One miniplate versus two miniplates in the fixation of mandibular angle fractures. An updated systematic review and meta-analysis.

PURPOSE: The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures. METHODS: A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed. RESULTS: Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I2=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I2=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I2=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I2=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I2=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I2=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I2=29.33%) were statistically significantly higher in the two miniplates arm. CONCLUSION: One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.

One miniplate compared with two in the fixation of isolated fractures of the mandibular angle.

The purpose of this study was to compare one miniplate with two in the management of isolated fractures of the mandibular angle as regards wound healing, failure of hardware, scarring, weakness of the facial nerve, and overall morbidity, by making a systematic review with a meta-analysis. I made a comprehensive electronic search with no date or language restrictions in October 2014. The inclusion criteria were studies in humans, including randomised or quasirandomised controlled trials (RCT), controlled clinical trials (CCT), and retrospective studies that compared the morbidity after treatment of such fractures with one and two miniplates. Ten publications were included: three RCT, three CCT, and four retrospective studies. Three studies showed a low, and seven a moderate, risk of bias. There was a significant difference between one and two miniplates in the incidence of wound healing, failure of hardware, weakness of the facial nerve, and overall complications (p=0.04, p =0.05, p=0.002, and p=0.05, respectively). The result of the meta-analysis showed that one miniplate placed on the external oblique ridge provided a significant reduction in the incidence of wound infection and dehiscence, failure of hardware, and overall complications, compared with two miniplates, one placed on the external oblique ridge and one placed on to the ventral surface of mandible to fix the fracture.