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Steffen C, Welter M, Fischer H, Goedecke M, Doll C, Koerdt S, Kreutzer K, Heiland M, Rendenbach C, Voss JO. Revision Surgery With Refixation After Mandibular Fractures. Craniomaxillofac Trauma Reconstr 2024; 17:214-224. [PMID: 39345950 PMCID: PMC11425749 DOI: 10.1177/19433875231179318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
Study Design Retrospective, descriptive observational study. Objective The need for revision surgery after mandibular fractures is an indicator for severe postoperative complications. This study aimed to characterise this patient cohort, describe solutions to deal with complications and evaluate treatment quality as a risk variable for complications. Methods Patients with revision surgery with refixation after open reduction and internal fixation (ORIF) of a mandible fracture were included. Patient- and therapy-specific information were assessed together with postoperative complications. The quality of fixation was evaluated individually by 6 specialists. Interobserver agreement was analysed using Fleiss' kappa. Results Out of 630 patients, inclusion criteria were met by 17 patients (14 male, 3 female) with an average age of 43.3 (±15.5) years. Complications at the mandible body/angle/symphysis led to refixation in all cases. Main indications for refixation were osteomyelitis (52.9%) or pseudarthrosis (41.2%). Risk factors were drug-related immune suppression, local infection or substance abuse (nicotine, alcohol or drugs). Six patients did not present any of these predictors. Of these, treatment of 4 patients was rated as not in accordance to the AO principles. The interrater reliability of treatment quality assessments was .239. Conclusions Patients with risk factors need to be carefully observed perioperatively after ORIF of mandibular fractures and treatments need to be adapted to these patients. Discrepancies of treatments to common guidelines may also be an independent predictor for treatment failure in patients without risk factors. Current treatment guidelines should be re-evaluated concerning additional treatment strategies for patients with specific risk factors.
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Affiliation(s)
- Claudius Steffen
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Margrit Welter
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Goedecke
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Koerdt
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan O Voss
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Voss JO, Heiland M, Preissner R, Preissner S. The risk of osteomyelitis after mandibular fracture is doubled in men versus women: analysis of 300,000 patients. Sci Rep 2023; 13:20871. [PMID: 38012360 PMCID: PMC10682452 DOI: 10.1038/s41598-023-48235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023] Open
Abstract
Postoperative complications following mandibular fracture treatment vary from local wound infections to severe conditions including osteomyelitis and impaired fracture healing. Several risk factors have been associated with the development healing disorders, including fracture localisation, treatment modality and substance abuse. However, limited research on the sex-specific influence of these complications exists. A total of about 300,000 female and male patients with mandibular fractures were examined in two cohorts. After matching for confounders (age, nicotine and alcohol dependence, malnutrition, overweight, anaemia, diabetes, osteoporosis and vitamin D deficiency), two cohorts were compared with propensity-score-matched patients according to outcomes (osteomyelitis, pseudoarthrosis and disruption of the wound) within 1 year after fracture. There were significant differences between female and male patients regarding the occurrence of osteomyelitis (odds ratio [OR] [95% confidence interval]: 0.621 [0.563; 0.686]) and disruption of the wound (OR [95% confidence interval]: 0.703 [0.632; 0.782]). Surprisingly, matching for the expected confounders did not change the results substantially. Sex plays a dominant role in determining the risk stratification for postoperative osteomyelitis and disruption of the wound, after accounting for other potential confounding factors. Additional research is needed to understand the underlying mechanisms and to develop sex-specific strategies to prevent these complications.
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Affiliation(s)
- Jan Oliver Voss
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Preissner
- Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Philippstr. 12, 10115, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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Muacevic A, Adler JR, Patil S. Rehabilitation and Management of Complex Multiple Para-Symphysis Mandible Fracture: A Case Report. Cureus 2022; 14:e31180. [PMID: 36505157 PMCID: PMC9727580 DOI: 10.7759/cureus.31180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
Abstract
Fractures of the parasymphysis occur in 15% of all cases of mandibular fracture. The mandible occupies the lowest portion of the face. The prominent bone of the face is severely injured when the lower face is hit by high impacts with upward or obliquely directed force. In this case study, we discussed the alleged trauma case of a 20-year-old man who fell from a height on August 27, 2022, at about 9:00 p.m. near Wardha. His family took him to the hospital in Wardha due to pain that was aggravated during chewing and swelling in his jaw. On investigation, an X-ray was done, and a left parasymphysis and right-side body fracture were noticed. Later, the patient underwent surgery, where open reduction and internal fixation of the left parasymphysis and the right-side body fracture with plating and intermaxillary fixation (IMF) were done. Then he was referred to the physiotherapy department for therapeutic intervention. Rehabilitation was given to reduce pain and swelling, regain full range of motion, gradually increase mobility, and keep associated muscles strong. A six-week protocol was administered to the patient. It was found that the therapeutic approach was quite effective for the patient.
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Togninalli D, Antonarakis GS, Schatz JP. Condylar resorption following mandibular advancement or bimaxillary osteotomies: A systematic review of systematic reviews. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e948-e955. [PMID: 35263683 DOI: 10.1016/j.jormas.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
Several systematic reviews have been published on the effects of mandibular surgery on condylar remodeling without reaching a consensus. The purpose of this systematic review of systematic reviews was to assess the impact of mandibular advancement or bimaxillary surgeries on condylar resorption. A literature search, using several electronic databases, was carried out by two reviewers independently. Article preselection was based on titles and abstracts, and final article selection based on full-text analysis of preselected studies. After final study selection, the quality of studies was assessed using the AMSTAR 2 tool. A decision algorithm was subsequently established to choose the best body of evidence. From an initial yield of 1'848 articles, 23 systematic reviews were identified for further analysis, with ten studies being included in the final selection. Despite the generally low quality of the reviews, certain associations could be made: young patients, female patients, and those with a high mandibular plane angle are more prone to condylar resorption following mandibular advancement osteotomies, especially if anterior rotation of the mandible is performed during surgery. Patients undergoing bimaxillary surgery also appear to have a higher risk of developing condylar resorption. In conclusion, these results confirm the multi-factorial nature of condylar resorption, stressing the need for well-controlled prospective studies with long-term follow-up to clearly identify potential risk factors associated with orthognathic surgery.
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Affiliation(s)
- David Togninalli
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Gregory S Antonarakis
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Jean-Paul Schatz
- Department of Orthodontics, University Clinic of Dental Medicine, Faculty of Medicine, University of Geneva, Switzerland
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Haravu PN, Abraha HM, Shang M, Iriarte-Diaz J, Taylor AB, Reid RR, Ross CF, Panagiotopoulou O. Macaca mulatta is a good model for human mandibular fixation research. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220438. [PMID: 36405636 PMCID: PMC9667141 DOI: 10.1098/rsos.220438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Biomechanical and clinical studies have yet to converge on the optimal fixation technique for angle fractures, one of the most common and controversial fractures in terms of fixation approach. Prior pre-clinical studies have used a variety of animal models and shown abnormal strain environments exacerbated by less rigid (single-plate) Champy fixation and chewing on the side opposite the fracture (contralateral chewing). However, morphological differences between species warrant further investigation to ensure that these findings are translational. Here we present the first study to use realistically loaded finite-element models to compare the biomechanical behaviour of human and macaque mandibles pre- and post-fracture and fixation. Our results reveal only small differences in deformation and strain regimes between human and macaque mandibles. In the human model, more rigid biplanar fixation better approximated physiologically healthy global bone strains and moments around the mandible, and also resulted in less interfragmentary strain than less rigid Champy fixation. Contralateral chewing exacerbated deviations in strain, moments and interfragmentary strain, especially under Champy fixation. Our pre- and post-fracture fixation findings are congruent with those from macaques, confirming that rhesus macaques are excellent animal models for biomedical research into mandibular fixation. Furthermore, these findings strengthen the case for rigid biplanar fixation over less rigid one-plate fixation in the treatment of isolated mandibular angle fractures.
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Affiliation(s)
- Pranav N. Haravu
- Department of Surgery, Section of Plastic Surgery, The University of Chicago Medical Centre, Chicago, IL, USA
| | - Hyab Mehari Abraha
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Victoria, Australia
| | - Michelle Shang
- Department of Surgery, Section of Plastic Surgery, The University of Chicago Medical Centre, Chicago, IL, USA
| | - Jose Iriarte-Diaz
- Department of Biology, The University of the South, Sewanee, TN, USA
| | | | - Russell R. Reid
- Department of Surgery, Section of Plastic Surgery, The University of Chicago Medical Centre, Chicago, IL, USA
| | - Callum F. Ross
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, USA
| | - Olga Panagiotopoulou
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Victoria, Australia
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6
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Mandibular fractures – what a difference 30 years has made. Br J Oral Maxillofac Surg 2022; 60:1202-1208. [DOI: 10.1016/j.bjoms.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022]
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7
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Shehri SZA, Ababtain RA, Fotawi RA, Alkindi M, Premnath S, Alhindi M, Divakar DD. Pediatric maxillofacial and dental trauma: A retrospective review of pediatric emergency management in Riyadh, Kingdom of Saudi Arabia. Saudi Dent J 2021; 33:328-333. [PMID: 34434035 PMCID: PMC8376668 DOI: 10.1016/j.sdentj.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/10/2021] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Due to the high prevalence of oral and maxillofacial (OMF) trauma in city of Riyadh, a special focus on pediatric trauma is needed. The purpose of this audit was to assess the protocol followed by the OMF unit at King Khalid University Hospital (KKUH) on pediatric trauma patients. The trauma incidence, mechanism of injury, volume, the type of pediatric trauma operated and dental management were analyzed. MATERIALS AND METHODS A quantitative retrospective review of 223 patients, at pediatric emergency unit of KKUH, Riyadh, KSA from January 2017 to July 2018, was done. The data retrieved included variables such as, age, gender, and cause of injury, site of injury, type of injury, and assessment of jaws, and teeth. Data regarding the type of investigations, treatment protocol, follow up visit, and dental management, were extracted from the medical records. RESULTS Of the 223 pediatric patients presenting to the emergency unit, 116 (52%) were under the age of 5 years. A total of 64.4% of patients reported "self-fall" as the cause of injury. Soft-tissue injuries were common in 63 (56.8%) of patients in the form of lacerations 87 (41.2%). Involvement of the teeth in the injury was observed in 57 patients, in which 33 (57.9%) patients were reported to have tooth/teeth avulsions, 15 (26.3%) patients had luxation and 9 (15.8%) patients had crown fractures. 27 (47%) patients were referred to the pedodontist for a follow-up visit. CONCLUSIONS It can concluded that clinicians facing maxillofacial trauma in an emergency department need to have access to useful and practice guidelines. The study also showed the need for more manpower-oriented training such as a pedodontist and a general dentist to join the OMFS team to manage pediatric patients. The regional referral hospitals should be equipped to decentralize the management of these patients to the Dental University Hospital.
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Affiliation(s)
- Saleh Zaid Al Shehri
- Department of Oral and Maxillofacial Surgery, King Saud University, Riyadh, Saudi Arabia
| | | | - Randa Al Fotawi
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alkindi
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Sangeetha Premnath
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Maryam Alhindi
- Department of Oral and maxillofacial surgery, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Darshan Devang Divakar
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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8
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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.
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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
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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.
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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
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Hsieh TY, Funamura JL, Dedhia R, Durbin-Johnson B, Dunbar C, Tollefson TT. Risk Factors Associated With Complications After Treatment of Mandible Fractures. JAMA FACIAL PLAST SU 2020; 21:213-220. [PMID: 30676610 DOI: 10.1001/jamafacial.2018.1836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Complications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes. Objective To describe the risk factors associated with complications in patients undergoing treatment for mandible fracture. Design, Setting, and Participants A retrospective review was conducted of 137 patients presenting to a tertiary care, level 1 trauma center with mandible fractures between January 1, 2014, and January 1, 2017. Outcomes and demographic characteristics for patients with at least 3 weeks of follow-up were compared using multivariate logistic regression analysis. Results Of the 137 patients meeting inclusion criteria, there were 113 males (82.5%) and 24 females (17.5%), with a mean (SD) age at presentation of 32.3 (15.7) years. Median follow-up was 71 days (range, 22-1189 days). Postoperative complications were identified in 29 patients (21.2%); complications included wound dehiscence or surgical site infection (n = 17), bony nonunion (n = 5), and hardware exposure (n = 13). Complications were managed surgically in 19 patients and nonsurgically in 10 patients. On univariate analysis, the initial surgery was completed later (mean [SD], 5.9 [6.6] days after injury) in patients who developed complications than in those who did not (mean [SD], 3.8 [4.0] days). On multivariate analysis, complications were associated with increased time from injury to treatment (odds ratio [OR], 1.60; 95% CI, 1.02-2.53; P = .04), tobacco use (OR, 8.10; 95% CI, 1.26-52.00; P = .03), and dental extraction (OR, 93.00; 95% CI, 1.19 to >999.00; P = .04). Residence in the same city as the medical center was associated with fewer complications (OR, 0.08; 95% CI, 0.01-0.69; P = .02). Conclusions and Relevance In a 3-year review of mandible fractures managed at a single academic center, complications were associated with an increased time to treatment, tobacco use, dental extraction, and living farther from the treatment facility. On a systems level, the results of this study suggest that expediting intervention for mandible fractures may improve outcomes. Level of Evidence 3.
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Affiliation(s)
- Tsung-Yen Hsieh
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | - Jamie L Funamura
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | - Raj Dedhia
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | | | - Chance Dunbar
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | - Travis T Tollefson
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
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Buron C, Mounier C, Guiavarc'h C, Lansonneur C, Conan M, Bouillon K, Le Toux G. Management of jaw fractures in oral surgery in public and private practice: a retrospective study from 2006 to 2017. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2019035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: To date, no epidemiological studies on jaw fracture have examined its characteristics according to hospital status (public vs private). The aim of this study was to examine their differences in terms of patient- and injury-related variables. Methods: A retrospective study was conducted using patients' medical records in 2 types of hospital located in the northern area of Brittany (France). All patients hospitalized for jaw fracture between 2006 and 2017 were eligible. Comparisons between centres according to age, gender, anatomic location of fracture, mechanism of injury, and length of stay were undertaken using χ2, Fisher exact test, t-test, and Cochrane-Armitage trend test. Results: A total of 142 patients were included: 45.1% in the public and 54.9% in the private hospitals. Of them, 84.5% were men and the mean age was 32.0. Main causes of fractures were assault (56.3%), fall (30.3%) and road traffic accident (10%). A small number of patients had polytrauma (4.2%). The mean duration of stay was less than 2 days. Compared to patients who were admitted in private hospital, those who were likely to be admitted in public hospital were those: who had a jaw fracture in context of road traffic accident (18.8% vs 2.6%), with polytrauma (9.4% vs 0.0%) and maxilla fracture (9.4% vs 1.3%), and who had a longer stay (2.2 vs 1.1 days). Conclusion: This study showed that differences observed in characteristics of jaw fractures between public and private hospitals may be due to recruitment process: more severely affected patients are likely to be admitted in the public hospital.
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12
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Cagetti MG, Marcoli PA, Berengo M, Cascone P, Cordone L, Defabianis P, De Giglio O, Esposito N, Federici A, Laino A, Majorana A, Nardone M, Pinchi V, Pizzi S, Polimeni A, Privitera MG, Talarico V, Zampogna S. Italian guidelines for the prevention and management of dental trauma in children. Ital J Pediatr 2019; 45:157. [PMID: 31801589 PMCID: PMC6894327 DOI: 10.1186/s13052-019-0734-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Dental trauma is a frequent occurrence in children and adolescent and a correct diagnosis and treatment are essential for a favourable long-term prognosis. The present Guidelines aim to formulate evidence-based recommendations to assist dentists, paediatricians, surgeons, teachers, school and sport staff, parents in the prevention and first aid of dental trauma in children and to provide a careful assessment of the medico-legal implications, reviewing the first draft of the guidelines published in 2012. A multidisciplinary panel on the behalf of the Italian Ministry of Health and in collaboration with the WHO Collaborating Centre for Epidemiology and Community Dentistry of Milan, developed this document. The following four queries were postulated: 1) Which kind of precautions the health personnel, parents, sports and educational personnel must activate in order to prevent the dental trauma damage? 2) How an orofacial trauma in paediatric patients should be managed either in the Emergency Care Unit and/or in private dental office? 3) What criteria should be adopted by a dentist private practitioner to fill in a certificate in cases of dental and/or tempomandibular joint trauma occurring in children and adolescents? 4) What are the elements that should lead clinicians to suspect a non-accidental dental trauma? A systematic review and analysis of the scientific literature published in English, Italian and French from 2007 to 2017 regarding dental trauma in children and adolescents aged 0-18 years was performed, and about 100 papers were analysed and included. The following four domains were analysed and discussed: Dental Trauma Prevention Strategies and Health Education, First aid in orofacial and dental trauma, Certificate of the dental trauma, Oral and dental signs of child abuse and neglect. Twenty-eight recommendations were draw up and codified by the panel according to the Methodological handbook, produced by the Istituto Superiore di Sanità, in order to guide physicians in the prevention and first aid of dental trauma in children and adolescents. In addition, a careful assessment of the medico-legal implications is reported in this document.
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Affiliation(s)
- Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, Milan, IT-20142 Italy
| | | | - Mario Berengo
- Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Piero Cascone
- Department of Oral and Maxillo Facial Science, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Livio Cordone
- ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - Patrizia Defabianis
- Department of Surgical Sciences, University of Turin, Via Nizza 230, 10126 Turin, Italy
| | - Osvalda De Giglio
- Department of Biomedical Sciences and Human Oncology, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Nicola Esposito
- Associazione Nazionale Dentisti Italiani, Lungotevere Raffaello Sanzio, 9, 00153 Rome, Italy
| | - Antonio Federici
- Unit 2, General Secretariat, Ministry of Health, Lungotevere Ripa, 1, 00153 Rome, Italy
| | - Alberto Laino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, “Federico II” University, Via Giosuè Carducci, 42 Naples, Italy
| | - Alessandra Majorana
- Department of Pediatric Dentistry, University of Brescia, P. le Spedali Civili 1, 25123 Brescia, Italy
| | - Michele Nardone
- Unit 2, General Secretariat, Ministry of Health, Lungotevere Ripa, 1, 00153 Rome, Italy
| | - Vilma Pinchi
- Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134 Florence, Italy
| | - Silvia Pizzi
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Antonella Polimeni
- Department Oral and Maxillofacial Sciences, Sapienza University of Rome, Via Caserta 6, 00161 Rome, Italy
| | - Maria Grazia Privitera
- Health prevention, Italian Ministry of Health, Viale Giorgio Ribotta, 5 -, 00144 Rome, Italy
| | - Valentina Talarico
- Department of Pediatrics, Pugliese-Ciaccio Hospital of Catanzaro, Viale Papa Pio X, 83, 88100 Catanzaro, Italy
| | - Stefania Zampogna
- Department of Pediatrics, Pugliese-Ciaccio Hospital of Catanzaro, Viale Papa Pio X, 83, 88100 Catanzaro, Italy
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13
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Goswami D, Sardar A, Baidya DK, Yadav R, Bhutia O, Roychoudhury A. Comparative Evaluation of Two Doses of Etoricoxib (90 mg and 120 mg) as Pre-Emptive Analgesic for Post-Operative Pain Relief in Mandibular Fracture Surgery Under General Anaesthesia: A Prospective, Randomised, Double-Blinded, Placebo-Controlled Trial. Turk J Anaesthesiol Reanim 2019; 48:24-30. [PMID: 32076676 PMCID: PMC7001814 DOI: 10.5152/tjar.2019.54614] [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: 12/17/2018] [Accepted: 02/28/2019] [Indexed: 11/25/2022] Open
Abstract
Objective This trial investigated the post operative analgesic efficacy of oarl etoricoxib 90 mg and 120 mg and a placebo in mandibular fracture pain model. Methods A total of 63 adult patients with mandibular fractures who were scheduled to undergo maxillofacial surgery were randomly allocated to receive etoricoxib 90 mg, etoricoxib 120 mg and a placebo 1 hour before the surgery. Patients were followed-up till 24 hours after the surgery. Duration of analgesia, intra-operative and post-operative analgesic requirement, pain score, post-operative patient satisfaction and adverse effects were measured. Results The baseline demographic parameters were similar in all the groups. Duration of analgesia was longer in both the E120 (6.00±0.816 hours) and E90 (4.37±1.008 hours) groups (p<0.05) as compared to the placebo group (2.60±0.821 hours). Mean difference of duration of analgesia between E120 and E90 was 1.62 (95% confidence interval: 0.234–3.484; p>0.05). Post-operative pain intensity was significantly lower in both the E120 and E90 groups as compared to the C group. Both the etoricoxib groups required less intra-operative (p=0.002) and post-operative (p=0.001) analgesic supplementation as compared to the placebo group. The patient satisfaction score and rate of occurrence of significant adverse effects were similar among all the three groups. Conclusion Etoricoxib 90 mg is equally efficacious to etoricoxib120 mg with a similar side effect profile in a severely acute setting.
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Affiliation(s)
- Devalina Goswami
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arijit Sardar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Yadav
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Toledano-Serrabona J, Párraga-Manzol G, Sánchez-Garcés MÁ, Gay-Escoda C. Osteoradionecrosis of the jaws triggered by dental implants placement: A case report. J Clin Exp Dent 2019; 11:e91-e96. [PMID: 30697400 PMCID: PMC6343996 DOI: 10.4317/jced.55326] [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: 09/28/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022] Open
Abstract
Background The decision-making process about how to rehabilitate edentulous osseous defects in patients with head and neck cancer history can be complex. Even though, endosseous dental implants could be considered to be the first choice for treating these patients, it is highly important to be aware of the complications that might occur. The aim of this report was to describe the clinical features of mandibular fracture after dental implants placement on a cancer irradiated patient and update the available information about this event. Case report The case describes a 70-year-old man, with medical background of radiotherapy in jaw bones to treat a carcinoma in the floor of the mouth and later on in the soft palate and cheek. One week after dental implant surgery, the patient presented a mandibular osteoradionecrosis that healed in 8 months. A fracture on the right side of the body mandible was diagnosed one year after implant placement. Although several options were suggested in order to repair the fracture, the patient did not accept any further treatment despite the callus formation not being radiographically evident. The implant-supported prosthesis is functionally useful for more than 8 years of follow-up without significant problems. Conclusions The implant treatment and management of oncologic irradiated patients require special considerations due to the risk of osteoradionecrosis and its possible complications, such as pathologic fracture. It is necessary to provide full information to the patient about risk factors and complications. Key words:Dental implants, mandibular fracture, osteoradionecrosis jaw, complications, fracture, cancer.
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Affiliation(s)
- Jorge Toledano-Serrabona
- DDS. Dental Degree. Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona (Spain)
| | - Gabriela Párraga-Manzol
- DDS, MS. Master's Degree Program in Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona (Spain)
| | - Mª Ángeles Sánchez-Garcés
- MD, DDS, MS, PhD, EBOS. Aggregate Professor of Oral Surgery. Master's Degree Program in Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona. Researcher of the IDIBELL institute, Barcelona (Spain)
| | - Cosme Gay-Escoda
- MD, DDS, MS, PhD, EBOS, OMFS. Chairman and Professor of Oral and Maxillofacial Surgery, Faculty of Medicine and Health Sciences, University of Barcelona. Director of the Master's Degree Program in Oral Surgery and Implantology (EFHRE International University/FUCSO). Coordinator/Researcher of the IDIBELL Institute. Head of the Oral Surgery, Implantology and Maxillofacial Surgery Department of the Teknon Medical Center, Barcelona (Spain)
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15
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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.
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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
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16
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Big data in facial plastic and reconstructive surgery: from large databases to registries. Curr Opin Otolaryngol Head Neck Surg 2017; 25:273-279. [PMID: 28525400 DOI: 10.1097/moo.0000000000000377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There are many limitations to performing clinical research with high levels of evidence in facial plastic and reconstructive surgery (FPRS), such as randomization into surgical groups and sample size recruitment. Therefore, additional avenues for exploring research should be explored using big data, from databases to registries. Other organizations have developed these tools in the evolving landscape of outcomes measurement and value in healthcare, which may serve as models for our specialty. RECENT FINDINGS Over the last 5 years, FPRS literature of large-scale outcomes research, utilizing several administrative databases, has steadily grown. Our objectives are to describe key administrative databases, strengths and weaknesses of each, and identify recent FPRS publications utilizing big data. A registry with FPRS defined outcomes has the most potential. SUMMARY Although FPRS research has trended to a more evidence-based approach in the modern healthcare era, gaps persist. Several large administrative databases or registries can address voids in outcomes research within FPRS.
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Krishnan B. The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible. Craniomaxillofac Trauma Reconstr 2016; 9:20-8. [PMID: 26889344 DOI: 10.1055/s-0035-1556050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/21/2015] [Indexed: 01/08/2023] Open
Abstract
Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results.
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Affiliation(s)
- Balasubramanian Krishnan
- Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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18
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Carlisle PL, Guda T, Silliman DT, Lien W, Hale RG, Brown Baer PR. Investigation of a pre-clinical mandibular bone notch defect model in miniature pigs: clinical computed tomography, micro-computed tomography, and histological evaluation. J Korean Assoc Oral Maxillofac Surg 2016; 42:20-30. [PMID: 26904491 PMCID: PMC4761569 DOI: 10.5125/jkaoms.2016.42.1.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To validate a critical-size mandibular bone defect model in miniature pigs. MATERIALS AND METHODS Bilateral notch defects were produced in the mandible of dentally mature miniature pigs. The right mandibular defect remained untreated while the left defect received an autograft. Bone healing was evaluated by computed tomography (CT) at 4 and 16 weeks, and by micro-CT and non-decalcified histology at 16 weeks. RESULTS In both the untreated and autograft treated groups, mineralized tissue volume was reduced significantly at 4 weeks post-surgery, but was comparable to the pre-surgery levels after 16 weeks. After 16 weeks, CT analysis indicated that significantly greater bone was regenerated in the autograft treated defect than in the untreated defect (P=0.013). Regardless of the treatment, the cortical bone was superior to the defect remodeled over 16 weeks to compensate for the notch defect. CONCLUSION The presence of considerable bone healing in both treated and untreated groups suggests that this model is inadequate as a critical-size defect. Despite healing and adaptation, the original bone geometry and quality of the pre-injured mandible was not obtained. On the other hand, this model is justified for evaluating accelerated healing and mitigating the bone remodeling response, which are both important considerations for dental implant restorations.
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Affiliation(s)
- Patricia L Carlisle
- Department of Craniomaxillofacial Regenerative Medicine, The United States Army Dental and Trauma Research Detachment, Fort Sam Houston, USA
| | - Teja Guda
- Department of Craniomaxillofacial Regenerative Medicine, The United States Army Dental and Trauma Research Detachment, Fort Sam Houston, USA.; Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - David T Silliman
- Department of Craniomaxillofacial Regenerative Medicine, The United States Army Dental and Trauma Research Detachment, Fort Sam Houston, USA
| | - Wen Lien
- Department of Craniomaxillofacial Regenerative Medicine, The United States Army Dental and Trauma Research Detachment, Fort Sam Houston, USA
| | - Robert G Hale
- Department of Craniomaxillofacial Regenerative Medicine, The United States Army Dental and Trauma Research Detachment, Fort Sam Houston, USA
| | - Pamela R Brown Baer
- Department of Craniomaxillofacial Regenerative Medicine, The United States Army Dental and Trauma Research Detachment, Fort Sam Houston, USA
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Carlsen A, Marcussen M. Spontaneous fractures of the mandible concept & treatment strategy. Med Oral Patol Oral Cir Bucal 2016; 21:e88-94. [PMID: 26636905 PMCID: PMC4765750 DOI: 10.4317/medoral.20716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 11/13/2015] [Indexed: 11/17/2022] Open
Abstract
Background Spontaneous fractures of the mandible dispose a surgical challenge in comparisons to fractures caused by trauma due to several complicating factors. Additionally: controversies exist concerning the terminology of the field. Material and Methods We conducted a retrospective study of all patients with mandibular fractures, with exclusion of fractures of the coronoid process and the alveolar process, treated at the Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Denmark between February 2003 and February 2013. Data collected from the medical records included sex, age, cause of fracture, site of fracture, and treatment. Results We identified 517 patients with 684 mandible fractures. Twenty-five of these were spontaneous fractures and 659 fractures were of traumatic origin. Condylar fractures rarely occur spontaneously, but constitute the majority of the traumatic fractures. Excluding these fractures from the analysis, we found a non-surgical approach in 14 of 24 (58%) of the spontaneous fractures and 110 of 376 (29%) of the traumatic fractures. This was statistically significant. Conclusions We found a statistical significant difference in favor of non-surgical approach in spontaneous fractures and we discussed the treatment challenges of these fractures. We addressed the terminological controversies regarding pathological fractures, and suggested the term spontaneous fractures denoting a fracture occurring during normal jaw function being either pathological or non-pathological. Key words:Mandibular fractures, spontaneous fractures, pathological fractures, traumatic fractures, treatment.
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Affiliation(s)
- Anja Carlsen
- Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark,
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20
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van Bakelen NB, Vermeulen KM, Buijs GJ, Jansma J, de Visscher JGAM, Hoppenreijs TJM, Bergsma JE, Stegenga B, Bos RRM. Cost-Effectiveness of a Biodegradable Compared to a Titanium Fixation System in Maxillofacial Surgery: A Multicenter Randomized Controlled Trial. PLoS One 2015; 10:e0130330. [PMID: 26192813 PMCID: PMC4507946 DOI: 10.1371/journal.pone.0130330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 05/18/2015] [Indexed: 11/27/2022] Open
Abstract
Background Biodegradable fixation systems could reduce/delete the problems associated with titanium plate removal. This means less surgical discomfort, and a reduction in costs. Aim The aim of the present study was to compare the cost-effectiveness between a biodegradable and a titanium system in Maxillofacial surgery. Materials and Methods This multicenter RCT was performed in the Netherlands from December 2006 to July 2009. Included were 230 patients who underwent a bilateral sagittal split osteotomy (BSSO), a Le Fort-I osteotomy, or a bi-maxillary osteotomy and those treated for fractures of the mandible, maxilla, or zygoma. The patients were randomly assigned to a titanium group (KLS Martin) or to a biodegradable group (Inion CPS). Costs were assessed from a societal perspective. Health outcomes in the incremental cost-effectiveness ratio (ICER) were bone healing (8 weeks) and plate removal (2 years). Results In 25 out of the 117 patients who were randomized to the biodegradable group, the maxillofacial surgeon made the decision to switch to the titanium system intra-operatively. This resulted in an Intention-To-Treat (ITT-)analysis and a Treatment-Received (TR-) analysis. Both analyses indicated that operations performed with titanium plates and screws had better health outcomes. In the TR-analysis the costs were lower in the biodegradable group, in the ITT-analysis costs were lower in the titanium group. Conclusion and Discussion The difference in costs between the ITT and the TR analyses can be explained by the intra-operative switches: In the TR-analysis the switches were analysed in the titanium group. In the ITT-analysis they were analysed in the biodegradable group. Considering the cost-effectiveness the titanium system is preferable to the biodegradable system in the regular treatment spectrum of mandibular, Le Fort-I, and zygomatic fractures, and BSSO’s, Le Fort-I osteotomies and bimaxillary osteotomies. Trial Registration Controlled-Trials.com ISRCTN 44212338
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Affiliation(s)
- N. B. van Bakelen
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - K. M. Vermeulen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - G. J. Buijs
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J. Jansma
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J. G. A. M. de Visscher
- Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Th. J. M. Hoppenreijs
- Department of Oral and Maxillofacial Surgery, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - J. E. Bergsma
- Department of Oral and Maxillofacial Surgery, Amphia Hospital Breda, Breda, The Netherlands
| | - B. Stegenga
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- UMCG Center for Dentistry and Oral Hygiene, Department of Oral Health Care & Clinical Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R. R. M. Bos
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
With demands for an evidence-based approach to patient care, the management of facial fractures will come under increasing scrutiny because there is an overall deficiency in higher level clinical evidence. This article reviews the management of facial fractures, focusing on an evidence-based approach. It focuses on select areas of facial trauma in which there is controversy and presents randomized studies and meta-analysis to help define best practice. The article notes the many areas where the evidenced-based literature is weak and looks at the future of evidence-based facial trauma care.
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Affiliation(s)
- Timothy D Doerr
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood, Box 629, Rochester, NY 14642, USA.
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