الفهرس 
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Abstract
The target of the study is to evaluate the use of Herbert cannulated bone screw in the management of various configurations of mandibular fractures from a clinical and radiographical perspective.
Eleven patients stricken by mandibular fracture have been selected from the cases admitted to the Emergency Ward of Alexandria University Teaching Hospital. All the selected subjects were of age with no gender predilection suffering from recent, uninfected, non-comminuted, Unfavorable fracture demanding open reduction and internal fixation mandibular fracture. Excluding those with systemic diseases that could have interfered with healing.
A detailed history taking and a thorough clinical examination and radiographic examination was performed and recorded for every patient. The utilized screw had a shaft diameter of 1.25 mm, cortical head diameter of 2.3 mm and a 2.0 cancellous head with that ranges from 10 to 35 mm.
Surgical Procedure
After securing the occlusion with temporary IMF, the fracture line is exposed and manually reduced, then a 0.8mm Kirschner guide wire is drilled and tapped into the opposite cortex of the distal fracture segment. The depth of the osteotomy was measured using a depth gauge to determine the length of the to be utilized screw. Next drilling under the guidance of the K-Guide wire using the 2mm cannulated spiral drill, followed by insertion of Herbert Bone Screw, with the aid of the cannulated torque shank screwdriver, to allow traction of the bone segments and fixation of the fracture line. In case of a symphyseal or a parasymphyseal fracture, a second screw was placed in the similar manner and direction to avoid rotation of the compressed fracture line in the area anterior to the mental foramina. All patients received intravenous antibiotics from the time of admission, followed by a course of oral antibiotics for 5–7 days after discharge.
Clinical and Radiographic follow up
Clinical evaluation for pain (assessed by visual analogue scale), state of occlusion, mouth opening (assessed by measuring inter-incisal distance in mm), sensory nerve function and wound healing was performed for 12 postoperative weeks.
All the cases experienced a statistically significant decrease in level of pain intensity score based on the Visual Analogue Scale (VAS) across the follow up period. The occlusal examination showed a normal occlusal and intercuspal relation in all of the cases. Two cases showed sensory impairment in the lower lip, both regained normal sensation by the end of the follow up period. None of the patients developed infection.
Radiographic Evaluation
A postoperative radiographic appraisal was performed using an immediate postoperative CT-scan and another after three months for radiodensitometric estimate of the mean bone density. All the cases demonstrated a statistically significant increase in the calculated mean bone density across the follow up period.
Conclusion
Despite that it is a technique sensitive treatment modality that requires surgical expertise and strict attention to its placement prerequisites, the use of Herbert Bone Screw for mandibular fractures management showed a satisfactory and predictable wound and bone healing outcomes.