Clinical results of two different three-dimensional plate types for the treatment of mandibular angle fractures: a retrospective analysis.

OBJECTIVES: The purpose of this study was to compare two different designs of three-dimensional osteosynthesis plates for their suitability in the treatment of mandibular angle fractures in terms of sufficient fracture healing and concomitant complications. MATERIALS AND METHODS: Retrospectively a total of 54 patients with 56 mandibular angle fractures were evaluated. Two different types of three-dimensional plates from the Medartis Trilock system were analyzed: (A) Square design plate (☐-plate) with a thickness of 1.0 mm, and (B) triangular-shaped 3D-plate (△-plate) with a thickness of 1.3 mm. Patient demographics, fracture mechanism and intraoperative details were recorded during an average follow-up period of 1 year. RESULTS: The utilization of △-plates was observed to entail a considerably lengthier surgical time in contrast to ☐-plate systems (P = 0.037). The application of △-plate showed a tendency of higher incidence of major complications than ☐-plate (P = 0.06), as evidenced by the occurrence of non-union in 2 out of 22 cases, resulting in higher surgical revision rate for △-plate (P = 0.027). CONCLUSION: Sufficient treatment of mandibular angle fractures is feasible by using 1.0 mm thick, square shaped three-dimensional plate systems. The use of thicker three-dimensional osteosynthesis plates seems to significantly increase the operating time and complication rates, whereby the geometry of the plate seems to have an influence. CLINICAL RELEVANCE: The plate design could have an impact on treatment outcomes of mandibular angle fractures. TRIAL REGISTRATION NUMBER: Not applicable.

A Finite Element Analysis of Single, Double & Matrix Miniplate in Fracture of the Mandibular ANGLE Region: An In Vitro Study.

Purpose: To evaluate and compare the efficacy of three osteosynthesis systems in fixation of mandibular angle fractures using Finite Element Analysis. Materials and Methods: In this study, we used a three-dimensional finite element analysis to assess the stress, deformation and strain in three different groups with bite force loads. A three-dimensional finite element model of the mandible with three different plating techniques using modelling software 'Solidworks2018' and was analysed for stress, deformation and strain produced in the bone following biting loads of different magnitude using analysing software 'ANSYS Workbench'. Results: In this study, we found out that the tensile forces in the matrix miniplate with vertical struts were well distributed in the cortical and cancellous bone on comparison with other two fixation systems in fixation of the mandibular angle fracture and therefore prevents lateral displacement, torsion and bending. The matrix miniplate system revealed less displacement of the fracture segments as compared to the other two plating systems. Conclusion: The use of matrix miniplate for the treatment of mandibular angle fractures can be considered efficacious. The stress transferred onto the cortical & cancellous bone is least in the matrix plate leading to better stability of the fixation system.

Morphological Changes of the Mandibular Angle After Orthognathic Surgery with Class III Deformity in East Asia.

The aims of this study were to analyze the morphological changes of the mandibular angle after orthognathic surgery for mandibular setback and investigate related factors. This retrospective study included patients from January 2017 to December 2021 diagnosed with skeletal class III deformity who underwent BSSRO (Group I) or bimaxillary surgery (Group II). Preoperative (T0), within 1 month postoperatively (T1), and 6 months postoperatively (T2) CT scans were collected from 61 patients to three-dimensionally analyze the proximal segment displacement, the linear and angular changes of the mandibular angle. The gonion points moved posteriorly and laterally (P < 0.001), while the inferior movement was not significant (P = 1.000, P = 0.274). The intergonial width increased by 3.32 ± 1.87 mm and 2.34 ± 1.77 mm as revealed by T2 CTs, respectively, in Group I and Group II. Mandibular angle decreased in both groups and by 1.41 ± 2.95° in Group I and 1.37 ± 3.41° in Group II. The increase in intergonial width between T1 and T0 was negatively correlated with the preoperative mandibular angle (P = 0.003) and positively correlated with the transverse outward movement of the proximal segment (P < 0.001). After surgery, the intergonial width increased and the inferior and posterior border of the proximal segment flared outward. The changes in intergonial width and mandibular angle were mainly related to the rotation of the proximal segment, which has a certain impact on the aesthetics of the lower face. Therefore, controlling the position of the proximal segment is of vital importance to lessen the changes in the mandibular angle area.Level of Evidence III. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mandibular angle fractures: a demographic review, with particular reference to post-operative complications.

BACKGROUND: Mandibular angle fractures (MAF) have a recognized complexity of treatment and an increased risk of incurring complications. METHODS: This retrospective study included 45 consecutive patients who were diagnosed with an isolated MAF and no other facial fractures. The average age was 27.3 (SD = 7.7). RESULTS: A comparatively low rate of complications (11.1%) and a low rate of reoperation (1.8%) are reported, along with a significant role of smoking in complications (p = 0.022). A non-significant association was noted between complications, male gender and assault as an aetiological factor. CONCLUSIONS: Review of the data from this study confirms that complication rates for patients attending the National Maxillofacial Unit are similar to or better than that of international studies. An overview of the aetiology of fracture complications is included.

Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial).

Background: Mandibular angle is the most common site for fractures, accounting for 23-42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture. Materials and Methods: This prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior-inferior miniplate fixation. The patients were then followed up for one year postoperatively. Results: It showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively. Conclusion: CAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes. Trial Registration: It was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.

The effects of anterior bite plane on temporomandibular joint and mandibular morphology.

Objectives: An anterior bite plane (ABP) is an orthodontic appliance that prevents posterior teeth from making contact. This appliance's functional concept is to reduce muscle activity, overcome deep overbite, and temporomandibular joint (TMJ) disorders (TMD). However, ABP treatment for malocclusion frequently results in unfavorable reversible and irreversible long-term effects. This problem presents difficulties for dentists in developing an appropriate treatment modification plan in order to achieve the best results. As a result, the goal of this study is to observe the effects of different ABP types on the TMJ and mandible. Materials and Methods: Thirty-six three-month-old male Wistar strain rats were divided into three groups: control, upper flat, and upper-lower inclined ABP. The overbite and body weight were measured. TMJ was examined histologically using hematoxylin and eosin (HE). To observe the entire mandibular bone in response to ABP, mandibular planes and angulations were measured. Results: After 7 days, the upper-lower inclined ABP group has significantly lower body weight than the control group. On days 7 and 14, overbite was significantly reduced in both the upper flat and upper-lower inclined ABP groups. The superficial layer of the condyle was depleted in both ABP groups, according to HE analysis. Mandibular angle analysis revealed that the upper-lower inclined ABP group had a greater incisal and ramus angle. Furthermore, lower incisor (Li)-condyle (Co) mandibular points increased significantly more in the upper-lower inclined ABP group than in the control group. Conclusion: According to this study, various forms of ABP may have an impact on the TMJ and mandibular morphology, specifically on the length, angulation, and superficial surface of the condyle.

Comparison of Single Versus Two Non-Compression Miniplates in the Management of Unfavourable Angle Fracture of the Mandible Orginal Research.

Aim: To compare the postoperative complications of fixing Mandibular angle fractures with two non-compression mini plates, on the superior and lateral the aspects of the mandible, to the standard technique of using a single non-compression miniplate on the superior border. Methodology: Fifty patients with MAF were divided equally into two groups. Patients in Group 1 were secured with two mini plates at the lateral and superior border of the MA using an extraoral approach; for patients in Group 2 a single non-compression miniplate was used via an intraoral extended third molar approach as described by Champy et al. The post-operative complications in both groups were compared statistically. Results: The findings of this study revealed that there was no significant difference in postoperative complications between the two groups when fixing MAF with two non-compression mini plates versus the standard technique of using a single non compression miniplate on the superior border of the mandible. However, the surgery time with one miniplate was significantly more than the dual plate approach. Conclusion: We advocate using two mini plates to treat an unfavorable angle fracture.

Comparison of bite force evaluation for mandibular angle fracture fixation by conventional miniplates versus new design miniplates: a clinical study.

PURPOSE: To evaluate postoperative masticatory efficacy of a new design non-compression titanium miniplate compared to conventional non-compression titanium miniplate on the basis of bite force for treatment of mandibular angle fractures. METHODOLOGY: The prospective study included 20 patients with mandibular angle fractures randomly categorized into 2 groups: Group I, fixation of angle fractures by conventional miniplates, and Group II, fixation of angle fractures by new design miniplates. Evaluation was done for clinical outcome, primarily bite force; radiological outcome; and associated postoperative morbidities at different time intervals. RESULTS: The results showed to be highly significant in terms of mean operating time for plate adaptation and fixation and bite force adaptation (p = 0.003 at follow-up of 6 months) for the newer miniplate compared to the conventional miniplate. No statistically significant difference was seen for postoperative paresthesia, malunion, non-union, occlusal discrepancy, or hardware failure. CONCLUSION: Within the limits of the study, it appears that the single, monocortical, non-compression, superior border new design miniplate proved to be a successful procedure for treating non-comminuted mandibular angle fractures specifically in terms of enhanced postoperative masticatory efficiency as compared to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.

Applying artificial intelligence algorithm in the design of a guide plate for mandibular angle ostectomy.

PURPOSE: Surgical guide plates can improve the accuracy of surgery, although their design process is complex and time-consuming. This study aimed to use artificial intelligence (AI) to design standardized mandibular angle ostectomy guide plates and reduce clinician workload. METHODS: An intelligence algorithm was designed and trained to design guide plates, with a safety-ensuring penalty factor added. A single-center retrospective cohort study was conducted to test the algorithm among patients who had visited our hospital between 2020 and 2021 for mandibular angle ostectomy. We included patients diagnosed with mandibular angle hypertrophy and excluded those combined with other facial malformations. The guide plate design method acted as the primary predictor, which was AI algorithm vs. experienced residents. Moreover, the symmetry of plate-guided ostectomy was chosen as the primary outcome. The safety, shape, location, effectiveness, and design duration of the guide plate were also recorded. The independent samples t-test and Pearson's chi-squared test were used and P-values < 0.05 were considered significant. RESULTS: Fifty patients (7 men, 43 women; 27 ± 4 years) were included. The two groups differed significantly in terms of safety (7.02 vs. 5.25, P < 0.05) and design duration (24.98 vs. 1685.08, P ＜ 0.05). The ostectomy symmetry and shape, location, and effectiveness of the guide plates did not differ significantly between the two groups. CONCLUSIONS: The intelligent algorithm can improve safety and save time for guide plate design, ensuring other quality of the guide plates. It has good potential applicability in accurate mandibular angle ostectomy.

Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery.

BACKGROUND: Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment. METHODS: We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared. RESULTS: 441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy. CONCLUSION: Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.

Single linear miniplate versus rectangular grid plate in the treatment of mandibular angle fractures: A prospective, clinico-radiographic, comparative study.

Study Design: Randomized Control Trial. Objective: A prospective, clinico-radiographic, comparative study was planned to evaluate the treatment outcome and postoperative complications in isolated mandibular angle fractures using 2.0-mm system single linear 4 hole with gap miniplate versus 4 hole rectangular grid plate, both stabilized with 4 8-mm monocortical screws. Methods: Thirty patients with isolated mandibular angle fractures were randomly categorized into two groups with 15 patients each. Group 1 patients were treated with single 2.0 mm × 4 hole linear miniplate along the superior border and Group 2 patients were treated with a 2.0 mm × 4 hole rectangular grid plate on lateral cortex of mandible. Pain, swelling, occlusion, bite force, maximum inter-incisal opening, intraoperative time, facial nerve injury, fracture stability, and postoperative complications were assessed and compared at regular intervals up to 12 months. Results: There was no major difference in terms of treatment outcome in both systems and both were equally effective without any statistically significant difference in any of the parameters. None of the patients presented with any of the complications except for postoperative infection which was reported by 1 patient from each group at 3 months postoperatively and were managed conservatively. Conclusion: Both plating systems are equally effective; however, the rectangular grid plate could be a safe and effective alternative to the single miniplate when adaptation and fixation is not possible along the external oblique ridge of the mandible (e.g., fracture with bone loss along the superior border).

Redefining Mandibular Sub-units: The "ABC" Classification and Surgical Strategies for Lower Face Contouring.

BACKGROUND: In east Asia, lower face contouring surgeries including reduction mandibuloplasty and genioplasty are the most popular aesthetic craniofacial surgeries. Conventional selection of surgical strategies mainly relied on the visual judgment of the mandibular angle, without overall assessment of the mandibular sub-units. Furthermore, only a few studies offered quantitative assessment of the mandibular shape. METHODS: From 2010 to 2021, 1241 patients diagnosed with square faces and received customized lower face contouring surgeries by the senior author were reviewed and analyzed to propose an "ABC" classification system for facilitating surgical planning. RESULTS: Among them, 998 (80.42%) received bilateral mandible reshaping, 155 (12.49%) underwent bilateral mandible reshaping combined with genioplasty, and 88 (7.09%) received asymmetric mandible reshaping. A modified classification system composed of three critical parameters (height, morphology/thickness, divergence) in three aesthetic zones (mandibular angle, mandibular body, chin) was proposed based on quantitative summarization of the CT database and the senior author's 12-year experience. The way to facilitate surgical planning with this classification was demonstrated. CONCLUSIONS: This modified classification system ushered a decision-making process that prioritized several critical measurements and proposed an operative planning form. Meanwhile, it can also be cooperated into the three-dimensional virtual surgical plan. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Finite element analysis of 3D-printed personalized titanium plates for mandibular angle fracture.

This paper discussed the size of 3 D-printed personalized titanium plates that can gain maximum stability of mandibular fracture and minimize stress shielding through finite element analysis. A 3 D virtual model of mandible with mandibular angle fracture was created from the CT data of patient. 3 D-printed personalized titanium plates varying in length and thickness were designed, and finite element analysis was performed under different loading conditions and fracture healing periods. After that, the stress distribution and deformation of the mandible with gonial fracture could be observed, and the stress shielding rate could be obtained. Finally, SPSS21.0 was used for statistical analysis. The results of finite element analysis indicated that as the thickness of titanium plates and the healing time decreased, the maximum displacement increased, under a certain condition in which the pore size, the width, the hole distance and the bridge spacing were 2.0 mm, 4.0 mm, 6.0 mm, 12.0 mm, respectively. What's more, in this condition, the thicker the titanium plate and the shorter the healing time were, the higher the stress shielding was at central occlusion. When the thickness of the personalized 3 D-printed titanium plate was 1.0 mm, the maximum displacement tended to be stable and the stress shielding was minimized. It can not only improve the bone stability after tension band fixation, but also minimize the stress shielding, which is expected to expand the indications of tension band fixation.

New design titanium miniplate versus conventional miniplate in treatment of mandibular angle fractures: A comparative study.

Introduction: Mandibular angle fracture (MAF) is the second most common site of all fractures of the mandible with the highest complication rate. Management of MAF has evolved in the past four decades. The purpose of the prospective study was to compare the efficacy of new design titanium miniplate (NDM) with conventional titanium miniplate (CTM) in the treatment of MAF. Objectives: Mouth opening, occlusion, bite force measurement, and radiographs compared preoperatively and first week, first month and third month postoperatively. Materials and Method: Fourteen patients diagnosed with MAF were randomly divided into two groups: Group A (seven patients) was treated with NDM and Group B (seven patients) with CTM. Patients were assessed preoperatively and postoperatively at an interval of one week, one month and three months. Results: Repeated measures ANOVA and Post hoc Tukey test showed a significant increase in bite force and mouth opening for both groups in first and third postoperative months. Unpaired t-test showed slightly better mouth opening in Group B and slightly higher bite force in Group A. Discussion: Both miniplates fulfilled all the study objectives and equally satisfactory healing was seen at the end of third month. NDM offers better stability, rigidity, and anatomic reduction of the fracture with a drawback of difficulty in adaptation and increased operative timing compared to CTM. Hence, we would like to conclude that both miniplates are equally efficient in the treatment of non-comminuted angle fractures with the NDM having upper hand in stability.

Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review.

Study Design: Systematic review. Objective: There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation. Methods: PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II). Results: Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (P = .043). Conclusions: For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.

Bone Apposition in the Mandibular Angle in Adult Patients Diagnosed with Bruxism: a Digital Panoramic Based Study.

Background: Bruxism is defined as a movement disorder of the masticatory system leading to serious problem in the integrity of the oral dentition; it is characterized by teeth grinding and clenching and has been typically classified into three types: a) bruxism occurring during sleep, b) awake-related bruxism, and c) mixed sleep/awake-related bruxism. Objective: The aim of this study was to assess any bone apposition in the mandibular angle in a group of adult patients diagnosed with bruxism using digital panoramic radiographs. Methods: In the sample of 150 digital panoramic radiographs of 66 women and 84 men with an age range of 24-78 years and diagnosed with bruxism were evaluated. Results: Among the 300 mandibular angles evaluated, 156 (52%) showed bone apposition against 144 (48%) who did not. Conclusion: The changes in the mandibular angle, especially bone apposition, can help diagnosing long term bruxism on panoramic radiographs.

The effect of different positions of unerupted lower third molar teeth on the fragility of mandibular angle: Finite element analysis.

Background: The mandibular bone is the largest and strongest bone in comparison to the other bones in the face skeleton. However, it is the most commonly fractured in facial injuries. The location of the fracture in mandible depends on various factors. The relationship of the impacted lower third molar teeth to mandibular angle fracture has been the subject of many epidemiological studies. It is argued that the risk of fracture in mandibular angle is two to four times more when there are particularly an impacted or partially impacted third molar teeth. However, the effect of the position of the impacted tooth on mandibular angle fracture is not clear yet. Aim: This study seeks to reveal the effect of third molar teeth that are impacted in various positions on the angle fragility. Materials And Methods: This study was performed using three-dimensional finite element stress analysis and static linear analysis methodology. Computed tomography (CT) images obtained previously from a patient were used to construct models of the bone tissue. An ILUMA CBCT device (3M Imtec, OK, USA) was used for tomographic scans. Impacted teeth in various positions were digitally modeled separately. Different direction forces were applied to the mandible, the stress values on the bone surrounding the third molar teeth impacted in different positions were determined. Results: Third molar teeth are impacted in mandibular bone in the following positions: mesioangular, vertical, horizontal, and distoangular positions. The study showed that the force that created the highest stress in the Mandibular angle among the modelled groups is the force by ipsilateral angle. Conclusion: For all kinds of impacted teeth, there was more stress accumulation in the buccal area than in the lingual area when the force is from the symphisis.

An In vitro study of biomechanical comparison between titanium 4-hole 3D plates and titanium conventional 4-hole miniplates for internal fixation of mandibular angle fractures.

Background: Fracture fixation, in the present times, is classically done using mini plates. The position and number of plates to fixate a mandibular angle fracture have been and are still extensively researched and reported in the literature. A more recent addition is 3D mini plates. Aim: To compare and evaluate the biomechanical behavior of one 2.0 mm titanium 3D miniplate fixation plate (4- hole) and one 2.0 mm titanium 4-hole miniplate in internal fixation of mandibular angle fractures. Objective: To measure load at break, maximum load, and displacement at maximal load for internal fixation done with 3D mini plates and conventional mini plates respectively. Methods: Five dry cadaveric mandibles were sectioned into 10 hemi-mandibles. Each cadaveric mandible was sectioned at the angle of mandible to simulate unfavorable mandibular angle fracture. The obtained hemimandible were divided into experimental groups (GROUP 1 and GROUP 2) with 5 samples in each group, plated with a linear miniplate and 3D miniplate respectively. Maximal load, Load at break, and displacement at maximum load were the only obtained parameters for comparison. Results: Conventional miniplate showed greater mean maximum load values of 174.93 N±54.45 compared to 3D mini plates which recorded a mean maximum load value of 106.96 N ± 23.86. Load at break and displacement at maximum load were found to be both insignificant. Conclusion: The results in this study showed statistically no significant difference with any of the above parameters except maximal load, between the two groups evaluated. Conventional linear miniplate according to Champy's lines of osteosynthesis can be used successfully for providing satisfactory osteosynthesis with the definitive advantage of cost-effectiveness.

Primum Non Nocere: A Case Report of Iatrogenic Fracture of the Mandibular Angle During Excision of an Impacted Third Molar.

Third molar extractions are one of the most commonly performed dental procedures. It is associated with numerous complications, of which mandibular angle fracture is a rare but distressing complication. These can occur as intraoperative and postoperative (late) events. Iatrogenic fractures involving the angle of the mandible represent a unique challenge for management owing to their complex biomechanics and various anatomical factors. Intraoperative fractures occur due to various reasons, which include the position of the tooth, depth of impaction, extent of odontectomy performed, and injudicious use of dental elevators. This exhibited report describes a case of iatrogenic mandibular angle fracture (IFM) during excision of an impacted third molar in a 30-year-old female. Additionally, it discusses the various reasons and preventive strategies to avoid such complications.

Correlation of radiomorphometric indices of the mandible and mandibular angle fractures.

This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times. Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities.