A Comparison of Plating Techniques for the Treatment of Mandible Fractures: A Systematic Review and Network Meta-Analysis

The purpose of this study was to compare complication rates for mandibular fracture management using 1 mini-plate, 2 mini-plates, reconstruction plates, and 3D plates. Complications that were assessed included infections, malocclusion, neurosensory disturbances, wound dehiscence, hardware failure, and malunion/nonunion. A network meta-analysis was conducted to compare the overall number of complications with each plating system. A traditional meta-analysis was then performed for the 6 pairwise comparisons between the 4 plating techniques for the overall number of complications. A subnetwork meta-analysis was conducted for each complication type with 1 mini-plate as the common comparator. The primary outcome assessed was the overall postoperative complication rate, which was defined as the percentage of total complications out of the total number of patients observed with each surgical technique. The secondary outcome assessed was the rate of each individual type of complication, defined as the percentage of each specific complication out of the total number of complications. Fifteen studies with 676 patients (1 mini-plate: 183 patients, 2 mini-plates: 301 patients, reconstruction plate: 32 patients, 3D plate: 160 patients) were included. Thirty-six percent, 32%, 9%, and 8% of patients with 1 mini-plate, 2 mini-plates, reconstruction plates, and 3D plates, respectively, experienced complications. Overall, the most common complication was neurosensory disturbances, which accounted for 46% of all complications. 3D mini-plates were associated with the fewest number of complications. Further research into the optimal plating scheme for patients with mandibular fractures is warranted.