PURPOSE:
To compare outcomes of open reduction and internal fixation (ORIF) of mandibular fractures followed by either immediate mobilization or 4 weeks of maxillomandibular fixation (MMF).
METHODS:
35 mandibular fractures treated over 2 years underwent follow up at 1, 3 and 6 months.   Of the 33 patients with noncondylar fractures, 19 patients underwent the standard 4 weeks of mandibulomaxillary fixation (MMF) using arch bars and 14 patients underwent open reduction internal fixation followed by immediate mobilization. The 2 patients with condylar fractures underwent MMF for 4 weeks.  Follow up was over 6 months with office visits at 1 month, 3 months and 6 months. 
Symphyseal and parasymphyseal fractures were exposed via the transoral approach.  Angle and body of mandible fractures were exposed in a percutaneous fashion.  All patients were placed in MMF with arch bars and Ivy loops at the beginning of the operative procedure.  Fractures were fixated with two titanium miniplates, one tension band using monocortical screws, and the other along the inferior border using bicortical screws. The 14 patients were randomized to immediate mobilization following open reduction internal fixation had their arch bars removed following the procedure. 19 patients had MMF maintained postoperatively for 4 weeks.  Patients were given a regimen of strict oral hygiene and soft diet. Variables including: temporomandibular joint mobility, occlusion, oral hygiene and wound status were documented during postoperative visits at 1, 3 and 6 months. 
RESULTS:
Temporomandibular joint (TMJ) mobility is followed as maximal inter-incisor disance in mm.  At 1 and 3 months postoperatively patients with immediate mobilization had significantly more TMJ mobility than the MMF group (p < .001).  With 2 to 3 months of intensive physical therapy, TMJ mobility improved in the MMF group to approach normal values.   Postoperatively both groups achieved class I occlusion throughout the follow up period.  Oral hygiene was graded on a scale of 1 to 3, with 1 representing poor, 2 - fair and 3 - good oral hygiene.  At 1 month postoperatively, oral hygiene was significantly worse in the MMF group, but improved dramatically in the following 5 months.
Three patients in the immediate release group and 2 patients in the MMF group suffered wound infection/dehiscence leading to plate removal. There was no difference for this variable between the 2 groups.  Osseous union was achieved 100% of both groups, and confirmed by postoperative radiological studies. 
CONCLUSION:   Immediate mobilization of mandible fractures produced satisfactory results in terms of TMJ mobility, occlusion, oral hygiene and wound healing compared with 4 weeks of MMF. The presumed beneficial effects of reduced fracture line stress with MMF was not realized, with no statistically significant differences in these variables between the MMF and immediate release group.  This small study supports the treatment option of immediate release of IMF following ORIF of mandible fractures.