COMPARISON OF MONOCORTICAL AND BICORTICAL SCREW FIXATION IN SYMPHYSIS AND PARASYMPHYSIS FRACTURES ASSOCIATED WITH BILATERAL CONDYLAR FRACTURES: A PROSPECTIVE RANDOMIZED CLINICAL TRIAL

Abstract

Background:

Undoubtedly, mandibular symphysis and parasymphysis fractures, those associated condylar fractures on the bilateral side, represent a unique challenge in oral and maxillofacial surgery. To maintain mandibular continuity, to restore occlusion, and to avoid developing complications such as lingual splaying, the reduction and fixation are important, although the reduction has to be adequate enough and also the fixation has to be adequate enough. However, since the use of monocortical screw fixation is commonly performed for ease of application and minimal risk of injury to vital structures, bicortical screws may provide better stability through their involvement of both the buccal and lingual cortices.

Objective:

The study we aimed to compare the lingual gap in symphysis and parasymphysis fixated with monocortical versus bicortical screws in patients with concomitant bilateral condylar fracture treated conservatively.

Methods:

A single-blind prospective randomized clinical trial was done in 60 adult patients with symphysis/parasymphysis fracture and bilateral condylar fracture. Two groups of patients with the two possible x-screws (monocortical vs. bicortical) were analyzed with CBCT. The lingual gap postoperatively was measured as the primary outcome.

Results:

Mean lingual gaps were significantly smaller (p < 0.05) with patients fixed with bicortical screws than with patients fixed with monocortical screws. Descriptive data on 29 randomly selected cases were obtained in each group and the average maximum distance between fracture segments was lower in the bicortical fixation group. Hardware failures or complications were not observed.