1
|
Dudde F, Schuck O, Schunk J, Filip B. Influence of COVID-19 pandemic on mandible fracture patterns in a German cranio-maxillofacial trauma center: PreCOVID (2019) versus IntraCOVID (2020). Dent Traumatol 2024; 40:425-434. [PMID: 38572818 DOI: 10.1111/edt.12949] [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: 02/14/2024] [Revised: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIMS The COVID-19 (Coronavirus Disease-2019) pandemic confronted the global healthcare system with a variety of challenges. The pandemic and the associated lockdowns also had an impact on multiple medical disciplines (i.e. delay of surgery, change of hospital admissions). The aim of this study was to analyze the impact of the COVID-19 pandemic on mandible fracture patterns/distributions and circumstances in a German cranio-maxillofacial trauma center. MATERIALS AND METHODS This retrospective study compared the mandible fracture patterns of patients in the PreCOVID (PC) era (February 2019-January 2020) with patients in the IntraCOVID (IC) era (February 2020-January 2021). In addition to baseline characteristics, the number/type of mandible fractures, location of the mandible fracture, circumstances leading to mandible fracture, and hospital admissions/treatments were analyzed. RESULTS A total of 127 patients was included in this study. In the IC period, the absolute frequencies of mandible fractures decreased (PC = 72 vs. IC = 55). There were minor changes in the mandible fracture locations. An increase of concomitant facial soft tissue injuries (IC = 69.1% vs. PC = 58.3%), as well as higher rates of traumatic tooth loss (IC = 32.7% vs. PC = 22.2%), was observed. Regarding the causes/accidents leading to mandible fractures, there were significant increases in falls and significant decreases in sports accidents as well as interpersonal violence during the IC period. A significant increase in accidents at home and domestic violence during the COVID-19 pandemic, with a simultaneous decrease in weekend and night-time trauma leading to mandible fractures was observed. Furthermore, a significant increase in days from trauma to surgery was recorded. CONCLUSION The COVID-19 pandemic had a significant impact on mandibular fracture patterns. The locations and types of mandibular fractures changed slightly. However, significant differences in the circumstances leading to mandible fractures (increased falls, decreased interpersonal violence) were recorded.
Collapse
Affiliation(s)
- Florian Dudde
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Oliver Schuck
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Johannes Schunk
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| | - Barbarewicz Filip
- Department of Oral and Maxillofacial Surgery, Army Hospital Hamburg, Hamburg, Germany
| |
Collapse
|
2
|
Fernandes IA, Al-Moraissi EA, Galvão EL, Falci SGM. Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial. Clin Oral Investig 2023; 27:6063-6071. [PMID: 37603168 DOI: 10.1007/s00784-023-05220-x] [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: 05/26/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE This randomized clinical trial aimed to compare the efficacy of Erich arch bars (EAB) and intermaxillary fixation (IMF) screws in reducing mandibular fractures during open reduction and internal fixation (ORIF). METHODS A total of 28 patients with mandibular fractures were randomly allocated to either the EAB group or the IMF screws group. The study evaluated various parameters including occlusal stability, complications, duration of application, oral hygiene status, quality of life, and patient characteristics. RESULTS The study found no significant differences in occlusal stability between the EAB and IMF screw groups. However, the application and removal times were longer for EAB compared to IMF screws. The EAB group showed a higher presence of biofilm on teeth, indicating poorer oral hygiene status compared to the IMF screws group. In terms of quality of life, patients in the EAB group reported worse results in the "handicap" domain at the 15th postoperative day. No significant differences were observed in other quality-of-life parameters. Patient characteristics were well distributed between the two groups, enhancing the reliability of the results. CONCLUSION Both EAB and IMF screws demonstrated comparable occlusal stability for minimally displaced mandibular fractures. However, IMF screws offered advantages such as shorter application and removal times, better oral hygiene maintenance, and potentially improved quality of life in the "handicap" domain. Further studies with larger sample sizes are necessary to validate these findings and explore the stability of IMF methods in cases requiring postoperative malocclusion correction or prolonged IMF.
Collapse
Affiliation(s)
- Ighor Andrade Fernandes
- Department of Dentistry, Section of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Centro - Oral Surgery Clinic, Diamantina, Minas Gerais, Brazil.
| | | | - Endi Lanza Galvão
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Dentistry, Oral and Maxillofacial Section, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| |
Collapse
|
3
|
Al-Moraissi EA, Neff A, Kaur A, Falci SGM, Maria de Souza G, Ellis E. Treatment for Adult Mandibular Condylar Process Fractures: A Network Meta-Analysis of Randomized Clinical Trials. J Oral Maxillofac Surg 2023; 81:1252-1269. [PMID: 37423262 DOI: 10.1016/j.joms.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE Using network meta-analyses (NMA) has become increasingly valuable as it enables the comparison of interventions that have not been directly compared in a clinical trial. To date, there has not been a NMA of randomized clinical trials (RCT) that compares all types of treatments for mandibular condylar process fractures (MCPFs). The aim of this NMA was to compare and rank all the available methods used in the treatment of MCPFs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted in 3 major databases up to January 2023 to retrieve RCTs that compared various closed and open treatment methods for MCPFs. The predictor variable is treatment techniques: arch bars (ABs) + wire maxillomandibular fixation (MMF), rigid MMF with intermaxillary fixation screws, AB + functional therapy with elastic guidance (AB functional treatment), AB rigid MMF/functional treatment, single miniplate, double miniplate, lambda miniplate, rhomboid plate, and trapezoidal miniplate. Postoperative complications were the outcome variables and included occlusion, mobility, and pain, among other things. Risk ratio (RR) and standardized mean difference were calculated. Version 2 of the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development, and Evaluations system were used to determine the certainty of the results. RESULTS The NMA included a total of 10,259 patients from 29 RCTs. At ≤6 months, the NMA revealed that the use of 2-miniplates significantly reduced malocclusion compared to rigid MMF (RR = 2.93; confidence interval [CI]: 1.79 to 4.81; very low quality) and functional treatment (RR = 2.36; CI: 1.07 to 5.23; low quality).Further, at ≥6 months, 2-miniplates resulted in significantly lower malocclusion compared to rigid MMF with functional treatment (RR = 3.67; CI: 1.93 to 6.99; very low quality).Trapezoidal plate and AB functional treatment were ranked as the best options in 3-dimensional (3D) plates and closed groups, respectively.3D-miniplates (very low-quality evidence) were ranked as the most effective treatment for reducing postoperative malocclusion and improving mandibular functions after MCPFs, followed closely by double miniplates (moderate quality evidence). CONCLUSIONS This NMA found no substantial difference in functional outcomes between using 2-miniplates versus 3D-miniplates to treat MCPFs (low evidence).However, 2-miniplates led to better outcomes than closed treatment (moderate evidence).Additionally, 3D-miniplates produced better outcomes for lateral excursions, protrusive movements, and occlusion than closed treatment at ≤6 months (very low evidence).
Collapse
Affiliation(s)
- Essam Ahmed Al-Moraissi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Thamar University, Yemen.
| | - Andreas Neff
- Professor, Chairman and Medical Director, Department of Oral and Craniomaxillofacial Plastic Surgery, Oral Surgery and Implantology, University Hospital Marburg, Marburg, Hesse, Germany
| | - Amanjot Kaur
- Assistant Professor, Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu, Jammu and Kashmir, India
| | - Saulo Gabriel Moreira Falci
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- Adujunct Professor, Department of Dentistry, Federal University of Vales do Jequitinhonha e Mucuri - UFVJM, Diamantina, Minas Gerais, Brazil
| | - Edward Ellis
- Professor and Chair, Department of Oral and Maxillofacial Surgery University of Texas Health Science Center at San Antonio
| |
Collapse
|
4
|
Helmer LM, Dubois L, Lobbezoo F, de Lange J, Bosmans JE. Healthcare costs of different treatment options for condylar fractures. Heliyon 2023; 9:e19851. [PMID: 37809381 PMCID: PMC10559232 DOI: 10.1016/j.heliyon.2023.e19851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Objective As treatment options for condylar fractures have comparable outcomes, getting insight into associated costs is a first step towards implementing value-based healthcare (VBH). Therefore, we described the actual costs of the different treatment options (surgical, conservative, and expectative treatment) for condylar fractures. We expected surgical treatment to be the most expensive treatment. Study design This is a cost-of-illness study, based on estimates from the literature. Firstly, care pathways of all treatment options were described. Secondly, the costs per step were calculated based on the literature and Dutch guidelines for economic evaluations in health care. Results The direct treatment costs of surgical treatment (€3721 to €4040) are three to five times higher than conservative treatment (€730 to €1332). When lost productivity costs during the recovery period are included, costs of surgical treatment remain 1.5 times higher (€9511 to €9830 for surgical treatment and €6224 to €6826 for conservative treatment). The costs of expectative treatment (€5436) are lower than both other treatments. Conclusion The costs for surgical treatment are considerably higher than those for conservative or expectative treatment, mainly related to direct treatment cost. Future research should focus on the patients' perspective, to support implementation of VBH in treating condylar fractures.
Collapse
Affiliation(s)
- Loreine M.L. Helmer
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam (AUMC) and Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Meibergdreef 9, AZ Amsterdam ZO, Amsterdam, 1105, the Netherlands
| | - Leander Dubois
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam (AUMC), Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, Meibergdreef 9, AZ Amsterdam ZO, 1105, the Netherlands
| | - Frank Lobbezoo
- Departments of Oral Health Sciences and of Orofacial Pain and Dysfunction, Academic Centre for Dentistry (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Gustav Mahlerlaan 3004, 1081, LA, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Centre of Amsterdam (AUMC), Academic Centre for Dentistry (ACTA), University of Amsterdam, Meibergdreef 9, AZ Amsterdam ZO, Amsterdam, 1105, the Netherlands
| | - Judith E. Bosmans
- Section Health Technology Assessment, Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081, BT Amsterdam, the Netherlands
| |
Collapse
|
5
|
Só BB, Jardim LC, Schuch LF, Kovalski LNS, Zan R, Calcagnotto T, Martins MD, Martins MAT. Analysis of factors that influence quality of life of individuals undergoing treatment for mandibular fractures: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:289-301. [PMID: 35440426 DOI: 10.1016/j.oooo.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures. STUDY DESIGN This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the search strategy was constructed according to the Populations, Interventions, Comparison, Outcomes, and Study Design principle in the following databases: PubMed, Web of Science, Scopus, and EMBASE. Risk of bias assessment was performed with Risk Of Bias In Non-randomized Studies of Interventions and Cochrane Risk of Bias tool for randomized trials 2. RESULTS Nineteen studies were included: 15 observational and 4 clinical trials. Mean age ranged from 28 to 39 years, with a higher proportion of males. The condyle was the main fracture location and traffic accident was the fracture cause. Treatment approaches were mostly open reduction (89.4%) and maxillomandibular fixation (63%). QoL measurements varied considerably with the General Oral Health Assessment Index (31.5%) and Oral Health Impact Profile-14 (21%) as the main instruments. Meta-analysis showed that open reduction and maxillomandibular fixation did not present significant differences to QoL (P = .39), but significant differences were observed with time (P < .00001). Other factors affected QoL, such as mental health, pain, socializing, appearance, and eating difficulties. CONCLUSIONS Several factors, apart from the treatment approach, mentioned in this review seemed to affect the QoL of patients with mandibular trauma. Treatment choice should be based on well-stablished clinical criteria and on all other factors mentioned here.
Collapse
Affiliation(s)
- Bruna Barcelos Só
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luisa Comerlato Jardim
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lauren Frenzel Schuch
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Luan Nathiel Santana Kovalski
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Zan
- Oral and Maxillofacial Surgery Department, FATEC Dental CEEO, Igrejinha, RS, Brazil
| | - Thiago Calcagnotto
- Oral and Maxillofacial Surgery Department, FATEC Dental CEEO, Igrejinha, RS, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
| | | |
Collapse
|
6
|
Jain A, Rai A. Is the Use of Intermaxillary Fixation Screws an Alternative to Erich Arch Bars for Maxillomandibular Fixation During Management of Maxillofacial Fractures? A Systematic Review and Meta-Analysis. Craniomaxillofac Trauma Reconstr 2021; 14:236-245. [PMID: 34471480 DOI: 10.1177/1943387520971410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design Systematic review and meta-analysis. Objective Maxillomandibular fixation (MMF) is a step of paramount importance during the management of maxillofacial trauma. Erich arch bars are being used for this purpose for decades but with advances in maxillofacial trauma management, intermaxillary fixation screws came into existence and are being used routinely. The present study was designed to identify if the intermaxillary fixation screws are really an alternative to Erich arch bars for management of maxillofacial trauma. Methodology An exhaustive literature search was conducted in May 2020 on various electronic databases and studies comparing Erich arch bars and intermaxillary fixation screws were recruited for the analysis. Random-effects model with Mantel Haenszel statistics was used to analyze oral hygiene and duration of achieving MMF. Results A total of 96 studies were identified, out of which 8 studies were included in the meta-analysis. There was no statistically significant difference in oral hygiene status of the patients in both the groups. Intermaxillary fixations screws required statistically significantly less time in achieving MMF. Needle stick injury was prominently seen with the use of Erich arch bar whereas other complications like mucosal coverage, root injury, screw loosening and screw fracture makes the use of intermaxillary fixation screws questionable. Conclusion The present meta-analysis suggests that there is not enough evidence to recommend the use of intermaxillary fixation screws as an alternative to Erich arch bars. Further research with large sample size, high quality evidence and better methodology is recommended in this direction.
Collapse
Affiliation(s)
- Anuj Jain
- Consultant Oral and Maxillofacial Surgeon, Nagpur, Maharashtra, India
| | - Anshul Rai
- Department of Dentistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| |
Collapse
|
7
|
Fernandes IA, Lopes ABS, Fonseca PG, da Silva Torres A, Rodrigues AB, Galvão EL, Falci SGM. Comparison between Erich arch bars and intermaxillary screws in maxillofacial fractures involving the dental occlusion: a meta-analysis. Int J Oral Maxillofac Surg 2020; 50:83-95. [PMID: 32798159 DOI: 10.1016/j.ijom.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/08/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022]
Abstract
This systematic review aimed to compare the Erich arch bars (EABs) with intermaxillary fixation (IMF) screws in maxillofacial fractures involving dental occlusion on perioperative parameters. Four electronic databases were searched: MedLine (Pubmed), Web of Science, VHL, and Cochrane Library. Inclusion criteria comprised clinical trials comparing the two IMF methods, assessing at least one of the outcomes: occlusal stability, oral hygiene, quality of life, time to apply and remove IMF appliances, and complications. Risk of bias was evaluated through the Cochrane risk of bias tool. Fifteen papers were included in the qualitative analysis and 12 of those in the meta-analysis. Times for EABs application (mean difference (MD) 46.83; 95% confidence interval (CI): 30.63-63.02) and removal (MD 22.89; 95% CI 14.61-31.17) were longer compared with IMF screws. There is higher risk of glove perforation (risk ratio (RR) 3.81; 95% CI 2.41-6.04) and lower risk of iatrogenic injuries (RR 0.21; 95% CI 0.09-0.48) when placing EABs compared with IMF screws. No significant differences in plaque index were found (MD 1.07; 95% CI -0.17 to 2.31). The quality of this evidence ranged from very low to low and was mainly compromised by risk of bias assessment. Further studies are necessary to evaluate transurgical IMF stability and postoperative occlusal quality and quality of life when comparing EABs with IMF screws.
Collapse
Affiliation(s)
- I A Fernandes
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - A B S Lopes
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - P G Fonseca
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - A da Silva Torres
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - A B Rodrigues
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - S G M Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| |
Collapse
|
8
|
Tan PG, Soh CL. Quality of life assessments in maxillofacial trauma patients – A systematic review. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2020. [DOI: 10.1016/j.ajoms.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Cabral LC, Alves GM, Furtado LM, Fernandes Neto AJ, Simamoto Júnior PC. Changes in mandibular and articular dynamics associated with surgical versus nonsurgical treatment of mandibular condylar fractures: a systematic review with meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:311-321. [PMID: 32102762 DOI: 10.1016/j.oooo.2019.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/14/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the mandibular and articular dynamics and the presence of complications associated with surgical or nonsurgical treatments of condylar fractures. STUDY DESIGN Clinical trials that compared open reduction internal fixation and maxillomandibular fixation in patients with condylar fractures were included. We performed an electronic search of PubMed, Scopus, Cochrane Library, Web of Science, and LILACS (Latin American and Caribbean Health Sciences) databases starting from February 2017 and updated in January 2019 and found 467 articles. We evaluated methodologic quality by using the criteria from Cochrane's Collaboration Tool. RESULTS After independent screening of abstracts, we assessed the full texts of 88 articles; 9 studies were included for qualitative synthesis; but only 8 were included for the meta-analysis. Four studies were considered to have high risk of bias, and 5 were considered to have low risk. The risk ratio (RR = 0.20; 95% confidence interval [CI] 0.13-0.32) was observed for complications. The quality of evidence, using GRADE software, was considered low for maximum mouth opening and protrusive movement and moderate for lateral excursion movement and complications. CONCLUSIONS This review suggested that open reduction internal fixation and maxillomandibular fixation are effective. However, surgical treatment presented higher objective parameters. Nonsurgical treatment presented a high index of complications, such as malocclusion, pain and deviation.
Collapse
Affiliation(s)
- Luana Cardoso Cabral
- Doctoral Student, School of Dentistry, Federal University of Uberlândia, Brazil.
| | | | - Lair Mambrini Furtado
- Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Uberlândia, Brazil
| | - Alfredo Júlio Fernandes Neto
- Professor, Department of Occlusion, Fixed Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberlândia, Brazil
| | - Paulo Cézar Simamoto Júnior
- Professor, Department of Occlusion, Fixed Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberlândia, Brazil.
| |
Collapse
|
10
|
Pabst AM, Blatt S, Epperlein P, Schmidtmann I, Krüger M, Schiegnitz E, Goetze E, Ziebart T, Al-Nawas B. The risk of tooth root injuries using cortical screws for intermaxillary fixation and osteosynthesis plates - A retrospective analysis. J Craniomaxillofac Surg 2019; 47:1767-1778. [PMID: 31711997 DOI: 10.1016/j.jcms.2019.08.006] [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: 05/27/2019] [Revised: 07/28/2019] [Accepted: 08/27/2019] [Indexed: 11/29/2022] Open
Abstract
Intermaxillary fixation (IMF) and osteosynthesis plates (OP) are widely used for the non-surgical and surgical treatment of mandible and condyle fractures. The aim of this retrospective study was to analyze the frequency of tooth root injuries by IMF and OP screws. Electronic patient reports (2004-2013) were screened for patients treated with either IMF screws and/or OP in the Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Germany. The frequency and the position of endangered and injured teeth were analyzed by orthopantomogram (OPTG) and cone beam computer tomography (CBCT). Next, possible predictive factors for tooth root injuries, namely interdental- and crestal distance, screw length and distance between tooth root and screw were evaluated. Further, the accuracy of OPTG vs. CBCT concerning the diagnosis of tooth root injuries was analyzed. Three-hundred sixty-six patients were included and 3388 teeth were defined as endangered by IMF- and OP screws. Overall, 16 injured teeth (0.5%) in 13 patients (3.55%) were detected. Nine injuries (56.3%) were caused by IMF- and seven injuries (43.8%) by OP screws. Three teeth were non-vital, one tooth had to be extracted. No correlation between the predictive factors crestal distance, screw length and tooth root injuries was found. If tooth injury occurred, a significant correlation between the interdental distance and the distance between tooth root and screw was found (κ = 0.48; p < 0,0001). Comparison between OPTG vs. CBCT demonstrated that many of the injuries that were seen in the OPTG (n = 230) could not be verified in the CBCT scans (n = 16) (κ = 0.12). To conclude, screws for IMF and OP can be considered as a safe procedure concerning the risk of tooth root injuries.
Collapse
Affiliation(s)
- Andreas Max Pabst
- Department of Oral- and Maxillofacial Surgery, Federal Armed Forces Hospital, (Head: Prof. Dr. Dr. R. Werkmeister), Rübenacherstrasse 170, 56072 Koblenz, Germany; Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany.
| | - Sebastian Blatt
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Pia Epperlein
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Center, (Head: Prof. Dr. S. Singer), Obere Zahlbacherstr. 69, 55131 Mainz, Germany
| | - Maximilian Krüger
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Eik Schiegnitz
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Elisabeth Goetze
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| | - Thomas Ziebart
- Department of Oral- and Maxillofacial Surgery, University Hospital Giessen and Marburg, Campus Marburg, (Head: Univ.-Prof. Dr. Dr. Andreas Neff), Baldingerstrasse, 35043 Marburg, Germany
| | - Bilal Al-Nawas
- Department of Oral- and Maxillofacial Surgery, University Medical Center, (Head: Univ.-Prof. Dr. Dr. B. Al-Nawas), Augustusplatz 2, 55131 Mainz, Germany
| |
Collapse
|
11
|
Is the SMARTLock Hybrid Maxillomandibular Fixation System Comparable to Intermaxillary Fixation Screws in Closed Reduction of Condylar Fractures? Ann Plast Surg 2018; 81:S35-S38. [DOI: 10.1097/sap.0000000000001497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Reporting Time Horizons in Randomized Controlled Trials in Plastic Surgery. Plast Reconstr Surg 2018; 142:947e-957e. [DOI: 10.1097/prs.0000000000005040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
13
|
|
14
|
Algan S, Kara M, Cakmak MA, Tan O, Cinal H, Barin EZ, Inaloz A. Experiences with a modified preauricular mini incision with subdermally dissection in condylar and subcondylar fractures of the mandible. J Craniomaxillofac Surg 2018. [PMID: 29526414 DOI: 10.1016/j.jcms.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Condylar and subcondylar fractures (CSFs) are among the most common mandible fractures. If reduction of these fractures is not carried out correctly, serious complications can result, including infection, damage to temporomandibular joint (TMJ) function, malocclusion, nonunion, malunion, and ankylosis of the TMJ. METHODS We used a preauricular, mini-incision, open technique (PMIOT) for CSF of the mandible. 66 patients (48 males, 18 females), with a total of 72 CSFs of the mandible, were repaired with PMIOT between 2011 and 2016. Average age was 37.8 years (range: 8-78). CSFs were located on the right side, left side, and bilaterally in 21, 27 and six patients, respectively. We used only one mini incision of length 2 cm for non-displaced subcondylar fractures. However, we had to perform a second mini incision for condylar fractures displaced by more than 45°, where subcondylar fractures overlapped, or where there was deep surgical exposure and difficulty with reduction. RESULTS No early complications, such as bleeding, hematoma, seroma, infection, or parotid fistula, were seen in any patients. Temporary facial nerve paresis was reported in three patients, but these recovered spontaneously with conservative treatment within 15 days. Permanent facial nerve paralysis occurred in none of the patients. CONCLUSION We believe that PMIOT is an effective, reliable, and feasible method for repair of CSF. It does not need any expensive and sophisticated tools, and has low complication rates. The mini incision used in our technique results in both a hidden scar and protection of essential structures in the region.
Collapse
Affiliation(s)
- Said Algan
- Medical Park Hospital, Plastic and Reconstructive and Aesthetic Surgery Clinic, Batman, Turkey.
| | - Murat Kara
- Regional Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Erzurum, Turkey
| | - Mehmet Akif Cakmak
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Onder Tan
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Hakan Cinal
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Ensar Zafer Barin
- Ataturk University, Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Erzurum, Turkey
| | - Akin Inaloz
- Regional Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Erzurum, Turkey
| |
Collapse
|
15
|
Gorka R, Gohil AJ, Gupta AK, Koshy S. Treatment Outcomes for Isolated Maxillary Complex Fractures with Maxillomandibular Screws. Craniomaxillofac Trauma Reconstr 2017; 10:278-280. [PMID: 29109838 DOI: 10.1055/s-0037-1601864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/26/2016] [Indexed: 10/19/2022] Open
Abstract
Intermaxillary fixation (IMF) is a basic and fundamental principle in the management of patients with fractures of the maxillomandibular complex. There are several shortcomings related to the conventionally recommended tooth-mounted devices that are used to achieve IMF. To circumvent these, the use of bone-borne screws has been advocated. We present a series of maxillary fractures treated with IMF screws. Over a 12-month period, 15 cases of maxillary fracture were managed with open reduction and bone plate fixation. IMF screws were used to achieve IMF intraoperatively and for a short duration postoperatively. Eight cortical titanium screws were inserted transmucosally, two for each quadrant at the junction of the attached and mobile mucosa. Satisfactory occlusion was achieved in all the patients with few complications. IMF screw fixation was observed to be a safe and quick method for open reduction of maxillary fractures. Tooth-borne devices are associated with problems such as poor oral hygiene and periodontal health, extrusion of teeth, loss of tooth vitality, traumatic ulcers of buccal and labial mucosa, and needle stick injury to the operator. These procedures are also time consuming. The use of cortical bone screws is a quicker and safe alternative for achieving satisfactory IMF.
Collapse
Affiliation(s)
- Rahul Gorka
- Department of Plastic, Burns, Reconstructive and Microvascular Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Amish Jayantilal Gohil
- Department of Plastic, Burns, Reconstructive and Microvascular Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Ashish Kumar Gupta
- Department of Plastic, Burns, Reconstructive and Microvascular Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Santosh Koshy
- Department of Dental Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| |
Collapse
|