For angle fractures, the ideal line of osteosynthesis is located along the upper border of the lateral surface of the mandible (A).
An alternative to this position is at the external oblique ridge (B).
The advantages of placement (A) are:
- no or minimal adaptation of the plate is required
- there is less risk of complications (plate exposure)
Al-Moraissi EA, Ellis E 3rd. What method for management of unilateral mandibular angle fractures has the lowest rate of postoperative complications? A systematic review and meta-analysis. J Oral Maxillofac Surg. 2014 Nov;72(11):2197-211.
Laverick S, Siddappa P, Wong H, Patel P, Jones DC. Intraoral external oblique ridge compared with transbuccal lateral cortical plate fixation for the treatment of fractures of the mandibular angle: prospective randomised trial. Br J Oral Maxillofac Surg. 2012 Jun;50(4):344-9.
Sugar AW, Gibbons AJ, Patton DW, Silvester KC, Hodder SC, Gray M, Snooks H, Watkins A. A randomised controlled trial comparing fixation of mandibular angle fractures with a single miniplate placed either transbuccally and intra-orally, or intra-orally alone. Int J Oral Maxillofac Surg. 2009 Mar;38(3):241-5.
NOTE: Be prepared to change the fixation plan to using two miniplates in case of poor reduction at the basal region or if the stability is not sufficient.