This study compared fixation of simple mandibular angle fractures with a single miniplate either placed from a combined transbuccal and intra-oral approach, or intra-orally alone. 140 consecutive patients were randomly allocated to the two treatment groups. Complications were noted and compared. An email questionnaire to all the participating surgeons examined their personal preferences between the two methods. 20% of plates needed to be removed during the 3 month study period in the combined transbuccal/intra-oral group compared with 36% in the intra-oral alone group (p<or=0.05). For the small number of cases (5) that required additional fixation, there was no significant difference between the groups. The combined transbuccal/intra-oral procedure was safer and more effective than the standard intra-oral technique in terms of complications requiring further surgery. The surgeons expressed a strong preference (11/12) for fixation using the combined transbuccal/oral approach. The principal reasons given were ease of use, minimal requirement to bend the plate and facilitation of placement of the plate in the neutral mid-point area of the mandible.