Objective The objective of this study are - To access the fracture stability i.e. to observe any deviation occur from intraoperatively achieved reduction and occlusion. To find the effects on bite force using gnathodynamometer. To find effect of Z plates on intraoperative time and occlusion. To find effect of Z plates on paraesthesia and infection. To find any postoperative complications like malunion, delayed union, Nonunion etc Methodology The patients will be randomly divided into two equal groups: Group I in which newly designed Z-shaped miniplates will be used for fixation of mandibular symphyseal and parasymphyseal region fractures. Group II in which two straight miniplates will be used for fixation of mandibular symphyseal and parasymphyseal region fractures. InterventionsArmamentarium: Plating kit Z Plate 6mm and 8mm screws (2mm system) Emergency screws (if required) 1.5 mm diameter drill bits Self-holding screw driver Ordinary screw driver Plate holder Plate bender Plate cutter General surgical instruments Diagnostics-probe, mouth mirror and tweezer BP Handle and Blade Periosteal elevator Howarth’s elevator Artery forceps Dissector Langenbeck retractors Malleable retractors Adson’s tissue holding forceps-toothed and non-toothed forceps Kocher Mouth prop Hister’s mouth opener Notched ramus retractors Tongue depressor Metallic scale Trimmers Chisel and mallet Micromotor Set and Straight Handpiece Surgical burs 10ml Syringe Bone curette Bone file Needle holder Dean’s scissors 3-0 Vicryl suture 4-0 Prolene suture Erich arch bar 24gauge wire Wire twister Wire cutter Bite Force recorder (Gnathodynamometer)
Surgical procedure: Patient will be laid on OT table and intravenous (IV) line will be secured. General anaesthesia will be induced by propofol and nasotracheal intubation will be done and anaesthesia will be maintained by Halothane, N2O and O2. The extraoral part preparation will be done using Savlon and Betadine followed by draping and intraoral part preparation using betadine. Erich Arch bar will be adapted in maxillary and mandibular arch and secured by 24 Gauge Stainless steel wires. Occlusion will be achieved by intermaxillary fixation. Vestibular/Degloving incision will be made to expose the fracture site. After exposure of the fracture site, anatomic reduction will be achieved followed by fixation using 2mm Z plate at lower border of mandible. In Group 1 patients, in which 2 mm Z plate will be placed at lower border of mandible secured with 8mm and 6 mm screws. In Group 2 patients, Two conventional 4-hole non-compression titanium miniplate will be adapted at the superior and inferior borders of fracture using 6mm and 8mm screws. Irrigation of surgical field using saline will be performed. After the haemostasis is achieved, the suturing will be done in two layers. The deep muscular layer will be closed followed by the suturing of mucosal layers using 3-0 polygalactin sutures. Patients will be prescribed antibiotics and analgesics postoperatively for 5 days. Patient will be reviewed at 1st,3rd day, 7th, 15th postoperative day, 1st month, 3rd month postoperatively. Post- operative radiographs will be taken at 1st day,5th day,1st month and 3rd month. Postoperative care: All the patients will be instructed to take strict soft and liquid diet for initial 4 weeks. All the patients will be advised to maintain oral hygiene by rinsing with 0.2% Chlorhexidine gluconate mouthwash three times a day and warm saline 24 hrs after surgery All the patients will be advised to avoid trauma to the face. Arch bar removal will be done after 6 weeks. Prescribed medications: Inj. Cefotaxime IV 1gm 12 hourly Inj. Metronidazole 100ml mg IV 8 hourly Inj. Dexamethasone 8 mg IV 8 hourly Inj. Diclofenac sodium 75mg IM 8 hourly for 2 days then orally for next 3 days Inj. Rantac 50 mg IV 12 hourly for 2 days and then Tab. Ranitidine 150mg B.D. for next 3 days Inj. Emeset 4mg IV 12 hourly Mouthwash 0.2% chlorhexidine gluconate thrice a day.
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