Management of Atrophic Mandible Fractures: Are Bone Grafts Necessary?

Management of patients with atrophic mandible fractures has been a challenge for maxillofacial surgeons for years. 1 Bruce R.A. Strachan D.S. Fractures of the edentulous mandible: The Chambers J. Lyons Academy study. J Oral Surg. 1976; 34: 393 Google Scholar , 2 Buchbinder D. Treatment of fractures of the edentulous mandible, 1943-93: A review of the literature. J Oral Maxillofac Surg. 1993; 51: 1174 Abstract Full Text PDF PubMed Scopus (40) Google Scholar , 3 Bruce R.A. Ellis III, E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1993; 51: 904-911 Abstract Full Text PDF PubMed Scopus (70) Google Scholar , 4 Marciani R.D. Hill O. Treatment of the fractured edentulous mandible. J Oral Surg. 1979; 37: 569 PubMed Google Scholar , 5 Eyrich G.K.H. Grantz K.W. Sailer H.F. Surgical treatment of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1997; 55: 1081 Abstract Full Text PDF PubMed Scopus (45) Google Scholar , 6 Tiwana P.S. Abraham M.S. Kushner G.M. et al. Management of atrophic edentulous mandibular fractures: The case for primary reconstruction with immediate bone grafting. J Oral Maxillofac Surg. 2009; 67: 882 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Techniques that have been used are splints, external pins, split ribs wire osteosynthesis, and rigid fixation. 1 Bruce R.A. Strachan D.S. Fractures of the edentulous mandible: The Chambers J. Lyons Academy study. J Oral Surg. 1976; 34: 393 Google Scholar , 2 Buchbinder D. Treatment of fractures of the edentulous mandible, 1943-93: A review of the literature. J Oral Maxillofac Surg. 1993; 51: 1174 Abstract Full Text PDF PubMed Scopus (40) Google Scholar , 3 Bruce R.A. Ellis III, E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1993; 51: 904-911 Abstract Full Text PDF PubMed Scopus (70) Google Scholar , 4 Marciani R.D. Hill O. Treatment of the fractured edentulous mandible. J Oral Surg. 1979; 37: 569 PubMed Google Scholar , 5 Eyrich G.K.H. Grantz K.W. Sailer H.F. Surgical treatment of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1997; 55: 1081 Abstract Full Text PDF PubMed Scopus (45) Google Scholar , 6 Tiwana P.S. Abraham M.S. Kushner G.M. et al. Management of atrophic edentulous mandibular fractures: The case for primary reconstruction with immediate bone grafting. J Oral Maxillofac Surg. 2009; 67: 882 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 7 Obwegeser H.L. Sailer H.F. Another way of treating fractures of the atrophic edentulous mandible. J Maxillofac Surg. 1973; 1: 213 Abstract Full Text PDF PubMed Scopus (39) Google Scholar Results with each of these techniques have had variable success depending on the amount of atrophy that the patient underwent before injury. There has been an evolution of treatment over the years in which closed techniques have been gradually replaced by open techniques. 1 Bruce R.A. Strachan D.S. Fractures of the edentulous mandible: The Chambers J. Lyons Academy study. J Oral Surg. 1976; 34: 393 Google Scholar , 2 Buchbinder D. Treatment of fractures of the edentulous mandible, 1943-93: A review of the literature. J Oral Maxillofac Surg. 1993; 51: 1174 Abstract Full Text PDF PubMed Scopus (40) Google Scholar , 3 Bruce R.A. Ellis III, E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1993; 51: 904-911 Abstract Full Text PDF PubMed Scopus (70) Google Scholar , 4 Marciani R.D. Hill O. Treatment of the fractured edentulous mandible. J Oral Surg. 1979; 37: 569 PubMed Google Scholar , 5 Eyrich G.K.H. Grantz K.W. Sailer H.F. Surgical treatment of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1997; 55: 1081 Abstract Full Text PDF PubMed Scopus (45) Google Scholar , 6 Tiwana P.S. Abraham M.S. Kushner G.M. et al. Management of atrophic edentulous mandibular fractures: The case for primary reconstruction with immediate bone grafting. J Oral Maxillofac Surg. 2009; 67: 882 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 8 Luhr H.G. Reidick T. Merten H.A. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: A retrospective evaluation of 84 cases. J Oral Maxillofac Surg. 1996; 54: 250 Abstract Full Text PDF PubMed Scopus (113) Google Scholar , 9 Wittwer G. Adeyemo W.L. Turbani D. et al. Treatment of atrophic mandibular fractures based on the degree of atrophy—Experience with different plating systems: A retrospective study. J Oral Maxillofac Surg. 2006; 64: 230 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar In 1976, Bruce and Strachan suggested that closed reductions should be tried first and that if an open reduction was required, wire mesh was preferable to a bone plate. 1 Bruce R.A. Strachan D.S. Fractures of the edentulous mandible: The Chambers J. Lyons Academy study. J Oral Surg. 1976; 34: 393 Google Scholar In 1979, Marciani and Hill, after reviewing 33 well-documented cases, recommended that a closed reduction of fractures of the atrophic mandibular body be done. 4 Marciani R.D. Hill O. Treatment of the fractured edentulous mandible. J Oral Surg. 1979; 37: 569 PubMed Google Scholar In the second Chalmers J. Lyons Academy study, published in 1993, Bruce and Ellis 3 Bruce R.A. Ellis III, E. The second Chalmers J. Lyons Academy study of fractures of the edentulous mandible. J Oral Maxillofac Surg. 1993; 51: 904-911 Abstract Full Text PDF PubMed Scopus (70) Google Scholar noted that 81.5% of the 104 patents had an open reduction and internal fixation with a bone plate. In 1996, Luhr et al presented their results in 84 patients with atrophic edentulous mandible fractures treated with compression bone plates. 8 Luhr H.G. Reidick T. Merten H.A. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: A retrospective evaluation of 84 cases. J Oral Maxillofac Surg. 1996; 54: 250 Abstract Full Text PDF PubMed Scopus (113) Google Scholar In 2006, Wittwer et al reviewed their outcomes of the treatment of 30 patients treated with different plating systems. 9 Wittwer G. Adeyemo W.L. Turbani D. et al. Treatment of atrophic mandibular fractures based on the degree of atrophy—Experience with different plating systems: A retrospective study. J Oral Maxillofac Surg. 2006; 64: 230 Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar They concluded that the more atrophic a fractured mandible is, the more rigid the fixation of the fracture needed to be. Tiwana et al, in 2009, suggested that for ideal healing of edentulous, atrophic mandible fractures, bone grafting is needed in addition to a large reconstruction plate and a bone graft. 6 Tiwana P.S. Abraham M.S. Kushner G.M. et al. Management of atrophic edentulous mandibular fractures: The case for primary reconstruction with immediate bone grafting. J Oral Maxillofac Surg. 2009; 67: 882 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar