Mandibular fractures – what a difference 30 years has made

Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study

PURPOSE

The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF).

MATERIAL AND METHODS

This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded.

RESULTS

Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type.

CONCLUSION

Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.

Interpersonal Violence and Maxillofacial Injuries: Toward an Active Surveillance Proposal Through the Presentation Profile in Hospital Emergency Services

To establish a set of variables that define a predictive profile of events of maxillofacial trauma resulting from interpersonal violence, we analyzed sociodemographic variables and clinical characteristics of injuries recorded in three tertiary care hospital centers in Chile. To assess the relation between categories, we applied a multiple correspondence analysis. We identified 567 cases. Two dimensions explained 53.4% of the model. The first dimension was composed of variables related to the severity of the injury: medical-legal prognosis (.574), type of trauma (.511), and the destination of the patient (.332); the second dimension was composed of variables related to the typology of interpersonal violence: type of violence (.398) and sex of the patient (.370). Two profiles were recognized: women, victims of domestic violence, with lesions affecting mainly soft tissues and not requiring hospitalization and men, victims of community violence, with lesions involving fractures associated with greater severity and requiring hospitalization. There are two key dimensions in the diagnosis of maxillofacial trauma resulting from interpersonal violence: severity of the injury and typology of the interpersonal violence. Exploring these predictive profiles can be a useful complement to the current screening tools of violence in clinical practice.