Effect of open reduction and internal fixation [ORIF] on salivary immunoglobulin a [SIgA] in parasymphyseal fractures of mandible

ABSTRACT

Oral and maxillofacial trauma studied has been directed extensively towards improvement of surgical approaches, appliances, and techniques, yet the study of surgical trauma with regards patient's immunocompetence has not received the same attention. The present investigation was directed to clarify the effect of open reduction and internal fixation [ORIF] and surgical insult in cases of parasymphyseal mandibular fractures on salivary immunoglobulin A [SIgA]. It was hoped to rationalize the trauma associated with surgery, especially in cases of already traumatized patients. This was an attempt to give the oral mucosal immune system the due attention in planning of different surgical techniques. Fourteen adult Egyptian patients with parasymphyseal mandibular fractures were the subjects of this study. All patients have been treated under general anaesthesia [G.A.]. Patients were divided randomly into two equal groups; Group I parasymphyseal fractures were managed by non-surgical lingual splint. Group II parasymphyseal fractures were managed by surgical open reduction and internal fixation [ORIF]. Unstimulated whole saliva samples were collected from the patients preoperatively [on the day of admission], postoperatively [before discharge], 24 hours postoperatively, then at one week, three weeks, six weeks, and eight weeks postoperatively. The quantitative determination of the concentration of salivary immunoglobulin A [SIgA] was done by enzyme linked immunosorbent assay [ELISA]. The data was tabulated and statistically analyzed. Group II patients returned to normal level of SIgA by the seventh day of postoperatively. The results revealed that though it seems that the surgical procedures of the ORIF are more insulting to the oral mucosal immune system than the application of the interdental wires of the splint, but the results of the study showed that the lingual splint to be more traumatizing and insulting to the oral mucosa