Mandibular angle fracture: Case report and critical review of internal fixation techniques
DOI:
https://doi.org/10.33448/rsd-v14i11.49990Keywords:
Mandibular fractures, Mandible, Osteosynthesis.Abstract
Mandibular angle fractures are among the most frequent injuries of the maxillofacial skeleton and carry a high risk of functional and aesthetic complications. This study aimed to report a clinical case of left mandibular angle fracture, highlighting diagnostic strategies, surgical access selection and fixation system, and to critically review fixation techniques described in the literature. An exploratory, descriptive, qualitative case report was conducted in a 42-year-old male patient who sustained facial trauma during physical aggression, presenting severe pain, malocclusion, and limited mouth opening. Diagnosis was established through thorough clinical examination and cone-beam computed tomography, including three-dimensional reconstruction for surgical planning. Open reduction was performed via intraoral approach with rigid internal fixation using two monocortical miniplates, following well-established biomechanical principles. The postoperative period evolved uneventfully, with satisfactory occlusal restoration and facial symmetry. Literature analysis shows a progressive evolution of fixation methods, from traditional wire fixation and maxillomandibular immobilization to plates and screws, including miniplates, 3D plates and locking plates, as well as advances in imaging and artificial intelligence for fracture detection. Individualized selection of surgical access and fixation system, supported by accurate imaging diagnosis, is decisive to achieve functional and aesthetic success in the management of mandibular angle fractures.
References
Chrcanovic, B. R. (2014). Fixation of mandibular angle fractures: Clinical studies. Oral and Maxillofacial Surgery, 18, 123–152. https://doi.org/10.1007/s10006-012-0374-1
Chukwulebe, S., & Hogrefe, C. (2019). The diagnosis and management of facial bone fractures. Emergency Medicine Clinics of North America, 37, 137–151. https://doi.org/10.1016/j.emc.2018.09.012
Custódio, G. P., Barbosa, D. R., Dourado, A. C. M., & Santos, J. S. (2024). Osteossíntese de fratura de ângulo mandibular: Relato de caso clínico. Research, Society and Development, 13(12), e85131247693. https://doi.org/10.33448/rsd-v13i12.47693
Ellis, E. III. (1999). Treatment methods for fractures of the mandibular angle. International Journal of Oral and Maxillofacial Surgery, 28, 243–252. https://doi.org/10.1016/S0901-5027(99)80152-0
Flandes, M. P., Dias, L. B. G. M., & Paulesini Júnior, W. (2019). Fratura de mandíbula – relato de caso. Revista de Odontologia da Universidade Cidade de São Paulo, 31(2), 205–212.
Fonseca, R. J., Walker, R. V., Barber, H. D., Powers, M. P., & Frost, D. E. (2015). Trauma bucomaxilofacial (4th ed.). Elsevier.
Gaia, L. G. T. M., Souza, F. B., Almeida, J. S., Pereira, V. A., & Gomes, P. R. (2023). Tratamento da fratura do ângulo mandibular. Revista Eletrônica Acervo Saúde, 23(4), 1–7. https://doi.org/10.25248/REAS.e12205.2023
Guastaldi, F. P. S., Monteiro, J. L. G. C., Takusagawa, T., & Guastaldi, A. C. (2021). A review of biomechanical studies for mandibular angle fracture internal fixation. Journal of Dentistry and Oral Maxillofacial Surgery, 4(1), 1–14. https://doi.org/10.31579/2643-6612/020
Kerdoud, O., Aloua, R., Kaouani, A., & Slimani, F. (2021). Management of mandibular angle fractures through single and two mini-plate fixation systems: Retrospective study of 112 cases. International Journal of Surgery Case Reports, 80, 105690. https://doi.org/10.1016/j.ijscr.2021.105690
Kim, M.-Y., Kim, C.-H., Han, S.-J., & Lee, J.-H. (2016). A comparison of three treatment methods for fractures of the mandibular angle. International Journal of Oral and Maxillofacial Surgery. https://doi.org/10.1016/j.ijom.2016.02.013
Lima, G. L. S., Oliveira, J. B., Pereira, M. M., Andrade, T. V., Silva, M. R. F., Santos, J. A., Marques, D. F. F., Almeida, G. G., Pessoa, D. M. L., Macêdo, L. F. A., Fonseca, J. V., Castro, M. F., Braga, J. N. Q., Gonçalves, L. M. D., & Silveira, A. K. G. (2025). Análise crítica do tratamento de fraturas mandibulares: Cirúrgico x conservador. Cuadernos de Educación y Desarrollo, 17(6), 1–22. https://doi.org/10.55905/cuadv17n6-129
Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. D. (2016). Princípios de cirurgia bucomaxilofacial de Peterson (3rd ed.). Santos.
Norton, N. S., & Netter, F. H. (2018). Netter atlas de anatomia da cabeça e pescoço (3rd ed.). Elsevier.
Oliveira, C. B. F., Lima, G. F., Martins, L. A., & Sousa, R. M. (2021). Osteossíntese a fio de aço do ângulo mandibular e bloqueio maxilo-mandibular: Relato de caso. Archives of Health Investigation, 10(5), 834–837. https://doi.org/10.21270/archi.v10i5.5183
Panesar, K., & Susarla, S. M. (2021). Mandibular fractures: Diagnosis and management. Seminars in Plastic Surgery, 35, 238–249. https://doi.org/10.1055/s-0041-1735818
Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica [E-book gratuito]. UFSM.
Son, D.-M., Yoon, Y.-A., Kwon, H.-J., & Lee, S.-H. (2022). Combined deep learning techniques for mandibular fracture diagnosis assistance. Life, 12(1711). https://doi.org/10.3390/life12111711
Squier, B. R., Kongsong, W., Cofield, S. S., Bignault, S., & Sittitavornwong, S. (2024). Comparison of strengths of mandibular angle fractures following different plate designs: A human cadaver study. Craniomaxillofacial Trauma & Reconstruction, 17(4), 295–305. https://doi.org/10.1177/19433875231225707
Vinayahalingam, S., Nistelrooij, N., van Ginneken, B., Bressem, K., Tröltzsch, D., Heiland, M., Flügge, T., & Gaudin, R. (2022). Detection of mandibular fractures on panoramic radiographs using deep learning. Scientific Reports, 12, 19596. https://doi.org/10.1038/s41598-022-23445-w
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
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Copyright (c) 2025 Gustavo Paiva Custódio, Gabriel Silva Rezende Freitas, Vitor Henrique Moreira Moreno, Ana Clara de Sousa Carvalho, José Fabrício Lima Monteiro, Vitor Simões Aragão, Marcio André Diniz Filho, Guilherme Rodrigues Marinho
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