Treatment Protocol for Fractures of the Atrophic Mandible

Purpose: This study was conducted to evaluate the outcomes after treatment of fractures through the atrophic mandible using open reduction, internal fixation, and immediate bone grafting. Patients and Methods: All patients treated surgically for fractures through an atrophic (<15 mm at the fracture site) mandible over a 17-year period were included if their records contained adequate information. Demographic data and details of treatment were tabulated, as were outcomes. Results: A total of 32 patients (19 males, 13 females; age range, 43 to 92 years) met the inclusion criteria. Of the 32 cases, 26 were bilateral fractures, and most occurred through the region of the body of the mandible. Most patients had significant medical comorbidities. Most of the fractures were treated through an extraoral approach with a rigid internal fixation technique. Immediate bone grafts were used in 23 of the 32 patients. No intraoperative or postoperative complications occurred. All patients healed uneventfully. In 4 patients, plates had to be removed for various reasons after fracture healing was complete. Conclusions: The use of a seemingly more aggressive approach for managing fractures through the atrophic mandible produced healing in all patients and, in the end, may be more "conservative" than a less aggressive approach. Despite the advanced age and medical comorbidities of most of the patients, all patients tolerated the surgery and did well postoperatively.