Principles in treating mandibular fractures consist of anatomical reduction, restoration of premorbid occlusion, and proper fixation until stable osseointegration is achieved. Miniplates (1.3 – 2.0 mm) and reconstruction plates (> 2.0 mm) are commonly used alone or together to treat simple as well as comminuted mandible fractures.  Although microplate systems (1.2 mm) are commonly used for internal fixation of maxillofacial fractures, their use in mandible fractures is not widely accepted. The purpose of this study was to evaluate the use of malleable titanium microplates for internal fixation of isolated, simple mandibular fractures.

Thirty-five patients with isolated mandibular fractures (26 double and 9 single) were treated by open reduction and internal fixation. Of a total of 61 fractures, 54 were stabilized using titanium microplates and 1.2-mm monocortical microscrews, 7 fractures were treated non-operatively. The symphyseal area and the superior border of the angle were exposed through an intraoral approach. The other regions were exposed through a percutaneous direct approach.  One or two microplates were used or combined with additional wiring. When the fracture was situated within the dental arch, interdental wiring was performed as a tension band to bring further stability to the dental arch, and maintained for 6 weeks. No intermaxillary fixation was used. All patients were allowed mouth opening immediately after the operation. Patients were evaluated for complications during a follow-up period ranging form 3 to 29 months. Fig. 1 shows preoperative and postoperative radiographs from two patients.

There were eight minor complications including mild malocclusion (3), paresthesia (3), delayed union (1), and non-symptomatic plate fracture (1) in seven patients who had double mandibular fractures. They required no further orthodontic or other treatment. Other complications such as infection, trismus, plate exposure, wound dehiscence, denture change, or nonunion did not occur. The single material-related complication was a case of non-symptomatic plate fracture.

The results indicate that malleable microplates can be used for adequate internal fixation of simple isolated mandibular fractures. Advantages of semirigid microplate fixation include a high adaptability to the fracture site, occlusal self-adjustment, and minimal mass effect.

Fig.1. (Above, left) Case 1. Preoperative panoramic X-ray views with a double mandibular fracture of the right symphysis and left angle. (Above, right) Postoperative result 13 months after internal fixation with 1.2-mm 4-hole microplates. (Below, left) Case 2. A double mandibular fracture of the right symphysis and left condyle. (Below, right) Postoperative image 8 months after surgery. Excellent occlusal state and complete bony union were observed in both cases.