J Korean Assoc Oral Maxillofac Surg.  2020 Dec;46(6):393-402. 10.5125/jkaoms.2020.46.6.393.

Cortical lag screw fixation for the management of mandibular injuries

• Elsayed SAH

• KMID: 2510010
• DOI: http://doi.org/10.5125/jkaoms.2020.46.6.393

Abstract

Objectives
Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites.
Materials and Methods
This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05.
Results
Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035).
Conclusion
We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

Keyword

Fractures; Mandibular fracture; Fixation; Fracture types

Figure

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  Fig. 1 A. Preoperative photograph showing displacement of right parasymphyseal fracture, malocclusion, and step deformity. B. Preoperative computed tomography (axial view) showing displaced parasymphyseal mandibular fracture.

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  Fig. 2 A. Photograph showing drills and screws used in cortical lag screw fixation technique (2.4 mm and 1.8 mm drill bits, pear and round shaped burs for countersinking and 2.4 mm screws of different lengths). B. Intraoperative exposure of a linear parasymphyseal fracture. C. Fracture reduction and pre-compression using bone clamp forceps and screwing of the first screw.

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  Fig. 3 A. Postoperative digital orthopantomogram radiograph showing perfect reduction and fixation of the symphyseal fracture using double lag screws in the same direction. B. Reduction and fixation of parasymphyseal fracture using double lag screws in the opposite direction. C. Perfect reduction and fixation of body fracture using a single lag screw. D. Reduction and fixation of angle fracture using a single lag screw.

Reference

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