Reposition, mm of the lower jaw in the area of the body angle

The angle of the lower jaw is one of the weakest parts of the bone, which is why fractures happen there so often: according to a 2026 meta-analysis, the angle accounts for 20–30% of all mandibular fractures. Mandibular osteosynthesis means the surgeon realigns the fragments (reduction) and fixes them with titanium miniplates and screws. At UKRMED Maxillofacial Surgery, surgeon Anna Kravchenko plans the operation on CT to restore the bite precisely.

What osteosynthesis means

Mandibular osteosynthesis is surgical fixation of the fragments with metal hardware. Unlike treatment with splints alone, plates hold the fragments firmly, so the patient can open the mouth and return to normal eating sooner. It is especially appropriate when the fragments are displaced, the fracture is unstable or there are several fracture lines. For simpler undisplaced fractures, reduction and immobilisation with splints is often enough.

Symptoms of a mandibular fracture

• pain and swelling at the jaw angle;
• a changed bite and pain when the teeth meet;
• limited mouth opening;
• numbness of the lower lip and chin from nerve irritation;
• bleeding gums, especially near the wisdom tooth.

An angle fracture line often runs through the wisdom tooth socket. Whether to remove that tooth is decided individually — sometimes it is kept so as not to weaken fixation.

Diagnosis

A jaw CT is essential: it shows the line and direction of the fracture, displacement, the teeth and the mandibular canal. This determines the approach and number of plates.

Mandibular fracture reduction and fixation

1. General anaesthesia or deep sedation supervised by an anaesthesiologist.
2. Access — usually through an incision inside the mouth, with no skin scars.
3. Reduction — realigning the fragments and restoring the bite using the teeth.
4. Fixation with a miniplate and screws.
5. Closing the mucosa.

How many plates are needed? A meta-analysis of 16 studies (more than 1,200 patients) compared one and two miniplates for angle fractures. Overall complications did not differ, but a single plate caused fewer hardware problems and less wound breakdown. So for most favourable angle fractures, one plate through an intraoral approach is enough, while two are considered for mechanically unfavourable fractures. The Cochrane review also stresses that the method depends on the fracture type.

Recovery

For the first days, expect swelling, discomfort and soft or liquid food. Rinse your mouth after every meal and do not chew hard food on the fractured side until allowed. Bone union usually takes about four to six weeks. Plates are usually left in place unless they cause problems.

Eating while the bone heals

• For the first weeks: liquid and puréed food — broths, purées, porridge, dairy products and smoothies.
• Eat small portions more often and include protein, which bone healing needs.
• Do not chew hard food on the fractured side for four to six weeks or until the doctor allows it.
• Rinse your mouth and brush with a soft brush after every meal: food debris near plates and stitches raises the risk of infection.

Possible complications

Infection, wound breakdown, plate problems, bite disturbance and prolonged lip numbness. The risk is reduced by early treatment, accurate reduction and careful hygiene.

Prices at UKRMED

The surgeon gives the cost of surgery after the CT scan: it depends on the fracture and the amount of hardware.

Sources

1. Jain A., Nimonkar P., Merchant Y. Comparative effectiveness of one versus two miniplates in the management of mandibular angle fractures: a systematic review and meta-analysis. Br J Oral Maxillofac Surg, 2026. https://doi.org/10.1016/j.bjoms.2025.12.011
2. Nasser M., Pandis N., Fleming P. S. et al. Interventions for the management of mandibular fractures. Cochrane Database Syst Rev, 2013. https://doi.org/10.1002/14651858.CD006087.pub3
3. AO Foundation. AO Surgery Reference: CMF trauma. https://surgeryreference.aofoundation.org/cmf/trauma