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Sobrero F, Roccia F, Omedè M, Merlo F, Dubron K, Politis C, Rabufetti A, Scolozzi P, Ramieri G, Birk A, Vesnaver A, Rizvi AO, Laverick S, Jelovac D, Konstantinovic VS, Vilaplana V, Roig AM, Goetzinger M, Bottini GB, Knežević P, Dediol E, Kordić M, Sivrić A, Derkuş FE, Yilmaz UN, Ganasouli D, Zanakis SN. Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study. J Craniofac Surg 2024; 35:1120-1124. [PMID: 38713082 DOI: 10.1097/scs.0000000000010128] [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: 09/13/2023] [Accepted: 01/22/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF). MATERIAL AND METHODS This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded. RESULTS Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type. CONCLUSION Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.
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Affiliation(s)
- Federica Sobrero
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Fabio Roccia
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Michela Omedè
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Francesca Merlo
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Kathia Dubron
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Alessandro Rabufetti
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Guglielmo Ramieri
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Ali O Rizvi
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Drago Jelovac
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vitomir S Konstantinovic
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Valentines Vilaplana
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Antonio Mari Roig
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Predrag Knežević
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Fatma Eriş Derkuş
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Utku Nezih Yilmaz
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Dimitra Ganasouli
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Stylianos N Zanakis
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
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Novelli G, Filippi A, Cartocci A, Mirabella S, Talarico M, De Ponti E, Meazzini MC, Sozzi D, Canzi G, Anghileri M. Correlation between Malocclusion and Mandibular Fractures: An Experimental Study Comparing Dynamic Finite Element Models and Clinical Case Studies. Bioengineering (Basel) 2024; 11:274. [PMID: 38534548 DOI: 10.3390/bioengineering11030274] [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: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024] Open
Abstract
Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative complications, none have tried to identify pre-existing conditions that may increase the risk of mandibular fractures. We hypothesized, through clinical observation, that anatomical conditions involving poor dental contacts, such as malocclusions, may increase the risk of mandibular fractures. This work was subdivided into two parts. In the first part, Digital Imaging and Communications in Medicine (DICOM) data of four healthy patients characterized by different dentoskeletal occlusions (class I, class II, class III, and anterior open bite) have been used to develop four finite element models (FEMs) that accurately reproduce human bone structure. A vertical and lateral impact have been simulated at increasing speed on each model, analyzing the force distribution within the mandibular bone. Both vertical and lateral impact showed higher level of stress at the impact point and in the condylar area in models characterized by malocclusion. Specifically, the class III and the open bite models, at the same speed of impact, had higher values for a longer period, reaching critical stress levels that are correlated with mandibular fracture, while normal occlusion seems to be a protective condition. In the second part of this study, the engineering results were validated through the comparison with a sample of patients previously treated for mandibular fracture. Data from 223 mandibular fractures, due to low-energy injuries, were retrospectively collected to evaluate a possible correlation between pre-existing malocclusion and fracture patterns, considering grade of displacement, numbers of foci, and associated CFI score. Patients were classified, according to their occlusion, into Class I, Class II, Class III, and anterior open bite or poor occlusal contact (POC). Class I patients showed lower frequencies of fracture than class II, III, and open bite or POC patients. Class I was associated with displaced fractures in 16.1% of cases, class II in 47.1%, class III in 48.8% and open bite/POC in 65.2% of cases (p-value < 0.0001). In class I patients we observed a single non-displaced fracture in 51.6% of cases, compared to 12.9% of Class II, 19.5% of Class III and 22.7% of the open bite/POC group. Our analysis shows that class I appears to better dissipate forces applied on the mandible in low-energy injuries. A higher number of dental contacts showed a lower rate of multifocal and displaced fractures, mitigating the effect of direct forces onto the bone. The correlation between clinical data and virtual simulation on FEM models seems to point out that virtual simulation successfully predicts fracture patterns and risk of association with different type of occlusion. Better knowledge of biomechanics and force dissipation on the human body may lead to the development of more effective safety devices, and help select patients to plan medical, orthodontic/dental, and/or surgical intervention to prevent injuries.
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Affiliation(s)
- Giorgio Novelli
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Andrea Filippi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- Post-Graduate School of Maxillofacial Surgery, Department of Medicine and Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Andrea Cartocci
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Sergio Mirabella
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- Post-Graduate School of Maxillofacial Surgery, Department of Medicine and Surgery, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Marco Talarico
- Department of Aerospace Science and Technology, Politecnico di Milano, Via La Masa 34, 20156 Milan, Italy
| | - Elena De Ponti
- Department of Medical Physics, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Maria Costanza Meazzini
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Davide Sozzi
- O.U. Maxillofacial Surgery, Department of Medicine and Surgery, School of Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Gabriele Canzi
- Maxillofacial Surgery Unit, Emergency Department, ASST-GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Marco Anghileri
- Department of Aerospace Science and Technology, Politecnico di Milano, Via La Masa 34, 20156 Milan, Italy
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Jin R, Georges K, Jasti S, Ahsanuddin S, Cadwell JB, Paskhover B. Impact of Age on Surgical Outcomes Following Mandible Fracture Repair. Laryngoscope 2023; 133:287-293. [PMID: 35638520 DOI: 10.1002/lary.30208] [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: 01/11/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Open repair of mandibular fractures are frequently performed surgical procedures. Increasing rates of such fractures are seen in older adults following falls. This study assesses the impact of older age on early complications following mandible fracture repair. STUDY DESIGN Retrospective analysis of national registry. METHODS The 2013-2018 National Surgical Quality Improvement Program database was queried for all cases of open mandible fracture repair and cases were categorized into younger (18-40), middle (41-65), and older (>65) age cohorts. Demographics and comorbidities were compared between the age groups. Rates of surgical, medical, and wound complications within 30-days of surgery were determined. Multivariable logistic analyses were performed to assess the relationship between age and complications. RESULTS Altogether, 1818 cases were included for analysis, of which 1269 (69.8%) were younger, 459 (25.2%) were middle, and 90 (5.0%) were older age. Increased rates of complications were seen in the older groups, including unplanned reoperation, unplanned readmission, wound disruption, and medical complications (p < 0.01). On unadjusted analysis, the older (>65) age group had an increased odds of experiencing a complication compared to the younger (18-40) group (OR: 4.19, p < 0.001). The older age group continued to have a significantly increased odds of medical complications after multivariable adjustment (adjusted OR: 8.64, p < 0.001). CONCLUSIONS On this analysis of a national database, advanced age was associated with an increased frequency of early postoperative complications following open mandibular fracture repair. Following multivariable adjustment, advanced age continued to be associated with increased odds of postoperative medical complications within 30 days of surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 133:287-293, 2023.
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Affiliation(s)
- Ryan Jin
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kirolos Georges
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shravya Jasti
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Salma Ahsanuddin
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joshua B Cadwell
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Boris Paskhover
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Roccia F, Sobrero F, Raveggi E, Rabufetti A, Scolozzi P, Dubron K, Politis C, Ganasouli D, Zanakis SN, Jelovac D, Konstantinovic VS, Birk A, Vesnaver A, Knežević P, Dediol E, Kordić M, Sivrić A, Rizvi AO, Laverick S, Vilaplana NV, Roig AM, Derkuş FE, Yilmaz UN, Goetzinger M, Bottini GB, Ramieri G. European multicenter prospective analysis of the use of maxillomandibular fixation for mandibular fractures treated with open reduction and internal fixation. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101376. [PMID: 36587846 DOI: 10.1016/j.jormas.2022.101376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The goal of mandibular fracture treatment is to restore static and dynamic occlusal functions. Open reduction and internal fixation (ORIF) of these fractures can be associated with an intraoperative and/or postoperative maxillo-mandibular fixation (MMF). The aim of this study was to analyse the use of perioperative MMF and its effects on occlusal outcomes in the management of mandibular fractures. MATERIAL AND METHODS This multicentric prospective study included adult patients with mandibular fractures treated with ORIF. The following data were collected: age, gender, pre-trauma dental status (dentate, partially dentate), cause of injury, fracture site, associated facial fractures, surgical approach, type of ORIF (rigid, non-rigid or mixed), thickness and number of plates, modality of intraoperative MMF (arch bars, self-tapping and self-drilling screws [STSDSs], manual, other) and duration of postoperative MMF. The primary outcome was malocclusion at 6 weeks and 3 months. Statistical analyses were performed with Fisher's exact test or chi-square test, as appropriate. RESULTS Between 1 May 2021 and 30 April 2022, 336 patients, 264 males and 72 females (median age, 28 years) with mandibular fractures (194 single, 124 double and 18 triple fractures) were hospitalized. Intraoperative MMF was performed in all patients. Osteosynthesis was rigid in 75% of single fractures, and rigid or mixed in 85% and 100% of double and triple fractures, respectively. Excluding patients who underwent manual reduction, postoperative MMF (median duration, 3 weeks) was performed in 140 (64%) patients, without differences by type or number of fractures (p > 0.05). No significant difference was found in the incidence of malocclusion in patients with postoperative MMF (5%, 95% confidence interval [CI], 2-10%) compared to those without (4%; 95% IC, 1-11%) (p > 0.05). CONCLUSION Postoperative MMF was performed in more than half of the patients despite adequate fracture osteosynthesis, with wide variability amongst centers. No evidence of a reduction in the incidence of postoperative malocclusion in patients treated with postoperative MMF was found.
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Affiliation(s)
- Fabio Roccia
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Città della Salute e delle Scienze Hospital, Via Genova 3, Torino 10131, Italy
| | - Federica Sobrero
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Città della Salute e delle Scienze Hospital, Via Genova 3, Torino 10131, Italy.
| | - Elisa Raveggi
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Città della Salute e delle Scienze Hospital, Via Genova 3, Torino 10131, Italy
| | - Alessandro Rabufetti
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Kathia Dubron
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Dimitra Ganasouli
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Stylianos N Zanakis
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Drago Jelovac
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Serbia
| | | | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Predrag Knežević
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Ali O Rizvi
- Department of Oral and Maxillofacial Surgery, University of Dundee, United Kingdom
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, United Kingdom
| | - Nil Valentines Vilaplana
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Antonio Mari Roig
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Fatma Eriş Derkuş
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Utku Nezih Yilmaz
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Guglielmo Ramieri
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Città della Salute e delle Scienze Hospital, Via Genova 3, Torino 10131, Italy
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Bohner L, Beiglboeck F, Schwipper S, Lustosa RM, Pieirna Marino Segura C, Kleinheinz J, Jung S. Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis. J Clin Med 2020; 9:jcm9092922. [PMID: 32927782 PMCID: PMC7565660 DOI: 10.3390/jcm9092922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022] Open
Abstract
Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital Münster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.
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Affiliation(s)
- Lauren Bohner
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149 Münster, Germany; (F.B); (S.S.); (J.K.); (S.J.)
- Correspondence: ; Tel.: +49-25183-47004
| | - Fabian Beiglboeck
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149 Münster, Germany; (F.B); (S.S.); (J.K.); (S.J.)
| | - Stephanie Schwipper
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149 Münster, Germany; (F.B); (S.S.); (J.K.); (S.J.)
| | | | | | - Johannes Kleinheinz
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149 Münster, Germany; (F.B); (S.S.); (J.K.); (S.J.)
| | - Susanne Jung
- Department of Oral and Maxillofacial Surgery, University Hospital Münster, 48149 Münster, Germany; (F.B); (S.S.); (J.K.); (S.J.)
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