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Guerra RC, de Fátima Borim Pulino B, Salomão Júnior VF, Dos Santos Pereira R, Thieringer FM, Sacco R, Sader R, Vieira EH. Finite element analysis of low-profile reconstruction plates for atrophic mandibles: a comparison of novel 3D grid and conventional plate designs. Oral Maxillofac Surg 2024; 28:595-603. [PMID: 37516667 DOI: 10.1007/s10006-023-01173-3] [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: 01/05/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES This study aimed to compare the reconstruction with type 2.4 and three-dimensional (3D) grid plates relating the areas of weakness to anatomical regions of force incidence in atrophic mandibles with and without segmentation using finite element analysis (FEA). MATERIALS AND METHODS Strength and force quality in the mandible were also determined. The atrophic mandible models with and without segmentation were divided into four groups, and the behavior of each plate was analyzed using finite element analysis. In the atrophic mandible without segmentation using the type 2.4 reconstruction plate, the highest stress concentration in the plate was observed in the posterior region of the mandibular body and in the grid type 3D reconstruction plate was observed in the mandibular angle. RESULTS In the segmented atrophic mandible with the 2.4 reconstruction plate, higher stress concentration was observed in the mandibular segment defect. Analysis of the 3D grid-like reconstruction plate revealed that the geometry of the plate conferred greater stiffness to the assembly, as the most significant stress concentration was observed at the mandibular angle. CONCLUSION The width of the plate design may influence the strength, not the thickness.
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Affiliation(s)
- Raphael Capelli Guerra
- Research and Education Institute - Hospital Sírio Libanes, DASA/Leforte Group, São Paulo State University Araraquara - UNESP, São Paulo Metodista University, São Paulo, Brazil
| | - Bianca de Fátima Borim Pulino
- Research and Education Institute, Hospital Sírio Libanes; São Paulo State University Araçatuba; DASA/Leforte Group, São Paulo Metodista University, Praça Francisco Manuel, 72, São Paulo, 01541-020, Brazil.
| | | | | | | | - Roberto Sacco
- Division of Dentistry, Oral Surgery Department, School of Medical Sciences, The University of Manchester, London, UK
| | - Robert Sader
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt Am Main, Frankfurt, Hessen, Germany
| | - Eduardo Hochuli Vieira
- DASA/Leforte Group, Research and Education Institute, Hospital Sírio Libanes; São Paulo State University - UNESP, Araraquara, Brazil
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Oksa M, Haapanen A, Kannari L, Furuholm J, Snäll J. Surgical treatment of clinically infected mandibular fractures. Oral Maxillofac Surg 2024; 28:839-847. [PMID: 38286958 PMCID: PMC11144672 DOI: 10.1007/s10006-024-01213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE To clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures. METHODS Patients with clinically infected mandibular fracture of the dentate part without preceding surgery were studied retrospectively. Clinical infection was defined to occur if pus, abscess, or a fistula in the fracture area was present. Patient-, fracture-, and surgery-related variables were evaluated, and predictors for postoperative complications were analysed. RESULTS Of 908 patients with surgically treated fracture in the dentate part of the mandible, 41 had infected fracture at the time of surgery (4.5%). Of these patients, 46.3% were alcohol or drug abusers. Median delay from injury to surgery was 9 days. Patient-related factors were the most common cause for delayed surgery (n = 30, 73.2%), followed by missed diagnosis by a health care professional (n = 8, 19.5%). Twenty-two fractures were treated via extraoral approach (53.7%) and the remaining 19 intraorally (46.3%). Postoperative surgical site complications were found in 13 patients (31.7%), with recurrent surgical site infections predominating. Notable differences between total complication rates between intraoral and extraoral approaches were not detected. Secondary osteosynthesis for non-union was conducted for one patient treated intraorally. CONCLUSIONS Postoperative surgical site complications are common after treatment of infected mandibular fractures, and these occur despite the chosen surgical approach. Infected mandibular fractures heal mainly without bone grafting, and non-union is a rare complication. Due to the high complication rate, careful perioperative and postoperative care is required for these patients.
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Affiliation(s)
- Marko Oksa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, FI-00290, Helsinki, Finland.
- Helsinki University Hospital, Haartmaninkatu 1A, FI-00029, Helsinki, Finland.
| | - Aleksi Haapanen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, FI-00290, Helsinki, Finland
- Helsinki University Hospital, Haartmaninkatu 1A, FI-00029, Helsinki, Finland
| | - Leena Kannari
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, FI-00290, Helsinki, Finland
- Helsinki University Hospital, Haartmaninkatu 1A, FI-00029, Helsinki, Finland
| | - Jussi Furuholm
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, FI-00290, Helsinki, Finland
- Helsinki University Hospital, Haartmaninkatu 1A, FI-00029, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, FI-00290, Helsinki, Finland
- Helsinki University Hospital, Haartmaninkatu 1A, FI-00029, Helsinki, Finland
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Pereira RVS, de Moraes SLD, Monteiro JLGC, Gomes ACA, Pellizzer EP, Vasconcelos BCDE. Effectiveness of Elastic Therapeutic Tape in Reducing Edema, Pain and Trismus following Surgery for Facial Fractures: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:997. [PMID: 38398310 PMCID: PMC10888644 DOI: 10.3390/jcm13040997] [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: 01/03/2024] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Facial fractures cause postoperative morbidity, including edema, pain, and trismus. Elastic therapeutic tapes are used for optimizing recovery. Background: The aim of the present systematic review and meta-analysis was to evaluate the effectiveness of elastic tape Kinesio taping (KT) in reducing postoperative morbidity in facial fractures surgeries. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Searches were conducted in the Cochrane, Medline, Scopus, Embase and Web of Science databases using a pre-established search strategy. Results: A total of 811 studies were retrieved after the duplicates were removed, and only randomized clinical trials were included. Eight trials, involving 319 participants, were deemed eligible. One study solely investigated the effect on edema, while the others analyzed at least two of the variables of interest. Results from two RCTs, where qualitative analysis was applicable, suggest a potential reduction in edema in the KT group compared to the control group on the second (RR -0.55, 95% CI -0.89 to -0.22; p = 0.01; I2 = 0%) and third postoperative days (RR -0.71, 95% CI -1.01 to -0.40; p < 0.00001; I2 = 0%). Conclusions: KT is effective in controlling postoperative edema following surgery for facial fractures. However, the effects on pain and trismus should be explored further in studies with standardized methods.
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Affiliation(s)
- Rebeca Valeska Soares Pereira
- Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco, Recife 50100-130, Brazil; (R.V.S.P.); (A.C.A.G.)
| | | | | | - Ana Cláudia Amorim Gomes
- Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco, Recife 50100-130, Brazil; (R.V.S.P.); (A.C.A.G.)
| | - Eduardo Piza Pellizzer
- Araçatuba Dental School, Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), Araçatuba 16015-050, Brazil;
| | - Belmiro Cavalcanti do Egito Vasconcelos
- Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco, Recife 50100-130, Brazil; (R.V.S.P.); (A.C.A.G.)
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Zhang M, Rao P, Xia D, Sun L, Cai X, Xiao J. Functional Reconstruction of Mandibular Segment Defects With Individual Preformed Reconstruction Plate and Computed Tomographic Angiography-Aided Iliac Crest Flap. J Oral Maxillofac Surg 2019; 77:1293-1304. [PMID: 30742792 DOI: 10.1016/j.joms.2019.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE With the development of imaging technology and computer-assisted surgery in oral and maxillofacial surgery, digital technology is widely used in vascularized bone flap grafts for mandibular reconstruction. The aim of this study was to use digital technology throughout the treatment process to show that digital techniques can provide a reliable and accurate match between the mandible and the iliac crest flap to achieve functional reconstruction of mandibular segment defects. MATERIALS AND METHODS Twenty patients underwent 3-dimensional (3D) computed tomography (CT), mirroring technology, 3D model prototyping, and CT angiography (CTA) for treatment planning. Individual preformed reconstruction plates were fabricated and iliac crest flaps were designed preoperatively. After complete resection of the mandibular lesion, the iliac crest flap was shaped to reconstruct the mandibular defects. RESULTS During follow-up (range, 12 to 36 months), the facial shape, facial symmetry, and mouth opening of all patients recovered well. The 3D CT reconstruction also was evaluated for height, width, length, and bone healing of the iliac crest flap. Postoperative examination showed ideal bone union between the iliac crest flap and the mandible at 6 months. Nine patients received implant-supported fixed dentures to restore dentition. After follow-up, all patients were satisfied with their facial esthetics and function. The new mandible provided a suitable 3D position for implant-supported fixed partial dentures. CONCLUSION Use of digital techniques throughout the course of treatment improves the predictability and convenience of functional mandibular reconstruction. Individual preformed reconstruction plates and CTA effectively guaranteed the accuracy of iliac flap preparation.
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Affiliation(s)
- Maorui Zhang
- Resident, Departments of Oral and Maxillofacial Surgery and Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, China
| | - Pengcheng Rao
- Resident, Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, China
| | - Delin Xia
- Professor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Libo Sun
- Associate Professor, Department of Oral and Maxillofacial Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoxiao Cai
- Professor, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jingang Xiao
- Professor, Departments of Oral and Maxillofacial Surgery and Oral Implantology and the Orofacial Reconstruction and Regeneration Laboratory, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, China.
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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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Nasser M, Pandis N, Fleming PS, Fedorowicz Z, Ellis E, Ali K. Interventions for the management of mandibular fractures. Cochrane Database Syst Rev 2013:CD006087. [PMID: 23835608 DOI: 10.1002/14651858.cd006087.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. OBJECTIVES The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (non-surgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated to include both clinical and methodological factors. MAIN RESULTS Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of post-operative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I(2) = 0%). Similarly, no difference in post-operative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I(2) = 27%). The included studies involved a small number of participants with a low number of events. AUTHORS' CONCLUSIONS This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.
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Affiliation(s)
- Mona Nasser
- Peninsula Dental School, University of Plymouth, Plymouth, UK.
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Warnke PH, Lott AJ, Sherry E, Wiltfang J, Podschun R. The ongoing battle against multi-resistant strains: In-vitro inhibition of hospital-acquired MRSA, VRE, Pseudomonas, ESBL E. coli and Klebsiella species in the presence of plant-derived antiseptic oils. J Craniomaxillofac Surg 2013. [DOI: 10.1016/j.jcms.2012.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ristow O, Hohlweg-Majert B, Kehl V, Koerdt S, Hahnefeld L, Pautke C. Does elastic therapeutic tape reduce postoperative swelling, pain, and trismus after open reduction and internal fixation of mandibular fractures? J Oral Maxillofac Surg 2013; 71:1387-96. [PMID: 23676774 DOI: 10.1016/j.joms.2013.03.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 03/12/2013] [Accepted: 03/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the present study was to investigate whether the application of elastic therapeutic tape (Kinesio Tape [KT]) prevents or decreases swelling, pain, and trismus after open reduction and internal fixation of mandibular fracture, thus improving patients' postoperative morbidity. MATERIALS AND METHODS To address the research purpose, the investigators designed and implemented an open-label, monocentric, parallel-group, randomized clinical trial. Patients were prospectively assigned for treatment of unilateral mandibular fractures and randomly allocated to receive treatment with or without KT application. KT was applied directly after surgery and maintained for 5 days postoperatively. Facial swelling was quantified using a 5-line measurement at 6 specific time points. Pain score was assessed using a 10-level visual analog scale; mouth opening was measured. In addition, all patients were asked to evaluate overall satisfaction and swelling (2 groups) and the effect of the tape on movement and comfort (KT group only). RESULTS The study included 26 patients (11 female and 15 male; mean age, 43 yr; standard deviation, 18.5 yr). Application of KT after surgery for mandibular fracture had a statistically significant influence on tissue reaction and swelling, decreasing the incidence of swelling and turgidity by more than 60% during the first 2 days after surgery. Although KT had no significant influence on pain control, patients in the KT group perceived significantly lower morbidity. CONCLUSION The present results showed that KT after open reduction and internal fixation of mandibular fracture is a promising, simple, less traumatic, and economical approach for managing postoperative swelling that is free from systemic adverse reactions, thus improving patients' quality of life.
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Affiliation(s)
- Oliver Ristow
- Medicine and Aesthetics, Private Clinic for Oral and Maxillofacial and Plastic Surgery, Munich, Germany.
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Rana M, Gellrich NC, von See C, Weiskopf C, Gerressen M, Ghassemi A, Modabber A. 3D evaluation of postoperative swelling in treatment of bilateral mandibular fractures using 2 different cooling therapy methods: A randomized observer blind prospective study. J Craniomaxillofac Surg 2013; 41:e17-23. [DOI: 10.1016/j.jcms.2012.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 04/18/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022] Open
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