Definition & Overview
Percutaneous treatment with external fixation is one of the techniques used to treat mandibular fractures. Other treatments for this condition include open treatment and closed treatment using interdental wiring.
While percutaneous treatment still involves an incision, the incision is significantly smaller than the large, open incision that is required in an open fracture treatment. This reduces the risks the patient faces, such as bleeding and scarring.
Who Should Undergo and Expected Results
Percutaneous treatment with external fixation is necessary for those who suffer from mandibular fractures or fractures of the jaw. These usually occur due to trauma to the jawbone or the chin or tumours in the bone that causes osteonecrosis.
In around 60% of all mandibular fractures, the mandible gets broken in two separate places. The fractures may occur at the condyle, the body of the jawbone, the angle, or the symphysis. Such injuries can have major effects on the teeth, mouth, and gum movement.
The procedure is a two-step process. The first step involves the percutaneous reduction of the fracture. The second step is the external fixation, which uses pins and screws to stabilise the fractured bone as it heals. Since fixation is done externally, the pins and screws are placed through the skin and into the bone.
The procedure offers a minimally invasive alternative to open surgery with better potential stabilising effects compared to closed treatment.
Studies also show that percutaneous reduction can effectively reduce fractures and restore mandibular height to normal without the need for open surgery. Risks, as well as operating time, are also minimal.
External fixation, on the other hand, refers to the use of externally placed devices that are meant to stabilise the bone and soft tissues around the affected area. Fixation is performed after a fracture has been reduced. It plays a key role in the long-term recovery of the fracture. Its purpose is to aid in the healing of the bone. Proper fixation helps ensure that bone continuity is restored and a functional soft tissue cover will grow over the area.
External fixation is less risky than internal fixation, but it may take longer for the bone to heal completely. This means that the external fixation device may have to be in place for weeks or even months.
How is the Procedure Performed?
Patients who suffer from jaw injuries do not require immediate surgery. Instead, they may undergo a series of diagnostic scans to determine the nature of the injury and the ideal course of treatment. All fractures need to be treated with reduction and fixation and there are several ways to do this.
It is important to note that trauma resulting in mandibular fractures often also causes other injuries, such as head injury, airway obstruction, and spine injury, among others. These other injuries have to be treated first to stabilise the patient’s condition.
When the patient is ready, the doctor threads a Kirschner wire into the fractured segment percutaneously. The Kirschner wire functions like a joystick and can effectively manipulate the fractured jawbones into their proper place without an open incision. The movement of the wires and the manipulation of the mandible can be performed with fluoroscopic guidance.
After the fracture is reduced percutaneously, the patient’s jaw is externally fixed into place with pins, screws, and wires that are inserted through the skin. These external fixators gradually push the two sides of the fractured bone millimetre by millimetre until a bone grows into the gap between them.
Possible Risks and Complications
Compared to open surgery, percutaneous treatment of mandibular fractures with external fixation is less risky for patients. In fact, studies show that patients who undergo this procedure were treated with no complications. Risks are limited to bleeding, infection, and allergic reaction to anaesthesia, due to the small incision required to perform the procedure. The risks of bleeding and scarring, however, are significantly reduced compared to an open procedure.
The percutaneous procedure is not only less risky; it is also less time-consuming in terms of total procedure time. However, since external fixation is used, recovery may take longer than when internal fixation is performed.
Boutros SG. “Closed reduction and fluoroscopically assisted percutaneous stabilization of displaced subcondylar mandible fractures.” Plast Reconstr Surg. 2005 Sep 15;116(4): 971-7. https://www.ncbi.nlm.nih.gov/pubmed/16163080 Nam SM, Lee JH, Kim JH. “The application of the Risdon approach for mandibular condylar fractures.” BMC Surg. 2013; 13:25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708819/ Kohli P, Agni N, Modak A, Nadkarni S, Sangle S. “Percutaneous approach for mandibular angle fracture using lag screw.” WIMJournal. 2014, 1(1). http://www.wimjournal.com/html/journal/images/D1.pdf