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Biplanar Plating of Mandibular Fractures
A New Concept With In Vitro Testing and Comparison With the Traditional Plate-and-Screw Technique
Sara Pieri, MD;
K. Holly Gallivan, MD, MPH;
David Reiter, MD, DMD
Arch Facial Plast Surg. 2002;4:47-51.
Objectives To introduce the concept of biplanar plating of mandibular fractures
and to present an in vitro comparison of this method with traditional use
of a single mandibular plate.
Design A device for the delivery of repetitive simulated masticatory stress
to mandibular models was developed. Using the device, we compared biplanar
with single-plate fixation of vertical mandibular body fractures by determining
cycles to failure.
Setting Tertiary care academic medical center.
Intervention A simulated masticatory force was delivered vertically to the anterior
end of polymer hemimandibles as used for in vitro teaching of plating methods.
Mobility at the fracture site was tested at intervals corresponding to 6000
chewing cycles each.
Results Of 5 specimens plated with a mandibular fixation plate, 4 developed
greater than 0.010 cm of vertical mobility at the fracture site after 12 000
cycles. Only 1 of the 5 specimens fixed with biplanar plating developed this
degree of mobility.
Conclusions Single-plate fixation of mandibular fractures is greatly enhanced by
a miniplate spanning the fracture along the inferior border. We used this
technique on 15 patients with unfavorable fractures and found it simple, secure,
and reliable. We had no complications. An inferior marginal plate serves the
same function as a tension band, and can be placed on mandibles through the
same incision as the main fixation plate without additional dissection. We
prefer this to a traditional tension band when the percutaneous route of access
to a mandibular fracture site is used.
From the Department of Otolaryngology–Head and Neck Surgery,
Jefferson Medical College, Philadelphia, Pa.
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