Treatment of comminuted mandibular fractures: a critical review.

The treatment of comminuted fractures of the mandible is challenging due both to the severity of the injuries generally associated with this type of fracture, and the lack of consensus as to the most appropriate treatment method.There are two distinct approaches for treating comminuted fractures of the mandible: closed reduction with maxillomandibular fixation (MMF) - the oldest and classical treatment - and open operation and internal fixation. The morbidity rate of closed reduction is lower but, with the advent of modern anaesthesia and antibiotics, open surgery has become more frequent. Stable internal fixation (SIF) is acheived using plates, miniplates and/or screws. The advantage of this approach is that there is a more precise reduction of the fragments, with the possibility of early function by eliminating or reducing the time of MMF. This paper reviews the main advantages, disadvantages and differences between the two techniques.