Percutaneous Approach to Mandibular Angle Fractures

Percutaneous Approach to Mandibular Angle Fractures

Michael A. Carron


Facial trauma is responsible for a substantial portion of injuries seen in the emergency room. The most common cause of injury is physical assault. However, falls, bicycle accidents, industrial accidents, motor vehicle accidents, and sporting injuries are also contributing elements. It is not unusual for victims of facial trauma to have a fracture of the mandible, and about 25% will occur at the mandibular angle. This injury is believed to occur due to the turning of the head upon attack, thereby exposing the angle of the mandible to the brute force. It is further susceptible to fracture because third molars occupy osseous space, thereby weakening the bone stock. Moreover, unique forces can act on the angle because it is a transition zone from the body to the ascending ramus of the mandible.

The region of the mandibular angle is very important as it plays a central role in the functional integrity of the jaw as well as facial aesthetics. Failure to properly reconstruct the mandibular angle may result in malunion or nonunion with resultant malocclusion, chronic pain, facial asymmetry, and impaired mastication. The treatment of these injuries requires expertise and becomes even more difficult and complex when patients have poor dentition, have poor oral hygiene, and are prone to miss appointments for follow-up care.

The repair of fractures of the mandibular angle can be performed through an external submandibular approach or percutaneously through an intraoral incision combined with a transbuccal trocar and screwdriver. The percutaneous approach reduces potential injury to the facial nerve and minimizes external incisions and scarring. However, when drilling holes and placing screws, the technique may be difficult in certain hard-to-reach areas of the mandibular angle.


Patients with a fracture of the mandible usually present to the emergency room with a complex history of trauma. The standard tenants of evaluating the trauma patient (airway, breathing, circulation, Glasgow Coma Scale, IV access) take priority over general patient history. Since the mandible is located in continuity to the floor of the mouth, edema or frank hematoma can displace the tongue posteriorly. Such a patient may present with difficulty breathing and harbor a significant potential for airway obstruction.

Once the trauma evaluation is complete and the patient is stabilized, attention is directed toward the events of the trauma, signs and symptoms related to these injuries, and the patient history. Questions regarding the current event, past surgical interventions, previous trauma, current medications, allergies, family history, and substance use are reviewed and recorded. The patient’s general health history is also obtained at this time and includes cardiac, pulmonary, hepatic, and renal systems. Depending upon the patient’s level of consciousness, the history may need to be obtained by family or accompanying others. Additional surgical specialists and social services are consulted as necessary.

Oct 7, 2018 | Posted by in OTOLARYNGOLOGY | Comments Off on Percutaneous Approach to Mandibular Angle Fractures
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