Klaus Louis Gerlach, Hans-Dieter Pape, and Maxime Champy

Complications connected with miniplate osteosynthesis are more frequently observed after treatment of mandibular fractures than in other situations. The most important complications include wound healing; for example, suture dehiscences, abscesses, osteomyelitis, and pseudarthrosis. The main factors predisposing to these are delayed treatment, missing perioperative antibiotic treatment, and insufficient fracture stability. Long-term follow-up studies indicated that some errors in technique and management led to certain complications, which were seldom seen by experienced surgeons (Champy et al., 1976b; Gerlach et al., 1985; Champy and Blez, 1992).

A breakdown in the intraoral closure commonly occurs between the fourth and eighth postoperative day after treatment of mandibular fractures. This complication is encountered mainly in the posterior region where the plate was located close to the external oblique ridge. In unselected series the incidence of this complication was reported to be between 2.7 % and 12 % after osteosyntheses (Champy et al., 1976b; Champy et al., 1978a; Cawood, 1985; Gerlach et al., 1985; Champy et al., 1986b; Champy and Blez, 1992).

Suture dehiscences were more frequently found if there had been an undue delay between the time of trauma and the time of operation; they can also occur following an inappropriate incision within the region of the attached gingiva. The incision line should be placed 5 mm below the attached gingiva or on the marginal rim. Pre-existing mucosal tears and poor oral hygiene were other possible factors contributing to wound dehiscence. In such cases, after removal of the sutures and wound cleaning with 1.5 % hydrogen peroxide, the wound is dressed with an iodoform Vaseline pack. A secondary suture is not necessary. An unimpaired bony union is ensured by normal, open-wound treatment.

Postoperative infections with abscess formations are also commonly observed in those patients whose treatment had been delayed for some days following trauma and who received no antibiotic prophylaxis (Champy et al., 1976b). This became obvious when, with the decrease of the preoperative time interval, the frequency of abscess formation also diminished from 6.6 % to 3.4 % (Gerlach et al., 1985; Champy and Blez, 1992). In larger series, the quota of postoperative infections was reported between 1 % and 6 % (Cawood, 1985; Champy, 1986b; Nakamura, Takenoshita, and Masuichiro, 1994; Tuovinen et al., 1994; Reinhart et al., 1996; Kakoschke, Mohr, and Schettler, 1996; Pape et al., 1996).

As well as the early treatment of fractures, a perioperative antibiotic treatment is recommended to avoid infections. In a randomized prospective study 200 patients with differing therapeutic regimes were compared (Gerlach and Pape, 1988). Patients received antibiotics prophylactically for different periods: 50 patients for 1 day, 49 patients for 3 days, 50 patients a one-shot prophylaxis, and 51 patients had no antibiotics. The first administration of a combination of mezlocillin and oxacillin was given in all cases 30 minutes before the operation. Infections were found in 23 of 200 patients. The analysis of the examined groups indicated 15 infections in the control group and one, three, and four infections, respectively, in the different prophylaxis groups. A 1-day perioperative antibiotic treatment is recommended.