CURRENT CONDITION, INDICATIONS AND CONTRAINDICATIONS OF CONSERVATIVE METHODS OF TREATMENT OF FRACTURES OF THE LOWER JAW

Authors:

Abstract:

This review explores the conservative approaches to treating mandibular fractures, focusing on methods like intermaxillary ligatures, splints, and orthopedic devices. It details the fabrication and application of common splints, such as the Tigerstedt splint, and describes various types of intermaxillary fixation. The role of medication, including analgesics, antibiotics, and supplements, is discussed. The article also outlines indications for conservative treatment, including linear fractures without significant displacement, high-risk patients, and pediatric cases. Furthermore, it addresses potential disadvantages such as muscle atrophy, joint contractures, and occlusal dysfunction. The text also covers strategies for preventing complications in surgical treatment, emphasizing multidisciplinary approaches and evidence-based practices to improve patient outcomes.

Keywords:

mandibular fractures fracture lower jaw mandibular conservative treatment intermaxillary fixation splints complications prevention surgical treatment

References:

1. Annino DJ Jr, Sethi RK, Hansen EE, Horne S, Dey T, Rettig EM, et al. Virtual planning and 3D-printed guides for mandibular reconstruction: Factors impacting accuracy. Laryngoscope Investig Otolaryngol. 2022;7(6):1798-1807. doi: 10.1002/lio2.830.
2. Bang K, Shenoi R, Waghchoure AV, Situt N. Maxillomandibular Fixation Using Orthodontic Brackets as a Treatment Option for Mandibular Fractures. Cureus. 2025;17(4):e83085. doi: 10.7759/cureus.83085.
3. Boiko AA, Malanchuk VA, Myroshnychenko MS. Reparative osteogenesis in mandible in cases of filling a bone defect with hydroxyapatite-containing osteotropic material and injecting the surrounding soft tissues with thymalin: experimental and morphological study. Wiad Lek. 2024;77(1):68-76. doi: 10.36740/WLek202401110.
4. Brodetskyi IS, Malanchuk VA, Savielieva NM, Myroshnychenko MS, Hromko YA, Boiko AA, et al. Macrophages and their involvement in mandibular reparative osteogenesis: Current insights. Wiad Lek. 2025;78(6):1176-1181. doi: 10.36740/WLek/205957.
5. Bu L, Zhang Y, Wei X, Xu Q, Jiao Z, Yang C. A 2 year follow-up self-controlled study on morphological changes in the musculoskeletal apparatus after conservative treatment of condylar head fracture. Sci Rep. 2025;15(1):16638. doi: 10.1038/s41598-025-01866-7.
6. Falci SGM, de Souza GM, Fernandes IA, Galvão EL, Al-Moraissi EA. Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg. 2021;50(11):1450-1463. doi: 10.1016/j.ijom.2021.02.009.
7. Gibson AC, Merrill TB, Boyette JR. Complications of Mandibular Fracture Repair. Otolaryngol Clin North Am. 2023;56(6):1137-1150. doi: 10.1016/j.otc.2023.05.008.
8. Guillaumet-Claure MA, Juiz-Camps AM, Gay-Escoda C. Prevalence of intraoperative and postoperative iatrogenic mandibular fractures after lower third molar extraction: A systematic review. J Clin Exp Dent. 2022;14:e85–94. 10.4317/jced.58390
9. Hofmann E, Koerdt S, Heiland M, Raguse JD, Voss JO. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent. 2023;16(3):499-509. doi: 10.5005/jp-journals-10005-2401.
10. Hofstee MI, Muthukrishnan G, Atkins GJ, Riool M, Thompson K, Morgenstern M, et al. Current Concepts of Osteomyelitis: From Pathologic Mechanisms to Advanced Research Methods. Am J Pathol. 2020;190(6):1151-1163. doi: 10.1016/j.ajpath.2020.02.007.
11. Huseynov AN, Malanchuk VA, Grygorovskiy VV, Brodetskyi IS, Myroshnychenko MS, Kalashnyk-Vakulenko YM. The relationship of clinical and morphological data in comminuted fractures of the lower jaw. Wiad Lek. 2022;75(10):2322-2328. doi: 10.36740/WLek202210102.
12. Kim YG, Yoon SH, Oh JW, Kim DH, Lee KC. Comparison of intermaxillary fixation techniques for mandibular fractures with focus on patient experience. Arch Craniofac Surg. 2022;23(1):23-28. doi: 10.7181/acfs.2021.00549.
13. Kovach IV, Zub HE, Lokes KP. Application of linear regression models to determine the effect of age on measured anatomical distances in the treatment of mandibular fractures in children. World of Medicine and Biology. 2024; 4(90):68–73. doi: 10.26724/2079-8334-2024-4-90-68-73.
14. Lee CC, Caruso DP, Wang TT, Hajibandeh JT, Peacock ZS. Mandibular Fracture Repair in Older Adults: Is Age Associated With Adverse Outcomes? J Oral Maxillofac Surg. 2022;80(6):1040-1052. doi: 10.1016/j.joms.2022.01.015.
15. Li L, Acharya K, Ghimire B, Li Y, Xing X, Hou X, et al. Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire. BMC Oral Health. 2023;23(1):601. doi: 10.1186/s12903-023-03309-z. Erratum in: BMC Oral Health. 2023;23(1):773. doi: 10.1186/s12903-023-03460-7.
16. Milic T, Raidoo P, Gebauer D. Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg. 2021;59(6):633-642. doi: 10.1016/j.bjoms.2020.09.020.
17. Monarchi G, Catarzi L, Paglianiti M, Valassina D, Balercia P, Consorti G. A Comparative Analysis of Surgical and Conservative Management in Intra-Articular Condylar Fractures: A Retrospective Study. Surgeries. 2024;5:1033–1042. doi: 10.3390/surgeries5040083.
18. Nayak SS, Arun S, Taranath Kamath A, Jaladhigere Lakshmanagowda B, Dubey E, Koshy J. The Influence of the Mandibular Chin Angle on the Occurrence of Mandibular Condylar Fracture: A Retrospective Study. Scientific World Journal. 2021;2021:2380840. doi: 10.1155/2021/2380840.
19. Nys M, Van Cleemput T, Dormaar JT, Politis C. Long-term Complications of Isolated and Combined Condylar Fractures: A Retrospective Study. Craniomaxillofac Trauma Reconstr. 2022;15(3):246-252. doi: 10.1177/19433875211026759.
20. Oksa M, Haapanen A, Marttila E, Snäll J. Simple dentate area fractures of the mandible – can we prevent postoperative infections? Acta Odontol Scand. 2022;80(7):494-500. doi: 10.1080/00016357.2022.2036812.
21. Patel HB, Desai NN, Matariya RG, Makwana KG, Movaniya PN. Unilateral Condylar Fracture with Review of Treatment Modalities in 30 Cases – An Evaluative Study. Ann Maxillofac Surg. 2021;11(1):37-41. doi: 10.4103/ams.ams_312_20.
22. Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg. 2021;35(4):238-249. doi: 10.1055/s-0041-1735818.
23. Polizzi A, Ronsivalle V, Lo Giudice A, Isola G, Bianchi A, Santonocito S, Leonardi R, Mummolo S. Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review. Children (Basel). 2023;10(3):605. doi: 10.3390/children10030605.
24. Prasad MK, Jain P, Alam A, Varshnay RK, Rani K, Chaudhary AK. The use of mandibular nerve block in unilateral mandibular fracture to evaluate the mouth opening for assessment of airway. Saudi J Anaesth. 2022;16(2):194-199. doi: 10.4103/sja.sja_773_21.
25. Réus JC, Pauletto P, Veronez FC, Souza BDM, Schuldt Filho G, Stefani CM, et al. Prevalence and management of neuropathic injury caused by dental implant insertion in mandible: a systematic review. J Oral Facial Pain Headache. 2024;38(2):25-47. doi: 10.22514/jofph.2024.012.
26. Rughubar V, Vares Y, Singh P. Combination of Rigid and Nonrigid Fixation Versus Nonrigid Fixation for Bilateral Mandibular Fractures: A Multicenter Randomized Controlled Trial. J Oral Maxillofac Surg. 2020;78(10):1781–1794. doi: 10.1016/j.joms.2020.05.012.
27. Sakong Y, Kim YH, Chung KJ. Analysis of Complication in Mandibular Angle Fracture: Champy Technique Versus Rigid Fixation. J Craniofac Surg. 2021;32(8):2732-2735. doi: 10.1097/SCS.0000000000007688.
28. Selvaraj DSS, Oommen AG, Jenifer D, Vinitha G, Ebenezer J. Conservative Approach for Treatment of Isolated Mandibular Fractures, the Adaptations During COVID 19 Pandemic. J Maxillofac Oral Surg. 2022;21(2):426-432. doi: 10.1007/s12663-020-01489-7.
29. Sethi A, Van Huekelom E, Mehra P. Outcomes following use of a standard antibiotic protocol in the management of maxillofacial trauma patients. J Oral Biol Craniofac Res. 2020;10(4):519-522. doi: 10.1016/j.jobcr.2020.08.009.
30. Stupnytskyi IR, Rozhko MM, Stupnytskyi RM, Silenko YuI, Yeroshenko GA. Anatomical and topographical features of the structure of the alveolar part of the mandible in patients with partial adentia. World of Medicine and Biology. 2021;2(76):142-147. doi: 10.26724/2079-8334-2021-2-76-142-147.
31. Systermans S, Cobraiville E, Camby S, Meyer C, Louvrier A, Lie SA, et al. An innovative 3D hydroxyapatite patient-specific implant for maxillofacial bone reconstruction: A case series of 13 patients. J Craniomaxillofac Surg. 2024;52(4):420-431. doi: 10.1016/j.jcms.2024.02.026.
32. Toropov OA, Avetikov DS, Skikevych MG, Ivanytska OS, Rozkolupa OO, Lokes KP. Features of the treatment of hypermobility of the articular heads and dislocations of the lower jaw on the background of fractures of the condygal processes of the mandible, as a prevention of alloplastic replacements of the tempomandibular joint. Ukrainian Dental Almanac. 2024;1:40-43. doi. 10.31718/2409-0255.1.2024.08
33. Troise S, De Fazio GR, Committeri U, Spinelli R, Nocera M, Carraturo E, et al. Mandibular reconstruction after post-traumatic complex fracture: Comparison analysis between traditional and virtually planned surgery. J Stomatol Oral Maxillofac Surg. 2025;126(1):102029. doi: 10.1016/j.jormas.2024.102029.
34. Venugopal P, Reshma Raj VP, Kumaran P, Xavier AM. Custom splint: a conservative approach to pediatric mandibular dentoalveolar trauma. Sci Dent J. 2022;6:146–51. doi: 10.4103/SDJ.SDJ_32_22.
35. Voss JO, Heiland M, Preissner R, Preissner S. The risk of osteomyelitis after mandibular fracture is doubled in men versus women: analysis of 300,000 patients. Sci Rep. 2023;13(1):20871. doi: 10.1038/s41598-023-48235-w.
36. Walker LJ, Koba S, Demiroglu A, Saulacic N, Burkhard JP. Retention of teeth in the fracture gaps of the mandible: a retrospective analysis. Clin Oral Investig. 2023;27(10):6055-6061. doi: 10.1007/s00784-023-05218-5.
37. Wang YC, Wu YC, Chen RF, Cheng NC, Lee SS. Simplified Fabrication of a Lingual Splint for Management of Mandibular Fractures. Plast Reconstr Surg Glob Open. 2024;12(6):e5919. doi: 10.1097/GOX.0000000000005919.
38. Wick EH, Deutsch B, Kallogjeri D, Chi JJ, Branham GH. Effectiveness of Prophylactic Preoperative Antibiotics in Mandible Fracture Repair: A National Database Study. Otolaryngol Head Neck Surg. 2021;165(6):798-808. doi: 10.1177/01945998211004270.
39. Zein Eddine SB, Cooper-Johnson K, Ericksen F, Brookes CC, Peppard WJ, Revolinski SL, Carver TW. Antibiotic Duration and Outcome Complications for Surgical Site Infection Prevention in Traumatic Mandible Fracture. J Surg Res. 2020;247:524-529. doi: 10.1016/j.jss.2019.09.050.
40. Zhmurko AO, Ulyanchych NV, Rublenko MV, Shevchenko SM, Kopchak AV, Kolomiiets VV, et al. Efficiency of replacement of bone defect in rabbit jaw with germanium-doped calcium phosphate ceramics. Pol Merkur Lekarski. 2025;53(2):239-249. doi: 10.36740/Merkur202502113.
41. Zoabi A, Redenski I, Oren D, Kasem A, Zigron A, Daoud S, et al. 3D Printing and Virtual Surgical Planning in Oral and Maxillofacial Surgery. J Clin Med. 2022;11(9):2385. doi: 10.3390/jcm11092385.

Publication:

«World of Medicine and Biology» Vol. 21 No. 94 (2025) , с. 270-275
УДК 616.716.4-001.5-08:616-089.87(048.8)

DOI:

https://doi.org/10.26724/2079-8334-2025-4-94-270-275