Different Therapeutic Measure Of Mandibular Angle Fractures: A Systematic Review And Meta-analysis

Objective: The aim of this study is to compare one miniplate with two miniplates in the management of isolated fractures of the mandibular angle,and making a systematic review with a meta-analysis.Besides,to compare the extraoral and transbuccal approaches for the treatment of mandibular angle fractures with regard to postoperative complications.Methods:Pubmed,Medline-Ovid,Embase,Science Direct,Wan fang Database,CNKI databases were searched from The date of estabilishment of the databases to 2017.We collected randomized controlled trials of different surgical programs in adult mandibular angle fractures.Clinical control study,retrospective studies,the Revman 5.3 software is adopted to conduct with the data by meta-analysis.Results:The result of the meta-analysis showed that one miniplate compared with two miniplates,There was a significant difference between one miniplate and two miniplates in the incidence of infection,dehiscence,failure of hardware,scar,weakness of the facial nerve,(tau2=0.37,chi2=39.10 df=10 P<0.0001;I2=74%),cumulative analysis(RR=0.62 95%CI[0.39,1.00];p=0.05)。Systematic results about different suirgical approachs show that In extraoral group the average of scaring,facial nerve weakness,infection,malocclusion,sialosyrinx,trismus,failure of hardware,bone ununion,were found to be 20.3%(range,6%-100%),24%(range,0%-53%),8.6%(range,0%-20%),18%(range,0%-50%),1.9%(range,0%-5.8%),0%,4.4%(range,0%-10%),0%.Respectively,The incidence of postoperative sialosyrinx,trismus,bone ununion,obevious scar were 0% in transbuccal approach,while,facial nerve weakness,infection rate were 6%(range 0%-13.3),7.1%(range,0%-20%),and malocclusion,failure of hardware rate were 3.8%(0%-12.5%),1.7%(0%-5.5%).Conculusion: The result of the meta-analysis showed that one miniplate provided a significant reduction in the incidence of wound infection and dehiscence,failure of hardware,overall morbidity compared with two miniplates.That transbuccal approach shows fewer complications than extraoral approach when used for the treatment of mandibular angle fractures.