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Savani R, Weihsin H, Patel S, Shah N, Chauhan S, Chavda Y. Effective strategies in the management of anterior mandibular fractures: a comprehensive systematic review. Br J Oral Maxillofac Surg 2024; 62:349-360. [PMID: 38604919 DOI: 10.1016/j.bjoms.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 04/13/2024]
Abstract
This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures.
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Affiliation(s)
- Rajan Savani
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India.
| | - Hu Weihsin
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
| | - Shital Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
| | | | - Shyam Chauhan
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
| | - Yashasvi Chavda
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
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Chopane S, Chaudhry K, Kohli A, Singh S, Banerjee M, Kumar P, Ganesan A, Chugh A. Safety and Efficacy of Resveratrol in Healing of Maxillofacial Fractures: A Randomized Controlled Study. J Maxillofac Oral Surg 2023; 22:987-994. [PMID: 38105826 PMCID: PMC10719438 DOI: 10.1007/s12663-023-01992-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/05/2023] [Indexed: 12/19/2023] Open
Abstract
Objectives To assess the efficacy of resveratrol in improving functional outcomes following open reduction and internal fixation of maxillofacial fractures. Study Design A single-center, randomized, parallel group, prospective, double-blind clinical trial was conducted on 40 patients between the age 20 and 60 years, requiring open reduction and internal fixation of maxillofacial fractures. The selected patients were randomly divided into two groups, Group 1 (placebo) and Group 2 (resveratrol) where tablets resveratrol 500 mg were given twice daily for 1 month following open reduction and internal fixation of fractured segments. Bite force was calculated pre-operatively and on the 1st, 4th, 8th and 12th week postoperatively. Serum markers osteocalcin and alkaline phosphate were calculated pre-operatively and at 4th and 12th week postoperatively. Results Bite force (690.55 ± 262.00) in the resveratrol group was higher than the placebo group (553.27 ± 300.08) at 12th week postoperatively. However, the difference was non-significant statistically (p = 0.132). Resveratrol group (116.80 ± 55.25) showed better maintenance of serum ALP level as compared to placebo group (107.90 ± 42.99) at 12th week postoperatively, but again it lacked statistical significance (p = 0.573). Resveratrol group after initial reduction at 4th week showed serum osteocalcin levels nearly equal to the preoperative values at 12th week, while the placebo group showed a decline both at 4th and 12th week postoperatively. However, these results were not statistically significant (p = 0.065). Conclusion There was no statistically significant difference in bite force, serum ALP level and serum osteocalcin levels between placebo group and resveratrol group. Though not statistically significant but early increased level of serum osteogenic markers, better restoration of bite force in group 2 (tab. Resveratrol) indicates toward its possible optimistic role in maxillofacial fracture healing. More studies with larger sample sizes are needed in order to confirm the efficacy of this drug in maxillofacial fracture.
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Affiliation(s)
- Shivkumar Chopane
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Aakash Kohli
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
| | - Aparna Ganesan
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Ankita Chugh
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India
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Rothweiler RM, Zankovic S, Brandenburg LS, Fuessinger MA, Gross C, Voss PJ, Metzger MC. Feasibility of Implant Strain Measurement for Assessing Mandible Bone Regeneration. MICROMACHINES 2022; 13:1602. [PMID: 36295956 PMCID: PMC9610677 DOI: 10.3390/mi13101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Nonunion is one of the most dreaded complications after operative treatment of mandible fractures or after mandible reconstruction using vascularized and non-vascularized bone grafts. Often diagnosis is made at advanced stage of disease when pain or complications occur. Devices that monitor fracture healing and bone regeneration continuously are therefore urgently needed in the craniomaxillofacial area. One promising approach is the strain measurement of plates. An advanced prototype of an implantable strain measurement device was tested after fixation to a locking mandible reconstruction plate in multiple compression experiments to investigate the potential functionality of strain measurement in the mandibular region. Compression experiments show that strain measurement devices work well under experimental conditions in the mandibular angle and detect plate deformation in a reliable way. For monitoring in the mandibular body, the device used in its current configuration was not suitable. Implant strain measurement of reconstruction plates is a promising methodical approach for permanent monitoring of bone regeneration and fracture healing in the mandible. The method helps to avoid or detect complications at an early point in time after operative treatment.
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Affiliation(s)
- René Marcel Rothweiler
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Sergej Zankovic
- G.E.R.N. Center for Tissue Replacement, Regeneration & Neogenesis, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79108 Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc-Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christian Gross
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Pit Jacob Voss
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc-Christian Metzger
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Complications of locking and non-locking plate systems in mandibular fractures. Int J Oral Maxillofac Surg 2019; 48:1213-1226. [DOI: 10.1016/j.ijom.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/09/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022]
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Desai V, Jain MK. Locking Miniplate Osteosynthesis of Anterior Mandibular Fractures-Quo Vadis? J Oral Maxillofac Surg 2019; 77:1041.e1-1041.e9. [PMID: 30796907 DOI: 10.1016/j.joms.2019.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study compared the clinical stability and efficacy of locking miniplates with those of standard miniplates in the osteosynthesis of anterior mandibular fractures using bite force recordings and other clinical parameters. MATERIALS AND METHODS A prospective randomized double-blinded clinical trial was carried out in patients from various hospitals of Hassan (India). Patients were randomly divided into 2 groups of locking (test) and standard (control) miniplate osteosynthesis. Bite force measurements were performed preoperatively and postoperatively at weekly intervals for 6 weeks using a bite force recorder. As a secondary outcome, patients also were assessed for other clinical parameters that might interfere with successful osteosynthesis at the fracture site. Appropriate statistical testing for intra- and intergroup measurements was carried out. RESULTS Forty-eight men 28 ± 12.3 years old met the inclusion criteria (24 patients in each group). A statistically significant difference (P < .05) was found in the incisor bite force between the 2 groups, with values in the locking group exceeding those in the standard group at postoperative weeks 2 and 5. Duration of surgery was shorter in the locking group (P = .015). No relevant difference was found for the other clinical parameters. CONCLUSIONS Bite force statistically increased at progressive follow-up visits compared with the preoperative recording in the locking group. Bite force recordings of patients treated with locking plates were higher and statistically relevant compared with those of patients treated with standard miniplates at the incisor region at postoperative weeks 2 and 5. The clinical outcomes of the 2 miniplate systems in the present study were similar; however, the locking miniplates required a relatively shorter operating time, produced less trauma to the periosteum and soft tissues with less hardware, and can be used as a "1-plate-for-all" system.
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Affiliation(s)
- Vyoma Desai
- Former Senior Resident, Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India
| | - Manoj Kumar Jain
- Former Associate Professor, Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka, India.
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Management of Mandibular Fractures Using Locking and Nonlocking Miniplates. J Craniofac Surg 2019; 30:448-452. [PMID: 30640857 DOI: 10.1097/scs.0000000000005128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The study proposed to determine the superiority between locking plate and nonlocking miniplate for mandibular fractures (MFs) treatment. METHODS A comprehensive electronic search examining Medline-Ovid, Embase, and PubMed databases language without date was performed in February 2018. Inclusion criteria were studies in humans, including randomized controlled trials, controlled clinical trials, with the aim of comparing the 2 techniques. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure the effect size. RESULTS Thirteen publications were enrolled into the analysis. The results showed that there were significant differences in overall complications (RR, 0.62; 95% CI, 0.351-1.094; P = 0.06), postoperative infection (RR, 0.503, 95% CI, 0.223-1.136) when comparing locking miniplates with nonlocking miniplates in treating mandible fractures. The incidence of malocclusion showed a statistically significant difference in the outcome favoring locking miniplates (fixed: RR, 0.503; 95% CI, 0.125-2.030; P = 0.06). In addition, the use of locking miniplates had a lower postoperative maxillomandibular fixation rate than the use of nonlocking miniplates (RR, 0.414; 95% CI, 0.196-0.872; P = 0.002). CONCLUSION The result of meta-analysis revealed that use of locking plate is superior to the nonlocking plate in the reducing of postoperative complication rates in the management of MFs.
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Three-dimensional versus standard miniplate, lag screws versus miniplates, locking plate versus non-locking miniplates: Management of mandibular fractures, a systematic review and meta-analysis. J Dent Sci 2019; 14:66-80. [PMID: 30988882 PMCID: PMC6445977 DOI: 10.1016/j.jds.2018.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 03/31/2018] [Indexed: 11/27/2022] Open
Abstract
Background/purpose The aims of the present study were to 1) evaluate the clinical outcomes between different fixation methods in the management of mandibular fractures (MFs) and 2) determine which fixation method is the best option for the treatment of mandibular fractures. Materials and methods A systematic review was conducted according to PRISMA guidelines, examining Medline-Ovid, Embase, and Pubmed databases. Inclusion criteria were studied in humans, including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. In addition, the incidence of complications was evaluated. Results Thirty-two publications were included: 20 randomized controlled trials, 4 controlled clinical trials, and 8 retrospective studies. There were statistically significant advantages for 3-dimensional miniplate and lag screws. There was no statistically significant difference between locking plates and standard miniplates (P = 0 0.2). The cumulative odds ratio was 0.64, meaning that the use of locking miniplate in the fixation of MFs decreases the risk for postoperative complications by 36% over the use of standard miniplates. Conclusion The results of the three-Dimensional Versus Standard miniplate showed that 3-dimensional miniplate is the best option for mandibular fractures. Regarding Lag Screws Versus Miniplates results of the meta-analysis found that the use of lag screws is superior to using miniplates in reducing the incidence of postoperative complications. And in regards to locking miniplates versus non-locking miniplate, the analysis indicates that the 2.0-mm locking miniplate is a prospective fixation system in the treatment of maxillofacial fractures.
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Glória JCR, Fernandes IA, Silveira EMD, Souza GMD, Rocha RL, Galvão EL, Falci SGM. Comparison of Bite Force with Locking Plates versus Non-Locking Plates in the Treatment of Mandibular Fractures: A Meta-Analysis. Int Arch Otorhinolaryngol 2018; 22:181-189. [PMID: 29619110 PMCID: PMC5882372 DOI: 10.1055/s-0037-1604056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Mandibular fractures represent a high percentage of all facial fractures, and the bite force is a fundamental parameter to measure the actual mandibular function and, subsequently, the masticatory efficiency and quality of life. Objectives The purpose of the present systematic review was to verify if there is any difference in the bite forces of patients with mandibular fractures fixed by locking or non-locking plates, testing the null hypothesis of no difference in this parameter. Data Synthesis A systematic review of the literature was conducted using four databases (PubMed, Virtual Health Library, Web of Science and Science Direct) without restrictions as to publication date or language. We found 3,039 abstracts, and selected 4 articles for this review. Conclusion The overall results show better performance in bite force for the locking plates when compared with the non-locking plates in the incisor region (mean deviation [MD]: 1.18; 95% confidence interval [95%CI]: 0.13-2.23), right molar region (MD: 4.71; 95%CI: 0.63-8.79) and left molar region (MD: 10.34; 95%CI: 4.55-16.13). Although the results of this study indicated a better bite force result with the locking plates, there is still no sufficient evidence to support this information safely.
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Affiliation(s)
- José Cristiano Ramos Glória
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Ighor Andrade Fernandes
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | | | - Glaciele Maria de Souza
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Ricardo Lopes Rocha
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Endi Lanza Galvão
- Research Department, Centro de Pesquisas Rene Rachou, Belo Horizonte, MG, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
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Jain MK, Kerur P. Bite Force as a Parameter for Comparison Between Three-Dimensional and Standard Titanium Miniplates for the Management of Anterior Mandibular Fractures: A Prospective Randomized Double-Blinded Clinical Trial. J Maxillofac Oral Surg 2018; 18:249-255. [PMID: 30996547 DOI: 10.1007/s12663-018-1091-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 02/05/2018] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives To compare the efficacy of three-dimensional (3D) miniplates with standard miniplates in the osteosynthesis of anterior mandibular fractures on the basis of bite force recordings and other clinical parameters. Methods A prospective randomized double-blinded clinical trial was carried out for the treatment of anterior mandibular fractures. In total, 20 patients were randomly divided into two groups of 2-mm 3D and standard titanium miniplates. The assessment of patients was done at weekly intervals for 6 weeks using bite force recordings and other clinical parameters. Results A statistically significant difference was found in the duration of surgery which was less in group A as compared to group B (p = 0.03). No significant difference was found in other clinical parameters. Interpretation and Conclusion The clinical outcome of both the 3D and standard miniplate systems in the present study was similar; however, the following advantages with the use of 3D miniplates can be highlighted:Relatively lesser operating time.Three-dimensional stability of the fracture site and simultaneous stabilization at superior and inferior borders in the fixation of mandibular fractures.
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Affiliation(s)
- Manoj Kumar Jain
- 1Department of Oral and Maxillofacial Surgery, Sri Hasanamba Dental College and Hospital, Hassan, Karnataka 573201 India
- Nuface/Sumukha Clinic, Benaka Complex 1st Floor, Sankar Matt Road 5th Cross, KR Puram, Hassan, Karnataka 573201 India
| | - Priyadarshini Kerur
- Department of Oral and Maxillofacial Surgery, Inderprastha Dental College and Hospital, Sahibabad, Ghaziabad, Uttar Pradesh 201010 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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Locking Plate System Versus Standard Plate Fixation in the Management of Mandibular Fractures. J Craniofac Surg 2017; 28:1456-1461. [DOI: 10.1097/scs.0000000000003857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kinra PK, Jayakumar K, Soumithran CS, Michael MJ, Passi D, Singh M. Comparative evaluation of bite force analytical study following mandibular osteosysthesis using three-dimensional and conventional locking miniplates. Natl J Maxillofac Surg 2017; 8:34-40. [PMID: 28761274 PMCID: PMC5512406 DOI: 10.4103/njms.njms_76_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES The aim is to study the effectiveness of 2 mm three-dimensional (3D) titanium miniplates and 2 mm conventional titanium miniplates in osteosynthesis of mandibular fractures by comparing the change in bite force. METHODOLOGY The study comprised forty patients of age group 20-40 years, weighing 55-75 kg having mandibular fractures. Patients were randomly divided into two equal groups In Group A, twenty patients underwent osteosynthesis using 3D titanium miniplates (2.0 mm system), whereas in Group B, twenty patients underwent osteosynthesis using conventional titanium miniplates (2.0 mm system). After fixation of fracture segments with miniplates, the patients were assessed on the basis of evaluation of bite force at incisor, right molar and left molar region after 1, 3, 6 , and 8 weeks. Comparison of change in bite force was done between Group A and Group B at different follow-ups at incisor, right molar, and left molar. RESULTS Bite force recordings showed increasing values at subsequent follow-ups, corresponding to the healing of the fracture in both groups. At follow-up III (6 weeks) and IV (8 weeks), bite force values reached near to those in healthy individuals. A significant difference was observed in change in bite force of Group A and Group B at incisor left molar and right molar on subsequent followups. 3D titanium miniplate requires less surgical exposure of the underlying fracture site, with a minimal traction of the surrounding soft tissue. INTERPRETATION AND CONCLUSION 3D miniplates in mandibular fractures are efficacious enough to bear masticatory loads during the osteosynthesis of fractures. It gives the advantage of greater stability, increased bite force, reduced implant material, and 3D stability.
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Affiliation(s)
- Pallav Kumar Kinra
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - K Jayakumar
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - C S Soumithran
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - Manoj Joseph Michael
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - Deepak Passi
- Department of Oral and Maxillofacial Surgery, ESI Dental College and Hospital, New Delhi, India
| | - Mahinder Singh
- Department of Oral and Maxillofacial Surgery, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, India
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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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Rastogi S, Reddy MP, Swarup AG, Swarup D, Choudhury R. Assessment of Bite Force in Patients Treated with 2.0-mm Traditional Miniplates versus 2.0-mm Locking Plates for Mandibular Fracture. Craniomaxillofac Trauma Reconstr 2016; 9:62-8. [PMID: 26889350 DOI: 10.1055/s-0035-1563697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 06/13/2015] [Indexed: 10/23/2022] Open
Abstract
The objective of this study is to analyze the difference in bite forces in patients treated for mandibular fractures with 2.0 mm conventional and locking titanium plating system. A randomized study was performed for the treatment of fractures of mandible. In this study, 20 adult patients with isolated mandibular fracture were included. The patients were randomly allocated into two groups, that is, Group I-2.0 mm nonlocking (traditional) and Group II-2.0 mm locking plates. Bite force was evaluated at 1st, 3rd, and 6th weeks. Comparison of all the assessed parameters between both the groups depicted no significant difference in terms of pain, swelling including the incidence of infection, paresthesia, and hardware failure. Although same was true in case of bite force between both the groups at various time intervals, there was statistically significant increase in the bite force within the group comprising patients in whom locking plates was used between 1st and 3rd weeks follow-up period and highly significant increase in bite force between 1st and 6th weeks of follow-up period. The rapid improvement of bite force values when locking plates were used implies that the locking plate can be used in preference to conventional plates to achieve early mobilization with assured stability in the treatment of mandibular fractures.
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Affiliation(s)
- Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Mahendra Parvath Reddy
- Department of Oral and Maxillofacial Surgery, Jaipur Dental College, Jaipur, Rajasthan, India
| | | | | | - Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Private Practice, Guwahati, India
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Kanno T, Okuma S, Karino M, Yoshino A, Sekine J. Unexpected Plate Fracture in a Three-Dimensional Subcondylar Locking Plate System. J HARD TISSUE BIOL 2016. [DOI: 10.2485/jhtb.25.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
- Division of Oral and Maxillofacial Surgery, Masuda Red Cross Hospital
| | - Masaaki Karino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Aya Yoshino
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
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Giri KY, Sahu P, Rastogi S, Dandriyal R, Mall S, Singh AP, Indra B NP, Pratap Singh H. Bite Force Evaluation of Conventional Plating System Versus Locking Plating System for Mandibular Fracture. J Maxillofac Oral Surg 2015; 14:972-8. [PMID: 26604472 PMCID: PMC4648785 DOI: 10.1007/s12663-015-0764-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022] Open
Abstract
AIMS AND OBJECTIVES To compare and evaluate the variation in recorded bite forces in patients with mandibular fractures undergoing open reduction and rigid internal fixation using standard 2.0 versus 2.0 mm locking miniplates. MATERIALS AND METHODS A prospective randomized study was conducted for the treatment of mandibular fractures. Twenty adult patients with 31 mandibular fractures requiring an open reduction and internal fixation were included in the study. The sample was divided into two groups depending upon whether the patients received 2.0 mm non-locking (standard) or 2.0 mm locking miniplates for rigid fixation respectively. Bite force was evaluated at 1st, 3rd and 6th week after the open reduction and rigid fixation using miniplates. RESULTS A statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. The results showed that amongst locking vs non-locking miniplates, the former showed a greater bite force enhancement when compared to baseline values(post-trauma).A comparison between 2nd day post-operative vs 6th week post-operative values showed a significant increase in bite force in Group 1 (non-locking) (p < 0.05) whereas the values Were highly significant (p < 0.001) in Group 2 (locking Plate). CONCLUSION The findings were suggestive that the efficacy of locking miniplates plate in mandibular fracture was superior in terms of bearing the masticatory loads during osteosynthesis of the fracture. However, the clinical results were almost similar to those seen with non-locking miniplate osteosynthesis.
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Affiliation(s)
- Kolli Yada Giri
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Puneet Sahu
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Ramakant Dandriyal
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Sunil Mall
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Aishwarya Pratap Singh
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Niranjana Prasad Indra B
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
| | - Himanshu Pratap Singh
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, U.P. India
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Biomechanical evaluation of different angle-stable locking plate systems for mandibular surgery. J Craniomaxillofac Surg 2015; 43:1589-94. [DOI: 10.1016/j.jcms.2015.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/03/2015] [Accepted: 06/29/2015] [Indexed: 11/30/2022] Open
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the anatomy and subunits of the mandible. 2. Review the cause and epidemiology of mandible fractures. 3. Discuss the preoperative evaluation and diagnostic imaging. 4. Understand the principles and techniques of mandible fracture reduction and fixation. SUMMARY The management of mandibular fractures has undergone significant improvement because of advancements in plating technology, imaging, and instrumentation. As the techniques in management continue to evolve, it is imperative for the practicing physician to remain up-to-date with the growing body of scientific literature. The objective of this Maintenance of Certification article is to present a review of the literature so that the physician may make treatment recommendation based on the best evidence available. Pediatric fractures have been excluded from this article.
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de Medeiros RC, de Moura AL, Sawazaki R, Fernandes Moreira RW. Comparative in vitro mechanical evaluation of techniques using a 2.0 mm locking fixation system for simulated fractures of the mandibular body. J Craniomaxillofac Surg 2015; 43:302-5. [PMID: 25573304 DOI: 10.1016/j.jcms.2014.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To perform a comparative evaluation of the mechanical resistance of simulated fractures of the mandibular body which were repaired using different fixation techniques with two different brands of 2.0 mm locking fixation systems. MATERIALS AND METHODS Four aluminum hemimandibles with linear sectioning simulating a mandibular body fracture were used as the substrates and were fixed using the two techniques and two different brands of fixation plate. These were divided into four groups: groups I and II were fixed with one four-hole plate, with four 6 mm screws in the tension zone and one four-hole plate, with four 10 mm screws in the compression zone; and groups III and IV were fixed with one four-hole plate with four 6 mm screws in the neutral zone. Fixation plates manufactured by Tóride were used for groups I and III, and by Traumec for groups II and IV. The hemimandibles were submitted to vertical, linear load testing in an Instron 4411 servohydraulic mechanical testing unit, and the load/displacement (3 mm, 5 mm and 7 mm) and the peak loads were measured. Means and standard deviations were evaluated applying variance analysis with a significance level of 5%. RESULTS The only significant difference between the brands was seen at displacements of 7 mm. Comparing the techniques, groups I and II showed higher mechanical strength than groups III and IV, as expected. CONCLUSION For the treatment of mandibular linear body fracture, two locking plates, one in the tension zone and another in the compression zone, have a greater mechanical strength than a single locking plate in the neutral zone.
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Affiliation(s)
| | | | - Renato Sawazaki
- Department of Oral and Maxillofacial Surgery, Piracicaba Dental School Unicamp, SP, Brazil; Department of Oral and Maxillofacial Surgery, University of Passo Fundo, Rio Grande do Sul, Brazil
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Kumar S, Gattumeedhi SR, Sankhla B, Garg A, Ingle E, Dagli N. Comparative evaluation of bite forces in patients after treatment of mandibular fractures with miniplate osteosynthesis and internal locking miniplate osteosynthesis. J Int Soc Prev Community Dent 2014; 4:S26-31. [PMID: 25452924 PMCID: PMC4247547 DOI: 10.4103/2231-0762.144575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aims and Objectives: The aim of present study was to compare the stability of fractured mandibular fragments under functional load, when fixed with conventional miniplate and internal locking miniplate. Materials and Methods: Bite force (in kg) recorded in twenty mandible fractured patients and fifty normal healthy individuals. Bite force was measured at incisor and molar regions. Comparative evaluation of bite force generated was performed between 10 cases treated with conventional miniplates and 10 cases treated with internal locking miniplates. Bite force generated by patients in mandibular fracture between symphysis and the angle of mandible was recorded in incisor and molar regions preoperatively. The fracture fragments were fixed using the above fixation techniques. Then same recording was undertaken on the 7th, 14th, 21st, 28th, and 90th days postoperatively. Results: Bite force generated by patients treated with locking plates at the 7th, 14th, 21st, 28th, and 90th postoperative days was significantly higher as compared to those in patients treated with miniplates. Conclusion: It was observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. There are no intraoperative difficulties associated with placement of the plate.
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Affiliation(s)
- Saurab Kumar
- Department of Oral and Maxillofacial Surgery, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Shashank Reddy Gattumeedhi
- General Dental Practitioner, Vokkaligara Sangha Dental College and Hospital, Bangalore, Karnataka, India
| | - Bharat Sankhla
- Department Oral Pathology, Government Dental College and Hospital, Jaipur, India
| | - Akshay Garg
- Department of Endodontics, Jaipur Dental College and Hospital, Jaipur, Rajasthan, India
| | - Ekta Ingle
- Department of Oral Medicine and Radiology, Vasantdada Dental College, Sangli, Maharashtra, India
| | - Namrata Dagli
- Editor in chief, Journal of Health Research and Review, Ahmedabad, Gujarat, India
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Kumar BP, Kumar KAJ, Venkatesh V, Mohan AP, Ramesh K, Mallikarjun K. Study of Efficacy and the Comparison Between 2.0 mm Locking Plating System and 2.0 mm Standard Plating System in Mandibular Fractures. J Maxillofac Oral Surg 2014. [PMID: 26225079 DOI: 10.1007/s12663-014-0718-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and comparison between 2.0 mm locking plate system and 2.0 mm Champy's titanium mini plating system in mandible fractures. MATERIALS AND METHODS A total of 20 patients with mandibular fractures were selected and divided into two groups A and B on randomized basis. Group A was treated with open reduction internal fixation using 2.0 mm locking plates and group B with 2.0 mm Champy's titanium miniplates. All patients were followed up for 12 weeks postoperatively. RESULTS Results of the study show less screw loosening, less precision in plate adaptation and less alteration of the osseous or occlusal relationship upon screw tightening in group A. Chi square test was applied to compare the results between the two groups. Statistical analysis did not show significant difference of incidence of malocclusion between the two groups (p value = 0.606). Statistical analysis using un-paired t test showed significant difference of working time between the two groups (p value = 0.00296). When comparing the overall complication rates according to plates used, the χ(2) test showed no statistically significant difference between the locking and nonlocking plates (p > 0.05). CONCLUSION It is observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. The precise adaptation required for using conventional plates is not needed when this locking plate/screw system is used. Locking plate/screw system provides better stability than the conventional plate/screw system.
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Affiliation(s)
- B Pavan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - K A Jeevan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - V Venkatesh
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - A P Mohan
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - K Ramesh
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - K Mallikarjun
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
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A meta-analysis comparing the 2.0-mm locking plate system with the 2.0-mm nonlocking plate system in treatment of mandible fractures. J Craniofac Surg 2014; 25:2094-7. [PMID: 25304139 DOI: 10.1097/scs.0000000000001018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to evaluate the efficacy of the 2.0-mm locking miniplate/screw system in comparison with the 2.0-mm nonlocking miniplate/screw system in treatment of mandible fractures. METHODS Articles published until March 2013 were searched in the PubMed and EMBASE electronic databases. Eligible studies were restricted to comparative controlled trials. RESULTS Four studies with 220 patients and 420 fracture sites were enrolled into the analysis. The results showed that there were no significant differences in overall complications (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.24-1.36; P = 0.21), postoperative infection (OR, 0.43; 95% CI, 0.13-1.41, P = 0.17), and postoperative pain (P > 0.05) when comparing 2.0-mm locking miniplates with 2.0-mm nonlocking miniplates in treating mandible fractures. However, the use of 2.0-mm locking miniplates had a lower postoperative maxillomandibular fixation (MMF) rate than the use of 2.0-mm nonlocking miniplates (OR, 0.18; 95% CI, 0.08-0.41; P < 0.0001). CONCLUSIONS Mandible fractures treated with 2.0-mm locking miniplates and nonlocking 2.0-mm miniplates present similar short-term complication rates, and the low postoperative maxillomandibular fixation rate of using 2.0-mm locking miniplates also indicates that the 2.0-mm locking miniplate has a promising application in treatment of mandibular fractures.
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Locking versus non-locking plate fixation in the management of mandibular fractures: a meta-analysis. Int J Oral Maxillofac Surg 2014; 43:1243-50. [PMID: 25115355 DOI: 10.1016/j.ijom.2014.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
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Kabasawa Y, Sato M, Kikuchi T, Sato Y, Takahashi Y, Higuchi Y, Omura K. Analysis and comparison of clinical results of bilateral sagittal split ramus osteotomy performed with the use of monocortical locking plate fixation or bicortical screw fixation. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:e333-41. [DOI: 10.1016/j.oooo.2012.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 01/15/2012] [Accepted: 02/01/2012] [Indexed: 11/24/2022]
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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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