Management of Atrophic Mandibular Fractures in Pakistan – Changing Trends with Preference to Extra-Oral Approach

Background: With the ever-increasing incidence of facial trauma in geriatric population, it is very important to improve the care given to these patients. This study has been focused on determining a better approach for management of atrophic mandibular fractures.  Objective: To compare the frequency of complications of extra-oral versus intra-oral approach for the management of atrophic mandible fractures. Study Design: Randomized control trial. Settings: Outdoor patient of department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore Pakistan. Duration: One year, 20th January, 2018 till 20th January, 2019. Methodology: Seventy consecutive patients were included in this study from the OPD of Oral and Maxillofacial Surgery. All the patients were randomly assorted in the both groups, group A being the intra-oral approach and group B being the extra-oral approach. The outcome was determined on the basis of presence or absence of mal-union or non-union after the fractures were treated. Results: The mean age of cases in extra and intra oral group was 76.54±8.13 years and 73.66± 8.04 years. In extra-oral group, there were 21(60%) male and 14(40%) females and in intra-oral group, there were 25(71/4%) male and 10(28.6%) female cases. In extra –oral group 3(8.6%) cases had complication and in intra-oral group 2(5.7%) cases had complications, the frequency of complication in both groups, p-value >0.05. Among complications in extra-oral group 2(5.7%) cases had non-union and 1(2.9%) had malunion and in intra-oral group 1(2.9%) cases had non-union and malunion each. The frequency of type of complication was statistically same in both group, p-value >0.05.  Conclusion: The incidence of complications is statistically same in both groups. Hence, we encourage the use of extra-oral approach for management of atrophic fractures of mandible.