الفهرس 
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Abstract
The objective of the study was to compare between the use of HBS and Lag screw in the management of anterior mandibular fractures from a clinical and radiographical perspective.
The study was conducted on twelve patients suffering from anterior mandibular fracture have been selected from the cases admitted to the Emergency Ward of Alexandria University Teaching Hospital. The patients were randomly selected with no age or gender predilection suffering from recent anterior mandibular fracture that demand open reduction and internal fixation. Patient with systemic diseases that could affect the process of healing was excluded.
Careful clinical and radiographic examination and detailed history was taken for each patient. Patients were divided to two groups, group 1 (n=6) Utilized HBS with shaft diameter 2mm, cortical head diameter 4mm, cancellous head 3mm and length range from 10mm to 30mm. Lag screw was utilized in group 2 (n=6) with head size of 2mm and shank diameter 1.8, comes with different lengths range from 16 to 30mm.
6.1.1 Surgical procedure
Following MMF, fracture line was exposed with intra-oral incision and reduced. In group1, 1.1mm Kirschner guide wire was drilled to the distal fracture segment, depth was estimated with depth gauge to determine the length of the screw needed. Then with the guide of the K-Guide wire, drilling with 2mm cannulated spiral drill and HBS was inserted using cannulated torque shank screwdriver. In group 2, a 1.6 mm pilot drill was used to reach distal bone segment, followed by a 2mm drill in the proximal segment only. Countersinking in the cortical segment was done to allow seating of the screw head and to be flushed with bone surface. Following Champy’s line, another screw is placed with the same manner. All patients were admitted, received pre-operative and post-operative course of anti-biotic for 5-7 days after discharge.
6.1.2 Clinical and radiographic follow up
Evaluation of pain by Visual Analogue Scale, state of occlusion, sensory nerve function, intra-fragmentary mobility and wound healing was performed for 12 weeks postoperatively.
All patient showed statistically significant decrease in pain level based on Visual Analogue Scale (VAS). group 1 showed 16.7% of the cases with post-operative malocclusion while group 2, 33.3% showed post-operative malocclusion which was treated in both groups with elastic traction for 14 days. Two cases showed impairment in sensory function and limited intra-fragmentary mobility in group 2, which retained to normal sensation and rigidity by the end of follow up period. None of the patient developed infection.
6.1.3 Radiographic Evaluation
Immediate post-operative CT-scan and three months CT-scan was performed to calculate mean bone density. All cases showed a statistically significant increase in the calculated mean bone density across the follow up period.