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Su CL, Su AC, Chang CC, Lin AYH, Yeh CH. Temporomandibular joint degenerative changes following mandibular fracture: a computed tomography-based study on the role of condylar involvement. Oral Radiol 2024; 40:385-393. [PMID: 38421497 DOI: 10.1007/s11282-024-00742-w] [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: 10/01/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES This study assessed the incidence of postfracture radiological temporomandibular joint (TMJ) degeneration in patients with different types of mandibular fractures, focusing on the impact of condylar fractures. METHODS This retrospective review included patients diagnosed as having mandibular fractures from 2016 to 2020 who had undergone initial computed tomography (CT) and a follow-up CT scan at least 1-month postfracture. Patient demographics, fracture details, treatment methods, and radiological signs of TMJ degeneration on CT were analyzed to identify risk factors for postfracture TMJ degeneration, with a focus on condylar head fracture and non-head (condylar neck or base) fractures. RESULTS The study included 85 patients (mean age: 38.95 ± 17.64 years). The per-patient analysis indicated that the incidence of new radiologic TMJ degeneration on CT was significantly the highest (p < 0.001) in patients with condylar head fractures (90.91%), followed by those with non-head condylar fractures (57.14%), and those without condylar involvement (24.49%). The per-joint analysis indicated nearly inevitable degeneration (93.94%) in 33 TMJs with ipsilateral condylar head fractures. For the remaining 137 TMJs, multivariate logistic regression revealed that other patterns (ipsilateral non-head, contralateral, or both) of condylar fractures (odds ratio (OR) = 3.811, p = 0.007) and the need for open reduction and internal fixation (OR = 5.804, p = 0.005) significantly increased the risk of TMJ degeneration. CONCLUSIONS Ipsilateral non-head condylar fractures and contralateral condylar fractures are associated with a high risk of postfracture TMJ degeneration. Indirect trauma plays a vital role in postfracture TMJ degeneration.
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Affiliation(s)
- Chun-Lin Su
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - An-Chi Su
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chen Chang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Arthur Yen-Hung Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Gamit M, Patel Y, Sood R, Vadera H, Savjani K, Bhatti Z. Comparison of bite force evaluation for mandibular angle fracture fixation by conventional miniplates versus new design miniplates: a clinical study. Oral Maxillofac Surg 2024; 28:645-652. [PMID: 37740128 DOI: 10.1007/s10006-023-01182-2] [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: 01/26/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To evaluate postoperative masticatory efficacy of a new design non-compression titanium miniplate compared to conventional non-compression titanium miniplate on the basis of bite force for treatment of mandibular angle fractures. METHODOLOGY The prospective study included 20 patients with mandibular angle fractures randomly categorized into 2 groups: Group I, fixation of angle fractures by conventional miniplates, and Group II, fixation of angle fractures by new design miniplates. Evaluation was done for clinical outcome, primarily bite force; radiological outcome; and associated postoperative morbidities at different time intervals. RESULTS The results showed to be highly significant in terms of mean operating time for plate adaptation and fixation and bite force adaptation (p = 0.003 at follow-up of 6 months) for the newer miniplate compared to the conventional miniplate. No statistically significant difference was seen for postoperative paresthesia, malunion, non-union, occlusal discrepancy, or hardware failure. CONCLUSION Within the limits of the study, it appears that the single, monocortical, non-compression, superior border new design miniplate proved to be a successful procedure for treating non-comminuted mandibular angle fractures specifically in terms of enhanced postoperative masticatory efficiency as compared to conventional miniplates. Further clinical studies with larger sample size can derive a more comprehensive conclusion.
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Affiliation(s)
- Mruga Gamit
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College and Hospital, Khokhra, Ahmedabad, India
| | - Yashesh Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College and Hospital, Khokhra, Ahmedabad, India.
| | - Ramita Sood
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College and Hospital, Khokhra, Ahmedabad, India
| | - Hitesh Vadera
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College and Hospital, Khokhra, Ahmedabad, India
| | - Kinjal Savjani
- Department of Periodontology, Ahmedabad Municipal Corporation Dental College and Hospital, Khokhra, Ahmedabad, India
| | - Zenish Bhatti
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College and Hospital, Khokhra, Ahmedabad, India
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Omeje KU, Famurewa BA, Agbara R, Fomete B, Suleiman A, Bardi M, Owobu T. Mandibular fractures in Kano, Northwest Nigeria: etiology and pattern of presentation. Minerva Dent Oral Sci 2024; 73:69-74. [PMID: 33929128 DOI: 10.23736/s2724-6329.21.04417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mandibular fractures are universal in distribution, but its etiologies and presentation patterns differ from one country to another because of varying socioeconomic, cultural and geographical factors. We analyzed the etiological factors and presentation patterns of mandibular fractures in a tertiary hospital at Nigeria's second largest city. METHODS Patients with isolated mandibular fractures at Aminu Kano Teaching Hospital, Kano were prospectively reviewed over a 12-months period. Patients' demographic information and fracture characteristics (etiology, site, pattern and number of fracture) were recorded and analyzed. RESULTS One hundred and forty-eight patients presented with 180 mandibular fractures. There were eight-fold higher men with mandibular fractures than women (M: F =8.3:1) with highest incidence in third decade of life. Road traffic accidents (84.46%) was the major etiology while iatrogenic fracture (0.68%) was found in one patient. Mandibular body was the most fractured site (41.11%) with parasymphyseal and angle regions accounting for 27.78% and 23.89% of total recorded fractures respectively. CONCLUSIONS Mandibular fractures in Kano, Northwest Nigeria occurred predominantly in men in the third decade and are mostly caused by road traffic accidents. The majority of these fractures involved the mandibular body.
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Affiliation(s)
- Kelvin U Omeje
- Department of Oral/Maxillofacial Surgery, Bayero University, Kano, Nigeria
| | - Bamidele A Famurewa
- Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria -
| | - Rowland Agbara
- Department of Dental and Maxillofacial Surgery, University of Jos, Jos, Nigeria
| | - Benjamin Fomete
- Department of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Martins Bardi
- Department of Oral/Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
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Hesham A, Geiger J, Alshamrani Y, Sawatari Y. Can the Mechanism of Injury Impact the Location of a Mandibular Fracture? A Systematic Review. J Maxillofac Oral Surg 2024; 23:363-370. [PMID: 38601229 PMCID: PMC11001800 DOI: 10.1007/s12663-022-01750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 06/05/2022] [Indexed: 10/16/2022] Open
Abstract
Purpose Mandible fractures are the second most common fractures of the facial skeleton because of the prominent position of the lower jaw. The purpose of this study was to calculate the prevalence of mandibular fractures based on their causes and locations. Materials and Method A systematic search of 3 electronic databases from January 2010 and January 2020 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 359 articles identified for screening against selection criteria. The search identified 39 articles to be included in our analysis. Results A total of 20,135 patients with 31,468 mandible fractures in this review. There was a 76% male predominance. The third decade was the most common age group (21-30). Motor vehicle accidents (39.89%) were the leading cause of mandible fractures, followed by falls (27.72%) and violence (25.35%). Condylar fractures are the most common cause of MVA and fall (33.11%, 50% respectively). Mandible body fractures are the second most common type of MVA injury (17.06%). When it came to violence, the angle of the mandible was the most common site (31.73%). Conclusions The prevalence of mandible fractures was higher in male patients in the current study, particularly in the second and third decades of life. Road traffic accidents were the most common cause, and the condylar process of the mandible was the most frequently affected region. Demographic data such as age, gender, and mechanism of injury can help surgeons predict and identify specific areas of mandibular fracture.
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Affiliation(s)
- Abdulrahman Hesham
- Department of Oral and Maxillofacial Surgery, University of Miami and Jackson Memorial Hospital, Miami, FL USA
| | - Joseph Geiger
- Department of Oral and Maxillofacial Surgery, University of Miami and Jackson Memorial Hospital, Miami, FL USA
| | - Yousef Alshamrani
- Department of Oral and Maxillofacial Surgery, University of Miami and Jackson Memorial Hospital, Miami, FL USA
| | - Yoh Sawatari
- Department of Oral and Maxillofacial Surgery, University of Miami and Jackson Memorial Hospital, Miami, FL USA
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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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McIntire DR, Spake CS, Jehle CC, Basta MN, Crozier JW, Woo AS. Mandible Fractures Undergoing Transfer Rarely Require Acute Intervention. Craniomaxillofac Trauma Reconstr 2024; 17:40-46. [PMID: 38371222 PMCID: PMC10874203 DOI: 10.1177/19433875231161907] [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: 02/20/2024] Open
Abstract
Study Design A retrospective review was conducted of all patients with mandibular fractures who were evaluated by plastic surgery at a Level I trauma center between January 1, 2017 and May 1, 2020. Data including demographic characteristics, mechanism of injury, type of presentation (e.g., primary or transfer), treatment plan, and time to intervention were recorded. Objective Mandibular fractures are common traumatic injuries. Because these injuries are managed by surgical specialists, these patients are often emergently transferred to tertiary care hospitals. This study aims to assess the benefits of emergent transfer in this patient group. Methods Variables were summarized using descriptive statistics. The relationship with initial disposition was assessed via tests of association, including Student's t-test, Fisher's exact test, or chi-square tests. Significance was set to p values less than 0.05. Multivariate regression analysis was conducted to determine predictors of presentation to outside hospital followed by transfer to our institution. Results Records from 406 patients with isolated mandibular fractures were evaluated. 145 (36%) were transferred from an outside hospital specifically for specialty evaluation. One patient required intervention in the Emergency Department (ED). Of the 145 patients that were transferred to our facility, eight (5.5%) were admitted for operative management. Patients with open injuries and pediatric patients showed benefit from transfer. Conclusions Patients are frequently transferred to tertiary care facilities for specialty service evaluation and treatment. However, when isolated mandible fractures were evaluated, only one patient required intervention in the ED. Patients with grossly open fractures and pediatric patients were more frequently admitted specifically for operative management. This practice of acute interfacility transfer represents an unnecessary cost to our health system as isolated mandible fractures can be managed on an outpatient basis. We suggest that pediatric patients and patients with open fractures be transferred for urgent evaluation and management, whereas most patients would be appropriate for outpatient evaluation.
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Affiliation(s)
- Damon R.T. McIntire
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Carole S.L. Spake
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Charles C. Jehle
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Marten N. Basta
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Joseph W. Crozier
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Albert S. Woo
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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Sohail A, Chishti FUDA, Manzar S, Zahid N, Ahmad F, Rafiq T. Can dynamic elastic therapy be established as the standard protocol of closed reduction for moderately displaced extracapsular condylar fractures? Oral Maxillofac Surg 2024; 28:385-391. [PMID: 37185928 DOI: 10.1007/s10006-023-01154-6] [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: 07/31/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study was conducted with the aim to establish standard technique of closed reduction (CR) and compare functional outcomes in patients of moderately displaced unilateral extracapsular condylar fractures. MATERIAL AND METHODS This study is a retrospective randomized controlled trial, conducted at a tertiary care hospital setting from August, 2013 to November, 2018. Patients of unilateral extracapsular condylar fractures with ramus shortening < 7mm and deviation < 35° were divided in two groups by drawing lots and were treated by dynamic elastic therapy and maxillomandibular fixation (MMF). Mean and standard deviation were calculated for quantitative variables, and one way analysis of variance (ANOVA) and Pearson's Chi-square test were used to determine significance of outcomes between two modalities of CR. P value < 0.05 was taken as significant. RESULTS The numbers of patients treated by dynamic elastic therapy and MMF were 76 (38 in each group). Out of which 48 (63.15%) were male and 28 (36.84%) were female. The ratio of male to female was 1.7:1. The mean ± standard deviation (SD) of age was 32 ± 9.57 years. In patients treated by dynamic elastic therapy, the mean ± SD (at 6-month follow-up) of loss of ramus height (LRH), maximum incisal opening (MIO) and opening deviation were 4.6mm ± 1.08mm, 40.4mm ± 1.57mm and 1.1mm ± 0.87mm respectively. Whereas, LRH, MIO and opening deviation were 4.6mm ± 0.85mm, 40.4mm ± 2.37mm and 0.8mm ± 0.63mm respectively by MMF therapy. One-way ANOVA was statistically insignificant (P value > 0.05) for above mentioned outcomes. Pre-traumatic occlusion was achieved in 89.47% of patients by MMF and in 86.84% patients by dynamic elastic therapy. Pearson's Chi-square test was statistically insignificant (p value < 0.05) for occlusion. CONCLUSION Parallel results were obtained for both modalities; thus, the technique as dynamic elastic therapy, which promotes early mobilization and functional rehabilitation, can be favored as standard technique of closed reduction for moderately displaced extracapsular condylar fractures. This technique eases patients' stress associated with MMF and prevents ankylosis.
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Affiliation(s)
- Aqib Sohail
- Dental College, Lahore Medical & Dental College, Lahore, Pakistan
| | | | - Saadia Manzar
- Department of Oral & Maxillofacial Surgery, Rashid Latif Dental College/Rashid Latif Medical Complex, Lahore, Pakistan.
| | - Nighat Zahid
- Department of Oral & Maxillofacial Surgery, Lahore Medical & Dental College, Lahore, Pakistan
| | - Fareed Ahmad
- Department of Oral Medicine, CMH Lahore Medical College & Institute of Dentistry, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Tayyaba Rafiq
- Department of Oral & Maxillofacial Surgery, Lahore Medical & Dental College, Lahore, Pakistan
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Gontarz M, Bargiel J, Gąsiorowski K, Marecik T, Szczurowski P, Zapała J, Wyszyńska-Pawelec G. "Air Sign" in Misdiagnosed Mandibular Fractures Based on CT and CBCT Evaluation. Diagnostics (Basel) 2024; 14:362. [PMID: 38396403 PMCID: PMC10888197 DOI: 10.3390/diagnostics14040362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Diagnostic errors constitute one of the reasons for the improper and often delayed treatment of mandibular fractures. The aim of this study was to present a series of cases involving undiagnosed concomitant secondary fractures in the mandibular body during preoperative diagnostics. Additionally, this study aimed to describe the "air sign" as an indirect indicator of a mandibular body fracture. METHODS A retrospective analysis of CT/CBCT scans conducted before surgery was performed on patients misdiagnosed with a mandibular body fracture within a one-year period. RESULTS Among the 75 patients who underwent surgical treatment for mandibular fractures, mandibular body fractures were missed in 3 cases (4%) before surgery. The analysis of CT/CBCT before surgery revealed the presence of an air collection, termed the "air sign", in the soft tissue adjacent to each misdiagnosed fracture of the mandibular body. CONCLUSIONS The "air sign" in a CT/CBCT scan may serve as an additional indirect indication of a fracture in the mandibular body. Its presence should prompt the surgeon to conduct a more thorough clinical examination of the patient under general anesthesia after completing the ORIF procedure in order to rule-out additional fractures.
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Affiliation(s)
- Michał Gontarz
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.B.); (K.G.); (T.M.); (P.S.); (J.Z.); (G.W.-P.)
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Egelko A, Kahler D, Donovan B, Gardella R, Reddy S, Jones C. Food Desert Residence Is Not Associated With Dietary Adherence or Complication Rates in Patients With Isolated Mandibular Fractures. J Oral Maxillofac Surg 2024; 82:191-198. [PMID: 37980938 DOI: 10.1016/j.joms.2023.10.009] [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: 05/22/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Mandible fracture management requires postoperative dietary modifications to promote healing. Over 20 million Americans live in food deserts, low-income neighborhoods over one mile from a grocery store. The relationship between food desert residence (FDR) and adherence to postoperative dietary instructions remains unexplored. PURPOSE This study's purpose is to evaluate the relationships between FDR, known risk factors, dietary adherence, and complications among patients with isolated mandible fractures. STUDY DESIGN, SETTING, SAMPLE This retrospective cohort study was conducted at a level 1 trauma center and analyzed patients with mandible fractures between January 2015 and December 2020. Inclusion criteria included operative treatment of adult patients for mandible fractures; pregnant, incarcerated, and patients with incomplete data were excluded. PREDICTOR VARIABLE FDR was the predictor variable of interest. FDR (coded yes or no) was generated by converting patient addresses to census tract GeoIDs and comparing them to the US Department of Agriculture Food Access Research Atlas. MAIN OUTCOME VARIABLES The study examined two outcome variables: dietary adherence and postoperative complications. Dietary adherence was coded as adherent or nonadherent, indicating documented compliance with postoperative dietary modifications. Postoperative complications were coded as present or absent, reflecting infection, hardware failure, and mandible malunion or nonunion. COVARIATES The covariates analyzed included age, sex, ethnicity, mechanism of injury, medical and psychiatric comorbidities (including diagnoses such as diabetes, hypertension, and schizophrenia), and tobacco use. ANALYSES Relative risks (RRs) and multivariate logistic regression models were generated for both outcome variables. Two-tailed P values < 0.05 were considered statistically significant. RESULTS During the study period, 143 patients had complete data allowing for FDR and dietary adherence determination, 124 of whom (86.7%) had complication data recorded. Of the cohort, 51/143 (35.7%) resided within a food desert, 30/143 (21.0%) exhibited dietary nonadherence, and 46/124 (37.1%) experienced complications. FDR was not associated with increased risk of dietary nonadherence (RR 0.92, 95% confidence interval [CI] 0.52 to 1.61, P = .76) or complications (RR 1.19, 95% CI 0.75 to 1.89; P = .46). On multivariate regression, dietary nonadherence was associated with increased complications (odds ratio 2.85, 95% CI 1.01 to 8.09, P = .049). CONCLUSION AND RELEVANCE There was no association between FDR and dietary nonadherence or complications in mandible fracture patients. However, dietary nonadherence was associated with complications, highlighting the need for further research and intervention.
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Affiliation(s)
- Aron Egelko
- Resident Physician, Department of General Surgery, Temple University Hospital, Philadelphia, PA.
| | - Dylan Kahler
- Resident Physician, Department of General Surgery, Temple University Hospital, Philadelphia, PA
| | - Brienne Donovan
- Resident Physician, Department of General Surgery, Temple University Hospital, Philadelphia, PA
| | - Rebecca Gardella
- Medical Student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Sai Reddy
- Medical Student, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Christine Jones
- Assistant Professor, Division of Plastic and Reconstructive Surgery, Temple University Hospital, Philadelphia, PA
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10
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Cohn JE, Othman S, Zaransky S, Zwillenberg S. Factors Associated With Complications and Failure in Transoral, Mandible Fracture Repair. J Craniofac Surg 2024:00001665-990000000-01283. [PMID: 38231251 DOI: 10.1097/scs.0000000000009961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE Open reduction internal fixation (ORIF) of the mandible has been a well-studied topic. However, there has not been a study investigating the relationship between suture type and complications. METHODS A retrospective chart review of patients who sustained mandibular fractures was conducted at an urban level I trauma center (2010-2018). Descriptive statistics were used to categorize the sociodemographic data. χ2 and Mann-Whitney U testing were used to compare variables between the polyglactin 910 (vicryl) and chromic sutured groups. RESULTS The study cohort consisted of 102 patients who underwent ORIF of the mandible through the transoral approach. Fifty-nine (57.8%) patients were closed with vicryl suture, whereas 43 (42.2%) with chromic gut suture. There were no differences in sociodemographics, immune status, substance abuse status, fracture type, time to repair, and managing care team between the two groups. Both groups had similar rates of wound dehiscence, infection, and revision surgery. Patients who were operated on earlier were more likely to experience a postoperative infection and dehiscence compared with patients operated on later (P = 0.029 and P = 0.008, respectively). Smokers were more likely to experience dehiscence compared with nonsmokers (P = 0.001). Females and immunocompromised patients were more likely to require revision surgery (P < 0.001). CONCLUSION Suture type for transoral, ORIF of the mandible does not impact the rate of infection, wound dehiscence, and revision surgery. However, risk factors for complications can include early operative repair, smoking, female sex, and immunosuppression.
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Affiliation(s)
- Jason E Cohn
- Department of Facial Plastic Surgery, Sunrise ENT, Lindenhurst
| | - Sammy Othman
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY
| | - Sydney Zaransky
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Seth Zwillenberg
- Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA
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Koti AS, Vega S, Johnson KL, Schlatter A, Ayson N, Menashe SJ, Feldman KW. Accidental and Abusive Mandible Fractures in Infants and Toddlers. Pediatr Emerg Care 2023; 39:923-928. [PMID: 36728119 DOI: 10.1097/pec.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Mandible fractures are uncommon injuries in infants and young children and may raise concern for nonaccidental trauma. Our study describes several children with mandible fractures to identify features that might differentiate abuse from accident. METHODS Records and imaging were reviewed for children aged 24 months and younger who were diagnosed with mandible fractures at 2 tertiary pediatric care centers. Twenty-one cases were included, 8 of whom had formal child abuse consultations. Cases were reviewed for mechanisms of injury, physical examination findings, and occult injuries identified, as well as the final abuse determination. RESULTS Among children with child abuse consultations, 5 injuries (62.5%) were determined to be accidental, 1 (12.5%) was abusive, and 2 were indeterminate for abuse or accident (25%). In each accidentally injured child, the reported mechanism of injury was a short fall with evidence of facial impact. No accidentally injured child had unexpected occult injuries or noncraniofacial cutaneous injuries. CONCLUSIONS Infants and young children can sometimes sustain mandible fractures accidentally after well-described short falls with evidence of facial impact. Abuse remains in the differential diagnosis, and children should be evaluated accordingly. We propose that accidental injury be considered when a well-evaluated child with an isolated mandible fracture has a history of a short fall.
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Demir O, Uslan I, Buyuk M, Salamci MU. Development and validation of a digital twin of the human lower jaw under impact loading by using non-linear finite element analyses. J Mech Behav Biomed Mater 2023; 148:106207. [PMID: 37922761 DOI: 10.1016/j.jmbbm.2023.106207] [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: 07/09/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
Mandibular fractures are one of the most frequently observed injuries within craniofacial region mostly due to tumor-related problems and traumatic events, often related to non-linear effects like impact loading. Therefore, a validated digital twin of the mandible is required to develop the best possible patient-specific treatment. However, there is a need to obtain a fully compatible numerical model that can reflect the patients' characteristics, be available and accessible quickly, require an acceptable level of modeling efforts and knowledge to provide accurate, robust and fast results at the same time under highly non-linear effects. In this study, a validated simulation methodology is suggested to develop a digital twin of mandible, capable of predicting the non-linear response of the biomechanical system under impact loading, which then can be utilized to design treatment strategies even for multiple fractures of the mandibular system. Using Computed Tomography data containing cranial (skull) images of a patient, a 3-dimensional mandibular model, which consists cortical and cancellous bones, disks and fossa is obtained with high accuracy that is compatible with anatomical boundaries. A Finite Element Model (FEM) of the biomechanical system is then developed for a three-level validation procedure including (A) modal analysis, (B) dynamic loading and (C) impact loading. For the modal analysis stage: Free-free vibration modes and frequencies of the system are validated against cadaver test results. For the dynamic loading stage: Two different regions of the mandible are loaded, and maximum stress levels of the system are validated against finite element analyses (FEA) results, where the first loading condition (i) transfers a 2000 N force acting on the symphysis region and, the second loading condition (ii) transfers a 2000 N force acting on the left body region. In both cases, equivalent muscle forces dependent on time are applied. For the impact loading stage: Thirteen different human mandibular models with various tooth deficiencies are used under the effects of traumatic impact forces that are generated by using an impact hammer with different initial velocities to transfer the impulse and momentum, where contact forces and fracture patterns are validated against cadaver tests. Five different anatomical regions are selected as the impact site. The results of the analyzes (modal, dynamic and impact) performed to validate the digital twin model are compared with the similar FEA and cadaver test results published in the literature and the results are found to be compatible. It has been evaluated that the digital twin model and numerical models are quite realistic and perform well in terms of predicting the biomechanical behavior of the mandible. The three-level validation methodology that is suggested in this research by utilizing non-linear FEA has provided a reliable road map to develop a digital twin of a biomechanical system with enough confidence that it can be utilized for similar structures to offer patient-specific treatments and can help develop custom or tailor-made implants or prosthesis for best compliance with the patient even considering the most catastrophic effects of impact related trauma.
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Affiliation(s)
- Osman Demir
- Gulhane Medical Design and Manufacturing Application and Research Center-SBU-METUM, University of Health Sciences, 06010, Ankara, Turkey; Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey.
| | | | - Murat Buyuk
- Department of Engineering Sciences, Middle East Technical University, 06800, Ankara, Turkey.
| | - Metin Uymaz Salamci
- Department of Mechanical Engineering, Gazi University, 06570, Ankara, Turkey; Additive Manufacturing Technologies Research and Application Center-EKTAM, Gazi University, 06980, Ankara, Turkey.
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13
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Adik K, Lamb P, Moran M, Childs D, Francis A, Vinyard CJ. Trends in mandibular fractures in the USA: A 20-year retrospective analysis. Dent Traumatol 2023; 39:425-436. [PMID: 37291803 DOI: 10.1111/edt.12857] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND/AIM The mandible is one of the most fractured bones in the maxillofacial region. This study analyzes trends in mandibular fracture patterns, demographics, and mechanisms since the early 2000s. MATERIAL AND METHODS Mandibular fractures were reviewed from the 2007, 2011, and 2017 National Trauma Data Bank including 13,142, 17,057, and 20,391 patients by year, respectively. This database contains hundreds of thousands of patients annually and represents the largest trauma registry in the United States. Variables included number of fractures, sex, age, injury mechanism, and fracture location. Mechanism of injury included assault, motor vehicle crash, fall, motorcycle, bicycle, pedestrian, and firearm. Anatomic locations based on ICD-9/10 codes included symphysis, ramus, condyle, condylar process, body, angle, and coronoid process. Frequencies were compared using Chi-square tests of homogeneity with effect sizes estimated using Cramer's V. RESULTS Mandibular fractures represent 2%-2.5% of all traumas reported in the database from 2001 to 2017. The proportion of patients sustaining a single reported mandibular fracture decreased from 82% in 2007 to 63% in 2017. Males consistently experienced 78%-80% of fractures. Eighteen to 54-year-olds experienced the largest percentages of fractures throughout the 21st century, while median age of fracture shifted from 28 to 32 between 2007 and 2017. The most common fracture mechanisms were assault (42% [2001-2005]-37% [2017]), motor vehicle crash (31%-22%) followed by falls (15%-20%). From 2001-2005 to 2017, a decrease was observed in assaults (-5%) and motor vehicle crash (-9%) and an increase in falls (+5%), particularly among elderly females. The mandibular body, condyle, angle, and symphysis represent approximately two-thirds of all fractures without a consistent temporal trend among them. CONCLUSIONS The temporal trends observed can be linked to shifting age demographics nationally that may aid clinicians in diagnosis and inform public safety policies aimed at reducing these injuries, particularly among the growing elderly population.
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Affiliation(s)
- Kevin Adik
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Patrick Lamb
- Department of Plastic Surgery, Summa Health, Akron, Ohio, USA
| | - Mary Moran
- Department of Trauma, Summa Health, Akron, Ohio, USA
| | - Dylan Childs
- Department of Plastic Surgery, Summa Health, Akron, Ohio, USA
| | - Ashish Francis
- Department of Plastic Surgery, Summa Health, Akron, Ohio, USA
| | - Christopher J Vinyard
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
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14
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Ay N, Yildirimturk Dogan S, Sirin Y. The biomechanical stability of miniplate osteosynthesis configurations in bilateral mandibular angle fractures. J Oral Sci 2023; 65:265-269. [PMID: 37648469 DOI: 10.2334/josnusd.23-0164] [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: 09/01/2023]
Abstract
PURPOSE The present study investigated the biomechanical stability of three miniplate osteosynthesis configurations used for internal fixation of bilateral mandibular angle fracture (BMAF). METHODS Standard fracture lines were created in 72 polyurethane mandibles and stabilized with 2.0-mm, 4-hole standard titanium miniplates and monocortical screws. The group descriptions and miniplate configurations were: 2Plates (1-1), 3Plates (1-2) and 4Plates (2-2). The mandibles were subjected to either incisal or molar loads (from both sides in the 3Plates group) up to a force of 120 N. The displacements of the constructs were recorded at each force increment of 10 N. ANOVA and Tukey's post-hoc tests were used for statistical analysis. RESULTS The 2Plates group showed higher displacement under both loading conditions (P < 0.05 for each). The same group reached displacement levels of 1 mm and 3 mm during molar loading and 1 mm, 3 mm, and 5 mm during incisal loading at lower force magnitudes relative to others (P < 0.05 for each). CONCLUSION Bone-plate constructs for BMAFs stabilized with three or four standard miniplates are more likely to provide similar resistance when subjected to incisal or molar loads, in contrast to the two-miniplate configuration, which is relatively more prone to displacement.
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Affiliation(s)
- Nida Ay
- Graduate School of Health Sciences, Department of Oral and Maxillofacial Surgery, Istanbul University
| | | | - Yigit Sirin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University
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15
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Cho RY, Byun SH, Park SY, On SW, Kim JC, Yang BE. Patient-specific plates for facial fracture surgery: A retrospective case series. J Dent 2023; 137:104650. [PMID: 37544353 DOI: 10.1016/j.jdent.2023.104650] [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: 10/18/2022] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVES Surgeons often encounter challenges when treating maxillofacial fractures using conventional methods that involve trimming or bending ready-made titanium plates for open reduction and internal fixation (ORIF) since it can be time-consuming, imprecise, and inconvenient. This retrospective case series aimed to introduce a novel bone reduction method that utilizes virtual planning, patient-specific surgical guides, and titanium plates. METHODS Seven patients with mandibular symphysis or subcondylar fractures resulting from facial trauma underwent cone-beam computed tomography (CBCT) or facial CT scans, and their medical histories were documented. Virtual surgery was conducted based on three-dimensional (3D) stereolithography images derived from CT scans using the FaceGide software (MegaGen, Daegu, Korea). ORIF was performed using patient-specific surgical guides and plates that were designed, printed, and milled. Radiographic, clinical, and occlusal evaluations were conducted at two weeks and six weeks postoperatively. Subsequently, 3D images from virtual surgery and postoperative CT scans were compared. RESULTS The comparison of 3D virtual surgery and postoperative images revealed minimal surface differences of less than 1 mm. T-scan evaluations indicated that there were no statistically significant differences between the two- and six-week postoperative assessments. Favorable clinical outcomes were observed. CONCLUSION This novel method demonstrated stable outcomes in terms of occlusion and healing, with no notable complications. Consequently, this approach may serve as a viable alternative to conventional methods. CLINICAL SIGNIFICANCE Facial fracture surgery that utilizes patient-specific surgical guides and plates within a digital workflow can facilitate meticulous surgical planning, reducing the risk of complications and minimizing operation time.
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Affiliation(s)
- Ran-Yeong Cho
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Soo-Hwan Byun
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sang-Yoon Park
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea
| | - Sung-Woon On
- Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea
| | - Jong-Cheol Kim
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Mir Dental Hospital, Daegu 41940, Republic of Korea
| | - Byoung-Eun Yang
- Department of Oral and Maxillofacial Surgery, Hallym University Sacred Heart Hospital, Anyang 14066, Republic of Korea; Department of Artificial Intelligence and Robotics in Dentistry, Graduate School of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea; Institute of Clinical Dentistry, Hallym University, Chuncheon 24252, Republic of Korea.
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16
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Amran AJ, Rizqiawan A, Mulyawan I, Prasetio O, Subagio EW, Rahman MZ. Quality of Life Evaluation of Postsurgical Mandibular Fracture Patients with Oral Health Impact Profile 14 and General Oral Health Assessment Index Parameters. Eur J Dent 2023; 17:1309-1315. [PMID: 36977476 PMCID: PMC10756817 DOI: 10.1055/s-0043-1761450] [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: 03/30/2023] Open
Abstract
OBJECTIVE Mandibular fracture is the most common maxillofacial fracture accompanied by complaints of malocclusion and pain. This causes a decrease in the quality of life. Mandibular fracture management can be done with open reduction and internal fixation or intermaxillary fixation. The Oral Health Impact Profile (OHIP 14) and the General Oral Health Assessment Index (GOHAI) were used to evaluate the quality of life after surgical treatment based on the distribution of age, sex, type of neglect, and surgical management. MATERIALS AND METHODS This research is an analytic study with an analytical observational method with total sampling. The total sample used was 15 patients during the 2006 to 2020 period. The results of this study were scored, and then, the data were processed using the eta test. RESULTS The results of the study based on the OHIP 14 parameters showed the results of each distribution, namely, age: p = 0.154, gender: p = 0.080, neglected type: p = 0.080, and management: p = 0.419. Meanwhile, the GOHAI parameters showed the results of each distribution, namely, age: p = 0.105, gender: p = 0.356, neglected type: p = 0.356, and management p = 0.286. The results of this distribution showed that there was no significant difference between patients' quality of life based on age, sex, neglected type, and treatment using both OHIP 14 and GOHAI parameters. CONCLUSIONS The results obtained in this study using characteristics of age, gender, type of fracture, type of neglect, and management did not have a significant effect on the level of patient satisfaction after surgery, using both OHIP 14 and GOHAI questionnaires.
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Affiliation(s)
- Ardian Jayakusuma Amran
- Postgraduate Program, Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Muslim Indonesia, Indonesia
| | - Andra Rizqiawan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Oral and Maxillofacial Surgery Dental Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Indra Mulyawan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Oral and Maxillofacial Surgery Dental Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Okky Prasetio
- Department of Oral and Maxillofacial Surgery, M. Soewandhie Hospital, Surabaya, Indonesia
| | - Eko Wicaksono Subagio
- Postgraduate Program, Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mohammad Zeshaan Rahman
- Department Oral and Maxillofacial Surgery, Pioneer Dental College and Hospital, Dhaka, Bangladesh
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17
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Rivis M, Juncar RI, Moca AE, Moca RT, Juncar M, Țenț PA. Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study. J Clin Med 2023; 12:4103. [PMID: 37373796 DOI: 10.3390/jcm12124103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20-29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines.
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Affiliation(s)
- Mircea Rivis
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeș" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 30041 Timișoara, Romania
| | - Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Rahela Tabita Moca
- Doctoral School of Biomedical Sciences, University of Oradea, 1 Universității Street, 410087 Oradea, Romania
| | - Mihai Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Paul Andrei Țenț
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
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18
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Yoshida K. Superior Dislocation of the Mandibular Condyle into the Middle Cranial Fossa: A Comprehensive Review of the Literature. J Clin Med 2023; 12:jcm12113781. [PMID: 37297975 DOI: 10.3390/jcm12113781] [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: 04/04/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from inception to 31 October 2022. A total of 116 cases from 104 studies were assessed; among the patients, 60% and 87.5% of the affected women and men required open reduction, respectively. The ratio of closed to open procedures within 7 days after injury was maintained; however, closed reduction decreased over time, and all cases required open reduction after 22 days. Eighty percent of the patients with a total intrusion of the condyle required open reduction, whereas the frequency for both procedures was comparable in the remaining patients. Open reduction was significantly more frequently performed for men (p = 0.026, odds ratio; 4.959, 95% confidence interval; 1.208-20.365) and less frequently performed in cases with partial intrusion (p = 0.011; odds ratio: 0.186; 95% confidence interval: 0.051-0.684); the frequency varied according to the time until treatment (p = 0.027, odds ratio; 1.124, 95% confidence interval; 1.013-1.246). Appropriate diagnostic imaging and prompt diagnosis are indispensable for minimally invasive treatment of this condition.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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19
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Canas M, Fonseca R, Diaz L, Filippis AD, Afzal H, Aldana JA, Machica C, Leonard J, Liang SY, Bochicchio K, Bochicchio GV. Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Assault. Surg Infect (Larchmt) 2023; 24:376-381. [PMID: 36799978 PMCID: PMC10398716 DOI: 10.1089/sur.2022.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.
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Affiliation(s)
- Melissa Canas
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ricardo Fonseca
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonardo Diaz
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alejandro De Filippis
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hussain Afzal
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jose A. Aldana
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chris Machica
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer Leonard
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y. Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelly Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant V. Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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20
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Fabrega M. Imaging of Maxillofacial Trauma. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00003-1. [PMID: 37032179 DOI: 10.1016/j.coms.2023.02.001] [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: 04/11/2023]
Abstract
Maxillofacial trauma is common. Computed tomography is the primary imaging tool for diagnosis. Study interpretation is aided by understanding regional anatomy and clinically relevant features of each subunit. Common injury patterns and the most important factors related to surgical management are discussed.
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Affiliation(s)
- Miguel Fabrega
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UTHealth Houston, University of Texas at Houston, MSB 2.130B, 6431 Fannin Street, Houston, TX 77030, USA.
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21
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Soliman L, King V, Yeoh MS, Woo AS. Update on ladder plates for mandibular angle fractures. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00056. [PMID: 36977126 DOI: 10.1097/moo.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE OF REVIEW Fractures of the mandibular angle are surgically challenging with high rates of postoperative complications. Among established fixation techniques for these injuries, Champy's tension band approach with miniplate fixation has held prominence. Rigid fixation, using two plates, also remains commonly used. More recently, geometric ladder plates, which confer greater three-dimensional stability have been developed to overcome the shortcomings of conventional fixation approaches. Herein, we aim to summarize the recent evidence surrounding the use of ladder plates and offer our own opinion for optimal treatment of these fractures. RECENT FINDINGS In high-powered studies, the rates of hardware failure, malocclusion, and malunion are lower among cohorts managed with ladder plates relative to miniplate groups. Rates of infection and paresthesia remain similar. Ladder plates have also been shown to decrease operative time in preliminary study. SUMMARY Ladder plates show superiority to miniplate approaches across several outcomes. However, the relatively larger strut plate constructs may not be necessary for minor, uncomplicated fractures. It is our belief that reasonable outcomes may be achieved with either approach depending on surgeon experience and comfort with the given fixation technique.
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Affiliation(s)
- Luke Soliman
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Victor King
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melvyn S Yeoh
- Division of Oral and Maxillofacial Surgery, University of Kentucky College of Dentistry, Lexington, Kentucky, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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22
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Barrett T, Chi J. Evidence-Based Medicine for Mandible Fracture Repair: Current Controversies and Future Opportunities. Facial Plast Surg 2023; 39:214-219. [PMID: 36603829 DOI: 10.1055/a-2008-2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Mandibular fractures are among the most common facial fractures resulting from trauma. The nature of the injury, involved facial structures, presence of associated injuries, the dental status of the patient, comorbid conditions, and psychosocial context all must be considered by the surgeon when planning the optimal treatment for these patients. While consensus exists for many aspects of the management of mandibular trauma, some elements remain controversial. Three such topics-antibiotic therapy, treatment of subcondylar fractures, and management of the third molar-remain particularly controversial, with significant heterogeneity in practice patterns and without widely accepted evidence-based guidelines to standardize care. The goals of this work are to (1) review the historical perspective underlying these controversies, (2) summarize recent evidence shaping the current debate, and (3) highlight opportunities for continued efforts to identify best practices.
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Affiliation(s)
- Thomas Barrett
- Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - John Chi
- Department of Otolaryngology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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23
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Shah J, Wang F, Ricci JA. Concomitant Cervical Spine Injuries in Pediatric Maxillofacial Trauma: An 11 Year Review of the National Trauma Data Bank. J Oral Maxillofac Surg 2023; 81:413-423. [PMID: 36620992 DOI: 10.1016/j.joms.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Craniofacial trauma with concomitant cervical fractures (CCFs) is responsible for significant morbidity and mortality in the pediatric population. We aim to characterize its incidence, injury patterns, outcomes, and risk factors, along with identifying any association between mandible fractures and cervical injuries via the National Trauma Databank. METHODS A retrospective cohort study was performed using National Trauma Databank records between 2007 and 2017 to identify patients equal or under the age of 18 years hospitalized for maxillofacial trauma and with recorded cervical injury. Variables of interest include age, gender, race/ethnicity, trauma type (blunt vs penetrating), Injury Severity Score, area involved, mechanism of injury, comorbid conditions, inpatient complications, and discharge disposition. Retrospective cohorts were separated by CCF status. Univariate, bivariate, and multivariable regression analysis was utilized, with P-value <.05 considered statistically significant. RESULTS A total of 32,952 patients were included in the study, with the majority being White (60.8%), male (68.2%), and between the ages of 13 and 18 years (65%). Of these, 8.2% experienced CCF. Most common mechanisms of injury were motor vehicle trauma (32.6%), interpersonal violence (18.8%), and falls (13.5%). Univariate analysis revealed patients with CCF were significantly older (15.2 vs 12.9; P < .001), more likely to be motor vehicle occupants (46.6 vs 31.9%; P < .001), and suffer polyfacial fractures (62.6 vs 60.7%; P < .001). Longer length of stay (9.4 vs 3.6 days; P < .001) and significantly higher inpatient complications such as deep vein thrombosis, pulmonary embolism, unplanned intubation, severe sepsis, pressure ulcer, ventilator-associated pneumonia, and unplanned return to operating room were observed in the CCF cohort. Female gender (1.5 [1.37 to 1.64; 95% confidence interval {CI}] P < .001) and higher Injury Severity Score (1.12 [1.11 to 1.11; 95% CI] P < .001) were associated with significantly higher odds on multivariable analysis. The presence of a mandible fracture was not associated with increased CCF on multivariate analysis (1.06 [0.92 to 1.22; 95% CI] P = .36). CONCLUSIONS There are statistically significant differences in demographics, outcomes, and injury patterns in maxillofacial patients with CCF that may help guide treatment. No association between mandible fractures and cervical trauma was identified.
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Affiliation(s)
- Jinesh Shah
- Resident, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Fei Wang
- Research Assistant, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Joseph A Ricci
- Assistant Professor, Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY.
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Retrospective clinical study of mandible fractures. Maxillofac Plast Reconstr Surg 2022; 44:36. [PMID: 36322224 PMCID: PMC9628403 DOI: 10.1186/s40902-022-00365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background As society becomes more complex, the incidence of mandibular fractures is increasing. This study aimed to analyze the incidence and type and identify etiological factors of mandibular fractures to use them in future treatments. Material and methods Data were collected from 224 patients who visited the department of oral and maxillofacial surgery at the Kyung Hee Medical Center dental hospital during a 6-year period (2016 to 2021). A logistic regression model was used for data analysis. Results In a total of 224 patients, 362 fractures were appeared. The average age of the patients was 34.1 years, with the highest incidence in the 20s. And the ratio between male and female was 4.09:1. Symphysis fractures were the most prevalent of all patients (52.7%), followed by unilateral condyle (37.1%), angle (36.2%), bilateral condyle (9.4%), body (8%), and coronoid (2.2%). The most common cause of fracture was daily-life activity (57.6%), followed by violence (30.4%), traffic accidents (8.5%), and syncope (3.6%). Patients with symphysis fracture were at low risk (OR < 1) of angle, body, and unilateral condyle fractures. Similarly, patients with unilateral fracture were at low risk (OR < 1) of symphysis, angle, body, and others site fractures. In contrast, patient with bilateral condyle fracture were at high risk (OR > 1) of coronoid fractures. And younger patients were high risk of mandibular angle fractures. Conclusion Through this study, it was confirmed that etiological factors of mandibular fractures were like those of previous studies.
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Correlation of radiomorphometric indices of the mandible and mandibular angle fractures. Heliyon 2022; 8:e10549. [PMID: 36132178 PMCID: PMC9483591 DOI: 10.1016/j.heliyon.2022.e10549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/29/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022] Open
Abstract
This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times. Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities.
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Bicsák Á, Abel D, Berbuesse A, Hassfeld S, Bonitz L. Evaluation of Mandibular Fractures in a German Nationwide Trauma Center Between 2015 and 2017. J Maxillofac Oral Surg 2022; 21:904-910. [PMID: 36274900 PMCID: PMC9474798 DOI: 10.1007/s12663-021-01513-4] [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: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022] Open
Abstract
Introduction This study analyses the treatment of isolated mandibular fractures between 1.1.2015 and 21.31.2017 at Dortmund General Hospital. Materials and Methods Patient documentation and radiological images have been assessed, and a descriptive statistical analysis has been performed. Results Three hundred and twenty-eight patients were identified with isolated mandibular fractures (259 male, 69 female). The male-to-female ratio is 3.75: 1. A total of 541 fracture sites have been identified (1.65 fractures/patient). Forty of these were observed in the dentoalveolar region (fracture of the alveolar process, dental injuries), and the other 501 injuries were distributed in the remaining parts of the lower jaw.A detailed analysis of the osteosynthesis implants is provided. A total of 20 serious complications were observed (6% in all primary cases, 4.5% without osseointegrated implants). Discussion The demographic data and the anatomical distribution of the fracture sites are comparable with international literature. Dentoalveolar injuries mostly occur in younger patients. The complication rate in this study (4.5%) is below the international data; however, we found a considerably higher rate than in the midfacial region (central midface: 0%, lateral midface: 1.43%). Despite this complication rate, the procedure can be considered safe. Supplementary information The online version of this article (10.1007/s12663-021-01513-4).
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Affiliation(s)
- Ákos Bicsák
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
- Department of Oral- and Maxillofacial Surgery, General Hospital Dortmund, Muensterstrasse 240, 4145 Dortmund, Germany
| | - Dietmar Abel
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| | - Anna Berbuesse
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| | - Stefan Hassfeld
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| | - Lars Bonitz
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
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Nys M, Van Cleemput T, Dormaar JT, Politis C. Long-term Complications of Isolated and Combined Condylar Fractures: A Retrospective Study. Craniomaxillofac Trauma Reconstr 2022; 15:246-252. [PMID: 36081681 PMCID: PMC9446271 DOI: 10.1177/19433875211026759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Abstract
Study Design Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have been reported. Objective We compared the long-term complications of patients with condylar fractures treated conservatively, with IMF, or with combined ORIF and IMF. Methods We retrospectively analyzed all patients diagnosed with unilateral or bilateral condylar fracture, isolated or combined with a fracture of the mandibular body, admitted to the Department of Maxillofacial Surgery at UZ Leuven between January 2013 and January 2020. We collected data on age, gender, side of condylar fracture, presence of associated fracture of the mandibular body, referrals, initial treatment, long-term complications and secondary treatment. Long-term complications were defined as sequelae still present 6 weeks after initial treatment. Results Among 192 patients, 68.8% had unilateral and 31.2% bilateral condylar fractures; an associated fracture of the mandibular body was seen in 45.8%, 31% received conservative treatment, 51% IMF only, and 18% combined ORIF and IMF. Forty-eight percent of all patients suffered from 1 or more long-term complications, most frequently malocclusion (24%), reduced mouth opening (15.1%), nerve disturbances (13.5%), pain (8.9%), and facial asymmetry (2.6%). Surgery as a secondary treatment was necessary in 25% of all cases. Conclusions The presence of bilateral condylar fractures or associated fracture of the mandibular body is a risk factor for developing long-term complications. Most patients with long-term complications were initially treated with combined ORIF and IMF, but long-term complications after initial conservative or IMF treatment were treated with secondary surgery.
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Affiliation(s)
- Margaux Nys
- Department of Oral and Maxillofacial
Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Van Cleemput
- Department of Oral and Maxillofacial
Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jakob Titiaan Dormaar
- Department of Oral and Maxillofacial
Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial
Surgery, University Hospitals Leuven, Leuven, Belgium
- Omfs Impath Research Group, Department
of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
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Snyder E, Trabia M, Trabelsi N. An approach for simultaneous reduction and fixation of mandibular fractures. Comput Methods Biomech Biomed Engin 2022:1-13. [PMID: 35901285 DOI: 10.1080/10255842.2022.2105143] [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: 11/03/2022]
Abstract
This article presents a new approach for the design of a flexible V-shaped miniplate for mandibular fractures, which combines simultaneous fracture reduction and fixation. A Computerized Tomography (CT) based finite element model was developed to assess the reliability of this design. Muscle and mastication forces were included to replicate post-surgery loading. The V-plate is compared with a standard, linear miniplate, typically used for mandibular fixation. The results indicate that the proposed design can support the fracture while inducing limited fracture displacement, in addition to reducing the duration of the surgery due to fracture reduction by tightening the wire.
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Affiliation(s)
- Ethan Snyder
- Department of Mechanical Engineering, University of Nevada, Las Vegas, United States of America
| | - Mohamed Trabia
- Department of Mechanical Engineering, University of Nevada, Las Vegas, United States of America
| | - Nir Trabelsi
- Department of Mechanical Engineering, Shamoon College of Engineering, Be'er Sheva, Israel
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Mallya SM, Ahmad M, Cohen JR, Kaspo G, Ramesh A. Recommendations for imaging of the temporomandibular joint. Position statement from the American Academy of Oral and Maxillofacial Radiology (AAOMR) and the American Academy of Orofacial Pain (AAOP). Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:639-648. [DOI: 10.1016/j.oooo.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
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Suskin JA, Rao V, Crozier JW, Yi T, Benz E, Woo AS. Re-evaluating the need for orthopantomography in the management of mandibular trauma: is computed tomography enough? Emerg Radiol 2022; 29:663-670. [PMID: 35426532 DOI: 10.1007/s10140-022-02049-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mandibular fractures are frequent indications for computed tomography (CT) and orthopantomography (OPG) scans in emergency rooms. Numerous studies found CT to have higher sensitivity and enhanced accuracy compared to OPG in diagnosing mandible fractures. Controversy exists regarding additional need for OPG when evaluating dental trauma. This study investigates whether OPG adds diagnostic value to CT in mandibular trauma and whether additional OPG significantly alters management. METHODS A retrospective chart review identified 100 patients ≥ 18 years of age with known mandibular trauma who received CT and OPG in the emergency department between May 2015 and January 2020. All patients demonstrated a fracture in at least one study. CT and OPG studies were anonymized and randomized. A single attending surgeon evaluated mandible fracture and dental trauma characteristics and subsequently compared findings. RESULTS One hundred patient CT and OPG scans were reviewed. CT detected mandible fractures in all patients and OPG detected fractures in 93% (p = 0.01). Twenty-eight patients had different findings between scans. CT demonstrated 1 or more additional fracture(s) than OPG in 20 patients and dental trauma not seen on OPG in 4. OPG detected 1 fracture and no dental trauma that was not seen on CT. CT drove treatment-determining differences in 17 cases and OPG in 0 cases. CONCLUSIONS CT appears efficacious in detecting clinically significant mandible fractures and dental trauma with little additional benefit from OPG in emergency settings. Helical CT may be the only imaging necessary in evaluating patients with such trauma.
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Affiliation(s)
- Johanna A Suskin
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, 2 Dudley Street, MOC 180, Providence, RI, 02905, USA.
| | - Vinay Rao
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, 2 Dudley Street, MOC 180, Providence, RI, 02905, USA
| | - Joseph W Crozier
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, 2 Dudley Street, MOC 180, Providence, RI, 02905, USA
| | - Thomas Yi
- Division of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Elizabeth Benz
- Division of Dentistry and Oral and Maxillofacial Surgery, Rhode Island Hospital, Providence, RI, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, 2 Dudley Street, MOC 180, Providence, RI, 02905, USA
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Aleksanyan LV, Poghosyan AY, Misakyan MS, Minasyan AM, Bablumyan AY, Tadevosyan AE, Muradyan AA. Epidemiology of maxillofacial injuries in "Heratsi" No 1 university hospital in Yerevan, Armenia: a retrospective study. BMC Oral Health 2022; 22:123. [PMID: 35413822 PMCID: PMC9002220 DOI: 10.1186/s12903-022-02158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to perform a retrospective analysis of the prevalence, etiologies, types of maxillofacial injuries (MFIs), sites of maxillofacial fractures (MFFs) and their management in Yerevan, Armenia.
Methods A retrospective cross-sectional study was conducted. The extracted data included age, sex, date of referral, mode of injury, etiology, radiology records and treatment methods. Study outcomes were measured using percentages, means, standard deviations and tests of proportions. P < .05 was considered significant. Results A total of 204 patients had a mean age of 36.26 ± 1.08 years (156 males and 48 females), and a total of 259 MFIs were recorded between 2017 and 2020. Interpersonal violence was found to be the most common etiology of MFFs in this study (42.1%), followed by road traffic accidents (RTAs) (27.9%) and falls (18.6%). The nasal bone was the most common injury site (47.5%), followed by the mandible (31.4%) and zygomatic complex (11.7%). The most common fracture site was the mandibular angle (37.9%), followed by the symphysis/parasymphysis (28.1%) and body (12.6%). Isolated soft tissue injuries were reported in 5.9% of the cases. The majority of MFFs were treated by open reduction and internal fixation. Conclusion Interpersonal violence, followed by RTAs and falls, was the most common cause of MFIs. Males in the 21–30 years age group had the highest MFI incidence rate. The nasal bone was the most common injury site, followed by the mandible and zygomatic complex. Social education with the objective of reducing aggression and interpersonal conflict should be improved, and appropriate RTA prevention strategies should be strengthened and implemented.
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Affiliation(s)
- Lusine V Aleksanyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia
| | - Anna Yu Poghosyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia.
| | - Martin S Misakyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia
| | - Armen M Minasyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Aren Yu Bablumyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Artashes E Tadevosyan
- Department of Public Health and Healthcare, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Armen A Muradyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
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Só BB, Jardim LC, Schuch LF, Kovalski LNS, Zan R, Calcagnotto T, Martins MD, Martins MAT. Analysis of factors that influence quality of life of individuals undergoing treatment for mandibular fractures: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:289-301. [PMID: 35440426 DOI: 10.1016/j.oooo.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures. STUDY DESIGN This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the search strategy was constructed according to the Populations, Interventions, Comparison, Outcomes, and Study Design principle in the following databases: PubMed, Web of Science, Scopus, and EMBASE. Risk of bias assessment was performed with Risk Of Bias In Non-randomized Studies of Interventions and Cochrane Risk of Bias tool for randomized trials 2. RESULTS Nineteen studies were included: 15 observational and 4 clinical trials. Mean age ranged from 28 to 39 years, with a higher proportion of males. The condyle was the main fracture location and traffic accident was the fracture cause. Treatment approaches were mostly open reduction (89.4%) and maxillomandibular fixation (63%). QoL measurements varied considerably with the General Oral Health Assessment Index (31.5%) and Oral Health Impact Profile-14 (21%) as the main instruments. Meta-analysis showed that open reduction and maxillomandibular fixation did not present significant differences to QoL (P = .39), but significant differences were observed with time (P < .00001). Other factors affected QoL, such as mental health, pain, socializing, appearance, and eating difficulties. CONCLUSIONS Several factors, apart from the treatment approach, mentioned in this review seemed to affect the QoL of patients with mandibular trauma. Treatment choice should be based on well-stablished clinical criteria and on all other factors mentioned here.
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Affiliation(s)
- Bruna Barcelos Só
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luisa Comerlato Jardim
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lauren Frenzel Schuch
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Luan Nathiel Santana Kovalski
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Zan
- Oral and Maxillofacial Surgery Department, FATEC Dental CEEO, Igrejinha, RS, Brazil
| | - Thiago Calcagnotto
- Oral and Maxillofacial Surgery Department, FATEC Dental CEEO, Igrejinha, RS, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil.
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Jain P, Prasad M, Alam A, Varshnay R, Rani K, Chaudhary A. The use of mandibular nerve block in unilateral mandibular fracture to evaluate the mouth opening for assessment of airway. Saudi J Anaesth 2022; 16:194-199. [PMID: 35431746 PMCID: PMC9009568 DOI: 10.4103/sja.sja_773_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Facial area is one of the most frequently injured area of the body, accounting for 23–97% of all facial fractures. Treatments under general anesthesia as those for maxillofacial fractures or infections is a highly complicated and a major challenging task in trismus associated patients. The main culprit in trismus is the increase muscle tone of masticatory muscles which are supplied via the mandibular nerve, blocking which could help increase the mouth opening thus, changing the whole of airway management. Material and Method: A prospective study was done on 50 patients of ASA grade I-II with unilateral mandibular fracture with trismus posted for maxillofacial surgery. Mandibular nerve block was given via extraoral approach with 5 ml of 0.5% bupivacaine using peripheral nerve stimulator to determine the difference in Pre block and Post block mouth opening and the VAS score at 2, 5, 10, 15, 20, 25, and 30 minutes. Results: The Interincisor distance measured Pre block was 1.20 ± 0.32 mm and was significantly increased after 5 mins onwards from the block (P < 0.005). The VAS score determined Pre block was 5.14 ± 1.37 which significantly decreased just 2 minutes after the application of block (P < 0.005). Conclusion: Mandibular nerve block decreases the pain and will aid in the decision making by an anesthetist regarding airway management as it helps in increasing the inter incisor distance significantly. Moreover, given the feasibility and effectiveness of the block it could be included in standard of care protocol for mandibular fracture patients.
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Lee CC, Caruso DP, Wang TT, Hajibandeh JT, Peacock ZS. Mandibular Fracture Repair in Older Adults: Is Age Associated with Adverse Outcomes? J Oral Maxillofac Surg 2022; 80:1040-1052. [DOI: 10.1016/j.joms.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
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Ahmed A, Ravindranath K, Karpe T, Pushpa S, Karuna, Managutti A, C. Tiwari R. Comparative evaluation of three-dimensional plating systems in maxillofacial trauma: An original research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S176-S178. [PMID: 36110797 PMCID: PMC9469407 DOI: 10.4103/jpbs.jpbs_61_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/12/2022] [Accepted: 01/29/2022] [Indexed: 11/04/2022] Open
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Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures. J Clin Med 2021; 10:jcm10245975. [PMID: 34945272 PMCID: PMC8708228 DOI: 10.3390/jcm10245975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The known preformed osteosynthesis plates for the midface are helpful tools for a precise and fast fixation of repositioned fractures. The purpose of the current study is to analyze the precision of newly developed prototypes of preformed osteosynthesis plates for the mandible. Methods: Four newly designed preformed osteosynthesis plates, generated by a statistical shape model based on 115 CT scans, were virtually analyzed. The used plates were designed for symphyseal, parasymphyseal, angle, and condyle fractures. Each type of plate has three different sizes. For analysis, the shortest distance between the plate and the bone surface was measured, and the sum of the plate-to-bone distances over the whole surface was calculated. Results: A distance between plate and bone of less than 1.5 mm was defined as sufficient fitting. The plate for symphyseal fractures showed good fitting in 90% of the cases for size M, and in 84% for size L. For parasymphyseal fractures, size S fits in 80%, size M in 68%, and size L in 65% of the cases. Angle fractures with their specific plate show good fitting for size S in 53%, size M in 60%, and size L in 47%. The preformed plate for the condyle part fits for size S in 75%, for size M in 85%, and for size L in 74% of the cases. Conclusion: The newly developed mandible plates show sufficient clinical fitting to ensure adequate fracture reduction and fixation.
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Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg 2021; 35:238-249. [PMID: 34819805 DOI: 10.1055/s-0041-1735818] [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: 10/20/2022]
Abstract
Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.
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Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington.,Divisions of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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Mehari Abraha H, Iriarte‐Diaz J, Reid RR, Ross CF, Panagiotopoulou O. Fracture Fixation Technique and Chewing Side Impact Jaw Mechanics in Mandible Fracture Repair. JBMR Plus 2021; 6:e10559. [PMID: 35079674 PMCID: PMC8770999 DOI: 10.1002/jbm4.10559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 12/04/2022] Open
Abstract
Lower jaw (mandible) fractures significantly impact patient health and well‐being due to pain and difficulty eating, but the best technique for repairing the most common subtype—angle fractures—and rehabilitating mastication is unknown. Our study is the first to use realistic in silico simulation of chewing to quantify the effects of Champy and biplanar techniques of angle fracture fixation. We show that more rigid, biplanar fixation results in lower strain magnitudes in the miniplates, the bone around the screws, and in the fracture zone, and that the mandibular strain regime approximates the unfractured condition. Importantly, the strain regime in the fracture zone is affected by chewing laterality, suggesting that both fixation type and the patient's post‐fixation masticatory pattern—ipsi‐ or contralateral to the fracture— impact the bone healing environment. Our study calls for further investigation of the impact of fixation technique on chewing behavior. Research that combines in vivo and in silico approaches can link jaw mechanics to bone healing and yield more definitive recommendations for fixation, hardware, and postoperative rehabilitation to improve outcomes. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Hyab Mehari Abraha
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology Monash University Melbourne Australia
| | | | - Russell R Reid
- Department of Surgery, Section of Plastic Surgery The University of Chicago Medical Centre Chicago IL USA
| | - Callum F Ross
- Department of Organismal Biology and Anatomy University of Chicago Chicago IL USA
| | - Olga Panagiotopoulou
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology Monash University Melbourne Australia
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Hino S, Iizuka T, Saulacic N, Lang NP, Burkhard JPM. No apparent association between dental implants and mandibular fractures resulting from external forces. Clin Oral Investig 2021; 26:2065-2072. [PMID: 34559318 DOI: 10.1007/s00784-021-04188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Dental implants are cylindrical metallic screws inserted into the jawbone to replace missing teeth. Their location may affect the pattern of fractures that occur as a result of the traumatic forces to the mandible. The aim of this study was to investigate possible influences of dental implants on the patterns of mandibular fractures triggered by external forces. MATERIAL AND METHODS In this observational cross-sectional study, a total of 390 patients with mandibular fractures diagnosed between February 2016 and December 2020 were examined and the presence or absence of dental implants in the fracture gap was noted. Clinical and radiological data were analyzed in relation to the fracture line, the dental status, and the location of any implants. RESULTS A total of 16 patients (4.1%) had previously placed dental implants in the mandible. Various fracture patterns were observed. Some yielded typical fracture lines located in the anatomically weak areas along the roots of the incisors, the mental foramina, and long-rooted molars. Occasionally, fracture lines were detected in combination with condylar fractures. Dental implants were not directly involved in any fracture line, except one. In that case, the fracture line extended from the alveolar process straight along the implant body, mimicking initial disintegration of the implant, with erosion of the surrounding bone. CONCLUSIONS Once dental implants have osseointegrated, mandibular fractures are rarely projected along the implant surface. CLINICAL RELEVANCE This observational retrospective cross-sectional study failed to associate mandibular fracture lines with the presence of dental implants.
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Affiliation(s)
- Shunsuke Hino
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama , 350-8550 , Japan.
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Niklaus P Lang
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - John-Patrik M Burkhard
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Figueiredo C, Afonso A, Caramelo F, Corte-Real A. Temporomandibular joint trauma and disability assessment - A longitudinal exploratory study. J Forensic Leg Med 2021; 82:102230. [PMID: 34385019 DOI: 10.1016/j.jflm.2021.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Orofacial trauma can encompass, isolated or not, several anatomical regions, namely facial, dental and temporomandibular joint (TMJ), one of the most complex joints in the human body. Evidence-based knowledge in the field of TMJ trauma and in temporomandibular joint disorders (TMD) diagnosis and treatment, provides the necessary data for medico-legal assessment. OBJECTIVE The aim of this study is to bring up epidemiological data referring to TMJ injuries and sequelae, in order to present a medico-legal approach of TMJ disability. METHODS An observational longitudinal exploratory study was performed in the database of the National Institute of Legal Medicine and Forensic Sciences, Portugal, between 2000 and 2017, regarding inclusion and exclusion criteria.Statistical significance was set as P‹0.05, Fisher's exact test, Binomial test and Goodman and Kruskal's test were used. RESULTS Post-traumatic orofacial reports (n = 2622) included 234 TMJ-injury and 149 TMJ-sequelae.Epidemiological data was presented regarding age,gender, professional status and etiology. There was a statistically significant association between TMJ injury and TMJ sequela, despite a weak relation (ƛ = 0.170). No statistically significant association was identified between TMJ-injury/TMJ-sequelae and the professional status, etiology. CONCLUSION The TMJ sequela group is smaller than the TMJ-injury, reflecting that 2/3 of the injuries have been cured without a monetary compensation value and without Health costs. The association between TMJ injury and TMJ sequelae reinforces the necessity of preventive measures in TMJ trauma, namely in physical violence context and in medico-legal impairment.
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Affiliation(s)
- Cristina Figueiredo
- Universidade Católica Portuguesa, Center for Interdisciplinary Research in Health (CIIS), Faculty of Dental Medicine, Viseu, Portugal.
| | | | - Francisco Caramelo
- Faculty of Medicine, Biostatistics and Medical Informatics Laboratory, Coimbra University, Portugal.
| | - Ana Corte-Real
- Faculty of Medicine, Forensic Dentistry Laboratory, Coimbra University, Portugal.
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Hsieh TY, Funamura JL, Tollefson TT. Commentary on "The Impact of Treatment Delay on Malunion and Nonunion After Open Reduction of Mandible Fractures" by Lander et al: Sooner than Later. Facial Plast Surg Aesthet Med 2021; 23:467-468. [PMID: 34314634 DOI: 10.1089/fpsam.2021.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tsung-Yen Hsieh
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jamie L Funamura
- Pediatric Otolaryngology, Department of Otolaryngology-Head & Neck Surgery, University of California Davis, Sacramento, California, USA
| | - Travis T Tollefson
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, University of California Davis, Sacramento, California. USA
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High Submandibular Anteroparotid Approach for Open Reduction and Internal Fixation of Condylar Fracture. Case Rep Dent 2021; 2021:5542570. [PMID: 34336305 PMCID: PMC8286183 DOI: 10.1155/2021/5542570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/04/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Aim There are several techniques for the treatment of mandibular condylar fractures. This is the first report of the high submandibular anteroparotid approach for open reduction and internal fixation of condylar fracture. Materials and Methods A 41-year-old woman fell indoors and injured her face. She was referred to our department for detailed examination and treatment of a suspected mandibular fracture. X-ray and computed tomography showed a right mandibular condylar base fracture and lateral dislocation of the fracture fragment. Open reduction and internal fixation procedures were performed for a right mandibular condylar fracture under general anesthesia. The mandibular ramus was reached by approaching from the inferior margin of the mandible, delaminating the masseter fascia posteriorly, and bypassing the anterior margin of the parotid gland. Once the fractured bone was reached, reduction and fixation were performed. Results We have achieved good results by the high submandibular anteroparotid approach, which is minimally invasive and simple, to reduce and fix condylar fractures. With this approach, no facial artery or retromandibular vein was encountered, and the mental stress for the surgeon was minimal. Postoperative wound infection, parotid gland complications such as parotitis and salivary fistula, facial nerve dysfunction such as facial paralysis, and esthetic disorders such as scarring were not observed. Conclusions Although it is necessary to examine more cases in the future, the high submandibular anteroparotid approach may be useful as a new approach for open reduction and internal fixation of condylar fractures.
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Jia Y, Xie L, Tang Z, Wang D, Hu Y, Zhang G, Chen Y, Gao Q. Parathyroid hormone promotes cartilage healing after free reduction of mandibular condylar fractures by upregulating Sox9. Exp Biol Med (Maywood) 2021; 246:2249-2258. [PMID: 34233524 DOI: 10.1177/15353702211027114] [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
After high fractures of the mandibular condyle, the insufficient blood supply to the condyle often leads to poor bone and cartilage repair ability and poor clinical outcome. Parathyroid hormone (PTH) can promote the bone formation and mineralization of mandibular fracture, but its effects on cartilage healing after the free reduction and internal fixation of high fractures of the mandibular condyle are unknown. In this study, a rabbit model of free reduction and internal fixation of high fractures of the mandibular condyle was established, and the effects and mechanisms of PTH on condylar cartilage healing were explored. Forty-eight specific-pathogen-free (SPF) grade rabbits were randomly divided into two groups. In the experimental group, PTH was injected subcutaneously at 20 µg/kg (PTH (1-34)) every other day, and in the control group, PTH was replaced with 1 ml saline. The healing cartilages were assessed at postoperative days 7, 14, 21, and 28. Observation of gross specimens, hematoxylin eosin staining and Safranin O/fast green staining found that every-other-day subcutaneous injection of PTH at 20 µg/kg promoted healing of condylar cartilage and subchondral osteogenesis in the fracture site. Immunohistochemistry and polymerase chain reaction showed that PTH significantly upregulated the chondrogenic genes Sox9 and Col2a1 in the cartilage fracture site within 7-21 postoperative days in the experimental group than those in the control group, while it downregulated the cartilage inflammation gene matrix metalloproteinase-13 and chondrocyte terminal differentiation gene ColX. In summary, exogenous PTH can stimulate the formation of cartilage matrix by triggering Sox9 expression at the early stage of cartilage healing, and it provides a potential therapeutic protocol for high fractures of the mandibular condyle.
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Affiliation(s)
- Yuanyuan Jia
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Liuqin Xie
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Zhenglong Tang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Dongxiang Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Yun Hu
- Department of Oral Histopathology, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Guoxing Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Youli Chen
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
| | - Qiong Gao
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Guizhou Medical University, Guiyang 550004, China
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Study of Pediatric Operative Recreational Trauma: A Retrospective Analysis of Pediatric Sports-Related Facial Fractures. J Craniofac Surg 2021; 32:1611-1614. [PMID: 33770047 DOI: 10.1097/scs.0000000000007620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the United States, most school-aged children participate in some form of organized sports. Despite the advantages to social and physical development that organized sports may have, these activities also place a significant number of America's youth at risk for facial injuries. Pediatric facial fractures resulting from sports trauma are well documented within pediatric literature. Despite knowledge of the importance of safety equipment, there is a continued need for increased awareness about fracture patterns resulting from sports injuries to develop better strategies for their prevention. METHODS A retrospective review of all pediatric patients (age <18) who presented to Children's Memorial Hermann Hospital as a level 1 trauma between January 2006 and December 2015 with radiologically confirmed facial fractures was performed. Data regarding patient demographic information, mechanism of injury, facial fracture location, associated injuries, hospital course, and need for surgical intervention was collected. RESULTS Of the 1274 patients reviewed, 135 (10.59%) were found to have facial fractures resulting from sports trauma and were included in our cohort. The median age was 14 with 77.8% of the cohort being male. The most common fractures identified were orbital (n = 75), mandibular (n = 42), nasal (n = 27), maxilla (n = 26). Fractures were more frequently related to involvement in baseball/softball and bicycling n = 46 and n = 31 respectively. Eighty-two (60.74%) patients required admission, 6 requiring ICU level care, 70 (51.85%) were found to require surgery. There were 14 patients who were found to have a concomitant skull fracture and 6 with TBI. There were no fatalities in this cohort of patients. CONCLUSION Pediatric facial fractures occur in the same anatomic locations as adult facial fractures. However, their frequency, severity, and treatment vary because of important anatomical and developmental differences in these populations. Despite available knowledge on this subject and increased use of protective equipment, pediatric facial fractures continue to occur with similar distribution as historically described. While sports participation confers numerous benefits, it is vital that we continue researching pediatric facial trauma and associated fractures to develop protective equipment and protocols to mitigate the risks of these activities.
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Mandibular Fractures Epidemiology and Treatment Plans in the Center of Italy: A Retrospective Study. J Craniofac Surg 2021; 32:e346-e349. [PMID: 33170830 DOI: 10.1097/scs.0000000000007118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The epidemiology of maxillofacial fractures is variable in different geographic regions. Economic and social conditions, laws and types of behavior can be considered the most important factors influencing these differences.Mandibular fractures were first cited in 1650 BC in an Egyptian papyrus. Today, these fractures are one of the most prevalent facial skeletal injuries.A 4-year retrospective study was performed and the trauma - related data were collected from medical and radiological archives. The analysis comprised patients admitted for mandibular fracture at Sapienza University of Rome - Policlinico Umberto I between January 1, 2016 and December 31, 2019. The data include age, sex, etiology, anatomical sites of the fractures, eventual maxillofacial associated fractures and treatment.We collected 172 patients, 138 males (80.2%) and 34 females (19.8%) with 270 mandibular fractures. The average age was 35.4 years. The youngest and oldest patients were aged 6 and 90 years, respectively. The age group 20 to 29 years was the most represented with 52 patients (30.2% of the total sample). Assaults were the most common etiology (n = 53, 30.8%), followed by falls (n = 45, 26.2%). The condyle was the most involved region (n = 86, 32%), followed by parasymphysis region (n = 72, 26.6%) and angle (n = 62, 23%).154 patients (89.5%) reported only mandibular fractures. Eighteen patients (10.5%) had other associated maxillofacial fractures; the most frequently encountered maxillofacial fractures associated with mandibular fractures were the zygomatic complex fractures (n = 9, 5.2%). Open reduction and internal fixation was the most preferred surgical treatment (n = 115, 66.9%).This study showed that mandibular fractures predominate in 20 to 29 years group and in the male sex. Assaults are the most frequent cause. The prevalent fracturing site is condylar process. Orbital - maxillary - zygomatic complex fractures were the most common associated maxillofacial fractures and open reduction and internal fixation was the preferred surgical strategy.The results of this analysis agree to other studies and provide important clinical information that will help in study of these injuries.
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Duplantier MJ, Marschall JS, Ritto F, Welch A, Alpert B, Tiwana PS. Anatomical Location of Initial and Repeat Mandible Fractures: A 5-Year, Multi-Institution Retrospective Study. J Oral Maxillofac Surg 2021; 79:1712-1722. [PMID: 33951449 DOI: 10.1016/j.joms.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of the present study was to investigate new fracture patterns resulting from low velocity mechanisms in subjects who had previously fractured their mandible and had been treated with open reduction and internal fixation (ORIF) or closed reduction. METHODS AND MATERIALS A multi-institutional retrospective cohort study was designed to analyze subjects presenting at 2 tertiary care centers with mandibular fractures with specific interest in subjects who had repeat mandible fractures. Variables recorded included demographic (age, sex, etc) data, fracture location of all fractures treated, and the location of previous fracture. Descriptive and bivariate analyses were completed of the data. RESULTS The sample included a total of 492 subjects and 875 total fractures from both institutions. Four hundred fourty-four (91.1%) were male. The average age of all subjects was 36.4 ± 14.9 years. Twenty-six (5.28%) subjects were previously treated for a mandible fracture. All subjects' subsequent fractures occurred outside of previous ORIF except for 1 subject. Original fracture location (P = .596) and previous ORIF type (P = .689) did not influence if the subsequent fracture was within a site of previous ORIF. CONCLUSIONS The present study demonstrates that repeat mandible fractures are relatively rare, likely to occur only 5% of the time at large tertiary care centers. The repeat fracture is not likely to occur in a site of previous ORIF, regardless of the ORIF modality. Furthermore, the fracture is likely to occur on the contralateral side. This is 1 of the largest data sets on repeat mandible fractures, which, given their rarity, are difficult to study.
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Affiliation(s)
- Martin J Duplantier
- Resident, Department of Oral and Maxillofacial Surgery, University of Oklahoma, Oklahoma City, OK
| | - Jeffrey S Marschall
- Resident, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
| | - Fabio Ritto
- Professor, Department of Oral and Maxillofacial Surgery University of Oklahoma, Oklahoma City, OK
| | - Austin Welch
- Resident, Department of Oral and Maxillofacial Surgery, University of Missouri-Kansas City, MO
| | - Brian Alpert
- Professor, Department of Oral and Maxillofacial Surgery, University of Louisville, Louisville, KY
| | - Paul S Tiwana
- Professor and Reichmann Chair, Department of Oral and Maxillofacial Surgery, University of Oklahoma, Oklahoma City, OK
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Chaudhry H, Hennedige A, Patel M. Review of prophylactic prescribing of antibiotics during the management of fractured mandibles. Surgeon 2021; 19:e519-e525. [PMID: 33582055 DOI: 10.1016/j.surge.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/14/2020] [Accepted: 12/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To provide evidence based guidance on the optimum prophylactic antibiotic prescribing regimens in the treatment of fractured mandibles to protect against surgical site infections. MATERIAL AND METHODS OVID and Pubmed databases were searched for articles published between 1946 and 2020. Inclusion criteria was for articles to be in English, involve adult patients aged 14 and over, and involve patients treated with oral or IV antibiotics preoperatively, perioperatively or postoperatively during treatment of open or closed fractures of the mandible. Exclusion criteria included infected fractures on presentation, immunocompromised patients, fractures resulting from gunshot and pathological fractures. RESULTS A number of retrospective and prospective, randomised, double blind placebo-controlled trials were identified as suitable for inclusion. The age range within these trials was 14-77 years old. The numbers of patients contained within each trial ranged from 30 to 642. The most commonly prescribed antibiotics were penicillin, administered orally or intravenously. Duration of administration ranged from hospital admission to five days postoperatively. Analysis of these studies failed to demonstrate a statistical difference on the number of surgical site infections and the duration of antibiotic course. CONCLUSIONS The available evidence reveals no statistical difference in infection rates whether antibiotics are prescribed pre, peri, or postoperatively. The duration of antibiotics therapy also appears not to be important. Current evidence does not support the recommendation of an optimum antibiotic prescribing regimen. Additional prospective studies looking at the duration and timing of antibiotics during the management of fractured mandibles are required to identify the optimum prescribing regimen.
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Affiliation(s)
- Hiba Chaudhry
- Department of Oral and Maxillofacial Surgery, University Hospital South Manchester, Manchester, United Kingdom.
| | - Anusha Hennedige
- Department of Craniofacial Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Manu Patel
- Department of Oral and Maxillofacial Surgery, University Hospital South Manchester, Manchester, United Kingdom
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Surgical Management of Mandibular Angle Fractures: Does the Extraction of the Third Molar Lead to a Change in the Fixation Pattern? A European Multicenter Survey. J Oral Maxillofac Surg 2020; 79:404-411. [PMID: 33064980 DOI: 10.1016/j.joms.2020.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The authors conducted a retrospective, multicenter study to investigate the differences in the fixation patterns, in terms of number and thickness of plates, between patients in whom a third molar (3M) was maintained or removed in the line of mandibular angle fractures. MATERIALS AND METHODS The study was conducted in 6 European level I and II maxillofacial trauma centers. Data were collected on patients ≥ 16 years of age who underwent open reduction internal fixation (ORIF) for mandibular angle fractures (MAF) from 2008 to 2018, in whom a 3M in the fracture line was present and who had a follow-up duration of 6 months. The study population was divided into 2 groups: patients treated with ORIF in whom the 3M was maintained (group 1) and those treated with ORIF in whom the 3M was extracted (group 2) during treatment. The 2 groups were compared for differences in the internal fixation pattern, specifically in terms of the number and thickness of the plates. RESULTS A total of 749 patients with 774 MAF were collected. A total of 1,050 plates were placed: 849 were ≤ 1.4 mm thick (80.9%) and 201 plates ≥ 1.5 mm thick (19.1%). 548 patients were treated with ORIF and 3M maintained (group 1), and 201 treated with ORIF and 3M extracted (group 2). Statistically significant differences were seen in the number of ≤1.4 mm plates between the 2 groups for single undisplaced/displaced MAF(P value ≤ 0.5) and for undisplaced/displaced angle + parasymphysis/body fractures (P-value ≤ 0.5). CONCLUSIONS Analyses of data collected from 6 European maxillofacial centers indicated that the majority of surgeons of our sample perceived the MAF as being more unstable when removing the 3M during ORIF leading them to perform a rigid fixation in the angular region.
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Figueiredo CP, Teixeira HM, Afonso AS, Corte‐Real A. Prevalence of, and disability approaches to, temporomandibular joint trauma: A 17‐year cross‐sectional study. Dent Traumatol 2020; 36:624-631. [DOI: 10.1111/edt.12587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Cristina Paiva Figueiredo
- Faculty of Dental Medicine Portuguese Catholic University Center for Interdisciplinary Research in Health (CIIS) Viseu Portugal
| | - Helena M. Teixeira
- Faculty of Medicine National Institute of Legal Medicine and Forensic Sciences Coimbra University Coimbra Portugal
| | | | - Ana Corte‐Real
- Faculty of Medicine Forensic Dentistry Laboratory Coimbra University Coimbra Portugal
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Krennmair S, Hunger S, Postl L, Winterhalder P, Holberg S, Malek M, Rudzki I, Holberg C. Edentulous mandible with four splinted interforaminal implants exposed to three different situations of trauma: A preliminary three‐dimensional finite element analysis. Dent Traumatol 2020; 36:607-617. [DOI: 10.1111/edt.12575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Stefan Krennmair
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Stefan Hunger
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Lukas Postl
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Philipp Winterhalder
- Department of Oral and Maxillofacial Surgery RWTH Aachen University Aachen Germany
| | - Svenia Holberg
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery Johannes Kepler University Linz Linz Austria
| | - Ingrid Rudzki
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
| | - Christof Holberg
- NumBioLab Department of Orthodontics Ludwig‐Maximilians University of Munich Munich Germany
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