Mandibular Angle Fracture Treatment Strategies

The mandibular angle fracture presents unique biomechanical and anatomical challenges due to the combination of masticatory muscle forces, the thin cross-sectional geometry of the angle region and the frequent association with third molars. Treatment strategies have evolved from closed reduction with rigid maxillomandibular fixation to a variety of open reduction and internal fixation techniques that balance mechanical stability, preservation of vascular supply and early functional rehabilitation. Contemporary practice employs monocortical miniplates, three-dimensional plate designs or customised patient-specific implants, applied via superior-border, inferior-border or biplanar configurations. Attention to plate positioning allows load sharing and neutralisation of tensile and compressive forces. Advances in computer-aided design and rapid prototyping have fostered bespoke solutions, reducing intraoperative contouring and promoting precise fit. Finite element modelling has illuminated stress distribution across different constructs, guiding optimisation of plate number, hole placement and material selection. Clinicians now integrate biomechanical insights with clinical outcomes to refine decision-making, selecting between single-plate fixation in low-stress scenarios and dual or three-dimensional plate systems when enhanced rigidity is required. Emphasis on reduced operative time, minimised hardware-related morbidity and early restoration of masticatory function underscores the global shift towards evidence-based, patient-centred care.

Research from Nature Portfolio

Recent studies have validated computational models against experimental mechanical testing, confirming the reliability of finite element analysis for predicting fixation performance in angle fractures. In one investigation, a validated finite element model of non-comminuted angle fractures fixed with various mini-plate configurations was subjected to polymeric mandible mechanical testing. The results demonstrated consistent outcomes between in silico and physical models, with dual-plate constructs yielding superior fracture stability compared to single-plate fixation at either the superior or inferior border. This alignment of theoretical and experimental data supports the application of computer-based simulations to preoperative planning and the potential extension of these models to more complex fracture patterns.

Mandibular Angle Fracture Treatment Strategies publication trend

The graph below shows the total number of articles in mandibular angle fracture treatment strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Finite element analysis (FEA): A computational method that subdivides a complex structure into discrete elements to predict stress, strain and displacement under applied loads.

Miniplate osteosynthesis: A surgical technique using small, low-profile metal plates and screws to stabilise bone fractures with minimal periosteal disruption.

Maxillomandibular fixation (MMF): A method of immobilising the mandible in relation to the maxilla to maintain occlusion and alignment during bone healing.

Customised implant: A patient-specific fixation device designed via computer modelling and manufactured to match an individual’s anatomical contours, reducing intraoperative modification.

References

1. Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing. Scientific Reports (2024).
2. Open Reduction and Internal Fixation of Mandibular Fracture without Rigid Maxillomandibular Fixation. International Archives of Otorhinolaryngology (2015).
3. The 3-dimensional miniplate is more effective than the standard miniplate for the management of mandibular fractures: a meta-analysis. European Journal of Medical Research (2017).
4. Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial). Journal of Maxillofacial and Oral Surgery (2023).
5. Management of mandibular angle fractures through single and two mini-plate fixation systems: Retrospective study of 112 cases. International Journal of Surgery Case Reports (2021).
6. Masticatory muscles activity in patients with mandibular angle fractures: A literature review on which procedure to use to reverse the best masticatory muscles functionality. Heliyon (2023).