Journal of Maxillofacial and Oral Surgery

, Volume 9, Issue 1, pp 9–12

A comparative study between transbuccal and extra-oral approaches in treatment of mandibular fractures

  • Tejraj P. Kale
  • S. D. Baliga
  • Nitin Ahuja
  • S. M. Kotrashetti
Comparative Study


Background and objectives

Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications.

Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve.

In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient.

Study design

Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach.

In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm.


Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring.


The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.


Transbuccal Trochar and cannula Occlusion Scar 


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  1. 1.
    Kroon FH, Mathisson M, Cordey JR, Rahn BA (1991) The use of miniplates in mandibular fractures — An in vitro study. J Craniomaxillofac Surg 19(5): 199–204PubMedGoogle Scholar
  2. 2.
    Choi BH, Yoo JH, Kim KN, Kang HS (1995) Stability testing of a two miniplates fixation technique for mandibular angle fractures. An in vitro study. J Craniomaxillofac Surg 23(2): 122–125Google Scholar
  3. 3.
    Toma VS, Mathog RH, Toma RS, Meleca RJ (2003) Transoral versus extra-oral reduction of mandible fractures: A comparison of complication rates and other factors. Otolaryngol Head Neck Surg 128(2): 215–219CrossRefPubMedGoogle Scholar
  4. 4.
    Dierks EJ (1987) Transoral approach to fractures of the mandible. Laryngoscope 97(1): 4–6CrossRefPubMedGoogle Scholar
  5. 5.
    Shira RB (1954) Open reduction of mandibular fractures. J Oral Surg (Chic) 12(2): 95–111Google Scholar
  6. 6.
    Wagner WF, Neal DC, Alpert B (1979) Morbidity associated with extra-oral open reduction of mandibular fractures. J Oral Surg 37(2): 97–100PubMedGoogle Scholar
  7. 7.
    Wittenberg JM, Mukherjee DP, Smith BR, Kruse RN (1997) Biomechanical evaluation of new fixation devices for mandibular angle fractures. Int J Oral Maxillofac Surg 26(1): 68–73CrossRefPubMedGoogle Scholar
  8. 8.
    Lizuka T, Lindqvist C, Hallikainen D, Paukku P (1991) Infection after rigid internal fixation of mandibular fractures a clinical and radiological study. J Oral Maxillofac Surg 49(6): 585–593CrossRefGoogle Scholar
  9. 9.
    Tams J, van Loon JP, Rozema FR, Otten E, Bos RR (1996) Three dimensional study of loads across the freacture for different fracture sites of the mandible. Br J Oral Maxillofac Surg 34(5): 400–405CrossRefPubMedGoogle Scholar
  10. 10.
    Berg S, Pape HD (1992) Teeth in the fracture line. Int J Oral Maxillofac Surg 21(3): 145–146CrossRefPubMedGoogle Scholar
  11. 11.
    Chuong R, Donoff RB (1985) Intra-oral open reduction of mandibular fractures. Int J Oral Surg 14(1): 22–28CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Tejraj P. Kale
    • 1
  • S. D. Baliga
    • 1
  • Nitin Ahuja
    • 1
  • S. M. Kotrashetti
    • 1
  1. 1.Dept. of Oral and Maxillofacial Surgery, KLE VK Institute of Dental SciencesKLE UniversityBelgaum, KarnatakaIndia

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