External fixation for tissue preservation following complex mandible trauma and its sequelae: reminder of a time-honored method and case series of 23 patients

Abstract

Objective: Oral and maxillofacial surgeons are often called upon to manage complex mandible injuries, which can be associated with significant tissue loss. External fixation (EF) of comminuted, contaminated, compound, and infected fractures can preserve tissue, maintain anatomic integrity, and provide an effective stage in comprehensive reconstruction. The purpose of this report is to review the EF surgical technique and share our outcomes and experience of using EF over 6 years in 23 patients.

Study design: Patients treated with mandibular EF were identified through a retrospective chart review for a single surgeon. Assessment of surgical outcomes included: evaluation of tissue preservation via clinical and radiographic exams; patients' subjective tolerance of the treatment; and a need for further reconstructive surgery.

Results: We identified and reviewed 23 patients who were treated with mandibular EF between September 2018 and June 2024. Diagnostic fracture categories for which the EF was used include: pathologic, infected with nonunion, subacute with infection, acute comminuted and compound, and ballistic. Treatment was well accepted and tolerated by most patients largely due to pain relief postfixation.

Conclusions: External fixation allowed anatomic reduction and healing in patients with acute injuries, served to temporarily stabilize fractures with gap defects, and was excellent for infected fractures. There were no instances of external fixator hardware failure or infection, including in patients with consistently poor hygiene.