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Daqiq O, Roossien CC, Wubs FW, van Minnen B. Biomechanical assessment of mandibular fracture fixation using finite element analysis validated by polymeric mandible mechanical testing. Sci Rep 2024; 14:11795. [PMID: 38782942 PMCID: PMC11116419 DOI: 10.1038/s41598-024-62011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
The clinical finite element analysis (FEA) application in maxillofacial surgery for mandibular fracture is limited due to the lack of a validated FEA model. Therefore, this study aims to develop a validated FEA model for mandibular fracture treatment, by assessing non-comminuted mandibular fracture fixation. FEA models were created for mandibles with single simple symphysis, parasymphysis, and angle fractures; fixated with 2.0 mm 4-hole titanium miniplates located at three different configurations with clinically known differences in stability, namely: superior border, inferior border, and two plate combinations. The FEA models were validated with series of Synbone polymeric mandible mechanical testing (PMMT) using a mechanical test bench with an identical test set-up. The first outcome was that the current understanding of stable simple mandibular fracture fixation was reproducible in both the FEA and PMMT. Optimal fracture stability was achieved with the two plate combination, followed by superior border, and then inferior border plating. Second, the FEA and the PMMT findings were consistent and comparable (a total displacement difference of 1.13 mm). In conclusion, the FEA and the PMMT outcomes were similar, and hence suitable for simple mandibular fracture treatment analyses. The FEA model can possibly be applied for non-routine complex mandibular fracture management.
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Affiliation(s)
- Omid Daqiq
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Charlotte Christina Roossien
- Engineering and Technology Institute Groningen, Department of Bio-Inspired MEMS and Biomedical Devices, University of Groningen, Nijenborgh 4, 9747 AG, Groningen, The Netherlands
| | - Frederik Wilhelm Wubs
- Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Nijenborgh 9, 9747 AG, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Saleh HO, Moussa BG, Salah Eddin KA, Noman SA, Salah AM. Assessment of CAD/CAM Customized V Pattern Plate Versus Standard Miniplates Fixation in Mandibular Angle Fracture (Randomized Clinical Trial). J Maxillofac Oral Surg 2023; 22:995-1005. [PMID: 38105847 PMCID: PMC10719228 DOI: 10.1007/s12663-023-02027-x] [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: 04/13/2023] [Accepted: 09/22/2023] [Indexed: 12/19/2023] Open
Abstract
Background Mandibular angle is the most common site for fractures, accounting for 23-42% of all cases of mandibular fractures. A customized fixation system is designed directly for a specific patient, which reduces the time spent bending and fixing the plate during the operation. This study was designed to assess the effect of CAD/CAM customized V pattern plate versus standard miniplates fixation in mandibular angle fracture. Materials and Methods This prospective randomized clinical trial included 26 patients suffering from mandibular angle fracture. Patients were selected from Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University and Ahmed Maher Teaching Hospital. Study group (13) needed open reduction and internal fixation by using CAD/CAM V plate with surgical guide, while control group (13) needed open reduction and internal fixation by using standard superior-inferior miniplate fixation. The patients were then followed up for one year postoperatively. Results It showed that there was a statistical difference between the study group and the control group regarding postoperative pain, occlusion, and maximal interincisal opening (p value < 0.05%). There was no statistical difference (p value > 0.05%) in the postoperative panoramic radiograph that was taken within the postoperative 1st week in both groups, while the increase in mean bone density was statistically significant (p value < 0.05%) from 6 months to one year postoperatively. Conclusion CAD/CAM customized V pattern plate is a suitable plate design because it offers sufficient stability for normal bone healing, the creation of an ideal occlusion, an early return to function, and adequate postoperative radiographic outcomes. Trial Registration It was registered at ClinicalTrials.gov. Registration number: NCT03761524. Registration date: 03.12.2018.
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Affiliation(s)
- Hiba Obad Saleh
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
- Department of Oral & Maxillofacial Surgery, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Basma Gamal Moussa
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Khaled Amr Salah Eddin
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Samer Abduljabar Noman
- Department Oral & Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Ahmed Mohammed Salah
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Sana’a University, Sana’a, Yemen
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Oksa M, Haapanen A, Marttila E, Furuholm J, Snäll J. Postoperative wound dehiscence in mandibular fractures. Acta Odontol Scand 2023; 81:555-561. [PMID: 37171859 DOI: 10.1080/00016357.2023.2211156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To clarify the occurrence and causes of non-infection-related surgical wound dehiscence (SWD) in intraorally treated mandibular fractures. MATERIAL AND METHODS Patients with one or two fractures of the dentate part of the mandible treated surgically via an intraoral approach were included in this retrospective study. The primary outcome variable was SWD. Associations between patient-, fracture- and surgery-related variables and SWD were evaluated. RESULTS Altogether 232 patients with 270 mandibular angle, body, symphysis and/or parasymphysis fractures were included in the analysis. In all, 22 SWDs were detected. These occurred in 9.5% of patients and in 8.1% of fractures. Surgery performed at night-time showed a significantly higher SWD rate than daytime surgeries (p = .012). Additionally, a significantly greater SWD rate was found among smokers (p = .041). Other studied variables remained statistically non-significant for SWD. In a multivariate analysis, night-time was the only significant independent variable with an odds ratio of 3.297 (95% CI 1.238 - 8.780, p = .017) for SWD. CONCLUSION The approach or closure technique used and the fracture type had only a minor effect on non-infection-related SWD in patients with mandibular fractures. To avoid SWDs, mandibular fracture surgeries should be conducted during the daytime with adequate support from an experienced surgeon.
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Affiliation(s)
- Marko Oksa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Emilia Marttila
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Furuholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland, and Helsinki University Hospital, Helsinki, Finland
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Vishnani R, Pattanshetti C, Gilani R, Sankeshwari B. New design titanium miniplate versus conventional miniplate in treatment of mandibular angle fractures: A comparative study. Natl J Maxillofac Surg 2023; 14:420-425. [PMID: 38273910 PMCID: PMC10806310 DOI: 10.4103/njms.njms_451_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 01/27/2024] Open
Abstract
Introduction Mandibular angle fracture (MAF) is the second most common site of all fractures of the mandible with the highest complication rate. Management of MAF has evolved in the past four decades. The purpose of the prospective study was to compare the efficacy of new design titanium miniplate (NDM) with conventional titanium miniplate (CTM) in the treatment of MAF. Objectives Mouth opening, occlusion, bite force measurement, and radiographs compared preoperatively and first week, first month and third month postoperatively. Materials and Method Fourteen patients diagnosed with MAF were randomly divided into two groups: Group A (seven patients) was treated with NDM and Group B (seven patients) with CTM. Patients were assessed preoperatively and postoperatively at an interval of one week, one month and three months. Results Repeated measures ANOVA and Post hoc Tukey test showed a significant increase in bite force and mouth opening for both groups in first and third postoperative months. Unpaired t-test showed slightly better mouth opening in Group B and slightly higher bite force in Group A. Discussion Both miniplates fulfilled all the study objectives and equally satisfactory healing was seen at the end of third month. NDM offers better stability, rigidity, and anatomic reduction of the fracture with a drawback of difficulty in adaptation and increased operative timing compared to CTM. Hence, we would like to conclude that both miniplates are equally efficient in the treatment of non-comminuted angle fractures with the NDM having upper hand in stability.
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Affiliation(s)
- Rozina Vishnani
- Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Sawangi, Wardha Maharashtra, India
| | - Channaveer Pattanshetti
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth Deemed to be University, Sangli, Maharashtra, India
| | - Rizwan Gilani
- Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Sawangi, Wardha Maharashtra, India
| | - Banashree Sankeshwari
- Department of Prosthodontics, Bharati Vidyapeeth Deemed to be University, Sangli, Maharashtra, India
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Jin R, Georges K, Jasti S, Ahsanuddin S, Cadwell JB, Paskhover B. Impact of Age on Surgical Outcomes Following Mandible Fracture Repair. Laryngoscope 2023; 133:287-293. [PMID: 35638520 DOI: 10.1002/lary.30208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Open repair of mandibular fractures are frequently performed surgical procedures. Increasing rates of such fractures are seen in older adults following falls. This study assesses the impact of older age on early complications following mandible fracture repair. STUDY DESIGN Retrospective analysis of national registry. METHODS The 2013-2018 National Surgical Quality Improvement Program database was queried for all cases of open mandible fracture repair and cases were categorized into younger (18-40), middle (41-65), and older (>65) age cohorts. Demographics and comorbidities were compared between the age groups. Rates of surgical, medical, and wound complications within 30-days of surgery were determined. Multivariable logistic analyses were performed to assess the relationship between age and complications. RESULTS Altogether, 1818 cases were included for analysis, of which 1269 (69.8%) were younger, 459 (25.2%) were middle, and 90 (5.0%) were older age. Increased rates of complications were seen in the older groups, including unplanned reoperation, unplanned readmission, wound disruption, and medical complications (p < 0.01). On unadjusted analysis, the older (>65) age group had an increased odds of experiencing a complication compared to the younger (18-40) group (OR: 4.19, p < 0.001). The older age group continued to have a significantly increased odds of medical complications after multivariable adjustment (adjusted OR: 8.64, p < 0.001). CONCLUSIONS On this analysis of a national database, advanced age was associated with an increased frequency of early postoperative complications following open mandibular fracture repair. Following multivariable adjustment, advanced age continued to be associated with increased odds of postoperative medical complications within 30 days of surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 133:287-293, 2023.
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Affiliation(s)
- Ryan Jin
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kirolos Georges
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shravya Jasti
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Salma Ahsanuddin
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joshua B Cadwell
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Boris Paskhover
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Vitkos EN, Papadopoulos KA, Dimasis P, Weissinger C, Kyrgidis A. One miniplate versus two miniplates in the fixation of mandibular angle fractures. An updated systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e865-e873. [PMID: 35872351 DOI: 10.1016/j.jormas.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures. METHODS A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed. RESULTS Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I2=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I2=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I2=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I2=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I2=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I2=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I2=29.33%) were statistically significantly higher in the two miniplates arm. CONCLUSION One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.
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Affiliation(s)
- Evangelos N Vitkos
- Department of General Surgery, General Hospital of Katerini, Katerini, Greece.
| | | | - Periklis Dimasis
- Department of General Surgery, General Hospital of Katerini, Katerini, Greece
| | - Christian Weissinger
- Division of Oral and Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Athanassios Kyrgidis
- Department of Oral and Maxillofacial Surgery, faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Elsayed SAH, Reda HM, Awadd MM, Mourad SI, Shokeir HMR, Elsayed EH, Al-Moraissi EA. Transbuccal vs. Intraoral Approach using an Angulated Screwdriver in Fixation of a Mandibular Angle Fracture. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2206200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives:
This study aimed to evaluate surgical stability and cosmetic outcomes in patients with mandibular angle fractures (MAFs) using an angled screwdriver (ASD) versus transbuccal trocar (TBT) for single locking plate fixation.
Methods:
A prospective cohort clinical study was done on 44 male patients (88%) and 6 (12% females patients with MAFs, categorized into 2 groups. Group A patients were treated with strictly intraoral vestibular incision using an angulated screwdriver; group B was treated with TBT. Both groups placed a single locking 2.0 mm mini-plates at the inferior border. The main outcome variables were the perioperative complication rate.
Results:
There were no statistical differences between both groups regarding postoperative wound dehiscence, screw or/and plate looseness, infection rate, and inferior dental nerve injury. The study (ASD) approach took 28.10±3.3minutes, while the TBT approach took 37.40±1.75minutes, indicating a highly significant difference in operating time (P=0.001). Post-operative edema had decreased significantly in the ASD group.
Conclusion:
According to the present results, a strictly intraoral approach for ASD enabled stable fixation of MAFs using a single mini-locking plate. This can significantly reduce operation time and postoperative edema and prevent extraoral scarring.
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Erdoğan MM, Şimşek T, Ugur L. Using Single Miniplate in Mandibular Angle Fractures: Finite Elements Analysis. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stanford-Moore G, Murr AH. Mandibular Angle Fractures. Facial Plast Surg Clin North Am 2021; 30:109-116. [PMID: 34809880 DOI: 10.1016/j.fsc.2021.08.009] [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: 11/29/2022]
Abstract
Angle fractures are the most common among the mandibular fractures. History and physical examination are crucial in guiding time course and specifics of management. Computed tomography (CT) has become the gold standard for diagnosis of mandible fractures, offering advantages for both surgical planning and assessing dental involvement. Currently the use of a single monocortical plate with the Champy technique for osteosynthesis is used preferentially for noncomminuted fractures of the mandibular angle. Other load-sharing options for plating include strut plates, malleable plates, and geometric or 3D plates. Load-bearing options remain viable for comminuted fractures or other complex circumstances.
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Affiliation(s)
- Gaelen Stanford-Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, School of Medicine, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA
| | - Andrew H Murr
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, School of Medicine, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
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Mehari Abraha H, Iriarte‐Diaz J, Reid RR, Ross CF, Panagiotopoulou O. Fracture Fixation Technique and Chewing Side Impact Jaw Mechanics in Mandible Fracture Repair. JBMR Plus 2021; 6:e10559. [PMID: 35079674 PMCID: PMC8770999 DOI: 10.1002/jbm4.10559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Lower jaw (mandible) fractures significantly impact patient health and well‐being due to pain and difficulty eating, but the best technique for repairing the most common subtype—angle fractures—and rehabilitating mastication is unknown. Our study is the first to use realistic in silico simulation of chewing to quantify the effects of Champy and biplanar techniques of angle fracture fixation. We show that more rigid, biplanar fixation results in lower strain magnitudes in the miniplates, the bone around the screws, and in the fracture zone, and that the mandibular strain regime approximates the unfractured condition. Importantly, the strain regime in the fracture zone is affected by chewing laterality, suggesting that both fixation type and the patient's post‐fixation masticatory pattern—ipsi‐ or contralateral to the fracture— impact the bone healing environment. Our study calls for further investigation of the impact of fixation technique on chewing behavior. Research that combines in vivo and in silico approaches can link jaw mechanics to bone healing and yield more definitive recommendations for fixation, hardware, and postoperative rehabilitation to improve outcomes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Hyab Mehari Abraha
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology Monash University Melbourne Australia
| | | | - 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 Melbourne Australia
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Falci SGM, de Souza GM, Fernandes IA, Galvão EL, Al-Moraissi EA. Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2021; 50:1450-1463. [PMID: 33676800 DOI: 10.1016/j.ijom.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
The aim of this review was to compare mandibular angle fracture fixation methods that were evaluated through randomized clinical trials considering postoperative complications. Additionally, different treatment methods were ranked based on their performance. A systematic review was performed based on the Cochrane and PRISMA guidelines. The quality of evidence and network meta-analysis were conducted using the GRADE tool and R software, respectively. Four databases were searched, and the papers were selected based on the PICOS strategy. A total of 3584 papers were found. After screening 15 papers were included. One plate placed on lateral border (tension zone) presented lower risk than one plate placed on superior border (tension zone) for infection [risk ratio (RR): 0.48, 95% confidence interval (CI): 0.33 to 0.71] and plate removal necessity (RR: 0.44, 95% CI: 0.28 to 0.69), with moderate quality of evidence. There were no significant differences among the mandibular angle fracture treatments for malocclusion and paraesthesia outcomes. In conclusion, one plate placed on the lateral border in the tension zone is the best choice regarding postoperative infection and plate removal necessity when fixing mandibular angle fractures. None of the tested fixation methods were associated with a significant risk of malocclusion and paraesthesia events.
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Affiliation(s)
- S G M Falci
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - G M de Souza
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - I A Fernandes
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
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Xu X, Cheng KJ, Liu YF, Fan YY, Wang JH, Wang R, Baur DA, Jiang XF, Dong XT. Experimental validation of finite element simulation of a new custom-designed fixation plate to treat mandibular angle fracture. Biomed Eng Online 2021; 20:15. [PMID: 33546713 PMCID: PMC7866451 DOI: 10.1186/s12938-021-00851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to validate biomechanical characteristics of a 3D-printed, novel-designated fixation plate for treating mandibular angle fracture, and compare it with two commonly used fixation plates by finite element (FE) simulations and experimental testing. METHODS A 3D virtual mandible was created from a patient's CT images as the master model. A custom-designed plate and two commonly used fixation plates were reconstructed onto the master model for FE simulations. Modeling of angle fracture, simulation of muscles of mastication, and defining of boundary conditions were integrated into the theoretical model. Strain levels during different loading conditions were analyzed using a finite element method (FEM). For mechanical test design, samples of the virtual mandible with angle fracture and the custom-designed fixation plates were printed using selective laser sintering (SLS) and selective laser melting (SLM) printing methods. Experimental data were collected from a testing platform with attached strain gauges to the mandible and the plates at different 10 locations during mechanical tests. Simulation of muscle forces and temporomandibular joint conditions were built into the physical models to improve the accuracy of clinical conditions. The experimental vs the theoretical data collected at the 10 locations were compared, and the correlation coefficient was calculated. RESULTS The results show that use of the novel-designated fixation plate has significant mechanical advantages compared to the two commonly used fixation plates. The results of measured strains at each location show a very high correlation between the physical model and the virtual mandible of their biomechanical behaviors under simulated occlusal loading conditions when treating angle fracture of the mandible. CONCLUSIONS Based on the results from our study, we validate the accuracy of our computational model which allows us to use it for future clinical applications under more sophisticated biomechanical simulations and testing.
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Affiliation(s)
- Xu Xu
- Department of Stomatology, People's Hospital of Quzhou, Quzhou, 324000, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Ying-Ying Fan
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Joanne H Wang
- Department of Orthopedic Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Ave., Cleveland, OH, 44016, USA
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Dale A Baur
- Department of Oral Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Xing-Tao Dong
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
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Ramos A, Semedo T, Mesnard M. Study of fixation of a mandibular plate for favourable fractures of the mandibular angle: numerical predictions. Br J Oral Maxillofac Surg 2020; 58:652-658. [DOI: 10.1016/j.bjoms.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
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In Vitro Evaluation of the Effects of Different Fixation Methods on Stabilization of Mandibular Body Fractures. J Craniofac Surg 2019; 30:1444-1447. [PMID: 31299740 DOI: 10.1097/scs.0000000000005385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Mandibular body fractures are considered to be one of the most affected fracture sites in the maxillofacial region. Although the rates of fracture in this region are high, biomechanical evaluations related to this region are rare. The purpose of this investigation was to reveal the effects of different treatment methods onmandibular body fractures. METHOD Twenty-five synthetic polyurethane hemi-mandibles were used in this study. The hemi-mandibles, which simulated simple unfavorable mandibular body fractures, were divided into 5 groups (n = 5/group) according to the treatment method. The bone segments were fixed using different osteosynthesis methods and 2.0 mm miniplate/screw systems. The groups consisted of locking or conventional systems, 5 or 11 mm long screws and 4 or 6 holes. The hemi-mandibles were loaded vertically with compressive strength until they reached 120 N. RESULTS The results were analyzed using Tamhane's T2 post hoc test, and the significance level was 0.05. Group 1 had the lowest mechanical resistance of all groups and group 5 had the highest. No significant differences were observed in group 2 or 3. CONCLUSION The locking system miniplate group showed better fixation stability than the conventional systems for the same screw length, and the number of holes and screw length seemed to be effective for stabilization.
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Wusiman P, Abasi K, Maimaitishawuti D, Moming A. Management of Mandibular Angle Fractures Using One Miniplate or Two Miniplate Fixation System: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 77:1673.e1-1673.e11. [DOI: 10.1016/j.joms.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
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Mishra N, Thakkar N, Kar I, Baig SA, Sharma G, Kar R, Sahu GR, Birmiwal KG. 3-D Miniplates Versus Conventional Miniplates in Treatment of Mandible Fractures. J Maxillofac Oral Surg 2019; 18:65-72. [PMID: 30728695 PMCID: PMC6328813 DOI: 10.1007/s12663-017-1068-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022] Open
Abstract
AIM To study whether the use of 3-D miniplate, when compared with conventional miniplate, gives better clinical outcomes with fewer complications in patients with fracture mandible. MATERIALS AND METHODS A prospective study was conducted in the Department of Oral and Maxillofacial Surgery, Trauma Care Centre, on 40 patients. They were randomly divided into Group-I and Group-II with 20 patients in each group. In Group-I, 3-D miniplate was used and in Group-II, conventional miniplate was used. Parameters such as fracture stability, occlusal status, mouth opening, nerve paresthesia, infection, pain, swelling, and complications were evaluated on 1st, 7th postoperative day, 1st month and 3rd month. RESULTS Fracture stability and occlusion were clinically better in Group-I than in Group-II on each follow-up; however, it was not statistically significant. Infection rate was lesser in Group-I than in Group-II (p = 0.003). Mouth opening was more in Group-II than in Group-I on immediate (p = 0.001) and 7th post-op day (p = 0.002). Overall complications were lesser in Group-I than in Group-II (p > 0.005). CONCLUSION There is no major difference observed in clinical outcomes between 3-D miniplate and conventional miniplate. Either method of fixation can be used successfully in treatment of mandible fractures with comparable rates of complications.
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Affiliation(s)
- Niranjan Mishra
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Nirav Thakkar
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Indubhusan Kar
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Shadab Ali Baig
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Gaurav Sharma
- Department of Public Health Dentistry, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Rosalin Kar
- Department of Prosthetic Dentistry, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Gyana Ranjan Sahu
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha India
| | - Krishna Gopal Birmiwal
- Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha India
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Ferrari R, Lanzer M, Wiedemeier D, Rücker M, Bredell M. Complication rate in mandibular angle fractures-one vs. two plates: a 12-year retrospective analysis. Oral Maxillofac Surg 2018; 22:435-441. [PMID: 30327980 DOI: 10.1007/s10006-018-0728-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Treatment of mandibular angle fractures using one or two osteosynthesis plates is still a controversial topic. Fracture, treatment, and patient-dependent influencing factors could affect the overall outcome. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed according to type of treatment. MATERIALS AND METHODS We analyzed retrospective medical records using the search terms "mandibular angle fracture." We included all patients presenting with a mandibular angle fracture treated by open reduction and internal fixation at our department between 2002 and 2012. RESULTS We included 186 patients treated with open reduction and miniplate fixation (84 one plate; 102 two plates). The early complication rate was significantly higher for the double-plate group (72.5% vs. 47.6%, respectively; p = 0.001). Most common findings in the postoperative period were transient hypoesthesia and tissue swelling. In the two-plate group, a significantly increased operation time of 183 min versus 150 min in the one-plate group was found (p < 0.001). Late complications did not differ significantly between both groups (21.4% single-plate group; 30.4% two-plate fixation group; p = 0.32). CONCLUSION We found a significantly increased early complication rate in the two-plate group. Long-term complications did not differ between both groups.
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Affiliation(s)
- Raphael Ferrari
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - M Lanzer
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - D Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bredell
- Cantonal Hospital Winterthur, Winterthur, Switzerland
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Abotaleb BM, Al-Moraissi E, Zhiqiang W, Ping C, Yongjie K, Alkebsi K, Lan Y. A detailed analysis of mandibular fractures epidemiology, treatment and outcomes: A 5-year retrospective study, Gansu Province-China. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mondal S, Singh G, Mishra M, Gaur A, Srivastava A. Comparative Evaluation between Single Noncompression Miniplate and Two Noncompression Miniplates in the Treatment of Mandibular Angle Fractures. Craniomaxillofac Trauma Reconstr 2018; 12:122-127. [PMID: 31073361 DOI: 10.1055/s-0038-1629907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 10/17/2022] Open
Abstract
This study was conducted to compare the outcome of single noncompression miniplate versus two noncompression miniplates in the treatment of mandibular angle fracture. A total of 40 patients were divided into two groups: Group I ( n = 20), patients were treated by single miniplate at superior border of mandible by intraoral approach; Group II ( n = 20), patients were treated by one miniplate at superior border of mandible, intraorally, and another at the lateral aspect of angle, transbuccally by trocar and cannula. Comparative evaluation was done at 1, 2, 4, 6, and 12 weeks and 6 months. The findings of this study suggest that there was no significant difference in postoperative complications (malocclusion, pain, swelling, infection, facial nerve injury, wound dehiscence, plate exposure) and bite force between the two groups.
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Affiliation(s)
- Shubhamoy Mondal
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madan Mishra
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Gaur
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhinav Srivastava
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
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Zimmermann C, Henningsen A, Henkel KO, Klatt J, Jürgens C, Seide K, Kienast B. Biomechanical comparison of a multidirectional locking plate and conventional plates for the osteosynthesis of mandibular angle fractures—A preliminary study. J Craniomaxillofac Surg 2017; 45:1913-1920. [DOI: 10.1016/j.jcms.2017.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 05/02/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022] Open
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Liu YF, Fan YY, Jiang XF, Baur DA. A customized fixation plate with novel structure designed by topological optimization for mandibular angle fracture based on finite element analysis. Biomed Eng Online 2017; 16:131. [PMID: 29141673 PMCID: PMC5688740 DOI: 10.1186/s12938-017-0422-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/10/2017] [Indexed: 12/26/2022] Open
Abstract
Background The purpose of this study was to design a customized fixation plate for mandibular angle fracture using topological optimization based on the biomechanical properties of the two conventional fixation systems, and compare the results of stress, strain and displacement distributions calculated by finite element analysis (FEA). Methods A three-dimensional (3D) virtual mandible was reconstructed from CT images with a mimic angle fracture and a 1 mm gap between two bone segments, and then a FEA model, including volume mesh with inhomogeneous bone material properties, three loading conditions and constraints (muscles and condyles), was created to design a customized plate using topological optimization method, then the shape of the plate was referenced from the stress concentrated area on an initial part created from thickened bone surface for optimal calculation, and then the plate was formulated as “V” pattern according to dimensions of standard mini-plate finally. To compare the biomechanical behavior of the “V” plate and other conventional mini-plates for angle fracture fixation, two conventional fixation systems were used: type A, one standard mini-plate, and type B, two standard mini-plates, and the stress, strain and displacement distributions within the three fixation systems were compared and discussed. Results The stress, strain and displacement distributions to the angle fractured mandible with three different fixation modalities were collected, respectively, and the maximum stress for each model emerged at the mandibular ramus or screw holes. Under the same loading conditions, the maximum stress on the customized fixation system decreased 74.3, 75.6 and 70.6% compared to type A, and 34.9, 34.1, and 39.6% compared to type B. All maximum von Mises stresses of mandible were well below the allowable stress of human bone, as well as maximum principal strain. And the displacement diagram of bony segments indicated the effect of treatment with different fixation systems. Conclusions The customized fixation system with topological optimized structure has good biomechanical behavior for mandibular angle fracture because the stress, strain and displacement within the plate could be reduced significantly comparing to conventional “one mini-plate” or “two mini-plates” systems. The design methodology for customized fixation system could be used for other fractures in mandible or other bones to acquire better mechanical behavior of the system and improve stable environment for bone healing. And together with SLM, the customized plate with optimal structure could be designed and fabricated rapidly to satisfy the urgent time requirements for treatment.
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Affiliation(s)
- Yun-Feng Liu
- Key Laboratory of E &M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou, 310014, Zhejiang, China.
| | - Ying-Ying Fan
- Key Laboratory of E &M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou, 310014, Zhejiang, China
| | - Xian-Feng Jiang
- Key Laboratory of E &M (Zhejiang University of Technology), Ministry of Education & Zhejiang Province, Hangzhou, 310014, Zhejiang, China
| | - Dale A Baur
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
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Dougherty WM, Christophel JJ, Park SS. Evidence-Based Medicine in Facial Trauma. Facial Plast Surg Clin North Am 2017; 25:629-643. [PMID: 28941514 DOI: 10.1016/j.fsc.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors.
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Affiliation(s)
- William M Dougherty
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - John Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
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Rastogi S, Paul S, Kukreja S, Aggarwal K, Choudhury R, Bhugra A, Indra B NP, Jawaid M. Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required? Craniomaxillofac Trauma Reconstr 2017; 10:188-196. [PMID: 28751942 DOI: 10.1055/s-0037-1600904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/27/2016] [Indexed: 10/19/2022] Open
Abstract
The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0-5), swelling (visual analog scale: 0-5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. 3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.
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Affiliation(s)
- Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, TMDCRC, Moradabad, Uttar Pradesh, India
| | - Sam Paul
- Department Orthodontics and Dentofacial Orthopaedics, Educare Institute of Dental Sciences, Chattiparamba, Malappuram, Kerala, India
| | - Sumedha Kukreja
- Department of Oral and Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Karun Aggarwal
- Department of Oral and Maxillofacial Surgery, Jodhpur Dental College and Research Center, Jodhpur, Rajasthan, India
| | - Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India
| | - Amit Bhugra
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Niranjana Prasad Indra B
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Moazzam Jawaid
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Simple Percutaneous Transbuccal Approach for Management of Mandibular Angular Fracture. J Craniofac Surg 2017; 28:1035-1037. [DOI: 10.1097/scs.0000000000003539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ribeiro-Junior PD, Vago TM, da Silva WS, Padovan LEM, Tiossi R. Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients. Cranio 2017; 36:234-242. [PMID: 28553749 DOI: 10.1080/08869634.2017.1330799] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF). METHODS Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study. RESULTS Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used. CONCLUSIONS The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.
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Affiliation(s)
| | - Thessio Miná Vago
- a Department of Oral and Maxillofacial Surgery , Sacred Heart University , Bauru , SP , Brazil
| | | | | | - Rodrigo Tiossi
- b Department of Restorative Dentistry , School of Dentistry, State University of Londrina , Londrina , PR , Brazil
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Yadav S, Mittal HC, Dhupar V, Akkara F, Sachdeva A. Transoral approach alone in single miniplate osteosynthesis of angle fracture - our experience. Natl J Maxillofac Surg 2017; 7:71-75. [PMID: 28163483 PMCID: PMC5242079 DOI: 10.4103/0975-5950.196136] [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] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to determine the outcome of transoral approach alone to treat the mandibular angle fracture using single 2.0 mm miniplate. Materials and Methods: In this study, 28 patients were included and treated with 2.0 mm single miniplate osteosynthesis at upper border along Champy's line of osteosynthesis using transoral approach alone. Results: All the cases were treated successfully with 2.0 mm single miniplate with common complications such as infection (two cases) and plate exposure (one case) in a total of two cases. Conclusion: Use of single miniplates by transoral approach alone for superior border osteosynthesis is effective and simple approach without need of extra armamentarium.
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Affiliation(s)
- Sunil Yadav
- Department of Dentistry, BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India
| | - Hitesh Chander Mittal
- Department of Dentistry, BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India
| | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Francis Akkara
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Akash Sachdeva
- Department of Oral and Maxillofacial Surgery, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
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In vitro evaluation of the resistance of three types of fixation to treat fractures of the mandibular angle. Br J Oral Maxillofac Surg 2016; 55:136-140. [PMID: 27776924 DOI: 10.1016/j.bjoms.2016.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/20/2016] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to compare the mechanical resistance of three different plates used to treat fractures of the mandibular angle: a regular 4-hole plate, a longer 4-hole plate (both positioned using the Champy technique), and a 3-dimensional plate positioned over the oblique line. Three equal groups of replicas of human dentate mandibles made out of polyurethane resin were used (n=21 in each group). The force was applied perpendicular to the occlusal plane at a rate of 2mm/minute at three different points: the first molar on the sectioned side; the first molar on the contralateral side; and between the central incisors. This was followed by a resistance-to-load test. The two varying factors (type of plate and site-of-load application) were tested by analysis of variance, and probabilities of less than 0.05 were accepted as significant. There were no significant differences between the subgroups, or between the mean values of the different types of plates (p=0.925). The three types of plates showed similar mechanical behaviour, which showed that the 3-dimensional plates positioned over the oblique line can produce mechanical scores similar to those of conventional plates.
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Beza SA, Attia S, Ellis E, Omara L. A Comparative Study of Transbuccal and Extraoral Approaches in the Management of Mandibular Angle Fractures: A Systematic Review. Open Access Maced J Med Sci 2016; 4:482-488. [PMID: 27703579 PMCID: PMC5042639 DOI: 10.3889/oamjms.2016.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of the present study was to compare the extraoral and transbuccal approaches for the treatment of mandibular angle fractures with regard to postoperative complications. PATIENTS AND METHODS An electronic search for relevant articles without language and date restrictions was performed in July 2016. Inclusion criteria were studies in humans including randomised controlled trials (RCTs), controlled clinical trials (CCTs), prospective studies (PS), and retrospective studies (RS). In total, 107 patients were included from four studies (transbuccal = 48, extraoral = 59). The follow-up period varied from 3 months to 24 months. RESULTS In extraoral group the average of unsightly scar, facial nerve weakness, infection, malocclusion, plate removal were found to be 55% (range, 10% -100%), 26.5% (range, 0%-53%), 11.7% (range, 0% - 20%), 22.5% (range, 0% -50%), 6.7% (range, 3.3% - 10%) respectively while these parameters in the transbuccal approach were found to be no obvious unsightly scar, 6.6 % (range, 0%-13.3%), 8.1% (range, 0% - 20%), 4.8% (range, 0% - 12.5%), 0%. The incidence of postoperative trismus and nonunion/malunion were 0% in both groups. CONCLUSION The results of this study suggest that transbuccal approach shows fewer complications than extraoral approach when used for the treatment of mandibular angle fractures.
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Affiliation(s)
- Sabah Ali Beza
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Sayed Attia
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery University of Texas Health Science Center at San Antonio, TX, USA
| | - Layla Omara
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
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Patel N, Kim B, Zaid W. A Detailed Analysis of Mandibular Angle Fractures: Epidemiology, Patterns, Treatments, and Outcomes. J Oral Maxillofac Surg 2016; 74:1792-9. [DOI: 10.1016/j.joms.2016.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/30/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
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Spinelli G, Lazzeri D, Arcuri F, Valente D, Agostini T. Management of Mandibular Angle Fractures by Two Conventional 2.0-mm Miniplates: A Retrospective Study of 389 Patients. Craniomaxillofac Trauma Reconstr 2016; 9:206-10. [PMID: 27516834 PMCID: PMC4980142 DOI: 10.1055/s-0036-1582457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022] Open
Abstract
Fractures of the mandibular angle account for 23 to 42% of all facial fractures with a high complication rate (0-32%). Although the ideal treatment remains debatable, two main procedures are commonly used to manage the majority of mandibular angle fractures that are open reduction and internal fixation by a noncompression miniplate placed on the external oblique ridge with or without a second miniplate on the outer cortex. The purpose of this study was to describe our management of mandibular angle fractures by two noncompression miniplates placed on the outer cortex via a transbuccal approach. Medical records and radiographic examination of 389 patients (258 males [66.3%] and 131 females [33.7%]) operated from January 2000 to December 2012 were retrospectively reviewed. Postoperative complications including malocclusion, infection, wound dehiscence, nonunion, and reoperative surgery were recorded and analyzed. Fifty-three patients developed postoperative complications (overall complication rate: 13.6%). No significant difference was found in the complication rate by age and gender variables and regarding the interval between the trauma and the operation and the presence of the teeth in the line of fracture. A higher rate of complications was found among patients with alcohol/drug addiction and in patients with multiple-site involvement. The findings of this study suggest that the use of two transbuccal miniplates placed on the outer cortex for the internal fixation of mandibular angle fracture provided a low rate of complications. The global incidence of screw loosening, wound dehiscence, plate exposure, infection, reoperation, and plate removal were similar with the data reported in the literature with improved health outcomes, lower postoperative morbidity, and a faster return to normal life.
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Affiliation(s)
- Giuseppe Spinelli
- Department of Maxillofacial Surgery, CTO-AOUC, “Careggi Hospital,” Florence, Italy
- Unit of Cranio-Maxillo-Facial Surgery, “Meyer Children's Hospital,” Florence, Italy
| | - Davide Lazzeri
- Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy
| | - Francesco Arcuri
- Department of Maxillofacial Surgery, CTO-AOUC, “Careggi Hospital,” Florence, Italy
- Unit of Cranio-Maxillo-Facial Surgery, “Meyer Children's Hospital,” Florence, Italy
| | - Domenico Valente
- Department of Maxillofacial Surgery, CTO-AOUC, “Careggi Hospital,” Florence, Italy
- Unit of Cranio-Maxillo-Facial Surgery, “Meyer Children's Hospital,” Florence, Italy
| | - Tommaso Agostini
- Department of Maxillofacial Surgery, CTO-AOUC, “Careggi Hospital,” Florence, Italy
- Unit of Cranio-Maxillo-Facial Surgery, “Meyer Children's Hospital,” Florence, Italy
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Cho JY, Jeong CH, Lee WY, Kim HM, Ryu JY, Yang SW. The effect of an interfragmentary gap on the clinical outcome after mandibular angle fracture surgery. Dent Traumatol 2016; 33:27-31. [DOI: 10.1111/edt.12300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jin-Yong Cho
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Chang-Hwa Jeong
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Woo-Yul Lee
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Hyeon-Min Kim
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Jae-Young Ryu
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Sung-Won Yang
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
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Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm. Ann Plast Surg 2016; 75:572-8. [PMID: 25393499 PMCID: PMC4888926 DOI: 10.1097/sap.0000000000000194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised. Materials and Methods A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article’s reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis. Result Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups. Conclusions Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.
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Katsarelis H, Lees T, McLeod N. Mandibular fractures - towards a national standard for "time to theatre" - national audit by the BAOMS Trauma Specialist Interest Group. Br J Oral Maxillofac Surg 2016; 54:796-800. [PMID: 27282082 DOI: 10.1016/j.bjoms.2016.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/15/2016] [Indexed: 11/25/2022]
Abstract
Recent studies have shown that in most patients, a delay of several days in the treatment of mandibular fractures is not associated with adverse outcomes, and this has challenged the traditional practice of recommending treatment within 24hours. Longer hospital stays cost more and lower the patients' quality of life, but we know of no standard recommendation about when these patients should be treated. Our aim therefore was to find out how many patients had reduction and fixation of a fractured mandible by the end of the next working day, with a view to developing a national standard. We invited all oral and maxillofacial surgery (OMFS) units in the UK to participate in a prospective audit over two months, and 35 agreed. Overall, 506 patients (80%) were operated on by the end of the next working day. The time to theatre varied from 1 hour 15minutes to 11 days, 20hours and 51minutes (median 22hours 7minutes). Patients admitted to units with an OMFS trauma list were more likely to be operated on by the next working day (p=0.011) as were those operated on at the weekend (p=0.019). We think that early fixation, return of function, and discharge, benefit patients most in terms of quality of life. Also, shorter hospital stays and reduced costs increase the availability of resources for elective operations. Setting a standard will improve our service and the care we deliver.
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Affiliation(s)
- H Katsarelis
- ST3 in Oral and Maxillofacial Surgery, Royal Surrey County Hospital, Egerton Road, Guildford. GU2 7XX.
| | - Tfa Lees
- Associate Specialist In Oral and Maxillofacial Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Royal Hospital, Great Western Road, Gloucester. GL1 3NN
| | - Nmh McLeod
- Consultant Oral and Maxillofacial Surgeon, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU
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Kanubaddy SR, Devireddy SK, Rayadurgam KK, Gali R, Dasari MR, Pampana S. Management of Mandibular Angle Fractures: Single Stainless Steel Linear Miniplate Versus Rectangular Grid Plate-A Prospective Randomised Study. J Maxillofac Oral Surg 2016; 15:535-541. [PMID: 27833349 DOI: 10.1007/s12663-016-0892-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 03/18/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This prospective study was conducted to evaluate the efficacy of stainless steel single linear miniplate with rectangular grid plate in the treatment of mandibular angle fractures. METHODS This study included 30 patients who were allocated randomly into two groups of each. Group 1 patients were treated with single 2 mm × 4 hole linear stainless steel miniplate and group 2 patients with 2 mm × 4 hole rectangular grid plate. Patients were evaluated for fracture stability, occlusion, mouth opening, and complications at 1st week, 1 and 3 months post operatively. RESULTS There were no significant differences between the two groups with respective variables statistically. In group 1 20 % (n = 3) had mild occlussal derangement 6.66 % (n = 1) patient had deranged occlusion at 1 week post operatively and 13.3 % (n = 2) had mild derangement at 1 month post operatively. In group 2 6.66 % (n = 1) had mild derangement at 1 week postoperatively. 20 % (n = 3) had limited mouth opening at 1 week in group 1 and 13.3 % (n = 2) in group 2. All patients in both groups achieved adequate mouth opening by the end of 3 month. None of the patients in both groups had plate fracture, screw loosening, non union or mal-union. CONCLUSION Within the limits of the study, use of rectangular grid plates for fixation of mandibular angle fractures was reliable with low complication rates, easy adaptation and an effective alternative to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.
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Affiliation(s)
- Sridhar Reddy Kanubaddy
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Sathya Kumar Devireddy
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Kishore Kumar Rayadurgam
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Rajsekhar Gali
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Mallikarjun Rao Dasari
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Sivaganesh Pampana
- Department of Oral Maxillofacial Surgery, Narayana Dental College, Chintareddy Palem, Nellore, Andhra Pradesh 524003 India
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Finite-Element Analysis of a New Designed Miniplate which is Used via Intraoral Approach to the Mandible Angle Fracture: Comparison of the Different Fixation Techniques. J Craniofac Surg 2016; 26:e445-8. [PMID: 26091053 DOI: 10.1097/scs.0000000000001890] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The mandible is the largest facial bone as well as the most commonly fractured bone in the maxillofacial region. Despite numerous studies conducted to identify optimal treatment modalities and plates configurations for intraoral and transoral approaches, no definitive conclusion has been reached. This study used finite element analysis (FEA) to assess 4 scenarios for treatment of an angle fracture (6-hole noncompression miniplate; 6-hole single plate/Champy's technique, 3D strut plate; 2 parallel 4-hole noncompression miniplates). Analysis included segmental displacement and Von Mises Stress evaluations of a 3D reconstruction of a human mandible. Von Mises Stress values for plates did not vary significantly among treatment groups. Moreover, no significant differences were observed in cumulative displacement of segments subjected to vertical and horizontal loads, with all treatment configurations demonstrating clinical acceptability.
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Pandey V, Bhutia O, Nagori SA, Seith A, Roychoudhury A. Management of mandibular angle fractures using a 1.7 mm 3-dimensional strut plate. J Oral Biol Craniofac Res 2016; 6:35-40. [PMID: 26937367 DOI: 10.1016/j.jobcr.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022] Open
Abstract
AIM We report our experience with the use of 1.7 mm 3-dimentional (3D) strut plate for the management of mandibular angle fractures. METHODS This prospective study enrolled 15 patients in whom mandibular angle fractures were treated with 1.7 mm 3D plate using trans-buccal trochar. Patients were evaluated at 72 h, 2 weeks, 6 weeks and 12 weeks for fracture stability, occlusion, soft-tissue swelling, infection and post-operative inferior alveolar nerve damage. Other complications like wound dehiscence, non-union, mal-union and hardware failure were also assessed. RESULTS In the immediate post-operative period, fracture instability was seen in 1 (6.7%) patient which resolved by 2 weeks. Mild occlusal discrepancy was also noted in 1 (6.7%) patient. Wound dehiscence was seen in 5 (33.3%) patients and all resolved by local measures. 1 (6.7%) patient developed post-operative nerve paraesthesia. Immediate post-operative radiographic evaluation demonstrated optimal reduction in all cases with no inferior border gaping. No case of infection, hardware failure, non-union and mal-union was noted. CONCLUSION Within the limitations of the study, 1.7 mm 3D strut plate was found to be effective for management of non-communited mandibular angle fractures.
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Affiliation(s)
- Varnika Pandey
- Ex-Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shakil Ahmed Nagori
- Ex-Resident, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith
- Professor, Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajoy Roychoudhury
- Professor and Head, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Strasz M, Wolschner R, Schopper C, Pöschl WP, Perisanidis C, Wick F, Seemann R. Miniplate osteosynthesis for mandibular angle fractures--A retrospective comparative study of 3 concepts in a temporal cohort. J Craniomaxillofac Surg 2015; 44:56-61. [PMID: 26646637 DOI: 10.1016/j.jcms.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/21/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Purpose of this retrospective study was to compare fixation of mandibular angle fractures by three different miniplating-concepts (single miniplate, double miniplate, TriLock mandibular angle plate) regarding osteosynthesis failure and hardware removal. METHODS In this retrospective study a temporal cohort of 184 patients with 194 simple mandibular angle fractures, which had been treated by open reduction and internal fixation via miniplates at the University Clinic of Cranio-, Maxillofacial and Oral Surgery (General Hospital Vienna) in the period of 2005-2011, were included. Patients with pathologic fractures (e.g. tumour or osteonecrosis related) or comminuted fractures were not considered. RESULTS 9 of 194 (4.6%) fractures showed osteosynthesis failures. The osteosynthesis failure rates were 2.9% in the single miniplate group, 3.4% in the TriLock plate group, and 11.1% in the double miniplate group. In the double miniplate group 33.3% of the patients had undergone hardware removal, 21.4% in the single miniplate group, and 11.4% in the TriLock plate group. CONCLUSION A single 4-hole locking plate with a thickness of 1.25-1.3 mm guarantees for low osteosynthesis failure rates without postoperative maxillo-mandibular fixation and requires less hardware removal in simple mandibular angle fractures. Two miniplates, longer plates with more holes and thicker plates are prone to hardware removal.
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Affiliation(s)
- Martin Strasz
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Rainer Wolschner
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christian Schopper
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Wolfgang Paul Pöschl
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christos Perisanidis
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Felix Wick
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Rudolf Seemann
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Sudhakar GVS, Rajasekhar G, Dhanala S, Vura N, Ramisetty S. Comparison of Management of Mandibular Angle Fractures by Three Approaches. J Maxillofac Oral Surg 2015; 14:979-85. [PMID: 26604473 DOI: 10.1007/s12663-015-0779-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/05/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Various methods have been reported in the literature for treating mandibular angle fractures comparing extra oral, intra oral and transbuccal approaches for achieving the goals of restoration of anatomic form, maintenance of segment position and bony union. MATERIALS AND METHODS This study was conducted to assess the simple and effective surgical approach in treating mandibular angle fractures and the outcome by means of three approaches i.e. intra oral, transbuccal and extra oral approaches. RESULTS/CONCLUSION A total of 45 patients with mandibular angle fracture were divided into three groups. Group I-intra oral approach-15 patients, Group II-transbuccal with intraoral approach-15 patients, Group III-extra oral approach-15 patients. The results of our study found intraoral approach to be much better because it is simple, precise, duration is short, and post operative complications are less with minimal morbidity and pain.
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Affiliation(s)
- Goparaju V S Sudhakar
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh India
| | - Gaddipati Rajasekhar
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh India
| | - Srikanth Dhanala
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh India
| | - Nandagopal Vura
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh India
| | - Sudhir Ramisetty
- Department of Oral and Maxillofacial Surgery, Mamata Dental College, Giriprasadnagar, Khammam, Andhra Pradesh India
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de Medeiros RC, Sigua EA, Navarro P, Olate S, Albergaria Barbosa JR. In Vitro Mechanical Analysis of Different Techniques of Internal Fixation of Combined Mandibular Angle and Body Fractures. J Oral Maxillofac Surg 2015; 74:778-85. [PMID: 26701138 DOI: 10.1016/j.joms.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate in vitro resistance of 5 techniques of internal fixation of bilateral fractures involving the mandibular angle and body. MATERIALS AND METHODS Twenty-five polyurethane mandibles were used as substrates, fixed with a 2-mm fixation system, and divided into 5 groups: I, 1 4-hole plate, without intermediate space, in the neutral zone of the mandibular body and another similar plate in the external oblique ridge of the contralateral mandibular angle; II, 1 6-hole plate, with intermediate space, in the neutral zone of the mandibular body and a similar plate in the external oblique ridge of the left mandibular angle; III, 1 4-hole locking plate, with intermediate space, in the right neutral zone and another similar plate in the left external oblique ridge; IV, 2 4-hole plates, with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body, and 1 4-hole plate, with intermediate space, in the external oblique ridge of the contralateral mandibular angle; V, 2 4-hole plates with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body and similarly in the buccal side of the left mandibular angle. Mandibles were subjected to vertical linear load tests by a mechanical testing machine (Instron 4411, Instron Corp, Norwood, MA) to record peak load and load for displacements of 3, 5, and 7 mm. RESULTS Group I had the least mechanical resistance of all groups, regardless of displacement, and group IV had the greatest mechanical resistance. Among groups II, III, and V, there was no statistically meaningful difference. CONCLUSION Fixation of bilateral mandibular fractures involving the mandibular angle and body using 2 plates in the region of the body and 1 plate in the tension zone in the region of the mandibular angle was the technique that presented the best mechanical resistance.
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Affiliation(s)
- Raquel Correia de Medeiros
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil.
| | - Eder Alberto Sigua
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Pablo Navarro
- Assistant Professor, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile
| | - Sergio Olate
- Assistant Professor and Head, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco; Associated Research, Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
| | - Jose Ricardo Albergaria Barbosa
- Adjunct Professor, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
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Butts SC, Floyd E, Lai E, Rosenfeld RM, Doerr T. Reporting of Postoperative Pain Management Protocols in Randomized Clinical Trials of Mandibular Fracture Repair: A Systematic Review. JAMA FACIAL PLAST SU 2015; 17:440-8. [PMID: 26335408 DOI: 10.1001/jamafacial.2015.1011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The control of pain associated with mandibular fractures is an important treatment outcome that affects function, adherence to treatment regimens, and patient comfort and satisfaction. OBJECTIVE To explore the pain management protocols reported in studies of mandibular fractures, including the reporting of quality-of-life measures. EVIDENCE REVIEW PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov were searched for randomized clinical trials published from 1970 to July 2014. We followed PRISMA reporting standards to assess study eligibility and extract data. Studies of patients older than 16 years who underwent operative mandibular fracture management were included. The primary data collected included the type of analgesic prescribed, associated adverse effects of the analgesic, method of pain assessment, and use of quality-of-life measures. A pain attentiveness score was assigned to studies based on the comprehensiveness of the information reported. Several variables were reviewed to determine the factors that predict reporting of pain-related data. Assessments of risk for bias were performed using the Cochrane Collaboration's domain-based evaluation method. FINDINGS The initial search identified 111 articles, of which 38 met inclusion criteria. Among the 38 reviewed articles, there were 38 trials and 1808 unique patients represented. Among the 38 articles, the procedures reported included maxillomandibular fixation only in 6 (16%), open reduction with internal fixation only in 20 (53%), and both in 12 (32%). Specific analgesics prescribed were reported in only 5 of the 38 studies (13%), and 3 of these used a combination of nonsteroidal anti-inflammatory drugs and acetaminophen (paracetamol). Thirteen studies (34%) reported pain assessments and 5 (13%) included quality-of-life measures. Geographic region was the only variable that predicted pain attentiveness, with studies from Europe (3 of 11 studies [27%]) and Asia (6 of 16 studies [38%]) most likely to have a high pain attentiveness score. A low rating was least common in the United States (2 of 5 studies [40%]) (P = .047, Fisher exact test). Most of the studies had unclear (n = 27) or high (n = 6) risks for bias in the key domains assessed. CONCLUSIONS AND RELEVANCE Pain management is a neglected outcome in randomized clinical trials of mandibular trauma; most studies did not describe the specific analgesics used. Many randomized clinical trials (13 [34%]) assessed pain levels among patients without providing information about the agents prescribed. The incorporation of validated pain measures and quality-of-life scores in future studies of mandibular trauma would focus attention on this key outcome measure.
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Affiliation(s)
- Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, College of Medicine, Brooklyn
| | - Elizabeth Floyd
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
| | - Erica Lai
- School of Public Health, State University of New York Downstate Medical Center, Brooklyn
| | - Richard M Rosenfeld
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
| | - Timothy Doerr
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
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Al-Moraissi E. One miniplate compared with two in the fixation of isolated fractures of the mandibular angle. Br J Oral Maxillofac Surg 2015; 53:690-8. [DOI: 10.1016/j.bjoms.2015.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/09/2015] [Indexed: 11/16/2022]
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Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Routine removal of the plate after surgical treatment for mandibular angle fracture with a third molar in relation to the fracture line. Ann Maxillofac Surg 2015; 5:77-81. [PMID: 26389039 PMCID: PMC4555954 DOI: 10.4103/2231-0746.161077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: The purpose was to analyze the clinical course of surgically treated mandibular angle fractures from the viewpoint of routine removal of the plate because these fractures are associated with high rates of complications and plate removal. Subjects and Methods: The subjects were 40 patients with unilateral mandibular angle fracture, which was intraorally reduced and principally fixed with a single miniplate on the external oblique ridge. The third molar in relation to the fracture line was extracted in seven patients during the surgery. Clinical course was evaluated in terms of removal of the plate, preservation of the third molar and complications. Results: One patient showed a wound infection postoperatively, and two patients developed pericoronitis during the follow-up. These were managed with medication and local irrigation. One patient with a preserved third molar did not make a required visit and was lost from the follow-up. Removal of the plates was performed in 39 patients after confirmation of good fracture healing, mostly within a year. Twenty-four of 32 preserved third molars were simultaneously extracted. These procedures were generally performed under local anesthesia on an outpatient basis, and they did not cause any complications. Conclusions: Routine removal of the plate after surgical treatment for mandibular angle fractures, simultaneously with extraction of the third molar if indicated, may be beneficial to avoid complications related to the plate and the third molar later in life.
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Affiliation(s)
- Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yumiko Matsusue
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tsutomu Sugiura
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Clinical outcomes of three different types of hardware for the treatment of mandibular angle fractures: a comparative retrospective study. Int J Oral Maxillofac Surg 2015; 44:1260-7. [PMID: 26233715 DOI: 10.1016/j.ijom.2015.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 04/22/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022]
Abstract
A retrospective study was conducted to compare the clinical outcomes of three different types of hardware that are used in mandibular angle fracture fixation. Thirty patients were selected from the hospital database. The patients were categorized into the following groups: group A, in which a single 2.0-mm locking miniplate was used; group B, in which a single rigid 2.3-mm plate was used; and group C, in which a single lag screw was inserted. All patients were followed for 6 months. With regard to intraoperative variables, significant differences were found among the groups in the duration of surgery and cost. Group C had the shortest surgical time, followed by group A and then group B. Two patients, one in group A and one in group B, suffered an occlusal discrepancy after surgery. Of the group A patients, two exhibited wound dehiscence and one had an infection. One patient in group B had an exposed plate. Sensory nerve involvement was noted in three group C patients and one group B patient. The lag screw was associated with the fewest complications and exhibited all of the advantages of plating systems in the treatment of angle fracture. The lag screw involved the least hardware and a short operating time, however the differences were not significant.
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Tay ABG, Lai JB, Lye KW, Wong WY, Nadkarni NV, Li W, Bautista D. Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures. J Oral Maxillofac Surg 2015; 73:1328-40. [DOI: 10.1016/j.joms.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
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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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50
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Muñante-Cardenas JL, Passeri LA. Biomechanical comparison of four mandibular angle fracture fixation techniques. Craniomaxillofac Trauma Reconstr 2015; 8:123-8. [PMID: 26000083 DOI: 10.1055/s-0034-1393737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to make a comparison of the biomechanical behavior of four different internal fixation systems for mandibular angle fractures. A total of 40 polyurethane mandible replicas were employed with different fixation methods: group 1SP, one 2.0-mm four-hole miniplate; group 2PPL, two 2.0-mm four-hole parallel miniplates; group 3DP, one 3D 2.0-mm four-hole miniplate; and group 3DPP, one 3D 2.0-mm eight-hole miniplate. Each group was subjected to incisal or homolateral molar region loading. The load resistance values were measured at load application causing tip displacement of 1, 3, and 5 mm, and at the time at which the system achieves its maximum strength (MS). Means and standard deviations were compared among groups using analysis of variance and the Tukey test. Group 2PPL showed higher strength for all the displacements. For incisal loading, no statistically significant differences were found between groups 1SP, 3DP, and 3DPP. For molar loading, group 1SP and 3DPP showed statistically significant differences. For MS testing, group 1SP and 2PPL showed statistically significant differences in incisal loading; group 1SP and 3DP showed no statistically significant differences; and group 3DPP showed lower values of strength. Two parallel miniplates provide the most favorable mechanical behavior under the conditions tested.
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Affiliation(s)
| | - Luis Augusto Passeri
- Department of Surgery, School of Medical Sciences, State University of Campinas, Sao Paulo, Brazil
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