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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.
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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
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Vitkos EN, Papadopoulos KA, Dimasis P, Weissinger C, Kyrgidis A. One miniplate versus two miniplates in the fixation of mandibular angle fractures. An updated systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e865-e873. [PMID: 35872351 DOI: 10.1016/j.jormas.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study is to compare the outcomes after using one miniplate fixation in the external oblique ridge versus two miniplate fixation for mandibular angle fractures. METHODS A systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library database was performed (last search date: 04 February 2022) according to the PRISMA guidelines. The research question was addressed using the PICO criteria. Only comparative studies between the two techniques were included. Random-effects model meta-analyses were performed. RESULTS Seventeen studies, comprising a total of 1667 patients, 846 undergoing one miniplate fixation and 854 undergoing two miniplate fixation for mandibular angle fractures were identified. No statistically significant differences were observed regarding surgical site infection (odds ratio [OR]= 0.94, 95% confidence interval [CI]: [0.69] - [1.28], p = 0.68, I2=0.00%), post-operative malocclusion (OR= 0.97, 95% CI: [0.53] - [1.18], p = 0.25, I2=0.00%), post-operative neurosensory dysfunction (OR= 0.67, 95% CI: [0.37] - [1.22], p = 0.19, I2=73.93%), pseudoarthrosis formation (OR=0.90, 95% CI: [0.58] - [(1.39], p = 0.63, I2=0.00%). Wound dehiscence was marginally less common in the one miniplate group (OR=0.52, 95% CI: [0.28] - [0.98], p = 0.04, I2=54.34%). The probability of scarring formation (OR=0.13, 95% CI: [0.05] - [0.32], p = 0.00, I2=0.00%) and hardware failure (OR=0.36, 95% CI [0.21] - [0.62], p = 0.00, I2=29.33%) were statistically significantly higher in the two miniplates arm. CONCLUSION One miniplate fixation and two miniplates fixation of mandibular angle fractures have similar results regarding post operative infection, malocclusion, neurosensory dysfunction and pseudoarthrosis formation while wound dehiscence, hardware failure and scarring seem to be more common when two miniplates are used as a fixation technique.
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Affiliation(s)
- Evangelos N Vitkos
- Department of General Surgery, General Hospital of Katerini, Katerini, Greece.
| | | | - Periklis Dimasis
- Department of General Surgery, General Hospital of Katerini, Katerini, Greece
| | - Christian Weissinger
- Division of Oral and Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Athanassios Kyrgidis
- Department of Oral and Maxillofacial Surgery, faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Stanford-Moore G, Murr AH. Mandibular Angle Fractures. Facial Plast Surg Clin North Am 2021; 30:109-116. [PMID: 34809880 DOI: 10.1016/j.fsc.2021.08.009] [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: 11/29/2022]
Abstract
Angle fractures are the most common among the mandibular fractures. History and physical examination are crucial in guiding time course and specifics of management. Computed tomography (CT) has become the gold standard for diagnosis of mandible fractures, offering advantages for both surgical planning and assessing dental involvement. Currently the use of a single monocortical plate with the Champy technique for osteosynthesis is used preferentially for noncomminuted fractures of the mandibular angle. Other load-sharing options for plating include strut plates, malleable plates, and geometric or 3D plates. Load-bearing options remain viable for comminuted fractures or other complex circumstances.
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Affiliation(s)
- Gaelen Stanford-Moore
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, School of Medicine, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA
| | - Andrew H Murr
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, School of Medicine, 2233 Post Street, 3rd Floor, San Francisco, CA 94115, USA; Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
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Press SG, Miller AJ, Luschen MC. Is There a Safe Zone for Lateral Border Fixation of Mandibular Angle Fractures? Craniomaxillofac Trauma Reconstr 2021; 14:284-288. [PMID: 34707788 DOI: 10.1177/1943387520983118] [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: 11/17/2022] Open
Abstract
Study Design Cross-sectional study design. Objective There are multiple accepted treatment options for internal fixation of mandibular angle fractures. The purpose of this study was to determine if there is a safe zone for lateral border fixation of mandibular angle fractures. Methods One hundred coronal images of facial computed tomography (CT) scans were reviewed on patients between the ages of 18 to 48. Measurements were taken in the area of the second and third molar region related to the inferior border to the superior extent of the inferior alveolar canal and apex of the second molar root, along with buccal cortical measurements to the inferior alveolar canal and apical third of the second molar root. Results The average measurement of the inferior border in the second molar area to the inferior alveolar canal and apex of the root was 1.12 cm (0.70-1.77) and 1.39 cm (0.91-2.30), respectively. The average measurement of the inferior border of the third molar to the inferior alveolar canal was 1.26 cm (0.78-1.83). The average measurement of the buccal cortex of the second molar to the inferior alveolar canal and apical one-third of the root was 0.64 cm (0.34-1.25) and 0.59 cm (0.33-0.98), respectively. The average measurement of the third molar buccal cortex to the inferior alveolar canal was 0.45 cm (0.18-0.98). Conclusion In the area of the second molar region, there is no ubiquitous safe zone for screw placement, cortical bone thickness is more critical than vertical placement of the fixation plate and screws. In the third molar region, cortical bone thickness and vertical orientation may provide a safe zone for screw placement.
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Affiliation(s)
- Steven G Press
- Envison Physician Services, Department of Facial Trauma, TriStar Skyline Medical Center, Nashville, TN, USA
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Falci SGM, de Souza GM, Fernandes IA, Galvão EL, Al-Moraissi EA. Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2021; 50:1450-1463. [PMID: 33676800 DOI: 10.1016/j.ijom.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
The aim of this review was to compare mandibular angle fracture fixation methods that were evaluated through randomized clinical trials considering postoperative complications. Additionally, different treatment methods were ranked based on their performance. A systematic review was performed based on the Cochrane and PRISMA guidelines. The quality of evidence and network meta-analysis were conducted using the GRADE tool and R software, respectively. Four databases were searched, and the papers were selected based on the PICOS strategy. A total of 3584 papers were found. After screening 15 papers were included. One plate placed on lateral border (tension zone) presented lower risk than one plate placed on superior border (tension zone) for infection [risk ratio (RR): 0.48, 95% confidence interval (CI): 0.33 to 0.71] and plate removal necessity (RR: 0.44, 95% CI: 0.28 to 0.69), with moderate quality of evidence. There were no significant differences among the mandibular angle fracture treatments for malocclusion and paraesthesia outcomes. In conclusion, one plate placed on the lateral border in the tension zone is the best choice regarding postoperative infection and plate removal necessity when fixing mandibular angle fractures. None of the tested fixation methods were associated with a significant risk of malocclusion and paraesthesia events.
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Affiliation(s)
- S G M Falci
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - G M de Souza
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - I A Fernandes
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
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Khiabani K, Keyhan SO, Ahmadi P, Gholamian A, Cheshmi B. Effect of using different methods of plate fixation in maxillary Lefort one fractures. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2019. [DOI: 10.1016/j.ajoms.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wusiman P, Abasi K, Maimaitishawuti D, Moming A. Management of Mandibular Angle Fractures Using One Miniplate or Two Miniplate Fixation System: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2019; 77:1673.e1-1673.e11. [DOI: 10.1016/j.joms.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
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Finite Element Simulation of Displacement of the Broken Zygoma and Forces Exerted to the Complex After Fixation with Resorbable and Non-Resorbable One-Point Mini-Plates and Applying Normal or Severe Occlusal Loads. Trauma Mon 2019. [DOI: 10.5812/traumamon.85586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ben Said M, Yildirimturk S, Sirin Y. The effect of the mandibular plane angle on fracture line stability: An ex vivo experimental study. Dent Traumatol 2019; 35:181-187. [PMID: 30714306 DOI: 10.1111/edt.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS Mandibular angle fractures fixated with plate osteosynthesis techniques have to withstand the effects of muscle attachments. Individual variations in the craniofacial morphology may alter the biomechanical resistance of the bone-plate construct. The aim of the present study was to determine the influence of variations in the mandibular plane angle (MPa) on the biomechanical stability of sheep mandibular angle fractures (MAFs). MATERIALS AND METHODS Sixty sheep hemi-mandibles were used. The mandibles were positioned on a test jig that simulated low (15°, group L), normal (25°, group N), and high (35°, group H) MPa. Unfavorable MAFs were created with thin diamond cutting disks. One four-hole, 9.0-mm-spacing, standard titanium miniplate of 2.0 mm thickness and 5.0-mm-long screws were inserted at the superior border of the alveolar bone in monoplanar orientation. Specimens were then subjected to vertical loads between 10 N and 150 N in a universal testing machine. The displacement values at each 10 N force increment and the load magnitude at which 3.0 mm displacement limit was reached were recorded. RESULTS Starting from 40 N, the displacement values at each 10 N increment in the H group were significantly higher than those of the L and N groups until 150 N (P < 0.05). The force magnitude required to reach 3.0 mm of displacement in the H group was significantly lower than that for the L and N groups (P < 0.05 for each). CONCLUSIONS The one-miniplate monoplanar fixation technique used in sheep MAF with high MPa is more likely to offer lower biomechanical resistance to the vertical forces applied over the molar region than do the normal and low MPa.
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Affiliation(s)
- Muhammed Ben Said
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Senem Yildirimturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
| | - Yigit Sirin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Ferrari R, Lanzer M, Wiedemeier D, Rücker M, Bredell M. Complication rate in mandibular angle fractures-one vs. two plates: a 12-year retrospective analysis. Oral Maxillofac Surg 2018; 22:435-441. [PMID: 30327980 DOI: 10.1007/s10006-018-0728-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Treatment of mandibular angle fractures using one or two osteosynthesis plates is still a controversial topic. Fracture, treatment, and patient-dependent influencing factors could affect the overall outcome. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed according to type of treatment. MATERIALS AND METHODS We analyzed retrospective medical records using the search terms "mandibular angle fracture." We included all patients presenting with a mandibular angle fracture treated by open reduction and internal fixation at our department between 2002 and 2012. RESULTS We included 186 patients treated with open reduction and miniplate fixation (84 one plate; 102 two plates). The early complication rate was significantly higher for the double-plate group (72.5% vs. 47.6%, respectively; p = 0.001). Most common findings in the postoperative period were transient hypoesthesia and tissue swelling. In the two-plate group, a significantly increased operation time of 183 min versus 150 min in the one-plate group was found (p < 0.001). Late complications did not differ significantly between both groups (21.4% single-plate group; 30.4% two-plate fixation group; p = 0.32). CONCLUSION We found a significantly increased early complication rate in the two-plate group. Long-term complications did not differ between both groups.
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Affiliation(s)
- Raphael Ferrari
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - M Lanzer
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - D Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bredell
- Cantonal Hospital Winterthur, Winterthur, Switzerland
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Sittitavornwong S, Denson D, Ashley D, Walma DC, Potter S, Freind J. Integrity of a Single Superior Border Plate Repair in Mandibular Angle Fracture: A Novel Cadaveric Human Mandible Model. J Oral Maxillofac Surg 2018; 76:2611.e1-2611.e8. [PMID: 30172764 DOI: 10.1016/j.joms.2018.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to compare the integrity of human mandibular angle fracture after fixation with a single titanium plate along the upper lateral border with that of the native human mandible. MATERIALS AND METHODS This cross-sectional anatomic study involved the left hemimandibles of 16 human cadavers. They were selected and divided in 2 groups by remaining dental status. Additional predictor variables, such as height of the left mandibular body and gender, were noted. Left hemisected native mandibles were mounted at the condyle and loaded on an Instron 5565 mechanical unit (Instron Corp, Norwood, MA) until fracture. Fractured left hemimandibles were fixated with a titanium miniplate and screws. After plate fixation, each hemimandible was reloaded on an Instron 5565 until fracture. Data pertaining to primary outcomes of load application were recorded in newtons at displacement values of 3.0, 5.0, and 7.0 mm and at displacement at fixation failure. Primary outcomes of maximum load and displacement at maximum load were recorded in newtons and millimeters, respectively. Descriptive statistics were used to summarize sample characteristics. Statistical comparisons were performed using t test, χ2 (or Fisher exact) test, and linear regression. Pearson correlation was used to examine relations between select biomechanical measurements. RESULTS The study sample was composed of 12 female and 4 male cadaveric hemimandibles. Donors' age at time of death ranged from 54 to 95 years (mean age, 78.94 yr). The mean maximum load in native and plated hemimandibles was 943.56 and 292.57 N, respectively (P < .0001). CONCLUSION Key clinical findings of this study include the inability of single plate mandible fixation to restore the mandible to preinjury levels and verification that gender, dental status, and height of the mandible do not alter the stability of a single plate fixated mandible.
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Affiliation(s)
- Somsak Sittitavornwong
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Douglas Denson
- Senior Resident, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - David Ashley
- Senior Resident, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - David Cruz Walma
- Third-Year Dental Student, University of Alabama at Birmingham, Birmingham, AL
| | - Sarah Potter
- Fourth-Year Dental Student, University of Alabama at Birmingham, Birmingham, AL
| | - Jonathan Freind
- Program Coordinator, Gross Anatomy Laboratory and Surgical Laboratory, University of Alabama at Birmingham, Birmingham, AL
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Khiabani K, Keyhan SO, Razmdideh R, Chaleh Chaleh Z, Amirzade-Iranaq MH. Effect of different miniplate osteosynthesis in different mandibular angle fracture patterns on bite force: A 3D finite element analysis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2018. [DOI: 10.1016/j.ajoms.2018.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rai A, Jain A, Datarkar A. Comparison of single versus two non-compression miniplates in the management of unfavourable angle fracture of the mandible: a prospective randomized clinical study. Oral Maxillofac Surg 2018; 22:157-161. [PMID: 29460154 DOI: 10.1007/s10006-018-0684-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of single versus two non-compression miniplates in the management of unfavourable angle fracture of mandible. MATERIALS AND METHODS A total of 28 patients who required open reduction of mandibular angle fracture were included in the study. The patients were randomly divided into two groups. Group I comprised of patients treated with two miniplates and those in group II were treated with single non-compression miniplate. The parameters of assessment were malocclusion, surgical site infection, need for implant removal, duration of surgery, inter-incisal mouth opening and cost of implants used, in both the groups. Statistical analysis was carried out to compare all the parameters. RESULTS Out of 14 patients in group II, inadequate reduction was noticed in three patients, whereas screw loosening had occurred in two cases. Screw loosening was always associated with chronic infection. In these cases, hardware removal was deemed necessary. Plate bending was observed in two cases resulting in malocclusion and difficulty in eating. Non-union of fracture occurred in one patient treated in group II. In group I, no plate bending, screw loosening, surgical site infection, non-union or malocclusion was observed. No patient had to undergo implant removal in group I. CONCLUSION In the management of unfavourable mandibular angle fracture, two miniplates must be preferred over the use of single miniplate as using two miniplates results in better results with minimal complications.
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Affiliation(s)
- Anshul Rai
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anuj Jain
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
| | - Abhay Datarkar
- Department of Oral and Maxillofacial Surgery, Government Dental College, Nagpur, Maharashtra, India
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Mondal S, Singh G, Mishra M, Gaur A, Srivastava A. Comparative Evaluation between Single Noncompression Miniplate and Two Noncompression Miniplates in the Treatment of Mandibular Angle Fractures. Craniomaxillofac Trauma Reconstr 2018; 12:122-127. [PMID: 31073361 DOI: 10.1055/s-0038-1629907] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 10/17/2022] Open
Abstract
This study was conducted to compare the outcome of single noncompression miniplate versus two noncompression miniplates in the treatment of mandibular angle fracture. A total of 40 patients were divided into two groups: Group I ( n = 20), patients were treated by single miniplate at superior border of mandible by intraoral approach; Group II ( n = 20), patients were treated by one miniplate at superior border of mandible, intraorally, and another at the lateral aspect of angle, transbuccally by trocar and cannula. Comparative evaluation was done at 1, 2, 4, 6, and 12 weeks and 6 months. The findings of this study suggest that there was no significant difference in postoperative complications (malocclusion, pain, swelling, infection, facial nerve injury, wound dehiscence, plate exposure) and bite force between the two groups.
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Affiliation(s)
- Shubhamoy Mondal
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Gaurav Singh
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Madan Mishra
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Gaur
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhinav Srivastava
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
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Zimmermann C, Henningsen A, Henkel KO, Klatt J, Jürgens C, Seide K, Kienast B. Biomechanical comparison of a multidirectional locking plate and conventional plates for the osteosynthesis of mandibular angle fractures—A preliminary study. J Craniomaxillofac Surg 2017; 45:1913-1920. [DOI: 10.1016/j.jcms.2017.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 05/02/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022] Open
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Dougherty WM, Christophel JJ, Park SS. Evidence-Based Medicine in Facial Trauma. Facial Plast Surg Clin North Am 2017; 25:629-643. [PMID: 28941514 DOI: 10.1016/j.fsc.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors.
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Affiliation(s)
- William M Dougherty
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - John Jared Christophel
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA
| | - Stephen S Park
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
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Rastogi S, Paul S, Kukreja S, Aggarwal K, Choudhury R, Bhugra A, Indra B NP, Jawaid M. Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required? Craniomaxillofac Trauma Reconstr 2017; 10:188-196. [PMID: 28751942 DOI: 10.1055/s-0037-1600904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/27/2016] [Indexed: 10/19/2022] Open
Abstract
The aim of this simple nonrandomized and observational study was to evaluate the efficacy of single three-dimensional (3D) plate for the treatment of mandibular angle fractures without maxillomandibular fixation. A total of 30 patients with noncomminuted fractures of mandibular angle requiring open reduction and internal fixation were included in the study. All the patients were treated by open reduction and internal fixation using single 3D titanium locking miniplate placed with the help of transbuccal trocar or Synthes 90-degree hand piece and screw driver. 3D locking titanium miniplates used in our study was four-holed, box-shaped plate, and screws with 2 mm diameter and 8 mm length. The following clinical parameters were assessed for each patient at each follow-up visit: pain (visual analog scale: 0-5), swelling (visual analog scale: 0-5), mouth opening, infection, paresthesia, hardware failure (plate fracture), occlusal discrepancies, and mobility between fracture fragments. A significant decrease in pain level was seen during the follow-up visits. No statistically significant changes were seen in swelling, but mouth opening increased in the subsequent visits. Also better results were seen in terms of fracture stability and occlusion in the postoperative period. Two cases of infection and two cases of hardware failure were noted in sixth postoperative week. 3D plating system is an easy to use alternative to conventional miniplates to treat mandibular angle fractures that uses lesser foreign material, thus reducing the operative time and overall cost of the treatment. Better fracture stability and occlusion was also achieved using the 3D plating system.
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Affiliation(s)
- Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, TMDCRC, Moradabad, Uttar Pradesh, India
| | - Sam Paul
- Department Orthodontics and Dentofacial Orthopaedics, Educare Institute of Dental Sciences, Chattiparamba, Malappuram, Kerala, India
| | - Sumedha Kukreja
- Department of Oral and Maxillofacial Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Karun Aggarwal
- Department of Oral and Maxillofacial Surgery, Jodhpur Dental College and Research Center, Jodhpur, Rajasthan, India
| | - Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India
| | - Amit Bhugra
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Niranjana Prasad Indra B
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Moazzam Jawaid
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Patel N, Kim B, Zaid W. A Detailed Analysis of Mandibular Angle Fractures: Epidemiology, Patterns, Treatments, and Outcomes. J Oral Maxillofac Surg 2016; 74:1792-9. [DOI: 10.1016/j.joms.2016.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/30/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
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Cho JY, Jeong CH, Lee WY, Kim HM, Ryu JY, Yang SW. The effect of an interfragmentary gap on the clinical outcome after mandibular angle fracture surgery. Dent Traumatol 2016; 33:27-31. [DOI: 10.1111/edt.12300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jin-Yong Cho
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Chang-Hwa Jeong
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Woo-Yul Lee
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Hyeon-Min Kim
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Jae-Young Ryu
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
| | - Sung-Won Yang
- Department of Oral and Maxillofacial Surgery; Gachon University Gil Medical Center; Incheon South Korea
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Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm. Ann Plast Surg 2016; 75:572-8. [PMID: 25393499 PMCID: PMC4888926 DOI: 10.1097/sap.0000000000000194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised. Materials and Methods A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article’s reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis. Result Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups. Conclusions Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.
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Does Intraoral Miniplate Fixation Have Good Postoperative Stability After Sagittal Splitting Ramus Osteotomy? Comparison With Intraoral Bicortical Screw Fixation. J Oral Maxillofac Surg 2016; 74:181-9. [DOI: 10.1016/j.joms.2015.06.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/18/2015] [Accepted: 06/02/2015] [Indexed: 11/17/2022]
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Strasz M, Wolschner R, Schopper C, Pöschl WP, Perisanidis C, Wick F, Seemann R. Miniplate osteosynthesis for mandibular angle fractures--A retrospective comparative study of 3 concepts in a temporal cohort. J Craniomaxillofac Surg 2015; 44:56-61. [PMID: 26646637 DOI: 10.1016/j.jcms.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/21/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Purpose of this retrospective study was to compare fixation of mandibular angle fractures by three different miniplating-concepts (single miniplate, double miniplate, TriLock mandibular angle plate) regarding osteosynthesis failure and hardware removal. METHODS In this retrospective study a temporal cohort of 184 patients with 194 simple mandibular angle fractures, which had been treated by open reduction and internal fixation via miniplates at the University Clinic of Cranio-, Maxillofacial and Oral Surgery (General Hospital Vienna) in the period of 2005-2011, were included. Patients with pathologic fractures (e.g. tumour or osteonecrosis related) or comminuted fractures were not considered. RESULTS 9 of 194 (4.6%) fractures showed osteosynthesis failures. The osteosynthesis failure rates were 2.9% in the single miniplate group, 3.4% in the TriLock plate group, and 11.1% in the double miniplate group. In the double miniplate group 33.3% of the patients had undergone hardware removal, 21.4% in the single miniplate group, and 11.4% in the TriLock plate group. CONCLUSION A single 4-hole locking plate with a thickness of 1.25-1.3 mm guarantees for low osteosynthesis failure rates without postoperative maxillo-mandibular fixation and requires less hardware removal in simple mandibular angle fractures. Two miniplates, longer plates with more holes and thicker plates are prone to hardware removal.
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Affiliation(s)
- Martin Strasz
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Rainer Wolschner
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christian Schopper
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Wolfgang Paul Pöschl
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christos Perisanidis
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Felix Wick
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Rudolf Seemann
- University Clinic of Cranio-Maxillofacial and Oral Surgery, Waehringer Guertel 18-20, 1090 Vienna, Austria
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de Medeiros RC, Sigua EA, Navarro P, Olate S, Albergaria Barbosa JR. In Vitro Mechanical Analysis of Different Techniques of Internal Fixation of Combined Mandibular Angle and Body Fractures. J Oral Maxillofac Surg 2015; 74:778-85. [PMID: 26701138 DOI: 10.1016/j.joms.2015.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate in vitro resistance of 5 techniques of internal fixation of bilateral fractures involving the mandibular angle and body. MATERIALS AND METHODS Twenty-five polyurethane mandibles were used as substrates, fixed with a 2-mm fixation system, and divided into 5 groups: I, 1 4-hole plate, without intermediate space, in the neutral zone of the mandibular body and another similar plate in the external oblique ridge of the contralateral mandibular angle; II, 1 6-hole plate, with intermediate space, in the neutral zone of the mandibular body and a similar plate in the external oblique ridge of the left mandibular angle; III, 1 4-hole locking plate, with intermediate space, in the right neutral zone and another similar plate in the left external oblique ridge; IV, 2 4-hole plates, with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body, and 1 4-hole plate, with intermediate space, in the external oblique ridge of the contralateral mandibular angle; V, 2 4-hole plates with intermediate space, one in the tension zone and the other in the compression zone of the mandibular body and similarly in the buccal side of the left mandibular angle. Mandibles were subjected to vertical linear load tests by a mechanical testing machine (Instron 4411, Instron Corp, Norwood, MA) to record peak load and load for displacements of 3, 5, and 7 mm. RESULTS Group I had the least mechanical resistance of all groups, regardless of displacement, and group IV had the greatest mechanical resistance. Among groups II, III, and V, there was no statistically meaningful difference. CONCLUSION Fixation of bilateral mandibular fractures involving the mandibular angle and body using 2 plates in the region of the body and 1 plate in the tension zone in the region of the mandibular angle was the technique that presented the best mechanical resistance.
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Affiliation(s)
- Raquel Correia de Medeiros
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil.
| | - Eder Alberto Sigua
- Postgraduate PhD Student, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Pablo Navarro
- Assistant Professor, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco, Chile
| | - Sergio Olate
- Assistant Professor and Head, Division of Oral and Maxillofacial Surgery, Universidad de La Frontera, Temuco; Associated Research, Center for Biomedical Research, Universidad Autónoma de Chile, Temuco, Chile
| | - Jose Ricardo Albergaria Barbosa
- Adjunct Professor, Department of Oral and Maxillofacial Surgery, Piracicaba Dental School, Universidade Estadual de Campinas, São Paulo, Brazil
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Butts SC, Floyd E, Lai E, Rosenfeld RM, Doerr T. Reporting of Postoperative Pain Management Protocols in Randomized Clinical Trials of Mandibular Fracture Repair: A Systematic Review. JAMA FACIAL PLAST SU 2015; 17:440-8. [PMID: 26335408 DOI: 10.1001/jamafacial.2015.1011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The control of pain associated with mandibular fractures is an important treatment outcome that affects function, adherence to treatment regimens, and patient comfort and satisfaction. OBJECTIVE To explore the pain management protocols reported in studies of mandibular fractures, including the reporting of quality-of-life measures. EVIDENCE REVIEW PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov were searched for randomized clinical trials published from 1970 to July 2014. We followed PRISMA reporting standards to assess study eligibility and extract data. Studies of patients older than 16 years who underwent operative mandibular fracture management were included. The primary data collected included the type of analgesic prescribed, associated adverse effects of the analgesic, method of pain assessment, and use of quality-of-life measures. A pain attentiveness score was assigned to studies based on the comprehensiveness of the information reported. Several variables were reviewed to determine the factors that predict reporting of pain-related data. Assessments of risk for bias were performed using the Cochrane Collaboration's domain-based evaluation method. FINDINGS The initial search identified 111 articles, of which 38 met inclusion criteria. Among the 38 reviewed articles, there were 38 trials and 1808 unique patients represented. Among the 38 articles, the procedures reported included maxillomandibular fixation only in 6 (16%), open reduction with internal fixation only in 20 (53%), and both in 12 (32%). Specific analgesics prescribed were reported in only 5 of the 38 studies (13%), and 3 of these used a combination of nonsteroidal anti-inflammatory drugs and acetaminophen (paracetamol). Thirteen studies (34%) reported pain assessments and 5 (13%) included quality-of-life measures. Geographic region was the only variable that predicted pain attentiveness, with studies from Europe (3 of 11 studies [27%]) and Asia (6 of 16 studies [38%]) most likely to have a high pain attentiveness score. A low rating was least common in the United States (2 of 5 studies [40%]) (P = .047, Fisher exact test). Most of the studies had unclear (n = 27) or high (n = 6) risks for bias in the key domains assessed. CONCLUSIONS AND RELEVANCE Pain management is a neglected outcome in randomized clinical trials of mandibular trauma; most studies did not describe the specific analgesics used. Many randomized clinical trials (13 [34%]) assessed pain levels among patients without providing information about the agents prescribed. The incorporation of validated pain measures and quality-of-life scores in future studies of mandibular trauma would focus attention on this key outcome measure.
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Affiliation(s)
- Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, State University of New York Downstate Medical Center, College of Medicine, Brooklyn
| | - Elizabeth Floyd
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
| | - Erica Lai
- School of Public Health, State University of New York Downstate Medical Center, Brooklyn
| | - Richard M Rosenfeld
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
| | - Timothy Doerr
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York
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Al-Moraissi E. One miniplate compared with two in the fixation of isolated fractures of the mandibular angle. Br J Oral Maxillofac Surg 2015; 53:690-8. [DOI: 10.1016/j.bjoms.2015.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/09/2015] [Indexed: 11/16/2022]
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Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Routine removal of the plate after surgical treatment for mandibular angle fracture with a third molar in relation to the fracture line. Ann Maxillofac Surg 2015; 5:77-81. [PMID: 26389039 PMCID: PMC4555954 DOI: 10.4103/2231-0746.161077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: The purpose was to analyze the clinical course of surgically treated mandibular angle fractures from the viewpoint of routine removal of the plate because these fractures are associated with high rates of complications and plate removal. Subjects and Methods: The subjects were 40 patients with unilateral mandibular angle fracture, which was intraorally reduced and principally fixed with a single miniplate on the external oblique ridge. The third molar in relation to the fracture line was extracted in seven patients during the surgery. Clinical course was evaluated in terms of removal of the plate, preservation of the third molar and complications. Results: One patient showed a wound infection postoperatively, and two patients developed pericoronitis during the follow-up. These were managed with medication and local irrigation. One patient with a preserved third molar did not make a required visit and was lost from the follow-up. Removal of the plates was performed in 39 patients after confirmation of good fracture healing, mostly within a year. Twenty-four of 32 preserved third molars were simultaneously extracted. These procedures were generally performed under local anesthesia on an outpatient basis, and they did not cause any complications. Conclusions: Routine removal of the plate after surgical treatment for mandibular angle fractures, simultaneously with extraction of the third molar if indicated, may be beneficial to avoid complications related to the plate and the third molar later in life.
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Affiliation(s)
- Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yumiko Matsusue
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tsutomu Sugiura
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Abstract
With demands for an evidence-based approach to patient care, the management of facial fractures will come under increasing scrutiny because there is an overall deficiency in higher level clinical evidence. This article reviews the management of facial fractures, focusing on an evidence-based approach. It focuses on select areas of facial trauma in which there is controversy and presents randomized studies and meta-analysis to help define best practice. The article notes the many areas where the evidenced-based literature is weak and looks at the future of evidence-based facial trauma care.
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Affiliation(s)
- Timothy D Doerr
- Department of Otolaryngology-Head and Neck Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood, Box 629, Rochester, NY 14642, USA.
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Comparison of three-dimensional plate versus double miniplate osteosynthesis for treatment of unfavorable mandibular angle fractures. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tdj.2015.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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What Method for Management of Unilateral Mandibular Angle Fractures Has the Lowest Rate of Postoperative Complications? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2014; 72:2197-211. [DOI: 10.1016/j.joms.2014.05.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 11/19/2022]
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Yoon WJ, Kim SG, Oh JS, You JS, Lim KS, Shin SM, Kim CM. A Clinical Study of Mandibular Angle Fracture. Maxillofac Plast Reconstr Surg 2014; 36:201-6. [PMID: 27489834 PMCID: PMC4283523 DOI: 10.14402/jkamprs.2014.36.5.201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 06/27/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To establish management protocol for mandibular angle fracture, we describe pertinent factors including cause, impacted third molar and recent treatment tendency. METHODS We examined the records of 62 patients who had unilateral mandibular angle fracture. Sixty patients who had open reduction surgery were examined at postoperative weeks 1, 4, 8, 12, and 28. RESULTS Left mandibular angle fracture is frequent in younger males. Presence of the mandibular third molar can increase fracture risk. Because of attached muscle, favorable fractures occurred primarily in the mandibular angle area. CONCLUSION Extracting the mandibular third molar can prevent angle fractures, and open reduction with only one plate adaptation is generally the proper treatment method for mandibular angle fracture.
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Affiliation(s)
- Wook-Jae Yoon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
| | - Su-Gwan Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
| | - Ji-Su Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
| | - Jae-Seek You
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
| | - Kyung-Seop Lim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
| | - Seung-Min Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
| | - Cheol-Man Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University
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Superior border versus inferior border fixation in displaced mandibular angle fractures: prospective randomized comparative study. Int J Oral Maxillofac Surg 2014; 43:834-40. [DOI: 10.1016/j.ijom.2013.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/01/2013] [Accepted: 09/18/2013] [Indexed: 11/18/2022]
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Chrcanovic BR. Fixation of mandibular angle fractures: clinical studies. Oral Maxillofac Surg 2014; 18:123-152. [PMID: 23179956 DOI: 10.1007/s10006-012-0374-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Accepted: 11/12/2012] [Indexed: 09/20/2023]
Abstract
PURPOSE The purpose of this study was to review the literature regarding the evolution of current thoughts on fixation of mandibular angle fractures (MAFs). METHODS An electronic search in PubMed was undertaken in August 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies from the last 30 years (from 1983 onwards) reporting clinical studies of MAFs. RESULTS The search strategy initially identified 767 studies. The references from 1983 onwards totaled 727 articles. Fifty-four studies were identified without repetition within the selection criteria. Two articles showing significance in the development of treatment techniques were included. Additional hand-searching yielded 13 additional papers. Thus, a total of 69 studies were included. CONCLUSIONS Prospective randomized controlled studies of MAFs repair techniques are scarce. The available data at best predict that complications are associated with all kinds of fixation techniques. The similar results of complications in studies using different methods of fixation indicate that biomechanics are only one factor to be considered when treating MAFs. A second fracture in the mandible (which was observed in the majority of the studies' population) can confound the outcome data because the fixation requirements of a double fracture are often different from those for an isolated fracture. It can be necessary additional effort intended for increase of stability when using biodegradable plate system to fixate MAFs. The use of 1.3 mm malleable miniplates was associated with an unacceptable incidence of plate fracture, suggesting that this is not the most adequate system to treat MAFs. The use of the 3D grid plates has shown good clinical results. The efficiency of locking miniplate system is yet to be proven because there are few clinical studies with its use to fixate MAFs, although they have shown good results. When considering the use of semirigid or rigid fixation systems, the use of two miniplates outweigh the advantages of the use of one reconstruction plate, although the use of miniplates is not recommended for displaced comminuted MAFs. Although it has been shown that absolute rigid fixation is not necessary for fracture healing, any system that provides superior stability without impacting negatively on other aspects of the procedure, i.e., time, exposure, and cost, should be favored. MAFs can be treated in a highly effective way and with a relatively low rate of complications with monocortical miniplate fixation. The large number of studies on the treatment of MAF reflects the fact that a consensus has not been reached for a single, ideal treatment method.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Carl Gustafs väg 34, SE-205 06, Malmö, Sweden,
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Braasch DC, Abubaker AO. Management of Mandibular Angle Fracture. Oral Maxillofac Surg Clin North Am 2013; 25:591-600. [DOI: 10.1016/j.coms.2013.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nasser M, Pandis N, Fleming PS, Fedorowicz Z, Ellis E, Ali K. Interventions for the management of mandibular fractures. Cochrane Database Syst Rev 2013:CD006087. [PMID: 23835608 DOI: 10.1002/14651858.cd006087.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. OBJECTIVES The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (non-surgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated to include both clinical and methodological factors. MAIN RESULTS Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of post-operative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I(2) = 0%). Similarly, no difference in post-operative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I(2) = 27%). The included studies involved a small number of participants with a low number of events. AUTHORS' CONCLUSIONS This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.
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Affiliation(s)
- Mona Nasser
- Peninsula Dental School, University of Plymouth, Plymouth, UK.
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Yazdani J, Taheri Talesh K, Kalantar Motamedi MH, Khorshidi R, Fekri S, Hajmohammadi S. Mandibular Angle Fractures: Comparison of One Miniplate vs. Two Miniplates. Trauma Mon 2013; 18:17-20. [PMID: 24350144 PMCID: PMC3860651 DOI: 10.5812/traumamon.9865] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/07/2013] [Accepted: 04/20/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Monocortical miniplate fixation is an accepted and reliable method for internal fixation of mandibular angle fractures. Although placement of a second miniplate may theoretically provide more stability; however, the clinical importance of this issue remains controversial. OBJECTIVES The present study assessed the postoperative complications and outcomes associated with the fixation of mandibular angle fractures using 1 and 2 miniplates in patients with favorable mandibular angle fractures. PATIENTS AND METHODS A prospective study of 87 patients (73 males, 14 females) with favorable mandibular angle fractures was done. In the first group, a 4-hole miniplate was placed at the superior border through an intraoral approach. In group 2, patients were treated with 2 miniplates, one placed at the superior border (similar to group 1) and the other on the lateral aspect of the angle at the inferior border through an intraoral and transcutaneous approach using a trocar. Postoperative complications including malocclusion, malunion and sensory disturbances associated with surgery, additional maxillomandibular fixation (MMF) by means of an arch bar and wires for a longer period (for delayed union) and infection were assessed in patients of both groups up to 12 months postoperatively. The data were analyzed using the chi-square test. RESULTS In the single miniplate group, 25 patients showed lip numbness associated with surgery (55.6%), 22 patients required additional use of MMF (48.9%) and 3 patients developed infections (6.7%). In the double miniplate group 20 patients showed lip numbness associated with surgery (47.6%), 18 patients required additional use of MMF (42.9%) and 1 patient developed infection (2.4%). None of the patients in either group showed malocclusion or malunion. No significant difference was observed between the groups regarding overall complication rate. CONCLUSIONS In this study, use of one miniplate or two miniplates for treatment of favorable mandibular angle fractures was associated with a similar incidence of complications. Thus, it seems that the use of two miniplates in this setting may not be warranted, nor cost-efficient.
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Affiliation(s)
- Javad Yazdani
- Department of Oral and Maxillofacial Surgery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Kourosh Taheri Talesh
- Department of Oral and Maxillofacial Surgery, Azad University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Hosein Kalantar Motamedi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Hosein Kalantar Motamedi, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel.: +98-9121937154, Fax: +98-2188053766, E-mail:
| | - Reza Khorshidi
- Department of Oral and Maxillofacial Surgery, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Sasan Fekri
- Department of Oral and Maxillofacial Surgery, Yazd University of Medical Sciences,Yazd, IR Iran
| | - Saeed Hajmohammadi
- Department of Oral and Maxillofacial Surgery, Tabriz University of Medical Sciences, Tabriz, IR Iran
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Hardware removal rates for mandibular angle fractures: comparing the 8-hole strut and champy plates. J Craniofac Surg 2013; 24:163-5. [PMID: 23348277 DOI: 10.1097/scs.0b013e31826468f5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare the removal rates of 8-hole angle strut plate and Champy line plate in repairing mandibular angle fractures. METHODS Retrospective chart review at a tertiary care academic center of adults who were at least 18 years old with at least 1 mandibular angle fracture of a traumatic origin who underwent open reduction and internal fixation by using single monocortical miniplate fixation in Champy line or by using 8-hole angle strut plate via transbuccal approach. The outcome measures were hardware removal rates and the reason for removal of the hardware. RESULTS One hundred four patients with a total of 106 angle fractures met the inclusion criteria for this study. Seventy-three angle fractures were treated with the 8-hole strut, and 33 angle fractures were treated with the Champy line plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8-hole strut plate group and 18.2% in the Champy line group (P = 0.133). Loose hardware was determined to be the cause of plate removal in 2 (2.7%) of the 8-hole strut plate group compared with all 6 (18.2%) of the Champy group (P = 0.005). CONCLUSIONS Overall, removal rates between Champy line and 8-hole strut plates are not different in treating mandibular angle fractures, although the 8-hole strut plate has a lower rate of loose hardware-related plate removal compared with the Champy line plate.
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Correction of Facial Asymmetry Resulting From Hemimandibular Hyperplasia. J Craniofac Surg 2012; 23:1898-900. [DOI: 10.1097/scs.0b013e318266f76b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Waiss W, Gosau M, Koyama K, Reichert TE. [Maxillary and mandibular fractures. Treatment concepts in maxillofacial surgery]. HNO 2011; 59:1079-87. [PMID: 22012486 DOI: 10.1007/s00106-011-2387-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Maxillary and mandibular fractures are a relatively frequent occurrence due to the exposed location of the jaws and are caused mainly by acts of violence, traffic and recreational accidents. Mandibular fractures can be treated conservatively with dental splints and intermaxillary fixation. Since Michelet, miniplate osteosynthesis via intraoral access has become the method of choice. Champy showed that the monocortical fixation of miniplates at the level of the linea obliqua results in stable osteosynthesis, despite postoperative micro-movements in the fracture gap, and postulated the principle of dynamic compression. Dislocated fractures of the mandibular collum are treated with stable osteosynthesis via an intra- or extraoral approach, while fractures of the mandibular joint are usually treated conservatively and early functional rehabilitation is favored. For mandibular fractures, the principle of load-bearing and load-sharing should be considered, i.e. in the case of sufficient bone and uncomplicated fractures, the bone can bear most of the force, such that miniplates are sufficient (load-sharing). If bones are weakened by atrophy or in the case of infected, comminuted or defect fractures osteosynthesis plates must bear the load alone (load-bearing).
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Affiliation(s)
- W Waiss
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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