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Introduction: The Risdon modified approach, for mandibular surgery, is well adapted to treatment of low subcondylar fractures. According to our experience, this approach with a low rate of complications should also be considered for non-traumatic ramus surgery., Material and Methods: Twenty Risdon modified approaches were used in 11 patients for non-traumatic indications (seven bilateral osteotomies, four unilateral osteotomies, one biopsy, one bone graft). One patient was operated twice with the same approach., Results: In all cases, the planned surgery could be performed using this approach. The only complication was a case of temporary paresis of the facial nerve's mandibular branch. The scar was always considered as quite acceptable., Discussion: As for traumatology, the Risdon modified approach is an improvement for ramus non-traumatic surgery. It has a very low rate of complications, especially for the facial nerve. The intraoral approach avoids scarring, but the resulting exposure is insufficient and requires using a transcutaneous device or endoscopy. In orthognathic surgery, the wide exposure of the lateral aspect of the ramus, the corpus, and the basilar edge, facilitates important mandibular advancement., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Fractures of the mandible angle raise the risk of infectious complications. We searched for factors predictive of these complications., Material and Methods: We reviewed retrospective all cases of mandibular angle fracture treated during a 26-month period. We compared two groups: fractures with wisdom teeth and fractures without wisdom tooth. For each group we noted clinical and radiological characteristics of the fractures and infectious complications., Results: The series included 72 mandibular angle fractures, 30 with a wisdom tooth against 42 without. Most of the patients were treated within 2 days, generally using mini-plate screw fixation. In the wisdom tooth group, 16.6% of patients developed infectious complications versus 9.5% in the without wisdom tooth group. All patients of the wisdom tooth group presented a potentially infectious focus on the preoperative x-rays. For without wisdom tooth group, irregular follow-up was found to be the only risk factor., Discussion: The angular localization increases the risk of infectious complications especially if the wisdom tooth is in the fracture. We propose a decision tree to determine when to preserve or not the wisdom tooth.

Various approaches have been proposed for surgical treatment of displaced condylar fractures included submandibular approach, preauricular approach, rhytidectomy approach or intraoral approach. Since 1992, we used a short retromandibular approach to treat displaced subcondylar fractures with a miniplate. When open reduction and osteosynthesis are required, the retro-mandibular approach is an easy and safe technique for displaced condylar fractures. The aim of this article was to describe the short retro-mandibular approach. Indications for surgical treatment, surgical approach and techniques of osteosynthesis for condylar fractures are discussed.

We present 114 cases of mandibular angle fractures treated by screwed miniplates placed through a transbuccal incision with transbuccal trochar instrumentation. Usually patients were young men who suffered traffic accidents. The mean hospitalization time was 7 days. 94.5% of the patients healed without incident, no malocclusion complication was observed. Two postoperative hematomas required surgical drainage without healing complication. One non union required removal of the miniplate and maxillo-mandibular immobilization. 2 temporary postoperative hypoaesthesiae were observed. One patient presented a pericoronary infection of a third impacted molar, four months after surgery, but the fracture was healed. The comparison of the results with the others in the literature confirms the reliability of this technique.

Fractures of the tooth-bearing part of the mandibular body require both orthopedic stabilization of the maxillomandibular joint and surgical fixation. From an evaluation of the anatomic and biomechanical features of the mandible, we propose the notion of a useful zone for fixation. The useful zone is basically submitted to traction forces and includes both the teeth and the teeth-bearing bone situated above the mandibular canal in the body and the entire symphysis. Applying an arch-plate on the useful zone has the advantage of providing initial stability, progressive loading and reduction in risk of displacement or secondary infection. This therapeutic approach gives better results than simple plate fixation.

There has been a certain amount of confusion in publications concerning fractures of the mandible due to the lack of consensus on classification. Starting with the embryological, anatomic, biomechanical, pathogenic and epidemiological features of these fractures, we propose a new terminology and a new distribution of the units and subunits of the mandible in traumatology. The main point is to incorporate the angle subunit into the ramus unit.

Clinical, radiographic and electronic axiographic follow-up examinations were performed in 45 patients with a luxation or highly displaced fractures treated with traction screw fixation from 1984 to 1989. Axiographic findings gave an excellent objective evaluation of joint function. The excellent results achieved with traction screw fixation suggest that this method can be recommended for condyleal fractures of the mandible.

Clinical and radiologic examinations were carried out after a mean 7 year follow up of functional conservative treatment of a mandibular condyle fracture in 16 patients. Anatomic and functional recovery was excellent in children and was often very good in adolescents. Signs of dysfunction were a frequent finding in adults, but these were not considered as important by the patients and their specific treatment was not required.

The method of patient referral; the patient's physical predisposition, the localization and the treatment undertaken for the different mandibular fractures seen by SOS Face over the past two years were analyzed. The 312 mandibular fractures were used to reevaluate the commonly accepted statistics concerning these parameters.

The author reports 50 cases of fractures involving the angle of the mandible treated by traction screw fixation. The technique is described and the excellent results are analysed.

The review of 192 cases of mandibulars fractures in childhood (between 10 days to 15 days old) demonstrates two important points: --the frequency of condylar fractures (110) but a low rate of temporo-mandibular ankylosis (2 cases); --a way to perform osteosynthesis with iron wire (5/10 degrees) through holes drilled with a hand perforator, that prevents follicular damages.

The author describes the particular type of fragility zones found in children's mandibles, which vary during growth, and discusses the anatomicoclinical types of fractures observed from the earliest age (symphysial disjunctions) until the end of mixed dentition. Emphasis is placed on one particular type, described in a previous communication: the paramedian form, which can be explained by the atomical position of certain dental germs, as well as the importance of reconstitution of the periosteum in displaced sub-condylar fractures.

The ideal treatment for fractures of the mandibular anterior arch is the simplest procedure which ensures reduction, and sufficient stability for satisfactory dental articulation. The forces applied during mastication are in fact of a low degree and there is a minimal risk of secondary displacement; bone consolidation rapidly occurs and effective remodelling of minor articulation disorders is possible in children under 10 years of age. No single technique is applicable in children, and treatment of mandibular fractures in children under 13 is a function of the dental age, and must employ local possibilities for each age group to the best advantage.

At Lyon's Maxillo-facial Surgery Center, children's mandible fractures represent 8% treated fractures at admited sick people (35 children for 56 fractures) for 1976-77-78. We insist on the treatment used in our center for articular region fractures: mandibular gymnastic in propulsion and laterality with a good result, orthopedic treatment only in case of gymnastic's failure. The other anatomic types are treated by orthopedic, surgical or mixed method, according to teething age, and fracture's diastasis.

Twenty-seven children aged from 0 to 15 years were treated for mandibular fractures in the Stomatology and Maxillofacial Surgical Unit in Nantes over a period of three years. Fractures of the condyle were frequently observed. Good results were obtained with functional treatment, but very strict criteria should be applied when assessing the quality of these results (which should be excellent, especially in relation to condylar mobility, in young subjects during the growing period).

It is exceptional for surgery to become necessary after the use of miniaturized plate and screws. When it is required it is because of faulty reduction or contention, mucosal disunion or an infective focus, or a combination of these factors. Surgery provides good final results, but 2 to 4 supplementary months of immobility are needed, and it can be avoided by respecting the indications and practical necessities of this method.

The authors report findings on a series of 148 injured patients, seen in one year in the Clinic of Maxillo-Facial Surgery in Lyon. The minimum criterion of inclusion in the series was a hairline fracture. After undertaking both aetiological and anatomo-pathological studies they set out what they consider appropriate management of each type of fracture. This is followed by a detailed analysis of the outcome observed over a retrospective period of 1 to 2 years. They stress in conclusion the importance of adapting the treatment to the requirements of each case. Also they note the continued problem of how best to manage fractures of the condyles.