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Analysis of Pediatric Maxillofacial Fractures: A 10-year Retrospective Study. J Craniofac Surg 2023; 34:448-453. [PMID: 36441830 DOI: 10.1097/scs.0000000000008846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study is to analyze patterns of maxillofacial fractures in children and adolescent in southeast of China,in a period of 10 years. MATERIAL AND METHODS In this retrospective study, the medical records of 162 hospitalized patients under 18 years old were analyzed in the Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Wenzhou Medical University, China. Age, gender, etiology, site, and type of fracture, monthly distribution, weekly distribution, dental complications, and treatment were evaluated. The cases were divided into 3 age groups: group A: 0 to 6 years, group B: 7 to 12 years, and group C: 13 to 18 years. RESULTS Three hundred thirty-four maxillofacial fractures in 162 patients younger than 18 years were analyzed. The male to female ratio was 2.24:1 and mean age of these patients was 9.85 years old . Falls were the leading cause of maxillofacial fractures.The most frequent fracture site was mandible. Most patients with maxillofacial fractures were treated by open reduction. And it was done more in adolescents than in children. CONCLUSIONS Falls were the main reason for maxillofacial fracutres in childern, and traffic accidents was the leading cause in adolescent. Preventive measures should be applied to reduce occurrences of pediatric facial fractures .Children can not be left at home alone, and monitoring is very necessary when children play in the high place. The government can consider related e-bike driving skills training. Teenagers must pass the relevant electric vehicle test before they can drive. Make the law that the driver of e-bike must wear a safety helmet. Our study shows that open reduction was a good choice for pediatric facial fractures, but usually conservative treatment is a better choice for condylar fractures.
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Khattak YR, Sardar T, Iqbal A, Khan MH, Khan A, Ullah U, Ahmad I. Treatment of pediatric bilateral condylar fractures: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101339. [PMID: 36403929 DOI: 10.1016/j.jormas.2022.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.
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Affiliation(s)
| | - Tariq Sardar
- Oral and Maxillofacial Surgery, KMU-Institute of Dental Sciences, Kohat, Pakistan.
| | | | | | - Ajmal Khan
- Oral and Maxillofacial Surgery, Saidu Medical College, Swat, Pakistan
| | - Umer Ullah
- Oral and Maxillofacial Surgery, Rehman College of Dentistry, Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
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Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg 2021; 49:196-205. [PMID: 33483246 DOI: 10.1016/j.jcms.2020.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.
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Affiliation(s)
- Adity Bansal
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Pereira I, Pellizzer E, Lemos C, Moraes S, Vasconcelos B. Closed versus open reduction of facial fractures in children and adolescents: A systematic review and meta-analysis. J Clin Exp Dent 2021; 13:e67-e74. [PMID: 33425234 PMCID: PMC7781215 DOI: 10.4317/jced.57323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/02/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Treatment of facial fractures in children and adolescents has always been a challenge for oral surgeon. The choice of treatment type must take into account several factors. This systematic review aimed to evaluate closed versus open reduction of facial fractures for pediatric facial fractures. MATERIAL AND METHODS A systematic review of the literature was conducted in three databases (PubMed/MEDLINE, Embase and The Cochrane Library) in accordance with the PRISMA statement. The PICO question was: Conservative treatment is more appropriate than surgical treatment for reducing facial fractures in children and adolescents? The full papers of 41 references were analyzed in detail. Eleven papers were included in this systematic review: one prospective study and ten retrospective studies. All studies evaluated the complication rate. RESULTS A total of 73 (7.68%) of the 950 patients experienced complications. Among these patients, 24 (3.85%) had been treated with conservative treatment and 49 (15.03%) with surgical treatment. The fixed-effects model revealed a lower complication rate with conservative treatment than surgical treatment (P<0.00001; RR: 0.18; 95% CI: 0.11-0.28). Heterogeneity was low for the complication rate outcome (X2: 5.64; P = 0.69; I2: 0%). CONCLUSIONS The present findings show that conservative treatment is more commonly performed for pediatric facial fractures and complications occur more with surgical treatment. Therefore, surgeons must evaluate all variables involved in choosing the most appropriate treatment method to ensure greater benefits to the patient with fewer complications. Key words:Closed fracture reduction, open fracture reduction, pediatrics, treatment failure.
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Affiliation(s)
- Igor Pereira
- Department of Prosthodontics and Bucco Facial Surgery, University of Pernambuco. Brazil
| | - Eduardo Pellizzer
- Department of Prosthodontics and Bucco Facial Surgery, University of Pernambuco. Brazil
| | - Cleidiel Lemos
- Department of Prosthodontics and Bucco Facial Surgery, University of Pernambuco. Brazil
| | - Sandra Moraes
- Department of Prosthodontics and Bucco Facial Surgery, University of Pernambuco. Brazil
| | - Belmiro Vasconcelos
- Department of Prosthodontics and Bucco Facial Surgery, University of Pernambuco. Brazil
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Absorbable Fixation Devices for Pediatric Craniomaxillofacial Trauma: A Systematic Review of the Literature. Plast Reconstr Surg 2019; 144:685-692. [PMID: 31461027 DOI: 10.1097/prs.0000000000005932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to investigate surgical outcomes with the use of resorbable plating systems for the repair of craniomaxillofacial trauma in the pediatric population. METHODS A systematic review of the literature was performed. A descriptive analysis, operative technical data, outcomes, and postoperative complications with the use of absorbable plating systems for craniomaxillofacial trauma were included. RESULTS The systematic literature review identified 1264 abstracts, of which only 19 met inclusion criteria. From these 19 studies, 312 clinical cases with 443 facial fractures that were treated with absorbable fixation systems were extracted for analysis. The review identified only level III/IV (n = 17) and level V (n = 2) studies. Minor and major complications were rare, occurring in 5.45 percent (n = 17) and 3.21 percent (n = 10) of cases, respectively. The most common complications were surgical-site infections (n = 4) and plate extrusion (n = 4). CONCLUSIONS This report is, to the authors' knowledge, one of the first comprehensive reports on the use of absorbable plating systems for pediatric craniomaxillofacial trauma. Their analysis suggests that the use of absorbable fixation devices for pediatric craniomaxillofacial trauma is relatively safe, with a low-risk profile. Outcome studies with longer follow-up periods specifically investigating facial growth, reoperation rates, standardized surgical outcome metrics, and cost are necessary to effectively compare these fixation devices to titanium alternatives for craniomaxillofacial trauma.
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Zavlin D, Jubbal KT, Echo A, Izaddoost SA, Friedman JD, Olorunnipa O. Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults. Craniomaxillofac Trauma Reconstr 2017; 11:41-48. [PMID: 29387303 DOI: 10.1055/s-0037-1603460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/25/2017] [Indexed: 10/19/2022] Open
Abstract
Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds ( p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.
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Affiliation(s)
- Dmitry Zavlin
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Kevin T Jubbal
- Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Shayan A Izaddoost
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jeffrey D Friedman
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas
| | - Olushola Olorunnipa
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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Abstract
Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.
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Affiliation(s)
- Brent B Pickrell
- Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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8
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Namdev R, Jindal A, Bhargava S, Dutta S, Singhal P, Grewal P. Patterns of mandible fracture in children under 12 years in a district trauma center in India. Dent Traumatol 2015; 32:32-6. [DOI: 10.1111/edt.12203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ritu Namdev
- Department of Pedodontics & Preventive Dentistry; Post Graduate Institute of dental sciences; Rohtak India
| | - Ayushi Jindal
- Department of Pedodontics & Preventive Dentistry; Post Graduate Institute of dental sciences; Rohtak India
| | - Smriti Bhargava
- Department of Pedodontics & Preventive Dentistry; Post Graduate Institute of dental sciences; Rohtak India
| | - Samir Dutta
- Department of Pedodontics & Preventive Dentistry; Post Graduate Institute of dental sciences; Rohtak India
| | - Parul Singhal
- Department of Pedodontics & Preventive Dentistry; Post Graduate Institute of dental sciences; Rohtak India
| | - Priyanka Grewal
- Department of Pedodontics & Preventive Dentistry; Post Graduate Institute of dental sciences; Rohtak India
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Anyanechi CE, Osunde OD, Bassey GO. Management of extra-capsular temporo-mandibular joint ankylosis: does conservative approach to treatment have a role? J Maxillofac Oral Surg 2015; 14:339-43. [PMID: 26028856 DOI: 10.1007/s12663-014-0625-9] [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: 09/18/2013] [Accepted: 04/04/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The conventional management of fibrous extracapsular temporo-mandibular joint (TMJ) ankylosis, a debilitating disease, is associated with surgical complications and financial burden on the patients. OBJECTIVE To assess the outcome of conservative approach to the management of fibrous extracapsular TMJ ankylosis. PATIENTS AND METHODS This is a prospective study of patients who presented at the Dental and Maxillofacial Surgery Clinic of the University of Calabar Teaching Hospital, Nigeria, during the period from January 1999 to December 2012 with a history of inability to open the mouth diagnosed as fibrous extracapsular TMJ ankylosis. RESULTS Twenty-one subjects were treated and their ages ranged from 11 to 22 years with mean at 15.0 years. There were 13 (61.9 %) males and 8 (38.1 %) females with male: female ratio of 1.6:1. The aetiological factor that predisposed to formation of extracapsular TMJ ankylosis was facial trauma. There was no facial asymmetry and the side distribution of the affliction showed that 1 (4.8 %) was bilateral while 20 (95.2 %) were unilateral. Eight cases (38.1 %) were incomplete ankylosis while the rest (n = 13, 61.9 %) were complete. The shorter the duration of fibrous ankylosis and the greater the initial inter-incisal distance before treatment, the better the treatment outcome. CONCLUSION The outcome of treatment suggests that the conservative approach to management of this condition was beneficial to these patients because they presented early. However, randomized controlled clinical trials are needed to validate this treatment option.
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Affiliation(s)
- C E Anyanechi
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, P. O. Box 3446, Calabar, Nigeria
| | - O D Osunde
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, P. O. Box 3446, Calabar, Nigeria
| | - G O Bassey
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar/University of Calabar Teaching Hospital, P. O. Box 3446, Calabar, Nigeria
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Anyanechi CE. Temporomandibular joint ankylosis caused by condylar fractures: a retrospective analysis of cases at an urban teaching hospital in Nigeria. Int J Oral Maxillofac Surg 2015; 44:1027-33. [PMID: 26008733 DOI: 10.1016/j.ijom.2015.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
Mandibular condylar fractures are common presentations to hospitals across the globe and remain the most important cause of temporomandibular joint (TMJ) ankylosis. This study aimed to analyze cases of mandibular condylar fracture complicated by TMJ ankylosis after treatment. A 16-year retrospective analysis was performed at the dental and maxillofacial surgery clinic of the study institution; patient data were collected from the hospital records and entered into a pro-forma questionnaire. It was found that 56/3596 (1.6%) fractures resulted in TMJ ankylosis. The age of patients with ankylosis ranged from 12 to 47 years. The age (P=0.03) and gender (P=0.01) distributions were significant, with most cases of ankylosis occurring in those aged 11-30 years (n=43/56, 76.8%). Fractures complicated by ankylosis were intracapsular (n=22/56, 39.3%) and extracapsular (n=34/56, 60.7%). Ankylosis increased significantly with the increase in time lag between injury and fracture treatment (P=0.001). Ankylosis was associated with concomitant mandibular (85.7%) and middle third (66.1%) fractures. Treatment methods were not significantly related to ankylosis (P=0.32). All cases of ankylosis were unilateral, and complete (n=36, 64.3%) and incomplete ankylosis (n=20, 35.7%) were diagnosed clinically. The incorporation of computed tomography scans and rigid internal fixation in the management of condylar fractures will reduce ankylosis.
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Affiliation(s)
- C E Anyanechi
- Oral and Maxillofacial Unit, Department of Dental Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
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11
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Zhang B, Liu ZH, Li J, Zhang K, Chen JJ, Zhang RM. Open reduction and internal fixation of severely dislocated fractures of condylar neck and base using bioabsorbable miniplate in children: a 3-10 years follow-up study. Int J Pediatr Otorhinolaryngol 2014; 78:1987-92. [PMID: 25249485 DOI: 10.1016/j.ijporl.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term clinical and radiologic outcomes of treating severely dislocated fractures of condylar neck and base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth sustained in childhood using bioabsorbable miniplate with open reduction and internal fixation (ORIF). METHODS Five children (age ranged from 3 to 11 years old averaged 8.2 years; 3 boys and 2 girls) with severely (the condyle dislocated from the glenoid fossa) dislocated fractures of condylar neck or base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth were treated with ORIF using 1 or 2 bioabsorbable miniplates (through preauricular approach and an oral vestibular approach). All patients have been followed-up clinically and radiographically for a mean of 5.6 years (range, 3-10 years). RESULTS All patients were cured satisfactorily with excellent occluding relation without restricted mandibular movement, facial asymmetry, retrognathism and ankylosis. 3-10 years follow-up study did not occur any mandibular development disorder. CONCLUSION The results suggested that ORIF using bioabsorbable miniplate was a reliable fixation technique for use in the treatment of severely dislocated fractures of the condylar neck and base with the comminuted fractures of parasymphysis or mental foramen, specially with crown fracture of deciduous molar and permanent molar or dislocation of the teeth in children when the non-invasive or occlusal therapies were ineffective.
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Affiliation(s)
- Bo Zhang
- Department of Oral and Maxillofacial Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, PR China.
| | - Zhao-Hui Liu
- Xin-Cheng Hospital of Gu-Zhang County, Hunan Province, PR China
| | - Jian Li
- Department of Oral and Maxillofacial Surgery, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, PR China
| | - Kevin Zhang
- Department Family and Preventive Medicine, School of Medicine, University of Utah, UT, USA
| | - Jing-Jing Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Ricardo M Zhang
- Division of International, Hunan Normal University, Changsha, PR China
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Comparison of Nonsurgical Treatment Options in Pediatric Condylar Fractures. J Craniofac Surg 2013; 24:e203-6. [DOI: 10.1097/scs.0b013e318293d605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Incidence and pattern of maxillofacial fractures in children and adolescents: a 10 years retrospective cohort study. Int J Pediatr Otorhinolaryngol 2013; 77:494-8. [PMID: 23318124 DOI: 10.1016/j.ijporl.2012.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/13/2012] [Accepted: 12/15/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate and compare the demographic characteristics of maxillofacial fractures between children and adolescents. METHODS The sample was composed of all children (less than 12 years) and adolescents (between 13 and 18 years old) who presented with maxillofacial fractures during a 10-year period (2000-2009). The age, gender, time of injury, mechanism of trauma, location and pattern of fracture, associated injuries, and treatment methods were recorded and analyzed. Data analysis included Chi-Square test, Fisher exact test. p less than 0.05 was considered significant. RESULTS Seventy-nine children (male-to-female ratio, 1.63:1) and 113 adolescents (male-to-female ratio, 3.52:1) sustained 389 maxillofacial fractures. Children were more involved in falls compared to adolescents (44.3% versus 23.9%, p=0.003), while adolescents sustained more assault-related injuries (13.3% versus 2.5%, p=0.010) and motorcycle accidents (22.1% versus 8.9%, p=0.015) compared to children. Children suffered mandibular fractures proportionally higher than adolescents (93.1% versus 64.5%, p<0.001). Adolescents sustained mid-facial fractures more frequently than children (35.5% versus 6.9%, p<0.001). Severe facial fractures occurred more in adolescents compared to children (35.4% versus 14.1%, p=0.001). Open reduction was done more in adolescents than in children (92.3% versus 74.6%, p<0.001). CONCLUSIONS The incidence and pattern of maxillofacial fractures in children were remarkably different from that in adolescents. Preventive measures and treatment plan should be designed with differences between the two groups in mind.
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Dose-dependent sustained local release of dexamethasone from biodegradable thermosensitive hydrogel of PEG–PLGA–PEG triblock copolymers in the possible prevention of TMJ re-ankylosis (Arakeri’s TMJ release technique). Med Hypotheses 2012; 78:682-6. [PMID: 22406097 DOI: 10.1016/j.mehy.2012.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 02/10/2012] [Indexed: 11/24/2022]
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Arakeri G, Kusanale A, Zaki GA, Brennan PA. Pathogenesis of post-traumatic ankylosis of the temporomandibular joint: a critical review. Br J Oral Maxillofac Surg 2012; 50:8-12. [PMID: 20970228 DOI: 10.1016/j.bjoms.2010.09.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
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Abstract
Despite recent advances in the diagnosis, treatment, and prevention of pediatric facial fractures, little has been published on the complications of these fractures. The existing literature is highly variable regarding both the definition and the reporting of adverse events. Although the incidence of pediatric facial fractures is relative low, they are strongly associated with other serious injuries. Both the fractures and their treatment may have long-term consequence on growth and development of the immature face. This article is a selective review of the literature on facial fracture complications with special emphasis on the complications unique to pediatric patients. We also present our classification system to evaluate adverse outcomes associated with pediatric facial fractures. Prospective, long-term studies are needed to fully understand and appreciate the complexity of treating children with facial fractures and determining the true incidence, subsequent growth, and nature of their complications.
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Closed reduction of laterally displaced fracture/dislocation of the mandibular condylar process in a child. J Craniofac Surg 2011; 22:1504-6. [PMID: 21778847 DOI: 10.1097/scs.0b013e31821d4db6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This is a unique case of isolated lateral fracture/dislocation of the condylar process in a 3-year-old child injured on an escalator. Immediate closed reduction under general anesthesia successfully restored condylar height and premorbid dental occlusion. Maxillomandibular fixation was not used because mandibular mobilization was encouraged. Clinical follow-up confirmed maintenance of normal dental occlusion and temporomandibular joint function.
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Abstract
There have been considerable advances in the management of craniomaxillofacial injuries in children. Conservative approaches such as close observation, a liquid-to-soft diet, and analgesics can be used for the management of mandibular fractures without displacement and malocclusion. However, displaced fractures need to be an anatomic reduction and immobilization. The basic principle of displaced mandibular fractures in both children and adults is the stabilization of fracture fragments forming the pretraumatic contour and occlusion state until osteosynthesis occurs. The major differences of pediatric fractures from adults are the flexibility of bones and very rapid healing pattern. Therefore, reduction in pediatric age group must be accomplished earlier. This case was an 11-year-old boy presented with a severely displaced parasymphyseal mandibular fracture resulting from a fall. He was given a soft diet and analgesic, given anti-inflammatory treatment of edema, and scheduled for operation. Subsequently, it was surprisingly observed that there was a significant improvement in the fracture line on the 12th posttraumatic day. The comparison of maxillofacial computed tomographic scans of the first and 12th posttraumatic days revealed a noteworthy remodeling and a remarkable approximation of the fracture lines. It can be concluded that bone remodelization in the pediatric age groups is perfect and very rapid, even in severely displaced fractures.
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Glazer M, Joshua BZ, Woldenberg Y, Bodner L. Mandibular fractures in children: analysis of 61 cases and review of the literature. Int J Pediatr Otorhinolaryngol 2011; 75:62-4. [PMID: 21035876 DOI: 10.1016/j.ijporl.2010.10.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 09/21/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose was to evaluate the incidence, etiology, site and patterns, management and treatment methods, and outcome of pediatric patients with mandibular fractures. METHODS Pediatric patients (1.5-16 years old) with mandibular fractures, treated at the Soroka University Medical Center were included in the study. Age, gender, etiology, site and type of fracture, associated injuries, mode of treatment, outcome, complications, and follow up were evaluated. The cases were divided into 3 age groups: Group A: 1.5-5 years, Group B: 6-11 years, and Group C: 12-16 years. RESULTS Sixty one patients were included in the study. The male to female ratio was 2:1. Motor vehicle accident was the most common cause. Associated trauma was more common in young children. The condyle was involved in 54% of the fractures. Closed reduction and intermaxillary fixation was the most common treatment used. Complications were rare. CONCLUSION Management of mandibular fracture in the pediatric age group is a challenge. The anatomical complexity of the developing mandible and teeth strongly suggest the use of surgical techniques that are different from those routinely used in adults. The conservative approach is recommended. Whenever possible closed reduction should be the treatment of choice.
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Affiliation(s)
- Michael Glazer
- Division of Anesthesiology and Critical Care, Soroka University Medical Center and Ben Gurion University of the Negev, Beer-Sheva, Israel
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Chrcanovic BR, Abreu MHNG, Freire-Maia B, Souza LN. Facial fractures in children and adolescents: a retrospective study of 3 years in a hospital in Belo Horizonte, Brazil. Dent Traumatol 2010; 26:262-70. [PMID: 20456472 DOI: 10.1111/j.1600-9657.2010.00887.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study was to review the etiology, incidence and treatment of selected oral and maxillofacial fractures in children in Belo Horizonte, Brazil, during a period of 3 years. MATERIALS AND METHODS The data collected for this study included age, gender, etiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture and treatment. The analysis involved descriptive statistics and chi-squared test, Bonferroni test, Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whiney tests and analysis of variance. RESULTS AND CONCLUSIONS This study examined 566 facial fractures in 464 children of 18 years of age or less. The majority of fractures were observed in children within the age group of 13-18 years of age. Bicycle accidents were the major cause of trauma, followed by falls. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the nose. A conservative approach was applied in most cases.
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Kim HM, Kim TW, Song SI, Lee JK. The conservative treatment of mandibular fracture in a child with circummandibular wiring: case report. J Korean Assoc Oral Maxillofac Surg 2010. [DOI: 10.5125/jkaoms.2010.36.2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hyung Mo Kim
- Department of Dentistry, Oral and Maxillofacial Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Tae Wan Kim
- Department of Dentistry, Oral and Maxillofacial Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seung Il Song
- Department of Dentistry, Oral and Maxillofacial Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jeong Keun Lee
- Department of Dentistry, Oral and Maxillofacial Surgery, Ajou University School of Medicine, Suwon, Korea
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Aizenbud D, Hazan‐Molina H, Emodi O, Rachmiel A. The management of mandibular body fractures in young children. Dent Traumatol 2009; 25:565-570. [DOI: 10.1111/j.1600-9657.2009.00815.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Abstract – This article reviews the management of mandibular body fractures in young children. Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non‐invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non‐invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored.
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Retrospective Analysis of Two Hundred Thirty-Five Pediatric Mandibular Fracture Cases. Ann Plast Surg 2009; 63:522-30. [DOI: 10.1097/sap.0b013e318194fdab] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pirttiniemi P, Peltomäki T, Müller L, Luder HU. Abnormal mandibular growth and the condylar cartilage. Eur J Orthod 2009; 31:1-11. [PMID: 19164410 DOI: 10.1093/ejo/cjn117] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Deviations in the growth of the mandibular condyle can affect both the functional occlusion and the aesthetic appearance of the face. The reasons for these growth deviations are numerous and often entail complex sequences of malfunction at the cellular level. The aim of this review is to summarize recent progress in the understanding of pathological alterations occurring during childhood and adolescence that affect the temporomandibular joint (TMJ) and, hence, result in disorders of mandibular growth. Pathological conditions taken into account are subdivided into (1) congenital malformations with associated growth disorders, (2) primary growth disorders, and (3) acquired diseases or trauma with associated growth disorders. Among the congenital malformations, hemifacial microsomia (HFM) appears to be the principal syndrome entailing severe growth disturbances, whereas growth abnormalities occurring in conjunction with other craniofacial dysplasias seem far less prominent than could be anticipated based on their often disfiguring nature. Hemimandibular hyperplasia and elongation undoubtedly constitute the most obscure conditions that are associated with prominent, often unilateral, abnormalities of condylar, and mandibular growth. Finally, disturbances of mandibular growth as a result of juvenile idiopathic arthritis (JIA) and condylar fractures seem to be direct consequences of inflammatory and/or mechanical damage to the condylar cartilage.
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Affiliation(s)
- Pertti Pirttiniemi
- Department of Oral Development and Orthodontics, Institute of Dentistry, University of Oulu, Finland.
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Abstract
The conservative approach in the treatment of maxillofacial trauma in children has been widely adopted. The type of fracture and its presence within the growing facial skeleton along with the presence of tooth buds may result in different management strategies to that employed in adults. An understanding of conservative treatment options is essential to make informed choices which will best manage these injuries, and an example is presented in this paper. This case report describes a 14-year-old boy who sustained trauma to the chin as a result of a fall, causing a mandibular symphyseal fracture. He was successfully treated by the means of applying direct interdental wiring combined with an acrylic splint.
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Affiliation(s)
- Ghalib Walid Qadri
- School of Dental Sciences, University Science Malaysia, Health Campus, Kelantan, Malaysia.
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Aizenbud D, Emodi O, Rachmiel A. Nonsurgical Orthodontic Splinting of Mandibular Fracture in a Young Child: 10-Year Follow-Up. J Oral Maxillofac Surg 2008; 66:575-7. [DOI: 10.1016/j.joms.2007.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
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Rocchi G, Fadda MT, Marianetti TM, Reale G, Iannetti G. Craniofacial Trauma in Adolescents: Incidence, Etiology, and Prevention. ACTA ACUST UNITED AC 2007; 62:404-9. [PMID: 17297332 DOI: 10.1097/01.ta.0000197627.05242.a4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The lack of a common agreement on the precise meaning of the term "adolescence" makes it difficult to interpret the literature regarding fractures in this age group. METHODS The records of all patients with craniofacial trauma admitted to the Division of Maxillo-Facial Surgery of the Rome "La Sapienza" University Hospital between February 2001 and August 2004 were reviewed retrospectively. Besides the anatomical site of the fracture, the authors also reviewed in the group of adolescent fractures the cause, complications, and the safety devices employed and their effectiveness. RESULTS Of 601 patients admitted after facial or craniofacial fractures, 96 were between 11 and 19 (15.97%). The most frequent cause of fracture in this age group was motorcycle crash (39/96), followed by car crash (26/96), sporting accident (15/96), attacks (11/96), microcar crash (2/96), accidental fall (2/96), and firearm trauma (1/96). Only three patients wearing a full-face helmet suffered facial fractures; the most severe fractures with neurosurgical complications occurred in patients without a helmet; the majority of facial fractures occurred in patients wearing an open-face helmet. CONCLUSIONS It is universally agreed that the primary cause of fracture is road collisions and, although car crashes prevail in all other age groups, motorcycle crashes are more frequent in adolescents. It is necessary to emphasize the need for protective devices capable of avoiding not only neurosurgical complications but also maxillofacial fractures (full-face helmet).
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Affiliation(s)
- Giovanni Rocchi
- Department of Neurosurgery, University of Rome La Sapienza, Rome, Italy
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Sales MAO, Oliveira JX, Cavalcanti MGP. Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report. Braz Dent J 2007; 18:74-7. [PMID: 17639206 DOI: 10.1590/s0103-64402007000100016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 10/10/2006] [Indexed: 11/21/2022] Open
Abstract
Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings.
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Affiliation(s)
- Marcelo Augusto Oliveira Sales
- Service of Oral and Maxillofacial Radiology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, PB, Brazil
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BRICKLEY MEGAN, SMITH MARTIN. Culturally Determined Patterns of Violence: Biological Anthropological Investigations at a Historic Urban Cemetery. AMERICAN ANTHROPOLOGIST 2006. [DOI: 10.1525/aa.2006.108.1.163] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chidzonga MM. Mandibular fracture in a neonate: report of a case. Int J Oral Maxillofac Surg 2005; 35:186-7. [PMID: 16153807 DOI: 10.1016/j.ijom.2005.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 06/10/2005] [Accepted: 07/09/2005] [Indexed: 10/25/2022]
Abstract
Neonatal mandibular fractures are rare and are mostly due to traumatic delivery. Attempted infanticide has also been reported as a cause. A case of a fractured mandible in a neonate assaulted by its mother suffering from postpartum psychosis is presented.
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Affiliation(s)
- M M Chidzonga
- Department of Dentistry, College of Health Sciences, University of Zimbabwe, Avondale, Harare.
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Dijkstra PU, Stegenga B, de Bont LGM, Bos RRM. Function Impairment and Pain After Closed Treatment of Fractures of the Mandibular Condyle. ACTA ACUST UNITED AC 2005; 59:424-30. [PMID: 16294086 DOI: 10.1097/01.ta.0000174942.80363.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the prognosis of fractures of the mandibular condyle after closed treatment. METHODS Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on radiographs. Follow-up was after 12 months in which the average pain, experienced during the last week (visual analog scale, 100 mm), and mandibular functioning were assessed (mandibular function impairment questionnaire (MFIQ)). RESULTS Data of 116 (81%) patients, 41 women (35%) and 75 men (65%), were available for analysis. Condylar neck fractures were most common (52%). Bilateral fractures were present in 28% of the patients. Pain (visual analog scale score >0) was found in 9% of the patients. Impaired mandibular function was found in 40% (MFIQ >0) and 24% (MFIQ > or =4) of the patients. The most important risk factor for pain was being a woman. The most important risk factors for function impairment were > or =25 years of age and gross displacement of the fracture parts. CONCLUSION The overall prognosis of mandibular function and pain after closed treatment of condylar fractures is good. The most important risk factor for pain persisting for 1 year after closed treatment of a condylar fracture is being a woman. The most important risk factors for function impairment are an age of > or =25 years and gross displacement of the fracture parts.
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Affiliation(s)
- P U Dijkstra
- Department Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.
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Oztan HY, Ulusal BG, Aytemiz C. The Role of Trauma on Temporomandibular Joint Ankylosis and Mandibular Growth Retardation: An Experimental Study. J Craniofac Surg 2004; 15:274-82; discussion 282. [PMID: 15167249 DOI: 10.1097/00001665-200403000-00024] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this pilot study was to analyze the role of different types of trauma in the formation of temporomandibular joint ankylosis. The specific aim was to explore the physical and histological effects of trauma on temporomandibular joint and mandibular growth. Fifty-five growing white male guinea pigs were used for the study. Initially, cadaveric studies were performed (n = 1) to assess the topographic anatomy of the temporomandibular joint region. Animals were then assigned to pilot (n = 4), experimental (n = 40), and control (n = 10) groups. The pilot group was used to assess the technical feasibility of creating various trauma types and endurance of the animals to the surgery. Four types of trauma were carried out in the experimental group: A) intra-articular hematoma (n = 10), B) mechanical damage to the articular surface (n = 10), C) fracture of the condyle neck (n = 10), and D) excision of the condyle head (n = 10). Each trauma group was further divided into two subgroups. Procedures were performed unilaterally or bilaterally in the subgroups. In the control group, no procedure was performed. Subjects were examined after a 2-month follow-up period. The development and anatomical structure of the mandible were evaluated, and histopathological assessment of the temporomandibular joint was carried out in each group. The results revealed that hyaline cartilage of the condylar head had an important role in the development of the mandible and traumas targeting this site may cause ankylosis, growth retardation, and resultant facial malformations. Hence, mechanical damage to the articular surface (B1, B2) and resection of the condylar head (D1, D2) almost always resulted in ankylosis. Intra-articular hematoma alone (A1, A2) was established not be a causative factor for ankylosis formation, however.
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Affiliation(s)
- Hasan Yucel Oztan
- Department of Plastic Surgery, Izmir Ataturk Research and Training Hospital, Izmir, Turkey
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