What trends are apparent in mandible fracture management and outcomes in patients treated with and without intraoperative arch bar use, and how do they correlate with outcomes?
Background: Erich arch bars are effective tools in achieving accurate reduction and premorbid occlusion in the surgical treatment of mandible fractures; however, it is often desirable to avoid arch bar placement in appropriately selected cases, and accurate reduction and segment stabilization must still be obtained. Manual reduction of fractured segments often provides sufficient fracture segment stabilization for open reduction internal fixation (ORIF).
Explore this issue:March 2016
Study design: Retrospective chart review of 734 patients (1,312 mandible fractures) sustained between Oct. 1, 2001, and Oct. 1, 2011.
Setting: Upstate Medical University, Department of Otolaryngology and Communication Sciences, Syracuse, New York.
Synopsis: Treatment options included conservative management; maxillomandibular fixation (MMF) alone, achieved with placement of arch bars; intraoperative arch bar placement to achieve MMF with ORIF; and manual reduction with ORIF. When considered as a whole, 456 patients were treated using arch bars to achieve MMF with ORIF, 167 underwent manual reduction with ORIF, 67 were managed with MMF alone, and 44 were treated conservatively. When considered annually, there was a decreased trend in arch bar utilization to achieve MMF with ORIF over the study period, coupled with an increased manual reduction use with ORIF. With subcondylar fractures excluded, there was a more pronounced increase in manual reduction use with ORIF. There was no statistically significant difference in malunion malocclusion and infection rates between patients treated with and without arch bars. Limitations included the retrospective nature of the study, lack of sufficient follow-up for a significant portion of patients, and physician choice dictating use or avoidance of arch bars.
Bottom line: Data suggest a shifting trend in mandible fracture management, with no statistical increase in complications when using manual reduction with ORIF. Arch bar application should be used if appropriate reduction and stabilization cannot be achieved without their use but is ultimately dependent on each case’s unique circumstances.
Citation: Kopp RW, Crozier DL, Goyal P, Kellman RM, Suryadevara AC. Decade review of mandible fractures and arch bar impact on outcomes of nonsubcondylar fractures. Laryngoscope. 2016;126:596-601.