Surgical Management of Mandibular Angle Fractures

Purpose: The study proposed to determine the superiority between different fixation methods in the mandibular angle fractures (MAFs) and to evaluate best option for surgeon and patient. Methods: A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. The quality of studies was assessed, and the odds risk (OR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. Subgroup analyses by different fracture regions and different miniplate sizes were performed. Publication bias was measured by a funnel plot. Results: Twenty-one articles were enrolled in this review: 8 randomized controlled trials, 2 controlled clinical trials, and 11 retrospective studies. There were significant advantages for 3-dimensional (3D) miniplate (OR - 0.48, P - 0.003, 95% CI, 0.35-0.67) and 1 miniplate (OR 0.38, 95% CI 0.25-0.58, P<0.00001). The cumulative OR for locking miniplate was 0.45, showing that the utilizing of locking mini-plate in management of MAFs decreases postoperative complications risk by 55% over the use of nonlocking mini-plate. Conclusions: The results of this review indicated that the use of 3D miniplate, locking plate, and 1 plate were more advanced to 2 miniplates technique in low incidence of postoperative complications in the treatment of MAFs.