51
|
Figueiredo CP, Teixeira HM, Afonso AS, Corte‐Real A. Prevalence of, and disability approaches to, temporomandibular joint trauma: A 17‐year cross‐sectional study. Dent Traumatol 2020; 36:624-631. [DOI: 10.1111/edt.12587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Cristina Paiva Figueiredo
- Faculty of Dental Medicine Portuguese Catholic University Center for Interdisciplinary Research in Health (CIIS) Viseu Portugal
| | - Helena M. Teixeira
- Faculty of Medicine National Institute of Legal Medicine and Forensic Sciences Coimbra University Coimbra Portugal
| | | | - Ana Corte‐Real
- Faculty of Medicine Forensic Dentistry Laboratory Coimbra University Coimbra Portugal
| |
Collapse
|
52
|
Krennmair S, Hunger S, Postl L, Winterhalder P, Holberg S, Malek M, Rudzki I, Holberg C. Edentulous mandible with four splinted interforaminal implants exposed to three different situations of trauma: A preliminary three‐dimensional finite element analysis. Dent Traumatol 2020; 36:607-617. [DOI: 10.1111/edt.12575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Stefan Krennmair
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Stefan Hunger
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Lukas Postl
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Philipp Winterhalder
- Department of Oral and Maxillofacial Surgery RWTH Aachen University Aachen Germany
| | - Svenia Holberg
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Ingrid Rudzki
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Christof Holberg
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| |
Collapse
|
53
|
Kannari L, Marttila E, Toivari M, Thorén H, Snäll J. Paediatric mandibular fracture-a diagnostic challenge? Int J Oral Maxillofac Surg 2020; 49:1439-1444. [PMID: 32680807 DOI: 10.1016/j.ijom.2020.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/16/2020] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to clarify the frequency of missed mandibular fractures and to identify possible predictive factors for missed diagnosis. This was a retrospective study that included patients <20 years of age with a recent mandibular fracture. The outcome variable was missed mandibular fracture, which was determined when a fracture was not suspected or diagnosed during the patient's first assessment in primary healthcare. The primary predictor variable was age group (i.e. children <13 years or teenagers/adolescents aged 13-19 years). The explanatory variables were sex, mechanism of injury, and type of facial facture. Other variables were clinical symptoms and findings. Mandibular fracture was missed at first contact in 27 of 182 patients (14.8%). Fracture was missed significantly more often in patients <13 years than in older patients (33.3% vs. 8.8%, P<0.001). The only significant symptom or clinical finding that was associated with missed fractures was skin wound of the jaw (P=0.009). There was no association between missed fracture and sex or mechanism of injury. Mandibular fractures in children are often missed at the first healthcare contact. Careful examination is necessary in paediatric mandibular injuries, particularly in the youngest age groups. Consultation should be smooth between paediatric trauma units and maxillofacial surgeons.
Collapse
Affiliation(s)
- L Kannari
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - E Marttila
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Toivari
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Thorén
- Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Turku, Turku, Finland; Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
| | - J Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
54
|
Ibrahim MH, Ali S, Abdelaziz O, Galal N. Will Closed Treatment Provide Better Mandibular Motion Than Open Reduction and Internal Fixation in Cases of Unilateral Displaced Subcondylar Fracture? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2020; 78:1795-1810. [PMID: 32554064 DOI: 10.1016/j.joms.2020.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of the present systematic review was to determine whether closed treatment (CLT) with intermaxillary fixation (IMF) is superior or equivalent to open reduction and internal fixation (ORIF) in the management of unilateral displaced subcondylar fractures regarding the range of mandibular motion. MATERIALS AND METHODS To address our question, we conducted a systematic review and meta-analysis of the reported data after a comprehensive manual and electronic database search of studies reported up to 2017 in the English language that had compared CLT and ORIF of mandibular condyle fractures in adults. The following outcomes were recorded: maximum interincisal opening (MIO), protrusive movement (PM), lateral excursion toward the fractured side (LEFS), and lateral excursion toward the nonfractured side (LENFS). RESULTS The search resulted in 8 studies, 4 of which were included in the meta-analysis. The MIO and PM showed no statistically significant differences, with an effect size of -0.823 (P = .112) and -0.633 (P = .079), respectively. However, the LEFS and LENFS were superior after CLT, with an effect size of -0.710 (P = .031) and -0.682 (P = .017), respectively. CONCLUSIONS The findings from the present review suggest that both ORIF and CLT can provide comparable MIO and PM in subjects with unilateral displaced subcondylar fractures. However, CLT was superior to ORIF for both LEFS and LENFS.
Collapse
Affiliation(s)
- Mohamed H Ibrahim
- Master's Degree Candidate, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt.
| | - Sherif Ali
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Omniya Abdelaziz
- Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Nadia Galal
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| |
Collapse
|
55
|
The Influence of Mandibular Gonial Angle on Fracture Site. J Oral Maxillofac Surg 2020; 78:1366-1371. [PMID: 32275898 DOI: 10.1016/j.joms.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The mandibular angle is influenced by multiple codependent morphologic dynamic factors, such as osseous anatomy, forces exerted by the muscles of mastication, occlusal loading patterns, and anatomic structures. These factors can influence the presence of a fracture in this area. Our research aimed to investigate a potential correlation between the risk of angle fractures and age, gender, fracture etiology, gonial angle size, presence of mandibular third molars, or presence of occlusal support. MATERIALS AND METHODS This retrospective cohort study was composed of patients treated for mandibular fractures between 2007 and 2018. The primary predictor variable was the gonial angle, and the primary outcome variable was the fracture site. Other study variables included demographic data, fracture etiology, third molar status, and presence of occlusal support. Appropriate univariate, bivariate, and multivariate statistics were applied, and statistical significance was set at P < .05. RESULTS Of 332 isolated mandibular fractures included, 109 were angle fractures; 165, condylar; and 58, body or symphysis. The mean age of patients with angle fractures was 25.5 years, compared with 31.3 years and 32.7 years for those with condylar fractures and body or symphysis fractures, respectively. The mean gonial angle was 125.4° in patients with angle fractures compared with 120.9° and 120.2° in those with condylar fractures and body or symphysis fractures, respectively. The variables that were found predictive of angle fractures were a wider gonial angle and the presence of third molars. CONCLUSIONS Third molars and the gonial angle are predictors of the location of mandibular fractures. Wide gonial angles and the presence of third molars are predictors of mandibular angle fractures.
Collapse
|
56
|
Differences in Facial Fracture Patterns in Pediatric Nonaccidental Trauma. J Craniofac Surg 2020; 31:956-959. [PMID: 32176005 DOI: 10.1097/scs.0000000000006294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize differences in facial fracture injury patterns among pediatric patients at highest risk of abusive head trauma/nonaccidental trauma (age ≤ 5 years). METHODS Using the National Trauma Databank from 2007 to 2015, patients (age ≤ 5 years) suffering facial fractures were included. Demographics and injury characteristics were compared between those sustaining accidental versus nonaccidental trauma (NAT). RESULTS Over 9 years 9741 patients were included with 193 patients (2.0%) suffering NAT. Nonaccidental trauma patients were younger (median [interquartile range]; 0 [0, 2] versus 3 [1, 4], P < 0.001), and more frequently were insured by Medicaid (76.7% versus 41.9%, P < 0.001). NAT patients were more likely to sustain mandible fractures (38.9% versus 21.1%, P < 0.001), but less likely to sustain maxilla (9.8% versus 18.3%, P = 0.003), or orbital fractures (31.1% versus 53.4%, P < 0.001). Nonaccidental trauma patients had fewer instances of multiple facial fracture sites (8.9% versus 22.6%, P < 0.001). Among those sustaining mandible fractures, NAT patients were more likely to sustain condylar fractures (75.8% versus 48.4%, P < 0.001), but less likely to sustain subcondylar fractures (0% versus 13.2%, P = 0.002), or angle fractures (1.6 versus 8.7%, P = 0.048). CONCLUSIONS Differences exist in facial fracture patterns in accidental versus nonaccidental trauma within the pediatric population at highest risk for abusive head trauma. Specifically, NAT is associated with fractures of the mandibular condyle and involve fewer facial fracture sites. In the appropriate context, presence of these fractures/patterns should increase suspicion for NAT.
Collapse
|
57
|
Xu TQ, Wiegmann AL, Jarazcewski TJ, Ritz EM, Santos CAQ, Dorafshar AH. Patient Race and Insurance Status Do Not Impact the Treatment of Simple Mandibular Fractures. Craniomaxillofac Trauma Reconstr 2020; 13:15-22. [PMID: 32642027 PMCID: PMC7311844 DOI: 10.1177/1943387520905399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Health-care disparities have been reported throughout medical literature for decades. While blatant explicit bias is not prevalent, a substantial body of research has been published suggesting that systemic biases related to sex, race, income, and insurance status likely exist. To our knowledge, no study has assessed the impact of patient race and insurance status on clinical decision-making in facial fracture repair in the United States. Thus, the objective of this project was to assess if race and insurance status impacted whether patients obtained open or closed treatment of simple mandibular fractures. METHODS Patients who had either open or closed treatment of mandibular fractures were extracted from the 2012 and 2013 National Inpatient Sample and analyzed. Patients who had a length of stay longer than 3 days or died during their inpatient stay were excluded. These exclusion criteria were used to control for patients with polytrauma as well as complicated fractures. Univariate analysis was undertaken to elucidate different variable associations with the type of reduction performed. All covariates were then entered into a multivariable logistic regression model to test the variables simultaneously. RESULTS Patients with simple condylar, alveolar border, and closed mandibular fractures were more likely to undergo closed reduction (CR) on univariate analysis, as were patients with female gender and a fall mechanism (P value < .05). African Americans, Hispanics, and patients without insurance were more likely to undergo open reduction on univariate analysis (P value < .05). Multivariate analysis demonstrated that patients with simple condylar, subcondylar, alveolar border, or closed mandibular fractures were more likely to undergo a CR, as were patients with female gender and a firearm or fall mechanism (P < .05). However, neither race nor insurance status demonstrated a statistically significant association with closed or open reduction. CONCLUSION Anatomic location and mechanism of injury were the variables found to be significantly associated with patients undergoing open reduction versus CR of simple mandibular fractures-not race or insurance status.
Collapse
Affiliation(s)
- Thomas Q. Xu
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Aaron L. Wiegmann
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Taylor J. Jarazcewski
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ethan M. Ritz
- Bioinformatics and Biostatistics Core at Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Carlos A. Q. Santos
- Bioinformatics and Biostatistics Core at Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Amir H. Dorafshar
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
58
|
Famurewa BA, Oginni FO, Aregbesola SB, Erhabor GE. Pulmonary functions of patients with isolated mandibular fractures: a preliminary report. J Korean Assoc Oral Maxillofac Surg 2020; 46:36-40. [PMID: 32158679 PMCID: PMC7049765 DOI: 10.5125/jkaoms.2020.46.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of this study was to evaluate pulmonary function in patients with mandibular fractures and to determine the pattern of pulmonary functions in these patients. Materials and Methods This was a cross-sectional study of pulmonary functions in Nigerian non-smoking patients with isolated mandibular fractures managed at our health institution from December 2015 to June 2017. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), and ratio of FEV1 to FVC (FEV1/FVC) were measured for all participants using a portable spirometer just before treatment. The pulmonary indices were compared with the predicted reference values for Nigerians to determine the respiratory pattern. Results Forty participants consisting of six females (15.0%) and thirty-four males (85.0%) with a female to male ratio of 1:5.7 were included in this study. The mean patient age was 34.5±13.1 years (range, 17–63 years). The mean FVC, FEV1, FEV1/FVC, and PEFR were 3.8±1.2 L, 3.0±1.0 L, 74.3%±13.8%, and 5.2±2.2 L/s, respectively. Comparison of data with predicted values revealed that 17 subjects (42.5%) had normal pulmonary function pattern while 23 subjects (57.5%) had features suggestive of obstructive and restrictive pulmonary function patterns. Conclusion Isolated mandibular fractures presented with abnormal pulmonary function pattern.
Collapse
Affiliation(s)
| | | | | | - Gregory Efosa Erhabor
- Department of Medicine (Pulmonology Unit), Obafemi Awolowo University, Ile-Ife, Nigeria
| |
Collapse
|
59
|
Nardi C, Vignoli C, Pietragalla M, Tonelli P, Calistri L, Franchi L, Preda L, Colagrande S. Imaging of mandibular fractures: a pictorial review. Insights Imaging 2020; 11:30. [PMID: 32076873 PMCID: PMC7031477 DOI: 10.1186/s13244-020-0837-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/23/2020] [Indexed: 11/23/2022] Open
Abstract
Mandibular fractures are among the most common maxillofacial fractures observed in emergency rooms and are mainly caused by road accidents. The clinical features of mandibular fractures include malocclusion and loss of mandibular function. Panoramic radiography is usually limited to isolated lesions, whereas computed tomography is the tool of choice for all other facial traumatic events. No reference standard classification system for the different types of mandibular fractures is defined. Therapeutic options include a conservative approach or surgical treatment based on the anatomic area and the severity of fracture. The main purpose of this pictorial review is to illustrate a practical description of the pathophysiology of mandibular fractures and describe both the imaging techniques to recognise them and the therapeutic indications.
Collapse
Affiliation(s)
- Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Chiara Vignoli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Michele Pietragalla
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolina Tonelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Lorenzo Franchi
- Department of Surgery and Translational Medicine, University of Florence, Via del Ponte di Mezzo, 46-48, 50127, Florence, Italy.,Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - Lorenzo Preda
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, Italy. .,Diagnostic Imaging Unit, National Centre of Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| |
Collapse
|
60
|
Krennmair S, Winterhalder P, Hunger S, Rupperti S, Holberg C. The Effects of Frontal Trauma on 4 Interforaminal Dental Implants: A 3-Dimensional Finite Element Analysis Comparing Splinted and Unsplinted Implant Configurations. J Oral Maxillofac Surg 2020; 78:961-972. [PMID: 31951811 DOI: 10.1016/j.joms.2019.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE With increased implant-prosthodontic rehabilitation for mandibular edentulism together with the increased life expectancy and activity of the elderly population, a greater number of implant patients may be at risk of facial trauma. The aim of this 3-dimensional (3D) finite element analysis (FEA) was to evaluate the biomechanical effects of the edentulous mandible (EM) with and without implants exposed to frontal facial trauma including assessment of the fracture risk of different mandibular areas. MATERIALS AND METHODS By use of a 3D FEA, our experimental study design comprised 3 different models (model A, EM; model B, EM with 4 unsplinted interforaminal implants; and model C, EM with 4 splinted interforaminal implants) exposed to application of symphyseal frontal trauma of 2 MPa. In 3 defined regions of interest (ROIs) (ROI 1, symphyseal area; ROI 2, mental foraminal area; and ROI 3, condylar neck), the effective stress was measured at predefined sites in the superficial cortical mandibular area. The stress values of all ROIs evaluated were compared within each model (intramodel) as well as between the 3 models (intermodel). RESULTS For all models evaluated, a frontal traumatic load generated the highest stress levels in the condylar neck. However, for both models with implants (models B and C), the stress values were reduced significantly (P < .01) in the condylar neck region (ROI 3) but increased significantly (P < .001) in the mental foraminal area (ROI 2) compared with the EM model without implants. For the symphyseal area (ROI 1) evaluated, the unsplinted 4-implant model (model B) presented significantly (P < .001) higher stress values than the splinted implant model (model C) when frontal forces were applied. CONCLUSIONS Regardless of splinting or lack of splinting of 4 interforaminal implants, force absorption or transmission may shift the predominant risk factor from the condylar neck to the corpus or foramen mandibulae. However, splinting of 4 interforaminal implants may be beneficial in reducing the risk of bone fracture by providing protection for anterior risk situations.
Collapse
Affiliation(s)
- Stefan Krennmair
- Research Fellow, NumBioLab, Department of Orthodontics, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Philipp Winterhalder
- Resident, Department of Oral Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Stefan Hunger
- Resident, Department of Oral Maxillofacial Surgery, Johannes Kepler University Linz, Linz, Austria
| | - Stefan Rupperti
- Research Fellow, NumBioLab, Department of Orthodontics, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christof Holberg
- Professor, Head of NumBioLab, Department of Orthodontics, Ludwig Maximilian University of Munich, Munich, Germany
| |
Collapse
|
61
|
The Influence of the Gonial Angle on the Initial Biomechanical Stability of the Plate Osteosynthesis in Polyurethane Mandibles With Angle Fractures. J Craniofac Surg 2020; 31:871-875. [PMID: 31895842 DOI: 10.1097/scs.0000000000006099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to examine the biomechanical stability of the mandibular angle fractures (MAF) fixated with standard titanium miniplates in polyurethane models with different gonial angles (GA). Three custom molds were prepared for 3-dimensional printed mandibles with low, normal and high GA. Twenty polyurethane replicas were cast per group and standard MAFs were created on each sample. Fractures were stabilized with 1 4-hole standard titanium miniplate inserted over the superior alveolar border. Half of the samples were subjected to molar loading and the other half to the incisal loading up until 150 N force magnitude. The load-displacement curves and the horizontal moment arms were recorded and analyzed. The samples with high GA demonstrated greater displacement than those with normal and low GA during molar loading (P < 0.05 for both). After correcting for the effects of the moment arm, the incisal loading also resulted in higher mean displacement in the high GA group than the others (P < 0.05 for both) and the normal GA samples showed higher displacement after 100 N level compared to those in low GA (P < 0.05). Within the limits of this in vitro study, it can be concluded that the MAFs of the polyurethane mandibles with high GA fixated with 1 standard monocortical plate are more likely to demonstrate higher displacement values under the effects of the molar and incisal loadings than do the mandibles with normal and low GA.
Collapse
|
62
|
Dehnad V, Nezafati S, Ghavimi M, Javadrashid R, Farhadi S. Comparison of accuracy of computed tomography scan and ultrasonography in the diagnosis of mandibular fractures. Dent Res J (Isfahan) 2020. [DOI: 10.4103/1735-3327.284728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
63
|
Identifying risk factors of cerebrovascular injuries following blunt mandible fracture; a retrospective study from a national data base. Eur J Trauma Emerg Surg 2019; 47:855-860. [PMID: 31786656 DOI: 10.1007/s00068-019-01272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this study was to determine the risk factors of cerebrovascular injury (CVI) in patients with blunt mandible fractures. METHODS All patients who sustained a mandible fracture as a result of blunt force trauma from the 2012-2014 National Trauma Data Bank from the United State of America were included in the study. A CVI was noted as having occurred if there was an injury to the vertebral or carotid artery in the neck. Patients' demography, injury mechanism, and additional fractures were compared between the groups of patients with and without CVI using univariate analyses. In addition, a multivariate logistic regression model was fit to identify risk factors for CVI in this cohort. All two-sided p values < 0.05 were considered statistically significant. RESULTS Out of 29,398 patients who qualified for the study, only 398 (1.4%) patients sustained a CVI. There were significant differences (p < 0.001) identified between the groups regarding sex, race, mechanism of injury, occurrence of c-spine fracture, and of Le Fort II and III fractures in the univariate analysis. The risk factors identified by the multiple logistic regression model echoed these results and showed that female gender, injuries due to motorcycle, motor vehicle crashes and the presence of a cervical spine or Le Fort fracture were all associated with the occurrence of CVI (p < 0.05). CONCLUSION The patients with mandible fracture who were female and sustained a high impact blunt force mechanism had a significantly higher risk of CVI. These high-risk patients should be screened for CVI at the time of initial evaluation.
Collapse
|
64
|
Contemporary Characterization of Injury Patterns, Initial Management, and Disparities in Treatment of Facial Fractures Using the National Trauma Data Bank. J Craniofac Surg 2019; 30:2052-2056. [DOI: 10.1097/scs.0000000000005862] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
65
|
Affiliation(s)
- Shravan Kumar Renapurkar
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University Medical Center, 520 N 11th street, Wood Building room 311, Richmond, VA 23298, USA.
| | - Robert A Strauss
- Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University Medical Center, 520 N 11th street, Wood Building room 311, Richmond, VA 23298, USA
| |
Collapse
|
66
|
Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2384. [PMID: 31592391 PMCID: PMC6756660 DOI: 10.1097/gox.0000000000002384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/04/2022]
Abstract
Mandibular fractures in adults commonly require rigid fixation to ensure proper occlusion while minimizing infection risks. Numerous centers have assessed the efficacy of resorbable materials as a potential alternative to metallic plates. The purpose of the current systematic review and meta-analysis is to shed light on overall outcomes for resorbable implants and to compare these results to those for metallic counterparts.
Collapse
|
67
|
Abstract
The mandibular fracture takes the second position among facial bones fractures, with significant increase of cases in the last years. The aim of this paper is to report a clinical case of a patient with facial trauma due to an automotive accident, resulting in an atypical fracture in a unilateral mandibular angle. In the image examinations an atypical favorable fracture in the right mandibular angle region involving the apex of the erupted 48 tooth was found. The fracture line started in the posterior region of mandibular ramus, below mandibular condyle, and spread out until inferior border of the mandible in premolar region. Despite the atypical design of the mandibular angle fracture described in this paper, the treatment showed satisfactory results, without any aesthetic or functional changes for the patient.
Collapse
|
68
|
Bavia PF, Keith DA. Isolated tympanic plate fracture and associated temporomandibular joint symptoms: Literature review and report of 2 cases. J Am Dent Assoc 2019; 150:794-798. [PMID: 31345418 DOI: 10.1016/j.adaj.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
|
69
|
Hassanein AG. Trends and Outcomes of Management of Mandibular Fractures. J Craniofac Surg 2019; 30:1245-1251. [DOI: 10.1097/scs.0000000000005469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
70
|
Edmunds MC, McKnight TA, Runyan CM, Downs BW, Wallin JL. A Clinical Comparison and Economic Evaluation of Erich Arch Bars, 4-Point Fixation, and Bone-Supported Arch Bars for Maxillomandibular Fixation. JAMA Otolaryngol Head Neck Surg 2019; 145:536-541. [PMID: 30946454 DOI: 10.1001/jamaoto.2019.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Erich arch bars, 4-point fixation, and bone-supported arch bars are currently used in maxillomandibular fixation, although to what extent they differ in terms of overall charges and clinical outcomes has yet to be reported. Objective To determine the association of Erich arch bars, 4-point fixation, and bone-supported arch bars in maxillomandibular fixation with hospital charges and clinical outcomes. Design, Setting, and Participants This historical cohort included 93 patients with mandible fracture who underwent maxillomandibular fixation from January 1, 2005, to June 30, 2015, at a tertiary care center. Statistical analysis was conducted from October 4, 2015, to September 8, 2017. Main Outcomes and Measures Charge analysis from an institutional perspective, operative time, necessity for a secondary procedure, and postoperative complications. Results Of the 93 patients in the study (18 women and 75 men; median age, 28.0 years [interquartile range, 23.0-40.0 years]), 27 (29%) received Erich arch bars, 51 (55%) received 4-point fixation, and 15 (16%) received bone-supported arch bars. The mean operative time for Erich arch bars (98.7 minutes; 95% CI, 89.2-108.2 minutes) was significantly longer than for 4-point fixation (48.8 minutes; 95% CI, 41.8-55.7 minutes) and bone-supported arch bars (55.9 minutes; 95% CI, 43.1-68.6 minutes). A total of 17 patients who received Erich arch bars (63%), 37 patients who received 4-point fixation (72%), and 1 patient who received bone-supported arch bars (7%) needed to return to the operating room for hardware removal. Patients who received Erich arch bars and those who received 4-point fixation had significantly higher odds of requiring a secondary procedure than did patients who received bone-supported arch bars (Erich arch bars: odds ratio, 27.1; 95% CI, 2.7-274.6; and 4-point fixation: odds ratio, 42.8; 95% CI, 4.4-420.7). Mean total operative charges for application of the hardware alone were significantly less for 4-point fixation ($5290; 95% CI, $4846-$5733) and bone-supported arch bars ($6751; 95% CI, $5936-$7566) than for Erich arch bars ($7919; 95% CI, $7311-$8527). When secondary procedure charges were included, the mean total charge for Erich arch bars ($9585; 95% CI, $8927-$10 243) remained significantly more expensive than the mean total for 4-point fixation ($7204; 95% CI, $6724-$7684) and bone-supported arch bars ($6924; 95% CI, $6042-$7807). No clinically meaningful difference in complications between groups was found (Erich arch bars, 3 [11%]; 4-point fixation, 5 [10%]; and bone-supported arch bars, 2 [13%]). Conclusions and Relevance Bone-supported arch bars have comparable complication outcomes, operative time for placement, and overall charges when compared with Erich arch bars and 4-point fixation, and have a lower likelihood of requiring removal in an operative setting.
Collapse
Affiliation(s)
- Meade C Edmunds
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - T Alex McKnight
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Christopher M Runyan
- Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Brian W Downs
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Jordan L Wallin
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| |
Collapse
|
71
|
The “European Mandibular Angle” Research Project: The Epidemiologic Results From a Multicenter European Collaboration. J Oral Maxillofac Surg 2019; 77:791.e1-791.e7. [DOI: 10.1016/j.joms.2018.12.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/14/2018] [Indexed: 11/22/2022]
|
72
|
|
73
|
Gong YP, Li R, Wang Y, Kang P, Cai JH, Liu YM, Gan K. [Clinic analysis of 198 elder patients with maxillofacial fracture]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:671-674. [PMID: 30593116 DOI: 10.7518/hxkq.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of the study was to analyze the characteristics of elder patients with maxillofacial fracture. METHODS We retrospectively analyzed the characteristics of maxillofacial fractures in the elder patients, who were treated from July 2010 to October 2017. The clinical characteristics of the etiology, fracture site, combined injury, systemic disease, and treatment method were analyzed. RESULTS In the 198 elderly patients with maxillofacial fractures, the male-to-female ratio was 3.95︰1, and the mean age was 66.15 years old. Traffic accident injury (78 patients, 39.39%), fall injury (49 patients, 24.75%), high fall injury (33 patients, 16.67%) were the main factors of maxillofacial fracture in elderly patients. The most frequently observed fracture site was the mandible (120 patients). A total of 60 patients demonstrated associated injuries, in which limb injuries were the most prevalent (28 patients); whereas 66 patients had other systemic medical conditions, in which cardiovascular diseases was the most frequent (50 patients). The main treatment method of 198 patients was rigid internal fixation with small or micro-plates. CONCLUSIONS Falling and traffic accidents are the main factors of maxillofacial fracture in elderly patients. Thus, interference measures should be observed for the prevention of maxillofacial fractures in elderly patients.
Collapse
Affiliation(s)
- Yu-Ping Gong
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Rui Li
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Wang
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Peng Kang
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jing-Hua Cai
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yi-Ming Liu
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Kang Gan
- Dept. of Oral and Maxillofacial Surgery, The First Affliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| |
Collapse
|
74
|
A comparison of panoramic radiography and cone beam computed tomography in the detection of osteosynthesis complications in sheep mandibular angle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:167-174. [PMID: 30415905 DOI: 10.1016/j.oooo.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic efficacy of panoramic radiography (PANO) and cone beam computed tomography (CBCT) in detecting simulated complications of plate osteosynthesis applied to mandibular angle fractures (MAFs). STUDY DESIGN Unfavorable MAFs were created in 100 fresh sheep hemimandibles. Fractures were fixed with 4-hole titanium miniplates and screws. Bone necrosis around the screws, penetration of the screw into the inferior alveolar canal, screw loosening, and plate breakage were simulated. The diagnostic efficacy of the imaging techniques was compared by using intra- and interobserver agreement scores and area under the receiver operating characteristic curve (AUC) values. Examination time (ET), confidence scores (CS), and planar preference (PP) in CBCT evaluation were assessed. RESULTS Intra- and interobserver agreement scores varied between 0.61 and 0.91. AUCs for screw penetration into the inferior alveolar canal and screw loosening were significantly higher in CBCT than in PANO (P < .05). CBCT presented significantly higher ET and CS values compared with PANO (P < .05). PP showed significant differences among types of complications (P < .05). CONCLUSIONS PANO provided acceptable outcomes in the detection of bone necrosis and broken plates around the screw, but CBCT was more likely to enable detection of all simulated types of complications with higher confidence.
Collapse
|
75
|
Clinical Outcomes Between Atrophic and Nonatrophic Mandibular Fracture in Elderly Patients. J Craniofac Surg 2018; 29:e815-e818. [DOI: 10.1097/scs.0000000000004863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
76
|
Moura LB, Dos Santos Trento G, de Azambuja Carvalho PH, Granucci M, de Oliveira JCS, Pereira-Filho VA. Double unilateral, bilateral, and multiple mandibular fractures: an observational study. Oral Maxillofac Surg 2018; 22:315-321. [PMID: 30109520 DOI: 10.1007/s10006-018-0713-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures. METHODS A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05). RESULTS In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality. CONCLUSION Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.
Collapse
Affiliation(s)
- Lucas Borin Moura
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil.
| | - Guilherme Dos Santos Trento
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Pedro Henrique de Azambuja Carvalho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Mariana Granucci
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Júlio César Silva de Oliveira
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Valfrido Antonio Pereira-Filho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| |
Collapse
|
77
|
Liu YF, Wang R, Baur DA, Jiang XF. A finite element analysis of the stress distribution to the mandible from impact forces with various orientations of third molars. J Zhejiang Univ Sci B 2018; 19:38-48. [PMID: 29308606 DOI: 10.1631/jzus.b1600552] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the stress distribution to the mandible, with and without impacted third molars (IM3s) at various orientations, resulting from a 2000-Newton impact force either from the anterior midline or from the body of the mandible. MATERIALS AND METHODS A 3D mandibular virtual model from a healthy dentate patient was created and the mechanical properties of the mandible were categorized to 9 levels based on the Hounsfield unit measured from computed tomography (CT) images. Von Mises stress distributions to the mandibular angle and condylar areas from static impact forces (Load I-front blow and Load II left blow) were evaluated using finite element analysis (FEA). Six groups with IM3 were included: full horizontal bony, full vertical bony, full 450 mesioangular bony, partial horizontal bony, partial vertical, and partial 450 mesioangular bony impaction, and a baseline group with no third molars. RESULTS Von Mises stresses in the condyle and angle areas were higher for partially than for fully impacted third molars under both loading conditions, with partial horizontal IM3 showing the highest fracture risk. Stresses were higher on the contralateral than on the ipsilateral side. Under Load II, the angle area had the highest stress for various orientations of IM3s. The condylar region had the highest stress when IM3s were absent. CONCLUSIONS High-impact forces are more likely to cause condylar rather than angular fracture when IM3s are missing. The risk of mandibular fracture is higher for partially than fully impacted third molars, with the angulation of impaction having little effect on facture risk.
Collapse
Affiliation(s)
- Yun-Feng Liu
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou 310014, China
| | - Russell Wang
- Department of Comprehensive Care, School of Dental Medicine, Case Western Reserve University, 2124 Cornell Rd. Cleveland, OH 44106-4905, USA
| | - Dale A Baur
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, 2124 Cornell Rd. Cleveland, OH 44106-4905, USA
| | - Xian-Feng Jiang
- Key Laboratory of E&M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou 310014, China
| |
Collapse
|
78
|
Rai A, Jain A, Datarkar A. Comparison of single versus two non-compression miniplates in the management of unfavourable angle fracture of the mandible: a prospective randomized clinical study. Oral Maxillofac Surg 2018; 22:157-161. [PMID: 29460154 DOI: 10.1007/s10006-018-0684-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of single versus two non-compression miniplates in the management of unfavourable angle fracture of mandible. MATERIALS AND METHODS A total of 28 patients who required open reduction of mandibular angle fracture were included in the study. The patients were randomly divided into two groups. Group I comprised of patients treated with two miniplates and those in group II were treated with single non-compression miniplate. The parameters of assessment were malocclusion, surgical site infection, need for implant removal, duration of surgery, inter-incisal mouth opening and cost of implants used, in both the groups. Statistical analysis was carried out to compare all the parameters. RESULTS Out of 14 patients in group II, inadequate reduction was noticed in three patients, whereas screw loosening had occurred in two cases. Screw loosening was always associated with chronic infection. In these cases, hardware removal was deemed necessary. Plate bending was observed in two cases resulting in malocclusion and difficulty in eating. Non-union of fracture occurred in one patient treated in group II. In group I, no plate bending, screw loosening, surgical site infection, non-union or malocclusion was observed. No patient had to undergo implant removal in group I. CONCLUSION In the management of unfavourable mandibular angle fracture, two miniplates must be preferred over the use of single miniplate as using two miniplates results in better results with minimal complications.
Collapse
Affiliation(s)
- Anshul Rai
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anuj Jain
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
| | - Abhay Datarkar
- Department of Oral and Maxillofacial Surgery, Government Dental College, Nagpur, Maharashtra, India
| |
Collapse
|
79
|
Aita TG, Pereira Stabile CL, Dezan Garbelini CC, Vitti Stabile GA. Can a Facial Injury Severity Scale Be Used to Predict the Need for Surgical Intervention and Time of Hospitalization? J Oral Maxillofac Surg 2018; 76:1280.e1-1280.e8. [DOI: 10.1016/j.joms.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/04/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
|
80
|
Abotaleb BM, Al-Moraissi E, Zhiqiang W, Ping C, Yongjie K, Alkebsi K, Lan Y. A detailed analysis of mandibular fractures epidemiology, treatment and outcomes: A 5-year retrospective study, Gansu Province-China. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
81
|
Vlavonou S, Nguyen TM, Touré G. Epidemiology of facial fractures in the elderly. JPRAS Open 2018; 16:84-92. [PMID: 32158816 PMCID: PMC7061603 DOI: 10.1016/j.jpra.2018.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/05/2018] [Indexed: 11/29/2022] Open
Abstract
Facial fractures are considered more common in young individuals. However, they are also increasing in the aging population. Investigation of the characteristics of such fractures is important so as to be able to devise preventive measures and specifications for their proper treatment. We carried out a descriptive retrospective epidemiological study. The information was taken from a database of medical files of patients over 65 years of age in the setting of the emergency ward. Patient information was included for 157 patients aged 65 to 100 years. Two-thirds of the individuals with facial trauma were women. Twenty-eight had a prior history of cognitive impairment. For half of the cases, the trauma occurred at their place of residence, while accidents and falls in public areas were not uncommon. The most frequent site for the fractures was the middle third of the face. These facial fractures were serious in light of their location, as well as the associated skeletal and intracranial lesions. The number of such fractures can be expected to increase with time. Their hospital cost is higher than with younger individuals. Preventative measures need to be devised and the treatment should be all-encompassing.
Collapse
Affiliation(s)
- Sandrine Vlavonou
- Université Paris Est - Créteil, Service de chirurgie maxillofaciale, CHI, Villeneuve-Saint-Georges, France
| | - Tan Mai Nguyen
- Université Paris Est - Créteil, Service de chirurgie maxillofaciale, CHI, Villeneuve-Saint-Georges, France
| | - Gaoussou Touré
- Université Paris Est - Créteil, Service de chirurgie maxillofaciale, CHI, Villeneuve-Saint-Georges, France
| |
Collapse
|
82
|
|
83
|
Amarista Rojas FJ, Bordoy Soto MA, Cachazo M, Dopazo JR, Vélez H. The epidemiology of mandibular fractures in Caracas, Venezuela: Incidence and its combination patterns. Dent Traumatol 2017; 33:427-432. [PMID: 28887820 DOI: 10.1111/edt.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM As reported in the literature by several authors, there is a great variation between countries in terms of etiology and patterns of mandibular fractures. The aim of this study was to determine the incidence of mandibular fractures at the Oral and Maxillofacial Surgery Unit, "Dr. Domingo Luciani" Hospital, Venezuela, during the period January 2010 to March 2013. MATERIALS AND METHODS A retrospective study was conducted to assess the etiology of trauma, age group, gender, anatomic distribution of injury, and combination patterns by reviewing patients records. RESULTS There were 334 patients with 522 mandibular fractures averaging 1.56 fractures per patient. Eighty-five percent of the patients were males with an overall male: female ratio of 6.15:1. The highest occurrence of trauma was in the 20-29 years (43.4%) age group. The etiology most frequently observed was motorcycle traffic accidents in 94 patients (28.1%), and the parasymphysis region was the most common location with 144 (27.6%) fractures. Almost half (48.8%) of the injuries were combined mandibular fractures with 29 different combinations, and the most common was a mandibular body fracture + parasymphysis fracture (22.1%). CONCLUSION Mandibular fracture is a common facial injury with variable incidence and etiology across gender and age range. The findings of this study are similar to other studies and provide important clinical information that will assist in the treatment planning of these types of injuries.
Collapse
Affiliation(s)
- Félix J Amarista Rojas
- Oral and Maxillofacial Surgery Unit, East General Hospital, "Dr. Domingo Luciani ", Caracas, Venezuela
| | - María A Bordoy Soto
- Oral and Maxillofacial Surgery Unit, East General Hospital, "Dr. Domingo Luciani ", Caracas, Venezuela
| | - Morelba Cachazo
- Oral and Maxillofacial Surgery Unit, East General Hospital, "Dr. Domingo Luciani ", Caracas, Venezuela
| | - Juan R Dopazo
- Oral and Maxillofacial Surgery Unit, East General Hospital, "Dr. Domingo Luciani ", Caracas, Venezuela
| | - Henrique Vélez
- Oral and Maxillofacial Surgery Unit, East General Hospital, "Dr. Domingo Luciani ", Caracas, Venezuela
| |
Collapse
|
84
|
Vieira E Oliveira TR, Kemmoku DT, da Silva JVL, Noritomi PY, Passeri LA. Finite Element Evaluation of Stable Fixation in Combined Mandibular Fractures. J Oral Maxillofac Surg 2017; 75:2399-2410. [PMID: 28732217 DOI: 10.1016/j.joms.2017.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/18/2017] [Accepted: 06/18/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE The fixation of combined mandibular fractures, especially symphyseal-condylar fractures, although occurring commonly and having a higher complication rate in the clinic, is rarely investigated regarding predictable therapeutic approaches. Thus this study's aim was to assess different forms of condylar fixation when combined with symphyseal fracture fixation. MATERIALS AND METHODS Using finite element models, we analyzed the stress distribution that occurs when a condylar fracture is fixed with 1 miniplate, 2 miniplates, or a trapezoidal condylar miniplate and when a symphyseal fracture is fixed with 2 parallel plates, 2 perpendicular plates, or 2 lag screws. The null hypothesis was that there would be no differences among the different fixation techniques. RESULTS The results showed a stress concentration in the anterior region of the condyle, close to the sigmoid notch. Moreover, adequate fixation in the symphysis could result in less tension at the condylar region. Therefore, when the symphysis was fixed with a lag-screw technique, condylar fixation was less required, showing a more adequate stress distribution when the condyle was fixed with 1 or 2 plates. Conversely, when the symphyseal fixation was less effective, by use of perpendicular plates, there was a change in the stress distribution at the condylar region, altering fixation behavior and resulting in more tension and displacement in the condyle, especially when a trapezoidal plate was used. CONCLUSIONS A lag screw and parallel double plates appear to be suitable for symphyseal fixation, whereas 2 straightly positioned plates and a trapezoidal plate are suitable for condylar fixation. However, the combination of perpendicular plates in symphyseal fixation and a trapezoidal plate in condylar fixation showed an altered stress distribution.
Collapse
Affiliation(s)
| | | | | | | | - Luis Augusto Passeri
- Researcher, School of Medical Sciences, State University of Campinas, Campinas, Brazil
| |
Collapse
|
85
|
Zavlin D, Jubbal KT, Echo A, Izaddoost SA, Friedman JD, Olorunnipa O. Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults. Craniomaxillofac Trauma Reconstr 2017; 11:41-48. [PMID: 29387303 DOI: 10.1055/s-0037-1603460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022] Open
Abstract
Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds ( p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.
Collapse
Affiliation(s)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Kevin T Jubbal
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Shayan A Izaddoost
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Olushola Olorunnipa
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
86
|
Abstract
Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.
Collapse
Affiliation(s)
- Brent B Pickrell
- Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
87
|
|
88
|
Patel N, Kim B, Zaid W. A Detailed Analysis of Mandibular Angle Fractures: Epidemiology, Patterns, Treatments, and Outcomes. J Oral Maxillofac Surg 2016; 74:1792-9. [DOI: 10.1016/j.joms.2016.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/30/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
|
89
|
Mandibular Fractures Admitted to the Emergency Department: Data Analysis from a Swiss Level One Trauma Centre. Emerg Med Int 2016; 2016:3502902. [PMID: 27656297 PMCID: PMC5021490 DOI: 10.1155/2016/3502902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/14/2016] [Accepted: 08/08/2016] [Indexed: 11/17/2022] Open
Abstract
Mandibular fracture is a common occurrence in emergency medicine and belongs to the most frequent facial fractures. Historically road traffic injuries (RTIs) have played a prominent role as a cause for mandibular fractures. We extracted data from all patients between August 2012 and February 2015 with “lower jaw fracture” or “mandibular fracture” from the routine database from the emergency department. We conducted a descriptive analysis at a Swiss level one trauma centre. 144 patients were admitted with suspected mandibular fractures. The majority underwent CT diagnostic (83%). In 7% suspected mandibular fracture was not confirmed. More than half of all patients suffered two or more fractures. The fractures were median or paramedian in 77/144 patients (53%) and in other parts (corpus, mandibular angle, ramus mandibularis, collum, and temporomandibular joint) in 100/144 (69%). Male to female ratio was 3 : 1 up to 59 years of age; 69% were younger than 40 years. 72% of all patients presented during daytime, 69% had to be hospitalized, and 31% could be discharged from the ED after treatment. Most fractures were due to fall (44%), followed by interpersonal violence (25%) and sport activities (12%). Falls were a dominant cause of fracture in all age groups while violence and sport activities were common only in younger patients. Comparisons to other studies were difficult due to lack of standardization of causes contributing to the injuries. In the observed time period and setting RTIs have played a minor role compared to falls, interpersonal violence, and sports. In the future, standardized documentation as well as categorization of causes for analytic purposes is urgently needed to facilitate international comparison of studies.
Collapse
|
90
|
|
91
|
Bewley AF, Farwell DG. Management of Mandible Fractures. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|