COMPARISON OF TWO INCISIONS FOR OPEN REDUCTION AND INTERNAL FIXATION OF MANDIBULAR BODY FRACTURES

Abstract

Background: Intraoral access is commonly used for open reduction and internal fixation of mandibular fractures. The choice of incision may influence postoperative swelling, mouth opening, wound healing, and neurosensory recovery. This study compared early postoperative outcomes following crevicular and vestibular incisions.

Settings & Duration: Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro/Hyderabad over a period of six months after approval of the synopsis from ERC.

Methods: This comparative study included 204 patients with mandibular fractures who underwent open reduction and internal fixation. Patients were divided equally into crevicular (n=102) and vestibular (n=102) incision groups. Postoperative swelling, mouth opening, wound healing, and neurosensory function were assessed at predefined follow-up intervals. Between-group differences were analyzed using appropriate statistical tests, with p<0.05 considered statistically significant.

Results: Baseline demographic and clinical characteristics were comparable between the groups. Postoperative swelling was significantly lower in the crevicular group on Days 1, 3, 7, and 14 (all p<0.01). Mouth opening was significantly greater in the crevicular group preoperatively and on Days 1, 3, and 7 (p=0.002, <0.001, 0.035, and 0.028, respectively), but the difference was not significant on Day 14 (p=0.260). Wound healing scores were significantly better in the crevicular group on Days 1, 3, and 7 (p=0.008, <0.001, and <0.001). Direction sense was also better in the crevicular group on Days 1 and 3 (p<0.001), with no significant difference by Day 7. Pin-prick sensation did not differ significantly between groups at any follow-up.

Conclusion: The crevicular incision was associated with less postoperative swelling, better early mouth opening, improved wound healing, and earlier recovery of direction sense compared with the vestibular incision. These findings suggest that the crevicular approach may provide favorable early postoperative outcomes in appropriately selected mandibular fractures.