Management of the fractured edentulous atrophic mandible

Nasser M, Fedorowicz Z, Ebadifar A

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Summary

Management of the fractured edentulous atrophic mandible

Fractures of the toothless, brittle and weakened lower jaw are fairly common in elderly people. Options for treatment include closed and open surgical techniques but there is still uncertainty as to which method has the most successful outcomes.
The review authors found insufficient evidence for the effectiveness of either approach, which may be partly attributable to a lack of agreement in what is open or closed and conservative and invasive treatment, in addition to some variability in what are the most appropriate measures of successful results.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Nasser M, Fedorowicz Z, Ebadifar A. Management of the fractured edentulous atrophic mandible. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006087. DOI: 10.1002/14651858.CD006087.pub2.

This version first published online: January 24. 2007

Abstract

Background

Fractures of the atrophic and edentulous (toothless) mandible (lower jaw) are fairly common in elderly people. Atrophy and weakening tend to occur as a result of reduced vascularity and decreased blood flow. Treatment options for reduction and fixation include closed and open techniques, with the degree of atrophy having a significant influence on the type of treatment. Many methods have been proposed for treating fractures of the atrophic mandible but there is still some uncertainty as to which method has the most successful outcomes.

Objectives

The objective of this review was to provide reliable evidence regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured edentulous atrophic mandibles.

Search strategy

We searched the Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE from 1966 and EMBASE from 1980, both to 30th January 2006. Last search was done in January 2006.

Selection criteria

Randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were to be included.

Data collection and analysis

Screening of eligible studies was conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.

Main results

No eligible randomised controlled trials were identified.

Authors' conclusions

This review illustrates that there is currently inadequate evidence for the effectiveness of a single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that until high level evidence is available treatment decisions should continue to be based on clinician's prior experience.
This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.

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