1
|
Shah A, Perez-Otero S, Tran D, Aponte HA, Oh C, Agrawal N. Infection Rates of an Intraoral Versus Extraoral Approach to Mandibular Fracture Repairs are Equal: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2024; 82:449-460. [PMID: 38336352 DOI: 10.1016/j.joms.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This study investigates whether the intraoral approach to mandibular open reduction and internal fixation, through exposure to the oral cavity's microbiome, results in higher infection rates compared to the extraoral approach, thus addressing a critical public health concern, potentially offering an opportunity to reduce health-care costs, and aiming to guide effective clinical practice. METHODS In this systematic review with meta-analyses, a review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was conducted using Embase and PubMed for articles published between 1989 and 2023. Inclusion criteria targeted studies on open reduction and internal fixation mandibular fractures comparing intraoral and extraoral approaches and reporting infection rates. Exclusion criteria eliminated non-English articles, case reports, and studies with insufficient approach-specific data. The primary outcome was the postoperative infection rate, with surgical approach as the predictor. Covariates such as age, sex, diabetes, and smoking status were included when reported. Data were analyzed using R software, employing random-effects models due to anticipated heterogeneity (I2 statistics). RESULTS From 61 studies, 11 provided direct comparisons involving 1,317 patients-937 intraoral and 380 extraoral. Infection rates were 5.9% for intraoral and 10% for extraoral approaches. Pooled relative risk was 0.94 [95% confidence interval, 0.63, 1.39], suggesting no significant risk difference. Prevalence of infections was estimated at 9% for intraoral and 6.1% for extraoral procedures, with significant heterogeneity (I2 = 84% for intraoral and 56% for extraoral). CONCLUSION Our meta-analysis found no significant difference in infection rates between the two approaches. There is opportunity to expand on reporting complication rates comparing the various approaches to mandibular fixation. Until these data are presented, surgeon preference may dictate the operative approach to expose the mandible for reduction and fixation.
Collapse
Affiliation(s)
- Alay Shah
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY.
| | - Sofia Perez-Otero
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - David Tran
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Hermes A Aponte
- Post-Doctoral Research Assistant, Department of Surgery, University of Puerto Rico School of Medicine, San Juan, PR
| | - Cheongeun Oh
- Clinical Assistant Professor, Biostatistics Division, Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY
| | - Nikhil Agrawal
- Post-Doctoral Research Fellow, Medical Student, Clinical Assistant Professor, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| |
Collapse
|
2
|
Kostares E, Kostare G, Kostares M, Kantzanou M. Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis. Sci Rep 2023; 13:11174. [PMID: 37430033 DOI: 10.1038/s41598-023-37652-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023] Open
Abstract
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
Collapse
Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
| | - Georgia Kostare
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Michael Kostares
- National and Kapodistrian University of Athens Faculty of Medicine: Ethniko kai Kapodistriako Panepistemio Athenon Iatrike Schole, 115 27, Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| |
Collapse
|
3
|
Singh PK, Singh G, Vignesh U, Mohammad S, Singh RK, Mehrotra D. Comparative Evaluation of Modified Tragus Edge Approach and Retromandibular Approach to Mid- or Low-Level Mandibular Condylar Fractures. J Maxillofac Oral Surg 2022; 21:184-190. [PMID: 35400921 PMCID: PMC8934813 DOI: 10.1007/s12663-020-01356-5] [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: 01/19/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives To compare and evaluate the modified tragus edge approach (MTEA) with retromandibular approach for surgical access to mid-level or low-level mandibular condylar fractures. Materials and Methods This study comprised of 22 patients with mid-level or low-level condylar fracture. Patients with clinical and radiological evidence of mid-level or low-level condylar fracture are included only in this study. Patients were randomly divided into two groups: group A includes 11 patients, in which modified tragus edge approach was used, and group B includes 11 patients treated with retromandibular approach. Patients were evaluated clinically after first week, second week, fourth week, third month, and sixth month radiographically. Results The mean age of the study subjects in group A was 32.45 ± 8.98 years, while in group B, the mean age was 26.91 ± 5.79 years. Post-operatively, no significant difference was seen in relation to pain, occlusal relationship, mouth opening, and deviation of jaw during opening and closing movements. In terms of post-operative complication, only significant difference found between two groups is post-operative scar visibility, which is higher in retromandibular incision group as compared to MTEA. Conclusion Thus, we can conclude that MTEA provides ease of operation as a good exposure of mandibular mid- or low-level condylar fracture as retromandibular approach but with less visibility of post-operative scar as compared to retromandibular approach.
Collapse
Affiliation(s)
- Praveen Kumar Singh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - Geeta Singh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, King George’s Medical University, Lucknow, U.P. 226003 India
| | - U. Vignesh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - Shadab Mohammad
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - R. K. Singh
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| | - Divya Mehrotra
- Department of Oral and Maxillofacial Surgery, King George’s Medical University, Lucknow, India
| |
Collapse
|
4
|
Ghezta NK, Ram R, Bhardwaj Y, Sreevidya Sasidhar, Sharma M, Bhatt R. Operator Experience and Fracture Location Affects the Rate of Facial Nerve Injury in Condylar Fractures: An Analysis of 89 Cases. J Oral Maxillofac Surg 2020; 79:1104.e1-1104.e9. [PMID: 33515504 DOI: 10.1016/j.joms.2020.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to measure the frequency and identify risk factors for facial nerve injury (FNI) in the open treatment of condylar neck and subcondylar fractures. MATERIALS AND METHODS A prospective cohort study was conducted over 5 years on patients who were treated surgically for mandibular condylar fractures using the retomandibular transparotid approach (RMTA). The primary result was FNI occurrence (yes/no). The predictor variables were demographic, fracture location, and pattern (dislocation, present or not), as well as surgeon experience. Post-treatment functional facial nerve changes were initially assessed in the operating room as the patient regained consciousness and documented thereafter within, the 1st and 3rd weeks, and 3rd and 6th months. Appropriate statistics were computed and, SPSS version 16 was used to analyze the data. χ2 test and Fisher exact test were used to assess significance (P ≤ 0.05). RESULTS Eighty-nine patients with 102 condylar fractures (63 subcondylar and 26 condylar neck), with a mean age of 28.5±7.5 years and 91% men were evaluated. There were 15 subjects (16.8%) with FNI and among them 6 subjects had persistent facial weakness for 6-8 weeks that completely resolved within 3 months, with no permanent facial nerve paralysis. The marginal mandibular (n = 7), buccal (n = 6), and zygomatic (n = 2) were the facial nerve branches involved. Risk factors for FNI were operator' inexperience, fracture-dislocation, and condylar neck fracture to the site and location of the fracture. Multivariate logistic regression showed that the location of the fracture at neck level (0.030∗), fracture dislocation (<0.001∗), and operator's inexperience (0.003∗) were significant risk factors for postoperative facial nerve injury (P ≤ 0.05). CONCLUSIONS If conducted properly, the RMTA is a safe method for treating condylar fractures with rare major complications; however, fracture dislocation, fractured condylar neck, and operator' in-experience were significantly associated with increased risk of developing transient postoperative FNI.
Collapse
Affiliation(s)
- Narotam Kumar Ghezta
- Assistant Professor, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India.
| | - Rangila Ram
- Professor, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Yogesh Bhardwaj
- Professor and Head, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Sreevidya Sasidhar
- Postgraduate residents, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Manish Sharma
- Postgraduate residents, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| | - Ravi Bhatt
- Postgraduate residents, Department of Oral & Maxillofacial Surgery, H.P.Govt. Dental College & Hospital, Shimla, Himachal Pradesh, India
| |
Collapse
|
5
|
Gupta S, Bansal V, Mowar A, Purohit J, Bindal M. Analysis between Retromandibular and Periangular Transmasseteric Approach for Fixation of Condylar Fracture - A Prospective Study. Ann Maxillofac Surg 2020; 10:353-360. [PMID: 33708579 PMCID: PMC7943978 DOI: 10.4103/ams.ams_28_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Condylar fractures make up for an average of 17.5%–52% of all mandibular fractures. The aim of the present study was to compare the ease, success, and complications between retromandibular and periangular transmasseteric approaches when used for open reduction and internal fixation of condylar fractures. Materials and Methods: A total 20 cases with condylar fracture, ten each for retromandibular and periangular transmasseteric approach, were included in the study. Patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were recorded. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey's syndrome, and hypertrophic scars were also evaluated. Results: The mean exposure time in the retromandibular approach was 10 min 31 s and 9 min 17 s in the periangular transmasseteric approach. The incidence of facial nerve injury was 2 of 10 patients in the retromandibular group and 3 of 10 patients in the periangular transmasseteric group, all of which resolved within 6 months. The incidence of sialocoele was 2 of 10 in the retromandibular group. The time taken for exposure of the fracture site was statistically significant between the two approaches (P = 0.048) with longer time required for retromandibular approach. Discussion: It can be summarized that both the approaches are comparable and well suited for surgical management of condylar fractures. It was observed that in displaced condylar neck fractures, greater difficulty was experienced in the periangular transmasseteric approach than the retromandibular approach.
Collapse
Affiliation(s)
- Saloni Gupta
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Apoorva Mowar
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Jayendra Purohit
- Department of Oral and Maxillofacial Surgery, College of Dental Science, Amargadh, Gujarat, India
| | - Mohit Bindal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| |
Collapse
|
6
|
Computer-Aided Design and Computer-Aided Manufacturing Cutting Guides in Eminoplasty for the Treatment of Temporomandibular Joint Dislocation. J Craniofac Surg 2019; 30:541-547. [PMID: 30730510 DOI: 10.1097/scs.0000000000005143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Temporomandibular joint (TMJ) dislocation means the condyle moves out of the normal position. There are several treatments for TMJ dislocation, including conservative treatment, injection treatment, minimally invasive treatment, and open surgical treatment. In this study, we tried to review the literature related to the augmentation of the articular eminence and proposed a modified eminoplasty technique of TMJ dislocation by computer-aided design and computer-aided manufacturing (CAD/CAM) cutting guides. METHODS The literature on eminoplasty for TMJ was reviewed with 3 charts. Besides, 2 (67 and 69 years old) patients with chronic recurrent dislocation were treated by the CAD/CAM-guided surgical technique in our study, and postoperative measures were recorded to verify the safety and effectiveness regarding this technique. RESULTS A total of 28 studies (including 268 patients) of the augmentation of the articular eminence have been reported since 1967, including the 2 present patients. According to the analysis of the recurrence and complications in the review, we found the modified technique had an obvious advantage. The technique with cutting guides was also found having higher accuracy. CONCLUSION The modified technique was a reliable method when treating the TMJ dislocation, and the combination of CAD/CAM cutting guides was useful for more accuracy, even reduced the operation difficulty.
Collapse
|
7
|
Lin X, Liu XY, Huang XP. A modified approach from the edge of the tragus in the surgical treatment of mandibular condyle fractures. Ann R Coll Surg Engl 2018; 100:1-6. [PMID: 30112938 PMCID: PMC6204522 DOI: 10.1308/rcsann.2018.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction We present our experiences using a modified surgical approach from the edge of the tragus for mandibular condyle fractures, to reduce the risk of postoperative complications and visible scars. Materials and methods Thirty-two patients presenting with mandibular condyle fractures were treated through a modified approach on the edge of the tragus. The age of the patients ranged from 6 to 62 years. All mandibular condyle fractures were fixed. The patients were asked to start open-mouth training one week postoperatively, undergoing a cone-beam computed tomography examination and clinical follow-up. Postoperative complications were evaluated after surgery. Results Mouth opening was normal (average 39.5 mm) in all the patients during the operation and the occlusion improved significantly compared with preoperatively. No cases of damaged facial nerves were observed during the final follow-up at six months and postoperative scars were less noticeable. Conclusions The modified surgical approach from the edge of the tragus for mandibular condyle fractures provides a good view of the operative field, reduces the risk of facial nerve damage and produces a less noticeable postoperative scar.
Collapse
Affiliation(s)
- X Lin
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the College of Stomatology, Guangxi Medical University, Nanning Guangxi, China
| | - X-Y Liu
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the College of Stomatology, Guangxi Medical University, Nanning Guangxi, China
| | - X-P Huang
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the College of Stomatology, Guangxi Medical University, Nanning Guangxi, China
| |
Collapse
|
8
|
Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of condylar fractures via extraoral approaches: A review of complications. J Craniomaxillofac Surg 2018; 46:1232-1240. [DOI: 10.1016/j.jcms.2018.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/24/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022] Open
|
9
|
Al-Moraissi EA, Louvrier A, Colletti G, Wolford LM, Biglioli F, Ragaey M, Meyer C, Ellis E. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. J Craniomaxillofac Surg 2018; 46:398-412. [DOI: 10.1016/j.jcms.2017.10.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022] Open
|
10
|
Rozeboom A, Dubois L, Bos R, Spijker R, de Lange J. Open treatment of unilateral mandibular condyle fractures in adults: a systematic review. Int J Oral Maxillofac Surg 2017; 46:1257-1266. [DOI: 10.1016/j.ijom.2017.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/06/2017] [Accepted: 06/09/2017] [Indexed: 12/16/2022]
|
11
|
Functional outcomes of preauricular underparotid retrograde approach for mandibular condyle fractures. J Craniofac Surg 2014; 25:1078-81. [PMID: 24717314 DOI: 10.1097/scs.0000000000000514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Management of condyle fractures includes a wide spectrum of alternatives including analgesia alone, physiotherapy, intermaxillary fixation, and open reduction and internal fixation. Various approaches have been previously mentioned for the access to the mandibular condyle. The aim of this retrospective clinical study was to evaluate our clinical results on preauricular underparotid retrograde approach for condylar fractures. This retrospective study included 20 condylar fractures in 16 patients who were treated surgically using a preauricular transparotid retrograde approach between 2010 and 2013. Functional outcomes with this method were addressed in light of the results obtained in this clinical series. We suggest this method in the management of condylar fractures.
Collapse
|
12
|
Ogura I, Sasaki Y, Kaneda T. Analysis of mandibular condylar and glenoid fossa fractures with computed tomography. Eur Radiol 2013; 24:902-6. [PMID: 24337861 DOI: 10.1007/s00330-013-3085-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the prevalence of glenoid fossa and condylar fractures in patients with mandibular fractures using multidetector computed tomography (MDCT). METHODS A prospective study was performed in 227 patients with mandibular fractures who underwent 64-MDCT. Mandibular fractures were classified into four types: median, paramedian, angle and condylar. Statistical analysis of the relationship between prevalence of condylar fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P value less than 0.05 was considered statistically significant. RESULTS The prevalence of condylar fracture was 64.8 % of all patients with mandibular fractures, 66.7 % of median type (P = 0.667), 45.5 % of paramedian type (P = 0.001) and 12.3 % of angle type (P = 0.000), respectively. Furthermore, glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures. CONCLUSIONS The results of the presented study suggest focusing also on incidental findings such as glenoid fossa fractures. KEY POINTS • The prevalence of condylar fracture was 64.8 % in patients with mandibular fractures. • Glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures. • The study suggests a focus on incidental findings such as glenoid fossa fractures.
Collapse
Affiliation(s)
- Ichiro Ogura
- Department of Radiology, Nihon University School of Dentistry at Matsudo, 2-870-1, Sakaecho-Nishi, Matsudo, Chiba, 271-8587, Japan,
| | | | | |
Collapse
|