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Sasaki R, Nagahama R, Okamoto T. Unilateral Surgical Treatment of Severe Deviated Condylar Base Fracture in Pediatric Bilateral Condylar Fracture: 12-Year Follow-Up. J Craniofac Surg 2024:00001665-990000000-01983. [PMID: 39345153 DOI: 10.1097/scs.0000000000010689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/25/2024] [Indexed: 10/01/2024] Open
Abstract
Pediatric condylar fractures are commonly managed conservatively, as the condyle typically exhibits spontaneous remodeling. However, should conservative treatment be administered for severe deviated condylar processes? In a case involving a 7-year-5-month-old girl who fell from a height of 3 m, she sustained a mandibular parasymphysis fracture and bilateral condylar fractures, including a condylar base fracture with 60-degree medial deviation on the right side and a condylar head fracture, Neff type A, on the left side. To address the fractures, internal fixation was performed on the right condyle via a classical retromandibular approach, and a mini-plate was removed four months postsurgery. At a follow-up 12 years and 7 months later, the patient showed normal occlusion, TMJ function, and no visible scars. In addition, there was no facial deviation, although the surgical site condyle was larger than the nonsurgical site, suggesting that the surgical site facilitated normal growth while the nonsurgical site impeded it.
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Affiliation(s)
- Ryo Sasaki
- Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, School of Medicine, Shinjuku-ku
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Nakano-ku
| | - Ryo Nagahama
- Department of Orthodontics, Showa University, School of Dentistry, Kitasenzoku Ota-ku, Tokyo, Japan
| | - Toshihiro Okamoto
- Department of Oral and Maxillofacial Surgery, Tokyo Women's Medical University, School of Medicine, Shinjuku-ku
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Bottini GB, Hitzl W, Götzinger M, Politis C, Dubron K, Kordić M, Sivrić A, Pechalova P, Sapundzhiev A, Pereira-Filho VA, de Oliveira Gorla LF, Dediol E, Kos B, Rahman T, Rahman SA, Samieirad S, Aladelusi T, Konstantinovic VS, Lazić M, Vesnaver A, Birk A, Sohal KS, Laverick S, Rae E, Rossi MB, Roccia F, Sobrero F. Management of Mandibular Condyle Fractures in Pediatric Patients: A Multicentric Retrospective Study with 180 Children and Adolescents. J Clin Med 2024; 13:5455. [PMID: 39336942 PMCID: PMC11431969 DOI: 10.3390/jcm13185455] [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: 07/29/2024] [Revised: 08/21/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment-stand-alone maxillomandibular fixation (MMF)-in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry.
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Affiliation(s)
- Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery and Center for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria
| | - Wolfgang Hitzl
- Research and Innovation Management, Biostatistics, Department of Ophthalmology and Optometry, Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Maximilian Götzinger
- Department of Oral and Maxillofacial Surgery and Center for Reconstructive Surgery, University Hospital of the Private Medical University Paracelsus, 5020 Salzburg, Austria
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7, 3000 Lueven, Belgium
| | - Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7, 3000 Lueven, Belgium
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, 88000 Mostar, Bosnia and Herzegovina
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, 88000 Mostar, Bosnia and Herzegovina
| | - Petia Pechalova
- Department of Oral Surgery, Faculty of Dental medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Angel Sapundzhiev
- Department of Oral Surgery, Faculty of Dental medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Valfrido Antonio Pereira-Filho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, Araraquara 14801903, SP, Brazil
| | - Luis Fernando de Oliveira Gorla
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University, UNESP, Araraquara 14801903, SP, Brazil
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Boris Kos
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Tabishur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh 202002, India
| | - Sajjad Abdur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh 202002, India
| | - Sahand Samieirad
- Oral & Maxillofacial Surgery Department, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Timothy Aladelusi
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria
| | - Vitomir S Konstantinovic
- Clinic of Maxillofacial Surgery, School of Dentistry, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Lazić
- Clinic of Maxillofacial Surgery, School of Dentistry, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, 1000 Ljubljana, Slovenia
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, 1000 Ljubljana, Slovenia
| | - Karpal Singh Sohal
- Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee DD1 4HR, UK
| | - Euan Rae
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee DD1 4HR, UK
| | - Maria Beatrice Rossi
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy
| | - Federica Sobrero
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, 10126 Turin, Italy
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Irgebay Z, Glenney AE, Cheng L, Li R, Mocharnuk JW, Smetona J, Balasubramani GK, Losee JE, Goldstein JA. Fracture Patterns, Associated Injuries, Management, and Treatment Outcomes of 530 Pediatric Mandibular Fractures. Plast Reconstr Surg 2024; 154:556e-568e. [PMID: 37585805 DOI: 10.1097/prs.0000000000010996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture cause, pattern, management, and treatment outcomes in pediatric mandibular fracture patients. METHODS A retrospective review was performed of patients younger than 18 years who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, cause, medical history, associated facial fractures, other associated injuries, treatments, and outcomes. RESULTS A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy and rest ( n = 253 [47.7%]). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared with patients with a single facial fracture ( P < 0.0001). Older age ( P < 0.001), sex ( P = 0.042), mechanism ( P = 0.008) and cause of injury ( P = 0.002), and specific fractures (eg, isolated angle [ P = 0.001]) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with closed reduction and external fixation or open reduction and internal fixation compared with conservative management (OR, 1.8, 95% CI, 1.0 to 3.2; and OR, 2.1, 95% CI, 1.2 to 3.5, respectively). CONCLUSIONS Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large-scale studies characterizing these injuries are critical for guiding physicians in the management of these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Zhazira Irgebay
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Anne E Glenney
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Lucille Cheng
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Runjia Li
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
| | - Joseph W Mocharnuk
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - John Smetona
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - G K Balasubramani
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
| | - Joseph E Losee
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Jesse A Goldstein
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
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Esposito NR, Cisternas IN, Gonzalez AC. Surgical treatment of paediatric fractures of the mandibular condyle: a systematic review of the literature. Br J Oral Maxillofac Surg 2024; 62:101-104. [PMID: 38155068 DOI: 10.1016/j.bjoms.2023.10.015] [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: 04/28/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 12/30/2023]
Abstract
This study aims to review surgical treatment in paediatric condylar fractures and describe different types of techniques performed, along with the results obtained from them. A retrospective review was conducted from records of paediatric patients (from one to 17 years old) who sustained fractures of the mandibular condyle and underwent surgical treatment from 2003 to 2023. The number of patients, age, location, and type of fracture, clinical and imaging examinations, treatment methods, intraoperative/postoperative complications, removal of osteosynthesis material, follow up and outcomes were recorded and analysed. A total of 68 patients with 79 fractures were identified. The most common fracture pattern was condylar neck fracture (61.1%). Of the 68 patients who underwent surgical treatment, one had a complication of minimal temporal paraesthesia and another patient had near-complete resorption of the condyle. A total of 55 patients (81%) reported normal dental occlusion, mouth opening (>35 mm), lateral excursions (7-8 mm), TMJ function, no pain, no deviation of the midline or the jaw, and no ankylosis. Thirteen patients (19%) developed an unsatisfactory result, nine patients (13%) had a jaw deviation on mouth opening, four patients (6%) had mandibular retrusion, and seven patients (10%) had signs of TMJ dysfunction. A total of 59 patients (87%) reported bone completely healed with no signs of bone abnormality; seven patients (10%) had shortening of the condylar neck and/or ramus. Surgical treatment can lead to good or excellent results for severely dislocated and displaced condylar fractures in children and can reduce the unsatisfactory results resulting from closed treatment.
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Affiliation(s)
- Nicolás Ríos Esposito
- Dentistry School, Faculty of Medicine. Pontificia Universidad Católica de Chile, Chile.
| | | | - Andrés Campolo Gonzalez
- Dentistry School, Faculty of Medicine. Pontificia Universidad Católica de Chile, Chile; Department of Oncology and Maxillofacial Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Chile.
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Trauma Surgery. J Oral Maxillofac Surg 2023; 81:E147-E194. [PMID: 37833022 DOI: 10.1016/j.joms.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Capote R, Preston K, Kapadia H. Craniofacial Growth and Development: A Primer for the Facial Trauma Surgeon. Oral Maxillofac Surg Clin North Am 2023; 35:501-513. [PMID: 37302949 DOI: 10.1016/j.coms.2023.04.007] [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] [Indexed: 06/13/2023]
Abstract
Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.
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Affiliation(s)
- Raquel Capote
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
| | - Kathryn Preston
- Center for Cleft and Craniofacial Care, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Orthodontics, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA; Department of Orthodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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Nourwali I, Aljohani M. Conservative management and follow-up of bilateral condylar fractures in pediatric patients: A case report. Clin Case Rep 2023; 11:e7842. [PMID: 37636881 PMCID: PMC10457479 DOI: 10.1002/ccr3.7842] [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: 07/11/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Key Clinical Message Conservative treatment of bilateral condylar fractures, including intermaxillary fixation using arch bars and elastic bands, yields satisfactory results in pediatric patients. Therefore, the conservative approach should be considered the first line of treatment for bilateral condylar mandibular fractures in pediatric patients. Abstract Road traffic accidents (RTAs) are considered the leading cause of mortality and morbidity of children and adults in Saudi Arabia. Head injuries and fractures are the most common form of injuries resulting from RTAs, with mandibular fractures being the most common head injury; condylar fractures are the most frequent type of mandibular fracture. A review of the literature reveals diverse opinions about the best approach for treating bilateral condylar fractures in pediatric patients. The findings of the literature review are reported in this study. The case presented here shows the result of adopting a conservative approach to treating a bilateral extracapsular displaced condylar fracture. An elastic band was fixed onto intermaxillary fixation (IMF) screws at the midline upper and lower jaws; the patient was followed up for almost 3 years. The conservative approach yielded excellent results, as both condyles were fully repositioned and healed, without causing any deviation or limitation of the mouth opening. The results of this case support considering the conservative approach as the first line of treatment for bilateral condylar mandibular fractures in pediatric patients.
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Affiliation(s)
- Ibrahim Nourwali
- Department of Oral and Maxillofacial Surgery, College of DentistryTaibah UniversityMadinahSaudi Arabia
| | - Marwan Aljohani
- Department of Oral and Maxillofacial Surgery, College of DentistryTaibah UniversityMadinahSaudi Arabia
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8
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Li A, Shao B, Chong DYR, Liu Z. The influence of maxillary incisor angles on the stress distributions of temporomandibular joints under incisal biting. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3702. [PMID: 36987734 DOI: 10.1002/cnm.3702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/13/2022] [Accepted: 03/11/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The incisal biting was one of the most regular jaw activities. The direction of bite force on the incisor tip and the mandible position were relevant to the incisor angle as biting. This study was carried out to explore the influence on the temporomandibular joint (TMJ) caused by the incisor angle. METHODS Twenty individuals belonging to three incisor subtypes of the buccal type were recruited. In addition, the 3D models including the maxillary, mandible and discs were established based on their cone-beam computed tomography and magnetic resonance imaging scannings. Then, the mandibular ligaments and the discal attachments were simulated in the finite element models to analyze the stress distributions of the TMJs under incisal biting. RESULTS The TMJ stresses of subtype I showed normal range and distribution. The stresses of the intermediate temporal bone tended to increase in subtype II. The intermediate and posterior bands of the discs sustained greater tensile stresses in subtype III. CONCLUSIONS Abnormal stress distributions are harmful to TMJs, so the incisor cusp was not suggested to incline to the palatal side too much.
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Affiliation(s)
- Annan Li
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, 610065, China
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, 644600, China
| | - Bingmei Shao
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, 644600, China
- Basic Mechanics Lab, Sichuan University, Chengdu, 610211, China
| | - Desmond Y R Chong
- Engineering Cluster, Singapore Institute of Technology, Singapore, 138683, Singapore
| | - Zhan Liu
- Key Lab for Biomechanical Engineering of Sichuan Province, Sichuan University, Chengdu, 610065, China
- Yibin Institute of Industrial Technology/Sichuan University Yibin Park, Yibin, 644600, China
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Jenkyn I, Bosley R, Jenkyn C, Basyuni S, Fowell C. Management of Mandibular Condyle Fractures in Paediatric Patients: a Systematic Review. J Oral Maxillofac Res 2023; 14:e2. [PMID: 37521323 PMCID: PMC10382193 DOI: 10.5037/jomr.2023.14202] [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: 03/28/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Objectives This systematic review searched three of the most used databases to assess if current evidence suggested a difference between surgical and non-surgical management of mandibular condyle fractures in paediatric patients. Material and Methods An electronic literature search was conducted of three well known databases - Ovid, PubMed and Web of Science. Studies included were conducted paediatric patients, in humans, written in English and published from January 1st 1996 until April 1st 2022. Data collection was carried out by two independent reviewers. Data collated from studies without high risk of bias was pooled for surgical vs non-surgical management and total tallies of all outcomes presented. Presence or absence of complications was recorded in 4 x 4 tables for each outcome and compared using a Chi-Square test. Results After duplicate records were removed, 182 records were screened. After exclusion of unsuitable reports, 20 were included in the review. Further analysis showed the included studies had high risk of bias. Given this, comparison of this pooled data showed no significant difference between management methods. Conclusions Presently it appears conservative management is functionally adequate without risks associated with surgical management, even though incidence of these risks was shown to be low in the studies included in this review.
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Affiliation(s)
- Ian Jenkyn
- Oral and Maxillofacial Surgery Department, Addenbrookes Hospital, Cambridge, Hills Rd, Cambridge CB2 0QQUnited Kingdom.
| | - Robert Bosley
- The University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SPUnited Kingdom.
| | - Claire Jenkyn
- Barts and The London School of Medicine and Dentistry, Garrod Building, Turner St, London E1 2ADUnited Kingdom.
| | - Shadi Basyuni
- Oral and Maxillofacial Surgery Department, Addenbrookes Hospital, Cambridge, Hills Rd, Cambridge CB2 0QQUnited Kingdom.
| | - Christopher Fowell
- Oral and Maxillofacial Surgery Department, Addenbrookes Hospital, Cambridge, Hills Rd, Cambridge CB2 0QQUnited Kingdom.
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Li F, Yang Q, Yi J, Chen A. The recovery of upper limb function and postoperative pain in children with lateral humeral condyle fractures were examined retrospectively in relation to the effects of brachial plexus block given in conjunction with general anesthesia. J Orthop Surg Res 2023; 18:181. [PMID: 36895031 PMCID: PMC9996921 DOI: 10.1186/s13018-023-03540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To assess in retrospect the effects of brachial plexus block and general anesthesia on children with lateral humeral condyle fractures in terms of postoperative pain and return of upper limb function. METHODS Randomly allocated to either the control group (n = 51) or the study group (n = 55) were children with lateral humeral condyle fractures who were admitted to our hospital between October 2020 and October 2021, depending on the surgical anesthetic technique used. The research group had internal fixation surgery with brachial plexus block in addition to anesthesia on the basis of the control group, whereas both groups of children underwent the procedure with general anesthesia alone. Postoperative pain degree, upper extremity functional recovery, occurrence of adverse reactions, etc. RESULTS: The study group had shorter mean times for surgery, anesthesia, propofol dose, return to consciousness, and extubation than the control group did at every measure of statistical significance. The T2 heart rate (HR) and mean arterial pressure (MAP) were both significantly lower than the pre-anesthesia HR and MAP, and the T1, T2, and T3 HR and MAP were all significantly lower in the study group compared to the control group (P < 0.05). The difference between the SpO2 values at T0 and T3 was not statistically significant (P > 0.05); the VAS scores at 4 h, 12 h, and 48 h after surgery were higher than those at 2 h after surgery, and reached the peak at 4 h after surgery; within 2 h, 4 h, and 12 h of surgery At 48 h, the study group had substantially lower VAS ratings than the control group (P < 0.05). Post-treatment Fugl-Meyer scale scores were considerably higher across the board compared to pre-treatment levels in both groups. When compared to the control group, individuals who participated in the flexion-stretching coordinated exercise and the separation exercise had significantly better ratings. Electrocardiogram, blood pressure, respiratory circulation, and hemodynamic parameters all remained within normal limits during the surgical procedure. The study group had a 9.09% reduced incidence of adverse events compared to the control group. 19.61% (P < 0.05). CONCLUSION When used in conjunction with general anesthesia, brachial plexus block can help children with lateral humeral condyle fractures regulate perioperative signs, maintain their hemodynamic level, lessen postoperative pain and unpleasant reactions, and improve the function of their upper limbs. Functional recovery, with high safety and effectiveness.
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Affiliation(s)
- Fan Li
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
| | - Qiao Yang
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
| | - Jinrong Yi
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
| | - Aiqiong Chen
- Department of Anesthesiology, Ganzhou Maternal and Child Health Hospital, No. 106, Da Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China.
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11
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Khattak YR, Sardar T, Iqbal A, Khan MH, Khan A, Ullah U, Ahmad I. Treatment of pediatric bilateral condylar fractures: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101339. [PMID: 36403929 DOI: 10.1016/j.jormas.2022.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.
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Affiliation(s)
| | - Tariq Sardar
- Oral and Maxillofacial Surgery, KMU-Institute of Dental Sciences, Kohat, Pakistan.
| | | | | | - Ajmal Khan
- Oral and Maxillofacial Surgery, Saidu Medical College, Swat, Pakistan
| | - Umer Ullah
- Oral and Maxillofacial Surgery, Rehman College of Dentistry, Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
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Sabbagh H, Nikolova T, Kakoschke SC, Wichelhaus A, Kakoschke TK. Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101596. [PMID: 36295031 PMCID: PMC9605380 DOI: 10.3390/life12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. METHODS Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. RESULTS Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. CONCLUSIONS A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.
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Affiliation(s)
- Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-53223
| | - Trayana Nikolova
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Sara Carina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Andrea Wichelhaus
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Tamara Katharina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
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Akkoc MF, Bulbuloglu S. The Treatment Perspective of Pediatric Condyle Fractures and Long-Term Outcomes. Cureus 2022; 14:e30111. [PMID: 36381803 PMCID: PMC9643693 DOI: 10.7759/cureus.30111] [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] [Accepted: 10/08/2022] [Indexed: 06/16/2023] Open
Abstract
PURPOSE In our study, the characteristics, treatment approach and long-term outcomes of condyle fractures treated in the pediatric plastic surgery and reconstruction unit in the last 10 years were evaluated. MATERIALS AND METHODS This study consisted of two retrospective and prospective sections with the participation of pediatric patients with condylar fractures who were treated in the Plastic, Reconstructive and Aesthetic Surgery clinic of a university hospital in the last 10 years. In the retrospective section, data were obtained from the electronic patient records and patient files regarding the treatment applied, as well as the characteristics of the patient and condyle fractures. In the perspective section, patients were invited to the clinic and the effectiveness of the treatment was evaluated. Statistical analyses were performed with SPSS (Statistical Package for Social Sciences) for IBM 25 package program. RESULTS It was determined that 55.8% of the pediatric patients had accompanying facial fractures, and 72.4% had unilateral condyle fractures. It was determined that 59.5% of the pediatric patients underwent intermaxillary fixation (IMF). Physical complications were seen in 6.75% in the long term after treatment. CONCLUSION Falling from height and traffic accidents, which are the most important factors in the occurrence of condyle fractures, should be eliminated by increasing parental attention and awareness. Surgical treatment should be considered in the treatment of pediatric condyle fractures, especially if there are accompanying facial and mandible bone fractures.
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Affiliation(s)
- Mehmet Fatih Akkoc
- Plastic Reconstructive and Aesthetic Surgery, Dicle University Campus, Diyarbakir, TUR
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Faustino Ângelo D, Nogueira J, Pinheiro C, Alves G, Cardoso HJ. Temporomandibular joint arterial variability. J Craniomaxillofac Surg 2021; 50:150-155. [PMID: 34949504 DOI: 10.1016/j.jcms.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
The study aimed to investigate temporomandibular joint (TMJ) arterial variability. In this prospective study, the vasculature variability was studied using a 3D volume rendering CT angiography including random patients at two hospitals. A 16-quadrant (A1-D4) evaluation grid was developed using the Frankfurt plan as main reference. For each quadrant, the number of arterial ramus or branches was scored as clearly visible (2), partially visible (1), or not visible (0). A total of 50 patients were enrolled (mean age of 62.9 ± 16.0); 21 (42%) were men, and 29 (58%) were women. The authors observed bilaterally higher arterial density in the posterior aspect of the ascending ramus of the mandible (p < 0.0001), corresponding to quadrants B2 (5.92 ± 2.27 and 6.14 ± 2.56), B3 (9.76 ± 2.97 and 11.18 ± 2.86) and B4 (7.38 ± 2.78 and 8.10 ± 2.42). A strong correlation was found between the number of vessels and the variability of the region (r = 0.87, p = 0.00001). No differences were observed between men and women. Within the limitations of the study, arterial variability was observed in the TMJ territory. The posterior zone of the condyle and ramus is the most vascularized area, with great variability, representing an increased risk for surgical bleeding. Therefore, this knowledge seems to be particularly relevant for surgeons dedicated to TMJ and other facial surgery or facial/cerebral radiologic interventions. The authors encourage future studies to include larger samples and to identify thoroughly the arterial branches in this area.
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Affiliation(s)
- David Faustino Ângelo
- Instituto Português da Face, Lisboa, Portugal; Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Portugal; Faculdade de Medicina da Universidade de Lisboa, Portugal.
| | - Jonatas Nogueira
- Universidade da Beira Interior, Faculdade de Ciências da Saúde, Portugal
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15
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Du C, Xu B, Zhu Y, Zhu M. Radiographic evaluation in three dimensions of condylar fractures with closed treatment in children and adolescents. J Craniomaxillofac Surg 2021; 49:830-836. [PMID: 34218975 DOI: 10.1016/j.jcms.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/19/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes. The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1-2 years of follow-up. In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% - including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1-2 years. Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.
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Affiliation(s)
- Changxin Du
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Bing Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Yanfei Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
| | - Min Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
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Association between shape of the mandibular condylar head and the occurrence of unilateral condylar fracture - A retrospective computed tomographic study. J Craniomaxillofac Surg 2021; 49:488-493. [PMID: 33933323 DOI: 10.1016/j.jcms.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/13/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022] Open
Abstract
This retrospective study aims to evaluate the correlation between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture using computed tomography. Medical records of patients diagnosed with unilateral condylar fractures from the year 2012-2019 were reviewed. The shape of the condylar head on the non - fractured side was analysed using a Radiant Dicom Viewer. The analysis was done using both visual and analytical methods. In the analytical method, a horizontal line was drawn at the base of the curvature of the condylar head. The highest peak point of the head was marked, and a perpendicular line was drawn connecting the highest point to the horizontal line. The shape was categorized into four types as convex, flat, angled, and round based on these lines. 201 CT scans were examined, of which 69 were excluded as they did not meet the inclusion criteria. The remaining 132 were included in our study. On examining the shape, flat-shaped condyle was seen in 57 scans (43.2%), followed by convex in 31 scans (23.4%), angled in 30 (22.7%) and round in 14 scans (10.6%). The relationship between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture was analysed using a chi-square test, which showed high statistical significance (p value 0.0001). The flat-shaped condylar head was more prone to fracture, and the round-shaped condylar head was least prone to fracture. In conclusion, the shape of the mandibular condylar head had a statistically significant association with the incidence of unilateral condylar fracture. The assessment of the shape of the condylar head can be taken as a guide to suspect condylar fractures and other associated mandibular fractures.
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Mandible Fractures Associated With the Introduction of an E-Scooter-Sharing System. J Craniofac Surg 2021; 32:1405-1408. [PMID: 33538446 DOI: 10.1097/scs.0000000000007518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT With the introduction of an e-scooter-sharing system in Germany, standing electric scooters became popular modes of transportation in many urban areas. But the increase in popularity has resulted in an increase in traumatic injuries associated with e-scooter accidents. The purpose of this investigation was to determine the common fracture pattern of patients with mandible fractures as a result of an electric scooter accident. The authors performed a retrospective investigation of 52 patients who were admitted to the trauma unit of an oral and maxillofacial department from June until November 2019 with a fracture of the mandible. Our study investigated the first 6 months of e-scooter sharing system in a major city with more than 1 million inhabitants. Our cohort consists of 52 patients, 38 males, and 14 females with a mean age of 37 years. E-scooter related mandible fractures were with 21% the third biggest group, after physical assault and falls. 45% of these patients were intoxicated by alcohol. Furthermore, the majority of e-scooter patients presented more than one fracture of the mandible (73%). For our cohort, a typical combination of a symphysis or body fracture and bilateral affected ramus and/or condyle was the prevalent recorded fracture combination (55%) of e-scooter related traumata. Small scooter wheels, a speed of 15 miles or 20 kilometers per hour and the individual clinging to the handlebar falling predestinate these vehicles for accidents with craniofacial trauma. Among all cranio-facial traumas mandible fractures were mostly documented for e-scooter accidents. The severity of e-scooter related mandible fractures and their fracture pattern should be recognized by trauma units.
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Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg 2021; 49:196-205. [PMID: 33483246 DOI: 10.1016/j.jcms.2020.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.
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Affiliation(s)
- Adity Bansal
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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