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Barrett T, Chi J. Evidence-Based Medicine for Mandible Fracture Repair: Current Controversies and Future Opportunities. Facial Plast Surg 2023; 39:214-219. [PMID: 36603829 DOI: 10.1055/a-2008-2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Mandibular fractures are among the most common facial fractures resulting from trauma. The nature of the injury, involved facial structures, presence of associated injuries, the dental status of the patient, comorbid conditions, and psychosocial context all must be considered by the surgeon when planning the optimal treatment for these patients. While consensus exists for many aspects of the management of mandibular trauma, some elements remain controversial. Three such topics-antibiotic therapy, treatment of subcondylar fractures, and management of the third molar-remain particularly controversial, with significant heterogeneity in practice patterns and without widely accepted evidence-based guidelines to standardize care. The goals of this work are to (1) review the historical perspective underlying these controversies, (2) summarize recent evidence shaping the current debate, and (3) highlight opportunities for continued efforts to identify best practices.
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Affiliation(s)
- Thomas Barrett
- Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - John Chi
- Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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2
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Sharifi F, Samieirad S, Grillo R, Da Graça Naclério-Homem M, Bardideh E, Manafi A, Mohammadi Z, Eshghpour M. The Causes and Prevalence of Maxillofacial Fractures in Iran: A Systematic Review. World J Plast Surg 2023; 12:1-11. [PMID: 37220578 PMCID: PMC10200082 DOI: 10.52547/wjps.12.1.3] [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: 01/19/2023] [Accepted: 04/05/2023] [Indexed: 05/25/2023] Open
Abstract
Background Maxillofacial fractures are a common type of injury that can result in significant morbidity and mortality. We aimed to systematically review the literature on the prevalence and causes of maxillofacial fractures in Iran to estimate the overall prevalence of maxillofacial fractures and the most common causes. Methods A systematic search of PubMed, Cochrane Library, Web of Science (WS) and Google Scholar (GS) electronic databases was conducted to identify relevant articles published up to January 2023. Studies reporting the prevalence and causes of maxillofacial fractures in Iran were included in the analysis. MOOSE guidelines were adopted for the current systematic review. No data or language restriction were applied. Risk of bias across the articles was assessed. Results A total of 32 studies comprising 35,720 patients were included in the analysis. The most common cause of maxillofacial fractures was road traffic accidents (RTAs), accounting for 68.97% of all cases, followed by falls (12.62%) and interpersonal violence (9.03%). The prevalence of maxillofacial fractures was higher in males (81.04%) and in the age group of 21-30 years (43.23%). Risk of bias across studies was considered low. Conclusion Maxillofacial fractures are a significant public health problem in Iran, with a high prevalence and RTAs being the leading cause. These results highlight the need for increased efforts to prevent maxillofacial fractures in Iran, especially through measures to reduce the incidence of RTAs.
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Affiliation(s)
- Faeze Sharifi
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, University of São Paulo, São Paulo, Brazil
- Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil
| | | | - Erfan Bardideh
- Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Manafi
- Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Mohammadi
- Department of Medical education, Tehran university of Medical Sciences, Tehran, Iran
| | - Majid Eshghpour
- Department of Oral & Maxillofacial Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
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Augmentation of the Atrophic Mandible with a Block Corticomedullary Graft. Case Rep Dent 2020; 2020:6837519. [PMID: 32685219 PMCID: PMC7341383 DOI: 10.1155/2020/6837519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/14/2020] [Accepted: 06/13/2020] [Indexed: 11/29/2022] Open
Abstract
The gradual loss of the dental alveolus leads to bone resorption, which may cause atrophy of the maxilla and mandible. One of the most complex procedures in reconstructive surgery is the rehabilitation of patients with atrophic mandibles. Herein, we present a clinical case study of atrophic mandible augmentation with grafts obtained from the iliac crest. The use of reconstruction plates may represent a feasible mechanism for treatment as well as fracture prevention. Mandible augmentation performed by grafting the donor site of the iliac crest showed satisfactory results and resolution of the aesthetic and functional impairments.
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Mesgarpour B, Aghababa S, Baradaran HR, Kabiri P, Kabir A, Sofi-Mahmudi A, Haghdoost AA. Achievements of the Cochrane Iran Associate Centre: Lessons Learned. Int J Health Policy Manag 2020; 9:222-228. [PMID: 32613789 PMCID: PMC7382907 DOI: 10.15171/ijhpm.2019.122] [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: 09/02/2019] [Accepted: 11/23/2019] [Indexed: 11/09/2022] Open
Abstract
Healthcare decision-making is a process that mainly depends on evidence and involves increasing numbers of stakeholders, including the consumers. Cochrane evidence responds to this challenge by identifying, appraising, integrating and synthesizing high-quality evidence. Recently, a collaborative effort has been initiated in Iran with Cochrane to establish a representative local entity. A variety of multifaceted interventions were conducted according to Cochrane’s strategy to 2020, such as producing evidence, making Cochrane evidence accessible, advocating for evidence and building an effective and sustainable organization. In this report, the authors present the two and half year performance and achievements of Cochrane Iran based on a comprehensive and systematic approach. This case might be an example of health diplomacy, which is initiated by a successful international collaboration and proceed with recognizing the importance of adherence to the strategic action plans and goals.
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Affiliation(s)
- Bita Mesgarpour
- Cochrane Iran Associate Centre, National Institute for Medical research Development (NIMAD), Tehran, Iran
| | - Sara Aghababa
- Cochrane Iran Associate Centre, National Institute for Medical research Development (NIMAD), Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Payam Kabiri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Sofi-Mahmudi
- Cochrane Iran Associate Centre, National Institute for Medical research Development (NIMAD), Tehran, Iran
| | - Ali Akbar Haghdoost
- Social Determinants of Health Research Centre, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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5
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Brucoli M, Boffano P, Romeo I, Corio C, Benech A, Ruslin M, Forouzanfar T, Rodríguez-Santamarta T, Vicente JCD, Tarle M, Dediol E, Pechalova P, Pavlov N, Daskalov H, Doykova I, Kelemith K, Tamme T, Kopchak A, Shumynskyi I, Corre P, Bertin H, Bourry M, Guyonvarc'h P, Dovšak T, Vozlič D, Birk A, Aničić B, Konstantinovic VS, Starch-Jensen T. Surgical management of unilateral body fractures of the edentulous atrophic mandible. Oral Maxillofac Surg 2019; 24:65-71. [PMID: 31848774 DOI: 10.1007/s10006-019-00824-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/06/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery. METHODS This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications. RESULTS A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases. CONCLUSIONS Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.
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Affiliation(s)
- Matteo Brucoli
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Paolo Boffano
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.
| | - Irene Romeo
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Chiara Corio
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Arnaldo Benech
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Muhammad Ruslin
- Department of Oral and Maxillofacial Surgery, Hasanuddin University, Makassar, Indonesia
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Juan Carlos de Vicente
- Servicio de Cirugía Maxilofacial, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marko Tarle
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Petia Pechalova
- Department of Oral surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - Nikolai Pavlov
- Private practice of oral surgery, University of Eastern Piedmont, Plovdiv, Bulgaria
| | - Hristo Daskalov
- Department of Oral surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - Iva Doykova
- Department of maxillofacial surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - Kadri Kelemith
- Department of maxillo-facial surgery, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Tiia Tamme
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Andrey Kopchak
- Bogomolets National Medical University, Stomatological medical center, Kyiv, Ukraine
| | - Ievgen Shumynskyi
- Bogomolets National Medical, University, Kyiv City Clinical Emergency Hospital, Kyiv, Ukraine
| | - Pierre Corre
- Division of Maxillofacial Surgery, Chu de Nantes, Nantes, France
| | - Helios Bertin
- Division of Maxillofacial Surgery, Chu de Nantes, Nantes, France
| | - Maeva Bourry
- Division of Maxillofacial Surgery, Chu de Nantes, Nantes, France
| | | | - Tadej Dovšak
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - David Vozlič
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Boban Aničić
- Department of Maxillofacial surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vitomir S Konstantinovic
- Department of Maxillofacial surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Thomas Starch-Jensen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Aalborg, Denmark
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A historical perspective with current opinion on the management of atrophic mandibular fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e276-e282. [PMID: 29066066 DOI: 10.1016/j.oooo.2017.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 11/23/2022]
Abstract
The management of atrophic mandibular fractures has been a challenge for maxillofacial surgeons for decades. During the past 70 years, various techniques for treating edentulous mandibular fractures have been advocated. These techniques have been praised, criticized, abandoned, improved, and used in combination with other methods. Although some of the principles of management outlined before the end of World War II are still valid in today's technological era, other concepts did not survive the test of time. The aim of this paper is to examine the evolution of treatment modalities for the management of atrophic mandibular fractures that have been employed over the years. Debates and discussions generated by this topic are included. Current techniques and treatment philosophies with thoughts for future therapies are provided.
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Castro-Núñez J, Shelton JM, Snyder S, Sickels JV. Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures. Craniomaxillofac Trauma Reconstr 2017; 11:150-156. [PMID: 29892332 DOI: 10.1055/s-0037-1601865] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/05/2017] [Indexed: 10/19/2022] Open
Abstract
Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.
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Affiliation(s)
- Jaime Castro-Núñez
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky.,Institución Universitaria Colegios de Colombia. Bogotá, Colombia
| | - Jared M Shelton
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Susan Snyder
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Van Sickels
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
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8
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Mancini JCMA, Garcia MRT, de Oliveira IRS, de Freitas RR, Luz JGC. Analysis of the blood supply to the post-fracture edentulous mandible: study by colour Doppler sonography. Oral Maxillofac Surg 2016; 20:417-424. [PMID: 27695992 DOI: 10.1007/s10006-016-0583-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE This study assessed the arterial blood supply to the mandible of edentulous patients treated for mandibular fractures using colour Doppler ultrasound. METHODS The blood supply of edentulous patients surgically treated for mandibular fractures (group A) and edentulous fracture-free individuals (group B) was assessed. Only the fractured sides were evaluated in the first group (N = 17), whereas each side was evaluated in the second group (N = 20). The arterial flow of six sites was assessed. The systolic-peak maximum velocity (SPV), final diastolic velocity (FDV), resistive index (RI), pulsatility index (PI), acceleration and flow direction of each artery were obtained. Additionally, the presence of local vascular obstructive factors was evaluated. The differences between groups were analysed using the Kruskal-Wallis test, which was complemented by the Mann-Whitney test, for correlations between the degree of alveolar atrophy and the study factors (p < 0.050). RESULTS There was a significant decrease in the flow of certain arteries, especially the submental (SPV, p = 0.007, PI, p = 0.022, and acceleration, p = 0.015), in the fracture group. The facial artery in both groups showed lower values related to local obstructive factors (SPV, p = 0.001, FDV, p = 0.040, and PI, p = 0.030). The submental artery flow was higher (SPV, p = 0.006, and FDV, p = 0.009) in non-atrophic individuals. CONCLUSIONS There was a decreased flow mainly in the submental artery, but there were no cases of major vascular injury in edentulous patients treated for mandibular fractures.
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Affiliation(s)
- Júlio Cezar M A Mancini
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo-USP, Brazil, Av. Prof. Lineu Prestes, 2227-Cidade Universitária, 02036-021, São Paulo, SP, Brazil
| | | | | | | | - João Gualberto C Luz
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo-USP, Brazil, Av. Prof. Lineu Prestes, 2227-Cidade Universitária, 02036-021, São Paulo, SP, Brazil.
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An unusual case of atrophic mandible fracture in a patient with osteogenesis imperfecta and on oral bisphosphonate therapy: Case report. Saudi Dent J 2014; 26:68-73. [PMID: 25408599 DOI: 10.1016/j.sdentj.2013.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/14/2013] [Accepted: 12/24/2013] [Indexed: 12/29/2022] Open
Abstract
Fractures of severely atrophic (height < 10 mm) edentulous mandibles are infrequent and challenging to manage. Factors such as sclerotic bone and decreased vascularity combined with systemic diseases complicate the management of such fractures. Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders of type I collagen metabolism. Patients with OI characteristically present with histories of long bone fractures, deformities, blue sclerae, and opalescent dentin. However, fractures of the facial skeleton are rare. Bisphosphonate therapy has been proven to effectively reduce the fracture risk in patients with OI. The purpose of this clinical report is to present an unusual case of spontaneous fracture of the atrophic mandible in a patient with OI. Despite open reduction and internal fixation (ORIF) with miniplate osteosynthesis, the patient developed a second fracture at a screw placement site distal to the first fracture. The patient was successfully treated with ORIF using locking reconstruction plates fixed in the symphyseal and angle regions. Bone healing following ORIF was normal, and no clinical sign of osteonecrosis as a result of bisphosphonate therapy was observed. Patients with OI can present with spontaneous fractures of already weakened mandibles. Although such fractures can be managed with care using established protocols, further research is required to examine the effects of concomitant medication, such as bisphosphonates.
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Franciosi E, Mazzaro E, Larranaga J, Rios A, Picco P, Figari M. Treatment of edentulous mandibular fractures with rigid internal fixation: case series and literature review. Craniomaxillofac Trauma Reconstr 2014; 7:35-42. [PMID: 24624255 DOI: 10.1055/s-0033-1364195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/04/2013] [Indexed: 10/25/2022] Open
Abstract
The aim of the study is to analyze the effectiveness of rigid internal fixation (RIF) for treating edentulous mandibular fractures. Because of the low incidence of fractures in edentulous mandible, there is no consensus of the optimal treatment for it. This study included all edentulous patients with mandibular fracture diagnosis, who were treated with internal fixation at the Hospital Italiano de Buenos Aires from November 1991 to July 2011. Data such as age, gender, etiology and location of fracture, surgical approach, type of osteosynthesis used, and postoperative complications were analyzed. A total of 18 patients, 76.2 years mean age, 12 females (66.6%), presented a total of 35 mandibular fractures. The mandibular body was the most common localization of the fractures. Twenty-five fractures received surgical treatment with RIF, mainly approached extraorally. Reconstruction plates were the most common type of fixation used. Fracture reduction was considered satisfactory in 96.5%, with 22.2% of complications and 11.1% of reoperations needed. Open reduction and RIF demonstrated to be a reliable method for treating edentulous mandibular fractures. Nevertheless, there is lack of high-level recommendation publication to support this.
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Affiliation(s)
- Edgardo Franciosi
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
| | - Eduardo Mazzaro
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
| | - Juan Larranaga
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
| | - Alfredo Rios
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
| | - Pedro Picco
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
| | - Marcelo Figari
- Division of Head and Neck, Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
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Nasser M, Pandis N, Fleming PS, Fedorowicz Z, Ellis E, Ali K. Interventions for the management of mandibular fractures. Cochrane Database Syst Rev 2013:CD006087. [PMID: 23835608 DOI: 10.1002/14651858.cd006087.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. OBJECTIVES The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (non-surgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated to include both clinical and methodological factors. MAIN RESULTS Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of post-operative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I(2) = 0%). Similarly, no difference in post-operative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I(2) = 27%). The included studies involved a small number of participants with a low number of events. AUTHORS' CONCLUSIONS This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.
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Affiliation(s)
- Mona Nasser
- Peninsula Dental School, University of Plymouth, Plymouth, UK.
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12
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Dharaskar S, Athavale S, Kakade D. Use of gunning splint for the treatment of edentulous mandibular fracture: a case report. J Indian Prosthodont Soc 2013; 14:415-8. [PMID: 25489166 DOI: 10.1007/s13191-013-0294-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022] Open
Abstract
Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. The complication rate of infection or malunion is higher compared to fractures in younger, dentulous patients. For such conditions, 'Gunning splint' is a better option as it provides close reduction and stabilization of mandibular fracture, thus improving the prognosis.
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Affiliation(s)
- Shrinivas Dharaskar
- Department of Prosthodontics, Dr. D. Y. Patil Dental College, Pimpri, Pune, 411018 India
| | - Smita Athavale
- Department of Prosthodontics, Dr. D. Y. Patil Dental College, Pimpri, Pune, 411018 India
| | - Dilip Kakade
- Department of Prosthodontics, Dr. D. Y. Patil Dental College, Pimpri, Pune, 411018 India
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Novelli G, Sconza C, Ardito E, Bozzetti A. Surgical treatment of the atrophic mandibular fractures by locked plates systems: our experience and a literature review. Craniomaxillofac Trauma Reconstr 2013; 5:65-74. [PMID: 23730420 DOI: 10.1055/s-0031-1300961] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/16/2011] [Indexed: 10/14/2022] Open
Abstract
The management of atrophic mandibular fractures in edentulous patients represents an insidious issue for the maxillofacial surgeon due to the biological and biomechanical conditions that are unfavorable for fracture fixation and bone healing. The purpose of this study was to evaluate the results of the treatment of atrophic mandibular fractures and to compare the outcomes of different plating systems used for stabilization. We selected a study group of 16 patients with fractures of completely edentulous atrophic mandibles who were treated in our department between 2004 and 2010. All patients were surgically treated by open reduction and internal rigid fixation using 2.0-mm large-profile locking and 2.4-mm locking bone plates. All patients achieved a complete fracture healing and fast functional recovery of mandibular movements without intraoperative or postoperative surgical complications. The results of our study demonstrated the efficacy of this type of treatment in association with a low postoperative complication rate, a reduction in the recovery time, and the possibility to have an immediately functional rehabilitation. There were very similar results using each of the two bone plating methods considered: no case had hardware failure or nonunion of the fracture. The 2.0-mm large locking plate is thinner, exposes through the soft tissues less frequently, and is much easier to shape and adapt to the mandibular anatomy. However, the 2.4-mm locking plate system still represents the reference hardware in the condition of severe bone atrophy.
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Affiliation(s)
- Giorgio Novelli
- Department of Maxillofacial Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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Comparative finite element analysis of the biomechanical stability of 2.0 fixation plates in atrophic mandibular fractures. J Oral Maxillofac Surg 2013; 71:335-42. [PMID: 23351762 DOI: 10.1016/j.joms.2012.09.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of the present study was to conduct a computational, laboratory-based comparison of the biomechanical stability of 2.0 fixation locking plates with different profiles in Class III atrophic mandibular fractures using 3-dimensional finite element analysis. MATERIALS AND METHODS Three-dimensional finite element models simulating Class III atrophic mandibular fractures were constructed. The models were divided into 4 groups according to plate thickness (1.0, 1.5, 2.0, and 2.5 mm). Fractures were simulated in left mandibular bodies, and 3 locking screws were used on each side of each fracture for fixation. Bite forces of approximately 63 N were simulated in the incisor and molar regions of the mandibles in finite element models. RESULTS The level of compressive strain on the bone around the screw was within the physiological limit. No significant difference was observed in the displacement of bone segments in the fracture region. Von Mises stress was higher during simulated bites in the molar region for plates with thicknesses of 1.0 mm. Plate tension values were below the level required for permanent deformation or fracture in all models. The 2.5-mm-thick plate presented better biomechanical performance than all other plates. The 2.0-mm-thick plate also showed satisfactory results and adequate safety limits. CONCLUSION Large-profile (2.0-mm-thick) locking plates showed better biomechanical performance than did 1.0- and 1.5-mm-thick plates and can be considered an alternative reconstruction plate for the treatment of Class III atrophic mandibular fractures.
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Knotts C, Workman M, Sawan K, El Amm C. A novel technique for attaining maxillomandibular fixation in the edentulous mandible fracture. Craniomaxillofac Trauma Reconstr 2013; 5:7-10. [PMID: 23449752 DOI: 10.1055/s-0031-1300962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/20/2011] [Indexed: 10/14/2022] Open
Abstract
Edentulous mandible fractures present a unique and challenging surgical problem, particularly because of lack of occlusive dental surfaces to capitalize upon maxillomandibular fixation (MMF). We present a novel technique to achieve MMF using rigid plates spanning the oral cavity to fixate the maxilla to the mandible. The process is rapid and allows stability using the established principles of rigidity, external fixation, and osteosynthesis. This technique allows for a faster MMF than with a Gunning splint and allows for easier oral hygiene. An illustrative case and pre- and postoperative imaging are provided.
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Affiliation(s)
- Christopher Knotts
- Division of Plastic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Korpi JT, Kainulainen VT, Sándor GK, Oikarinen KS. Tent-Pole Approach to Treat Severely Atrophic Fractured Mandibles Using Immediate or Delayed Protocols: Preliminary Case Series. J Oral Maxillofac Surg 2013; 71:83-9. [DOI: 10.1016/j.joms.2012.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 09/06/2012] [Accepted: 09/08/2012] [Indexed: 11/28/2022]
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Fixation of atrophic edentulous mandible fractures by bone plating at the inferior border. J Oral Maxillofac Surg 2011; 70:883-9. [PMID: 21676515 DOI: 10.1016/j.joms.2011.03.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 03/03/2011] [Accepted: 03/30/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE No consensus has been reached regarding the best treatment for repair of fractures of the severely atrophic mandible (<10 mm vertical height). The most complete Cochrane review of the published data could not substantiate a single best practice recommendation for treating these fractures. The present study reports the results of such treatment by placing miniplates at the inferior border of the mandible of 23 fractures of the mandibular body in 16 patients. MATERIALS AND METHODS This was a consecutive case series during a 30-year period performed by a single surgeon at several practice locations using the technique of extraoral plating at the inferior border. All patients were prospectively monitored clinically and radiographically for achievement of bony union and for complications of sensory disturbances of the lower lip, delayed healing, and hardware removal. The mean observation time was 23.1 months (range 1 to 60), with only 2 cases observed for less than 6 months. RESULTS All the patients achieved clinical union of their fractures. Two cases of fibrous union did not reach ossification until 5 months after surgery. The hardware removal rate was 13.6%, and the infection/prolonged inflammation rate was 13.6%. There was 1 case of malunion. Those patients who had dentures were able to return to denture wearing postoperatively. CONCLUSIONS Miniplate fixation of fractures of the severely atrophic mandible at the inferior border is safe and effective.
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Wood G, Campbell D, Greene L. Transmucosal fixation of the fractured edentulous mandible. Int J Oral Maxillofac Surg 2011; 40:549-52. [DOI: 10.1016/j.ijom.2010.10.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 08/30/2010] [Accepted: 10/29/2010] [Indexed: 11/30/2022]
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Suwanwela J, Lee J, Lin A, Ucer TC, Devlin H, Sinsheimer J, Garrett NR, Nishimura I. A genetic association study of single nucleotide polymorphisms in FGFR1OP2/wit3.0 and long-term atrophy of edentulous mandible. PLoS One 2011; 6:e16204. [PMID: 21283824 PMCID: PMC3023796 DOI: 10.1371/journal.pone.0016204] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/15/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND After dental extraction, the external surface of alveolar bone undergoes resorption at various rates, and a group of patients develop excessive jawbone atrophy. Oral mucosa overlying the atrophied jawbone is unusually thin; therefore, we have hypothesized that excessive jawbone atrophy may be associated with abnormal oral mucosa contraction. FGFR1OP2/wit3.0, a cytoskeleton molecule initially identified in oral wound fibroblasts, has been shown to induce oral mucosa contraction after dental extraction. This study examined the genetic association between single nucleotide polymorphisms (SNPs) of FGFR1OP2/wit3.0 and excessive atrophy of edentulous mandible. METHODS AND FINDINGS First, the expression of FGFR1OP2/wit3.0 was determined in gingival tissues of 8 subjects before and after dental extraction. In situ hybridization revealed that all subject increased FGFR1OP2/wit3.0 expression in the post-operative oral mucosa tissues; however, significantly high levels of FGFR1OP2/wit3.0 were observed in 3 out of 8 subjects. In a separate study, 20 long-term edentulous subjects (66.4 ± 9.4 years) were recruited. Tag-SNPs in the FGFR1OP2/wit3.0 allele were determined by Taqman-based polymerase chain reaction. The mandibular bone height was determined following the American College of Prosthodontists (ACP) protocol. Subjects with minor allele of rs840869 or rs859024 were found in the highly atrophied group by the ACP classification (Chi square test, p = 0.0384 and p = 0.0565, respectively; Fisher's Exact, p= 0.0515 and p = 0.2604, respectively). The linear regression analysis indicated a suggestive association between rs859024 and the decreased bone heights (Mann-Whitney, p = 0.06). The average bone height of the subjects with rs840869 or rs859024 minor alleles (10.6 ± 3.2 mm and 9.6 ± 3.2 mm, respectively) was significantly smaller than that of those subjects with the major alleles (14.2 ± 4.5 mm, p<0.05). CONCLUSIONS The patients with the minor allele of rs840869 or rs859024 were associated with excessive atrophy of edentulous mandible. This study may provide the basis for a genetic marker identifying susceptible individuals to develop jawbone atrophy after dental extraction.
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Affiliation(s)
- Jaijam Suwanwela
- The Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
- Division of Oral Biology and Medicine, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
- Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Jaehoon Lee
- The Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Audrey Lin
- The Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
| | - T. Cemal Ucer
- School of Dentistry, University of Manchester, Manchester, United Kingdom
| | - Hugh Devlin
- School of Dentistry, University of Manchester, Manchester, United Kingdom
| | - Janet Sinsheimer
- Departments of Human Genetics and Biomathematics, David Geffen School of Medicine at the University of California Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Neal R. Garrett
- The Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
| | - Ichiro Nishimura
- The Weintraub Center for Reconstructive Biotechnology, Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
- Division of Oral Biology and Medicine, University of California Los Angeles (UCLA) School of Dentistry, Los Angeles, California, United States of America
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Management of Atrophic Mandible Fractures: Are Bone Grafts Necessary? J Oral Maxillofac Surg 2010; 68:1392-5. [DOI: 10.1016/j.joms.2009.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Accepted: 08/19/2009] [Indexed: 11/18/2022]
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Fractures of the mandibular condyle: evidence base and current concepts of management. Br J Oral Maxillofac Surg 2009; 48:520-6. [PMID: 19900741 DOI: 10.1016/j.bjoms.2009.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 10/08/2009] [Indexed: 11/22/2022]
Abstract
Management of mandibular condylar fractures remains a source of ongoing controversy. While some condylar fractures can be managed non-surgically, recognition of fracture patterns that require surgical intervention and selection of an appropriate operative procedure are paramount to success in treating these injuries.The objective of this review is to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.
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Palarie VP. Poster 263: Screw Implant Supported System in Osteosynthesis of Mandible Fractures in Patients With Edentulous Maxillary Bones. J Oral Maxillofac Surg 2007. [DOI: 10.1016/j.joms.2007.06.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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