Comparative Analysis of Outcomes: Intra-Oral and Transbuccal Approach Using Trocar for Fixation of Mandibular Fractures
Intra-Oral and Transbuccal Approach Using Trocar for Fixation of Mandibular Fractures
DOI:
https://doi.org/10.54393/pjhs.v7i7.3516Keywords:
Mandible Angle Fracture, Transbuccal, Intraoral, Occlusion, Surgical TimeAbstract
Mandibular fractures are frequent maxillofacial injuries. Open reduction and internal fixation may be intraoral or transbuccal, with each having varying access, visualization, and aesthetic effects. Objectives: To compare intraoral and transbuccal methods of fixation of mandibular fractures. Methods: It was a prospective interventional study among 70 patients with unilateral displaced fracture of the mandible, who were divided into intraoral (n=35) and transbuccal (n=35) groups. All cases were subjected to standard intraoral access. The fixation was done intraorally & using a transbuccal trocar. They were assessed in relation to surgical time, ease of accessibility (VAS 13), post-operative occlusion, and radiographic fracture reduction (adequate 3 mm gap or below). The continuous variables were evaluated using the Mann-Whitney U test, and the chi-square test was applied to the categorical variables with a level of significance at p<0.050. Results: Fracture reduction (82.9 vs. 80.0; p=0.759) and post-operative occlusion (both 88.6; p<0.001) did not reveal any significant difference. The transbuccal group had better access to surgery. The intraoral method was shorter in terms of the time of operations (median 45 vs. 70 minutes; p<0.001). Conclusions: The transbuccal method enhances the accessibility of the surgery, and the intraoral method is faster. The choice of approach must take into account the position of fractures and the experience of the surgeon.
References
Hassan A, Baig YS, Afzal M, Babar A, Khan AA, Khan N. Comparison of Transbuccal Versus Transoral Approach for Management of Mandibular Angle Fractures. Pakistan Armed Forces Medical Journal. 2025 Oct; 75(5): 865. doi: 10.51253/pafmj.v75i5.10271. DOI: https://doi.org/10.51253/pafmj.v75i5.10271
Qamar A, Donepudi N, Thakur D, Datta A, Jain A, Singh A et al. Transbuccal with Transoral Versus Transoral-Only Approach for Open Reduction and Internal Fixation of Mandibular Angle Fractures: A Prospective Study. Cureus. 2025 Aug; 17(8). doi: 10.7759/cureus.90784. DOI: https://doi.org/10.7759/cureus.90784
Gerçek AO and Bayrakçi N. Mandibular Condyle Remodeling and Joint Space After Open Reduction and Internal Fixation of Mandibular Parasymphysis and Angle Fractures: A Retrospective Study. BioMed Central Oral Health. 2025 Sep; 25(1): 1437. doi: 10.1186/s12903-025-06809-2. DOI: https://doi.org/10.1186/s12903-025-06809-2
Pavithra SK, Vivek N, Saravanan C, Karthik R, Prashanthi G, Scott C. Comparison of Conventional Versus Right Angled Fixation Technique in Management of Mandibular Angle Fractures–A Prospective Randomized Clinical Study. Journal of Oral and Maxillofacial Surgery. 2023 Aug; 81(8): 1001-10. doi: 10.1016/j.joms.2023.04.005. DOI: https://doi.org/10.1016/j.joms.2023.04.005
Kent S, Adatia A, James P, Bains K, Henry A, Blore C et al. Risk Factors Associated with Short-Term Complications in Mandibular Fractures: The MANTRA Study—A Maxillofacial Trainee Research Collaborative (MTReC). Oral and Maxillofacial Surgery. 2023 Dec; 27(4): 609-16.
Mathew N, Singh I, Gandhi S, Solanki M, Bedi NS. The Efficacy of Fixation of Unilateral Mandibular Angle Fracture with Single 3D Plate vs Single Miniplate Using Transbuccal Approach. Journal of Maxillofacial and Oral Surgery. 2022 Jun; 21(2): 405-12. doi: 10.1007/s12663-020-01465-1. DOI: https://doi.org/10.1007/s12663-020-01465-1
Elsayed SA, Reda HM, Awadd MM, Mourad SI, Shokeir HM, Elsayed EH et al. Transbuccal vs. Intraoral Approach Using an Angulated Screwdriver in Fixation of a Mandibular Angle Fracture. The Open Dentistry Journal. 2022 Aug; 16(1). doi: 10.2174/18742106-v16-e2206200. DOI: https://doi.org/10.2174/18742106-v16-e2206200
Cha HG, Kim YJ, Nam SM, Kim SH, Park ES. Intraoral Open Reduction for Mandibular Angle Fracture Using an Angulated Screwdriver System. Journal of Craniofacial Surgery. 2022 Oct; 33(7): 1987-90. doi: 10.1097/SCS.0000000000008585. DOI: https://doi.org/10.1097/SCS.0000000000008585
Roccia F, Cocis S, Segura-Pallerès I, Duran-Valles F, Zanakis SN, Petrov P et al. Surgical Management of Mandibular Angle Fractures: Does the Extraction of the Third Molar Lead to a Change in the Fixation Pattern? A European Multicenter Survey. Journal of Oral and Maxillofacial Surgery. 2021 Feb; 79(2): 404-11. doi: 10.1016/j.joms.2020.09.022. DOI: https://doi.org/10.1016/j.joms.2020.09.022
Sehrawat K, Malik B, Vallabha HV, Vaishnavi AB, Pendyala SK, Ibrahim M et al. A Comparative Evaluation of Transbuccal Versus Transoral Approach for the Management of Mandibular Angle Fractures: A Prospective, Clinical, and Radiographic Study. Journal of Pharmacy and Bio-Allied Sciences. 2021 Nov; 13(Suppl 2): S1295-9. doi: 10.4103/jpbs.jpbs_112_21. DOI: https://doi.org/10.4103/jpbs.jpbs_112_21
Rai A, Jain A, Datarkar A. Comparison of Single Versus Two Non-Compression Miniplates in the Management of Unfavourable Angle Fracture of the Mandible: A Prospective Randomized Clinical Study. Oral and Maxillofacial Surgery. 2018 Jun; 22(2): 157-61. doi: 10.1007/s10006-018-0684-z. DOI: https://doi.org/10.1007/s10006-018-0684-z
Mahmoud N and Ashour E. Comparative Study Between Three Different Plating Techniques in Management of Mandibular Angular Fractures. A Retrospective Study. Egyptian Dental Journal. 2021 Jan; 67(1-January (Oral Surgery)): 167-80. doi: 10.21608/edj.2020.36904.1185. DOI: https://doi.org/10.21608/edj.2020.36904.1185
Şahar D, Gerçek AO, Bayrakçi N. Risk Factors of Mandibular Angle Fractures Based on Digital Reduction Method: A Retrospective Analysis. BioMed Central Oral Health. 2025 Aug; 25(1): 1338. doi: 10.1186/s12903-025-06706-8. DOI: https://doi.org/10.1186/s12903-025-06706-8
Sakong Y, Kim YH, Chung KJ. Analysis of Complication in Mandibular Angle Fracture: Champy Technique Versus Rigid Fixation. Journal of Craniofacial Surgery. 2021 Nov; 32(8): 2732-5. doi: 10.1097/SCS.0000000000007688. DOI: https://doi.org/10.1097/SCS.0000000000007688
Said H. Management of Unfavorable Displaced Mandibular Angle Fracture with Combined Rigid and Semi-Rigid Fixation Using Trans-Oral and Trans-Buccal Approaches. One-Year Prospective Clinical and Radiographic Study. Egyptian Dental Journal. 2022 Oct; 68(4): 3117-28. doi: 10.21608/edj.2022.142056.2128. DOI: https://doi.org/10.21608/edj.2022.142056.2128
Lee H, Kim KS, Choi JH, Hwang JH, Lee SY. Trauma Severity and Mandibular Fracture Patterns in a Regional Trauma Center. Archives of Craniofacial Surgery. 2020 Oct; 21(5): 294. doi: 10.7181/acfs.2020.00556. DOI: https://doi.org/10.7181/acfs.2020.00556
Wusiman P, Taxifulati D, Weidong L, Moming A. Three-Dimensional Versus Standard Miniplate, Lag Screws Versus Miniplates, Locking Plate Versus Non-Locking Miniplates: Management of Mandibular Fractures, A Systematic Review and Meta-Analysis. Journal of Dental Sciences. 2019 Mar; 14(1): 66-80. doi: 10.1016/j.jds.2018.04.004. DOI: https://doi.org/10.1016/j.jds.2018.04.004
Kumar A, Shah SF, Ali MH, Hassan SG. Mandibular Angle Fracture: Comparison of Complication Rates of Intraoral and Transbuccal Approach. The Professional Medical Journal. 2019 Mar; 26(03): 430-3. doi: 10.29309/TPMJ/2019.26.03.3243. DOI: https://doi.org/10.29309/TPMJ/2019.26.03.3243
Stanford-Moore G and Murr AH. Mandibular angle fractures. Facial Plastic Surgery Clinics. 2022 Feb 1;30(1):109-16. doi: 10.1016/j.fsc.2021.08.009. DOI: https://doi.org/10.1016/j.fsc.2021.08.009
El-Anwar MW and Sweed AH. Simple Percutaneous Transbuccal Approach for Management of Mandibular Angular Fracture. Journal of Craniofacial Surgery. 2017 Jun; 28(4): 1035-7. doi: 10.1097/SCS.0000000000003539. DOI: https://doi.org/10.1097/SCS.0000000000003539
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