CROOMA, complication rates of operatively treated mandibular fractures, paramedian and body Rudolf Seemann, MS, MD, a Günter Lauer, MD, DMD, PhD, a Paul W. Poeschl, MD, DMD, a Kurt Schicho, DSc, PhD, a Michael Pirklbauer, a Günter Russmüller, MD, DMD, a Gerald Krennmair, MD, DMD, PhD, a Christos Perisanidis, MD, DMD, a Rolf Ewers, MD, DMD, PhD, b and Clemens Klug, MD, DMD, PhD, a Vienna, Austria MEDICAL UNIVERSITY OF VIENNA Introduction. This retrospective study comprises an exploratory analysis of 10 years of surgical treatment of symphysis (S) and parasymphysis/body (P/B). Correlations of complications, as well as dependencies of surgical concepts, are investigated. Materials and methods. All surgically treated patients in the period of 1995 to 2005 with at least one mandibular fracture mesial to the mandibular angle were included in this study. A total of 63 patients (46 men, 17 women) with 63 symphysis fractures were included and 497 patients (369 men, 128 women) with 553 P/B were included; 99.27% (549) of these fractures were included in the study, 4 had to be dismissed because of inconclusive documentation. Results. Of patients with P/B, 96.04% were successfully treated with 1 open reduction, 3.76% had 2, and 0.20% had 3 surgeries. Of the surgically treated patients, 75.77% (416) were completely free of complications, whereas the other 24.23% of the P/B showed 1 or more complications. The main complication was mild nerve damage (24.8%). Osteosynthesis failure rate (OFR) was 2.4% (7 of 298) for 2 miniplates, 5.7% (3 of 53) for 1 tension screw, and 8.4% (9 of 107) for 1 miniplate. Regarding OFR, 2 miniplates showed to be superior in a Fisher exact test (P = .018, adjusted P = .132). Symphysis fractures were completely free of complications in 81.8% and showed 2 major complications, i.e., 1 severe nerve damage and 1 osteosynthesis failure. Discussion. This study has the limitations of a retrospective study. Conclusion. A high success rate of open reduction and osteosynthesis with 2 miniplates can be guaranteed. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111:449-454) Facial trauma is frequently accompanied by fractures of the facial skeleton. Reconstructions of fractures of the frontal bone, the maxilla, and the mandible follow different treatment goals and concepts. Common aims of recovery comprise good occlusion, chewing func- tion, and decompression of sensitive nerves. In contrast to mandibular fractures, reduction of maxillary frac- tures aims to recover mobility of the eye, eliminate diplopia, and recreate esthetic bony prominences. Frac- tures of the lower jaw show different problems such as higher mechanical stress along with increased rates of osteosynthesis failure and pseudarthrosis. Topographic classification of mandibular fractures separates symphysis, parasymphysis, mandibular body, angle, ramus, mandibular neck, and diacapitular frac- tures. The fracture localization again accounts for di- versity in surgical treatment concepts and different complication rates. Surgical treatment of angle and neck fractures is more error prone than parasymphysis and body fractures. A series of scientific publications is dedicated to the previous 2 regions. 1,2 In the parasymphysis and mandibular body region (subsequently summarized as P/B), several surgical concepts have been established: rigid osteosynthesis in the base of the mandibular body according to the function stable AO concept (Arbeitsfemeinschaft für Osteosynthe- sefragen), osteosynthesis with 2 miniplates according to the exercise stable principle of Champy, 3 and tension screws 4-6 mesial to and below the mental foramen and especially in the symphysis region. In cases of noncom- minuted fractures and good reduction, surgeons might even use 1 single miniplate in mandibular body fractures distal to the mental foramen according to Champy (see Figs. 1 and 2). Postoperative intermaxillary fixation (IMF) is used as a nonrigid treatment alternative or temporary adju- vant therapy. The preferred surgical approach in our clinic is the marginal incision and thus most of the collected cases a Department of Cranio-, Maxillofacial, and Oral Surgery, Medical University of Vienna, Vienna, Austria. b Head, Department of Cranio-, Maxillofacial, and Oral Surgery, Medical University of Vienna, Vienna, Austria. Received for publication Apr 29, 2010; returned for revision Jun 5, 2010; accepted for publication Jun 16, 2010. 1079-2104/$ - see front matter © 2011 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2010.06.008 449