major complications, which initially responded to antibiotics, but recurrent sinus formation and discharge prompted removal of plates and screws after 2 months. As there was clinical bony union, no further xation was required. A minor complication in the form of soft tissue infection was encountered at 1 month post-treatment in four (10%) additional patients in group A, which resolved with antibiotics (Fig. 3). Only minor complications were observed in group B, occurring in ve patients (12.5%). One (2.5%) patient had soft tissue swelling, which resolved following extraction of the tooth in the fracture line and the use of antibiotic therapy; four patients (10%) had wound dehiscence, which was managed with
Table 4. Comparison of swelling in group A and group B by Students paired t-test. Paired differences Mean Group A* Group By 4.36 4.49 SD 0.70 0.35 SEM 0.11 0.05 95% CI of the difference 4.58 to 4.13 4.61 to 4.38 39.20 80.83 39 39 0.000z 0.000z t df P-value
SD, standard deviation; SEM, standard error of the mean; CI, condence interval. * Group A were treated by open reduction and internal xation using 2.0-mm miniplates. y Group B were treated by open reduction and internal xation using 2.5-mm cortical screws applied using the lag screw principle. z Signicant (P < 0.05).

Table 5. Comparison of postoperative restriction of lip movement. Restricted lip mobility For 4 days For 8 days For 10 days Total
* y
Group A (n = 40)* 24 12 4 40 (60%) (30%) (10%) (100%)
Group B (n = 40)y 35 0 5 40 (87.5%) (0%) (12.5%) (100%)
x2 value 28.82
P-value <0.0001, signicant
Fig. 3. Comparison of postoperative complications.
external support using an adhesive elastic bandage on the chin. These situations resolved uneventfully (Fig. 3). When complications were correlated with the time interval between injury and treatment, it was observed that most of the complications occurred in patients who had received treatment at 37 days after injury in both groups, and no complications were noted when the patients received treatment within 72 h of injury (Table 6).
Discussion
This study evaluated the efcacy of miniplates and cortical screws (using the lag screw principle) in open reduction and internal xation of mandibular symphysis/parasymphysis region fractures.
Notable results found in the comparison of the two techniques are outlined below. A shorter duration of postoperative oedema and functional lip restriction was found with the use of lag screws as compared to miniplates, in spite of similar surgical access. It may be presumed that the greater quantity of implanted hardware and the greater amount of bone drilling required for placement of a large number of screws in the miniplate group contributed to more persistent postsurgical oedema and associated functional lip restriction. A minimally invasive technique for the treatment of anterior mandibular fractures has been proposed by Forrest,7 but this has limitations such as difculty in the direct visualization of the fracture site, assessment of the anatomical reduction, inability to control reduced seg-
ments during lag screw xation, and hindrances in the implant placement, etc. The time duration for completion of the procedure was less for miniplate xation as compared to the cortical (lag) screw xation. This is in contrast with the observations of Ellis and Ghali,6 who reported that lag screws could be applied more rapidly as compared to miniplates as the latter require contouring and adaptation, which may be time-consuming considering the complexities of the anterior mandible contour. The authors of the present study had carried out lag screw placement rather infrequently in practice, and therefore the time required for placement of cortical screws during the study was initially longer. Ellis and Ghali6 also stated that the displacement of bone fragments was much more common during placement of bone plates, since the adequacy of plate contouring was not completely known until the screws were inserted and the plate drawn to the mandible. However, none of the patients in the present study had any unsatisfactory reduction as judged radiographically or clinically. Primary stabilization achieved by cortical screws was greater than that achieved by miniplate xation (100% of cases in the former and 97.5% of cases in the latter). Postoperative MMF was not required in patients who received cortical (lag) screw xation, indicating earlier functional rehabilitation. In cases of lag screw xation, it appears important to manipulate the jaw segments to check for instability after releasing the MMF, as recommended by Ellis and Ghali.6 According to Ardary, the ultimate stability of screw xation is dependent on the number of screws used, the method of screw placement, bicortical placement of screws, and the holding power of the screws.8 In cases of doubtful stability, removal of the lag screws and xation of miniplates is recommended instead of MMF.4 However, a lack of
Table 6. Correlation of complications and time interval between injury and treatment. Time interval between injury and treatment Wound dehiscence without discharge 1 day 1 day to <3 days 3 days to <7 days 7 days to <14 days 14 days to <21 days 21 days to <28 days
* y
Group A (n = 40)* Wound dehiscence with discharge None None None None None None Swelling/ discharge without wound dehiscence None None 4 4 None None Wound dehiscence without discharge None None 4 None None None
Group B (n = 40)y Wound dehiscence with discharge None None None None None None Swelling/ discharge without wound dehiscence None None 1 None None None
None None None None None None
Agnihotri et al.
Ideal prerequisites to prevent malocclusion are stable intraoperative MMF, proper adaptation of plates, drilling holes perpendicular to the fracture line in the case of cortical (lag) screws, and verication of accurate anatomic reduction of the lingual cortical plate. Although it is recommended that osteosynthesis with miniplates be performed within 12 h,9 the majority of our patients received treatment 37 days after injury, primarily owing to delays in hospitalization. However, we did not observe any disturbances in healing regardless of the time lapse between injury and treatment. This observation is in agreement with studies done by Zachariades et al.13 and Tuovinen et al.9 However, in an unpublished study of 244 mandibular fractures treated with rigid internal xation (bicortical bone plates according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) principles), the authors encountered an infection rate that varied between 1% for those treated within the rst week and 4% for those treated in 2 weeks or more.14 In the present study, the overall incidence of postoperative complications was 16.25% (miniplate group 20%, cortical (lag) screw group 12.5%). Only minor complications were observed in group B, occurring in ve patients (12.5%). One (2.5%) patient had soft tissue swelling, which resolved following extraction of the tooth in the fracture line and the use of antibiotic therapy; four patients (10%) had wound dehiscence (without discharge), which was managed with external support using an adhesive elastic bandage on the chin. These situations resolved uneventfully. The majority of complications occurred in patients treated between 3 and 7 days after injury. This observation needs further validation since the higher incidence of infection during this period may simply be due to the fact that most patients were treated within this time period. On analyzing wound dehiscence, only four patients in the cortical (lag) screw group developed this problem. The probable contributing factors could be inadequate muscle approximation during closure, pre-existing mucosal tear, poor oral hygiene, and delayed treatment. Resolution was obtained by irrigation with normal saline followed by placement of an adhesive elastic bandage over the chin. Unlike Cawood2 who encountered 12% wound dehiscence with miniplate xation, we did not observe this complication in the group treated with miniplates. Assael15 concluded that lag screw xation of symphyseal fractures had a particularly high rate of technique-related failures. Improper or inadequate countersinking was the chief reason for fractures of the outer cortex or distraction of the fracture when the screw was tightened. Even though the time required for lag screw xation was high in our series, adherence to a sound clinical technique could be the reason for not having experienced technique-related failures. In lag screw xation of anterior mandibular fractures, Kallela et al.10 reported paresthesia in the region of the mental nerve distribution in 68% of cases, which recovered within an average of 5.4 weeks. Cawood reported an incidence of 8% for mental nerve paresthesia and attributed this to direct damage to the mental nerve caused whilst inserting the Plate.2 We emphasize the need for careful intraoperative identication and preservation of the mental nerve along with gentle retraction to mitigate the possibility of this complication. Champy et al. reported an incidence of 0.5% for delayed union and non-union in patients treated with small plate osteosynthesis.3 In contrast we did not experience the above problems in our patients. The single patient in the miniplate group who needed supplemental MMF also had a clinically stable union by 6 weeks. In order to achieve a rapid recovery of form and function, internal xation surgery should meet four basic conditions: (1) anatomic reduction of the bone fragments; (2) functionally stable xation of the fragments; (3) preservation of the blood supply to the fragments by atraumatic operating technique; and (4) early, active, pain-free mobilization. All the above requirements are met by miniplates as well as lag screws. Lag screws have the added advantage of achieving inter-fragmentary compression and stability with a minimum of implant material. Our observations suggest that cortical screw xation using the lag screw principle offers the advantages of xation using minimal hardware, functional stability, is associated with minimal inammatory complications and functional restriction, and has a lower incidence of infection when considering the treatment of linear, non-comminuted symphyseal region fractures. The procedure, however, requires more skill and expertise. This recommendation is not complete in itself, as the study is limited by the number of patients evaluated. Our observations therefore require validation with a larger sample size.
stability was encountered in two patients in the miniplate group in our study and supplemental MMF did not adversely affect the outcome of treatment. The incidence of major complications (infection requiring hardware removal) was higher with miniplate xation. In contrast, minor complications occurred more frequently with the use of cortical screws. Four patients (10%) required plate removal secondary to infection; this is in contrast to the study of Tuovinen et al.,9 who determined the incidence of infection-related plate removal to be 3.6%. Tuovinen et al.9 also removed plates for other reasons, such as patient discomfort and plate fracture, but we did not have any necessity for removal on these grounds. None of the patients treated with cortical (lag) screws required removal of implants. The cortical screw xation group had a lower incidence of postoperative complications compared to the miniplate xation group, even though the percentage (12.5%) was much higher compared to those of the studies by Ellis and Ghali6 and Kallela et al.10 However, all the postoperative complications in the cortical screw group were minor and resolved without any aggressive management. Possible reasons for infection in the symphyseal region could be pre-existing subclinical infection, loose implant, foreign body reaction, inappropriate sterilization, poor host defence, and poor oral hygiene. None of the patients had any malocclusion and there were no instances of drill breakage. Tiwana et al.11 encountered drill breakage in 5.9% of cases. This problem was not encountered in the present study. The probable reason for this could be correct recognition of the appropriate drilling angle required to engage the opposite fracture cortex. Further, while drilling the traction hole, all attempts were made to engage the opposing cortex as perpendicularly as possible and to avoid forcing the drill. These precautions are necessary to minimize the possibility of drill breakage. Tuovinen et al.9 reported that malocclusion developed in 4.7% patients treated with miniplates, whereas, Cawood2 reported malocclusion in 6% of patients treated with miniplates in symphysis region fractures; these observations are not in concurrence with those of the present study. It might be supposed that compression caused by the cortical screws was too extensive, resulting in bone necrosis and misalignment, leading to malocclusion.12 However, in this study, we found no abnormalities in clinical healing of the fractures and occlusion.

Funding
a preliminary report. J Oral Maxillofac Surg 1970;28:4079. Niederdellmann H, Akuamoa-Boateng E, Uhlig G. Lag-screw osteosynthesis: a new procedure for treating fractures of the mandibular angle. J Oral Surg 1981;39: 93840. Ellis E, Ghali GE. Lag screw xation of anterior mandibular fractures. J Oral Maxillofac Surg 1991;49:1321. Forrest CR. Application of minimal access techniques in lag screw xation of fractures of the anterior mandible. Plast Reconstr Surg 1999;104:212734. Ardary WC. Prospective clinical evaluation of the use of compression plates and screws in the management of mandible fractures. J Oral Maxillofac Surg 1989;47:11503. Tuovinen V, Norholt SE, Pedersen SS, Jensen J. A retrospective analysis of 279 patients with isolated mandibular fractures treated with titanium miniplates. J Oral Maxillofac Surg 1994;52:9315. Kallela I, Ilzuka T, Laine P, Lindqvist C. Lag screw xation of mandibular parasymphyseal and angle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81: 5106. Tiwana PS, Kushner GM, Alpert B. Lag screw xation of anterior mandibular fractures: a retrospective analysis of intra-operative and
None.
Competing interests
5.
12.
13.
None declared.
6.
Ethical approval
Approval was given by the Ethics Committee of the Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India.
References
1. Brown JS, Grew N, Taylor C, Millar BG. Intermaxillary xation compared to miniplate osteosynthesis in the management of fractured mandible: an audit. Br J Oral Maxillofac Surg 1991;29:30811. 2. Cawood JI. Small plate osteosynthesis of mandibular fractures. Br J Oral Surg 1985;23:7791. 3. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Oral Maxillofac Surg 1978;6:1421. 4. Brons R, Boering G. Fractures of the mandibular body treated by stable internal xation:
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postoperative complications. J Oral Maxillofac Surg 2007;65:11805. Ellis E. Use of lag screws for fractures of the mandibular body. J Oral Maxillofac Surg 1996;54:13146. Zachariades N, Mezitis M, Papdemetriou I. Use of lag screws for the management of mandibular trauma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81: 1647. Ziccardi VB, Schneider RE, Kummer FJ. Wurzburg lag screw plate versus four-hole miniplate for the treatment of condylar process fractures. J Oral Maxillofac Surg 1997;55:6027. Assael LA. Evaluation of rigid internal xation of mandible fractures performed in the teaching laboratory. J Oral Maxillofac Surg 1993;51:13159.
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Address: Amit Agnihotri Behind S.P. Bungalow Old Bus Stand Shahdol Madhya Pradesh 484001 India Tel: +91 90 39245980 E-mails: [email protected], [email protected]

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YIJOM-2725; No of Pages 7

Clinical Paper Trauma

A. Agnihotri, S. Prabhu, S. Thomas

Comparison of cortical screws and miniplates

(0%) (20%) (10%) (0%) (10.0%) (0%)

Group B (n = 40)y 10 25 5 0 40 (25%) (62.5%) (12.5%) (0%) (100%)

P-value <0.0001, signicant

for for for for

Comparison of cortical screws and miniplates

Group A (n = 40)* 24 12 4 40 (60%) (30%) (10%) (100%)

Group B (n = 40)y 35 0 5 40 (87.5%) (0%) (12.5%) (100%)

P-value <0.0001, signicant

Fig. 3. Comparison of postoperative complications.

None None None None None None

Comparison of cortical screws and miniplates

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