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Kalluri MH, Edalatpour A, Thadikonda KM, Blum JD, Garland CB, Cho DY. Patient outcomes and complications following various maxillomandibular fixation techniques: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 92:151-176. [PMID: 38520780 DOI: 10.1016/j.bjps.2024.02.075] [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: 12/17/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and complications. In this study, we reviewed the literature to evaluate and compare all MMF methods. METHODS A systematic review of all MMF types was conducted and post-operative outcome data were analyzed and compared among the different types. Conventional Erich arch bars were compared to hybrid arch bars, MMF screws, and eyelet interdental wiring. A random-effects meta-analysis was used to determine the mean differences, and 95% confidence intervals (CIs) with a statistical significance of P < 0.05. RESULTS Among the 4234 articles identified, 24 were included, and 17 were meta-analyzed. Time to achieve MMF (-43.38 min; 95% CI, -58.20 to -28.56; P < 0.001), total operative time (-30.33 min; 95% CI, -61.05 to 0.39; P = 0.05), incidence of wire puncture injuries and glove perforations (0.11; 95% CI, 0.04 to 0.30; P < 0.001), and incidence of poor oral hygiene (0.08; 95% CI, 0.02 to 0.28; P < 0.001) were lower for alternative MMF interventions compared to those of the conventional Erich arch bars. CONCLUSIONS Alternative MMF methods required shorter operative time to achieve MMF and demonstrated other increased efficiencies of practice such as shorter total operative time and decreased glove perforations, when compared to conventional Erich arch bars. If a patient is a candidate for MMF, the presented alternative MMF techniques should be considered depending on the clinical context and availability of institutional resources.
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Affiliation(s)
- Manasa H Kalluri
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Armin Edalatpour
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kishan M Thadikonda
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica D Blum
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catharine B Garland
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Y Cho
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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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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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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Gadkaree SK, Derakhshan A, Nyabenda V, Ncogoza I, Tuyishimire G, Shaye DA. Wire Osteosynthesis in the Treatment of Mandible Fractures in Low Resource Settings: A Force Study. Craniomaxillofac Trauma Reconstr 2024; 17:13-17. [PMID: 38371214 PMCID: PMC10874206 DOI: 10.1177/19433875221143605] [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 Cadaveric investigation. Objective Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF. Methods Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site. Results For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (P < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (P < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (P = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (P = .29). Conclusions Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.
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Affiliation(s)
- Shekhar K. Gadkaree
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Adeeb Derakhshan
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Victor Nyabenda
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
| | - Isaie Ncogoza
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
| | - Gratien Tuyishimire
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
| | - David A. Shaye
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
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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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Krennmair S, Malek M, Stehrer R, Stähler P, Otto S, Postl L. The effect of frontal trauma on the edentulous mandible with four different interforaminal implant-prosthodontic anchoring configurations. A 3D finite element analysis. Eur J Med Res 2023; 28:608. [PMID: 38115128 PMCID: PMC10729383 DOI: 10.1186/s40001-023-01580-y] [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: 02/06/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE The present three-dimensional (3D) finite element analysis (FEA) was aimed to assess the biomechanical effects and fracture risks of four different interforaminal implant-prosthodontic anchoring configurations exposed to frontal trauma. MATERIAL AND METHODS A symphyseal frontal trauma of 1 MPa was applied to four dental implant models with different configurations (two unsplinted interforaminal implants [2IF-U], two splinted interforaminal implants [2IF-S], four unsplinted interforaminal implants[ 4IF-U], four splinted interforaminal implants [4IF-S]. By using a 3D-FEA analysis the effective cortical bone stress values were evaluated in four defined regions of interest (ROI) (ROI 1: symphyseal area; ROI 2: preforaminal area; ROI 3: mental foraminal area; and ROI 4: condylar neck) followed by a subsequent intermodel comparison. RESULTS In all models the frontal traumatic force application revealed the highest stress values in the condylar neck region. In both models with a four-implant configuration (4IF-U, 4IF-S), the stress values in the median mandibular body (ROI 1) and in the condylar neck region (ROI 4) were significantly reduced (P <0.01) compared with the two-implant models (2IF-U, 2IF-S). However, in ROI 1, the model with four splinted implants (4IF-S) showed significantly (P < 0.01) reduced stress values compared to the unsplinted model (4IF-U). In addition, all models showed increased stress patterns in the area adjacent to the posterior implants, which is represented by increased stress values for both 2IF-U and 2IF-S in the preforaminal area (ROI 3) and for the four implant-based models (4IF-U, 4IF-S) in the mental foraminal area. CONCLUSION The configuration of four splinted interforaminal implants showed the most beneficial distribution of stress pattern representing reduced stress distribution and associated reduced fracture risk in anterior symphysis, condylar neck and preforaminal region.
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Affiliation(s)
- Stefan Krennmair
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
- NumBioLab, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Michael Malek
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
| | - Raphael Stehrer
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria
| | - Philip Stähler
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany
| | - Lukas Postl
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
- Department of Oral and Maxillofacial Surgery, Kepler University Hospital, Johannes Kepler University, Krankenhausstrasse 7a, Linz, Austria.
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Lindwurmstrasse 2a, 80337, Munich, Germany.
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Jain M, Krishnan V, Panneerselvam E, Raja VBK. Management of Lingual Cortex Fracture of Mandible Using Lingual Arch Bar: A Finite Element Analysis of Reduction with a Pilot Clinical Trial. J Maxillofac Oral Surg 2023; 22:979-986. [PMID: 38105814 PMCID: PMC10719211 DOI: 10.1007/s12663-023-02031-1] [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: 04/04/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Fractures of lingual cortex are frequently left untreated leading to poor resolution of patient's symptoms and function. Positioning an implant on same side of fracture would provide better reduction. The study aims at improving stability offered by Erich arch bar placed on lingual surface, by Finite element analysis (FEA) along with a pilot clinical trial. Methods Two FEA models were generated from CT scan of an individual having lingual cortex fracture: control model with labial arch bar and study model with lingual arch bar. Parameters assessed: Stress distribution (Mpa) along lines of osteosynthesis; Separation of fracture fragments (mm) across fracture line. Associated, was a clinical trial of 5 patients, managed by placing lingual arch bar. Feasibility of arch bar, post-operative pain, radiographic inter-fragmentary gap and complications were assessed clinically. Results Lingual positioning of arch bar demonstrated less displacement (mm) of fracture fragments compared to labial placement (0.123 vs. 0.677) upon application of masticatory load. Insignificant lingual splay and lesser degree of stress distribution (Mpa) was observed (83.1 vs. 99.3) favoring placement of arch bar on lingual side. Clinical trial correlated with outcomes of FEA, resulting in improvement of patient's symptoms. Conclusion FEA and supporting clinical trial provided an effective method of reduction for lingual cortical fracture.
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Affiliation(s)
- Meghana Jain
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - Velavan Krishnan
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
| | - V. B. Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Tamil Nadu, Bharathi Salai, Ramapuram Campus, Ramapuram, Chennai, 600089 India
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Barrow BE, Kachare MD, Kachare SD, Alur AA, Little J. Call the Bomb Squad: An Interesting Case of a Retained Explosive in the Mouth. EPLASTY 2023; 23:QA9. [PMID: 37799323 PMCID: PMC10550257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Brooke E Barrow
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, North Carolina
| | - Milind D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Swapnil D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Abhishek A Alur
- Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Jarrod Little
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
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Schwartz A, Park J, Durham D, West W, Su R, Wainwright D, Troy J. Characteristics and Complication Rates of Mandibular Fractures Caused by Violent Mechanisms Versus Nonviolent Mechanisms. EPLASTY 2023; 23:e59. [PMID: 37743967 PMCID: PMC10517665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Mandibular fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of mandibular fractures and their outcomes. Methods In this institutional review board-approved, retrospective study, we examined our institution's records for adult patients >18 years of age who presented with ≥ 1 mandibular fractures from January 2011 to January 2022. Violence was defined as trauma intended to hurt another or self. Demographics, fractures, mechanism, concomitant injuries, treatment, and complications were analyzed with Excel and SPSS statistical software. Results A total of 692 patients were diagnosed with mandibular fractures, with 323 of these due to violence (47%). These patients of violence (POVs) had an average fracture per patient of 1.6 ± 0.7. The majority (88%) were male and African American (33%), and the average age was 34.3 ± 13.2 years. The most common violent mechanism was a punch (68%). The POVs presented with fewer concomitant injuries, were less likely to be admitted to the intensive care unit, and were more often surgically managed with open reduction than were patients of nonviolence (PONVs) (P < .01). POVs were more likely to have healing complications; though not statistically significant, this population was observed to be frequently lost to follow-up (P = .12). POVs notably had a much higher proportion of hardware exposure among complications than was seen in PONVs (23% vs 9%). Conclusions Patients with violent fracture mechanisms may tend to be predisposed to more complications compared with patients who have nonviolent fracture mechanisms despite lesser severities due to social determinants of health. Characteristics of this patient subset may tend to cause difficulties in postoperative care and follow-up. Effective discharge instruction communication, patient outreach programs, and homelessness and drug abuse screening in this subset may help reduce healing complications.
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Affiliation(s)
- Adam Schwartz
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Julie Park
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Devon Durham
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - William West
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Rachel Su
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - D'Arcy Wainwright
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Jared Troy
- Department of Plastic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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Grippaudo C, Lo Giudice A, Saponaro G, Todaro M, Moro A, D’Addona A. The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures. Bioengineering (Basel) 2023; 10:1023. [PMID: 37760125 PMCID: PMC10525750 DOI: 10.3390/bioengineering10091023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.
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Affiliation(s)
- Cristina Grippaudo
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, 95123 Catania, Italy;
| | - Gianmarco Saponaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Mattia Todaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alessandro Moro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio D’Addona
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
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11
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Tucker J, Goldenberg D, Brandon C, King TS, Ziai K, Lighthall JG. Limited Efficacy of Empiric Antibiotics for Pediatric Facial Fractures. J Oral Maxillofac Surg 2023; 81:869-877. [PMID: 37116541 PMCID: PMC10790685 DOI: 10.1016/j.joms.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair. PURPOSE This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections. STUDY DESIGN, SETTING, SAMPLE In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18 years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing of antibiotic administration, categorized by pre, intra, and postoperative administration. MAIN OUTCOME VARIABLES Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts. COVARIATES Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture. ANALYSES χ2 analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P < .05. RESULTS This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P = .12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P = .79). There was a significant association between the timing of antibiotic use and infection (P = .044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P = .023). CONCLUSION AND RELEVANCE While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.
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Affiliation(s)
- Jacqueline Tucker
- Medical Student, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Dana Goldenberg
- Medical Student, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Cameron Brandon
- Resident, Department of Neurosurgery, The Ohio State University, Columbus, OH
| | - Tonya S King
- Statistician, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Kasra Ziai
- Chief Resident, Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Jessyka G Lighthall
- Associate Professor, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
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12
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Kwofie M, Policeni B. Reconstructive Surgeries After Head And Neck Trauma: Imaging Appearances. Semin Roentgenol 2023; 58:311-330. [PMID: 37507172 DOI: 10.1053/j.ro.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Michael Kwofie
- Department of Radiology, The University of Iowa Hospital and Clinics, Iowa City, IA.
| | - Bruno Policeni
- Department of Radiology, The University of Iowa Hospital and Clinics, Iowa City, IA
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13
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Polizzi A, Ronsivalle V, Lo Giudice A, Isola G, Bianchi A, Santonocito S, Leonardi R, Mummolo S. Orthodontic Approaches in the Management of Mandibular Fractures: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10030605. [PMID: 36980163 PMCID: PMC10047072 DOI: 10.3390/children10030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
Non-surgical approaches have been proposed in the management of mandibular fractures, especially in children, but there is a lack of clear guidelines on the clinical indications of conservative approaches. The aim of this scoping review is to provide the available evidence of the role of the orthodontist in the management of mandibular fractures. The PRISMA-ScR guidelines were followed to select eligible articles from the PubMed, Scopus, and Web of Science databases according to precise inclusion criteria. The research questions were formulated as follows: "what is the scientific evidence concerning the rule of orthodontists in the management of mandibular fractures" and "the preferential use of the direct bonding technique with orthodontic brackets rather than rigid arch bars"? Seventeen articles were included. Five articles presented the use of removable acrylic splints or functional appliances, six articles concerned the employment of cemented acrylic or rigid splints, and six articles described the management of mandibular fractures in adults and children using orthodontic brackets or mini-screws. Most of these techniques have been employed in children and growing subjects, while fewer data were available regarding conservative treatments in adults. Preliminary evidence suggests that condylar and some minor parasymphyseal fractures in children may be managed with conservative approaches. In adults, minor condylar and stable body mandibular fractures with minimal displacement have been reduced similarly. However, there are no sufficient elements that could suggest the preferential use of orthodontic brackets over rigid arch bars in adults. Further randomized and non-randomized clinical trials with long follow-ups will be needed to better define the clinical indications of the orthodontic approaches in the management of mandibular fractures based on severity, location, and age.
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Affiliation(s)
- Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Alberto Bianchi
- Department of General Surgery and Medical Surgery Specialties, Section of Maxillofacial Surgery, University of Catania, 95100 Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Rosalia Leonardi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Stefano Mummolo
- Department of Life, Health & Environmental Sciences, Postgraduate School of Orthodontics, University of L'Aquila, 67100 L'Aquila, Italy
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14
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The Assessment of Intermaxillary Fixation and Open Reduction Using Skeletal Anchorage System Compared With Arch Bar in Mandible Fracture Based on CT Image. J Craniofac Surg 2023:00001665-990000000-00641. [PMID: 36935402 DOI: 10.1097/scs.0000000000009308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/28/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND There are many different techniques to achieve intermaxillary fixation (IMF) for open reduction of mandible fractures. The arch bar has long been used as the gold standard of IMF to assist open reduction. However, owing to its long operating time, risk of needle stick injury, and gingival trauma, surgeons looked into different treatment options for IMF, such as the skeletal anchorage system (SAS). Therefore, this study aimed to compare the stability between IMF with arch bar and IMF with SAS based on computed tomography image. MATERIALS AND METHODS In this retrospective study, postoperative computed tomography and panoramic radiographs were taken 1 week and 6 months after surgery, respectively. The treatment of mandibular fractures using IMF with arch bar and SAS were compared by evaluating changes in the dental midlines and condyle positions. Thirty patients with mandibular fractures were enrolled into 2 groups-IMF with arch bar and IMF with SAS. RESULTS The arch bar showed slightly more deviation in dental midline. In SAS, the condyle moved more medially compared with the arch bar. CONCLUSIONS Skeletal anchorage system could be used for IMF with reliable stability in mandible fracture. There were no significant differences in the treatment outcome between the 2 groups.
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15
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Satishchandran S, Umorin M, Manhan AJ, Abramowicz S, Amin D. Does the Treatment Approach for Mandibular Condyle Fractures Impact Self-Perceived Quality of Life? J Oral Maxillofac Surg 2023; 81:184-193. [PMID: 36375512 DOI: 10.1016/j.joms.2022.10.006] [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: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE There is no consensus in mandibular condylar fracture/s treatment. In medicine, quality of life (QOL) includes the individual's satisfaction toward their own health condition, disease, or treatment. The purpose of this study was to investigate self-perception QOL outcomes for patients who sustained mandibular condylar fracture/s. METHODS This cross-sectional study surveyed patients at Grady Memorial Hospital in Atlanta, Georgia from November 2016 to June 2020. The study included patients who were at least 16 years old at the time of injury, diagnosed with mandibular condylar fracture/s, treated by close reduction or open reduction and internal fixation (ORIF), presented for 6-months post-operative follow-up, and had a valid phone number. The primary predictor variable was treatment approach. The primary outcome variable was mood. Covariates were demographics, injury details, and self-perception QOL questionnaire. Univariate, bivariate, and ordinal regression analysis were performed (P < .05 significance). RESULTS A total of 108 patients met inclusion criteria. Response rate was 84.2%. Our data showed that patients who underwent ORIF treatment were statistically more likely to experience no or milder pain when chewing (tau = 0.390, P = .002), to not require pain medications (tau = 0.389, P = .002), to report larger maximum mouth opening (tau = 0.402, P = .0003), and to report better QOL (tau = 0.440, P = 7.407e-05). Ordinal regression analysis showed that patients who had undergone ORIF treatment were positively associated with better mood (estimate: -0.062; OR: 0.54; P = .29) and statistically significant associated with excellent QOL (estimate: -2; OR: 0.13; P = 3.99e-05). Patients who sustained class III Lindahl mandibular condyle fracture were statistically significantly associated with depressed mood (estimate: 1.46; OR: 4.33; P = .002). CONCLUSION ORIF treatment was positively associated with better QOL when compared to closed reduction for mandibular condyle fracture.
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Affiliation(s)
- Sruthi Satishchandran
- Resident, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - Mikhail Umorin
- Assistant Professor, Department of Biomedical Sciences, School of Dentistry, Texas A & M University, Dallas, TX
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine, Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Texas A & M University, Dallas, TX.
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16
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Facial Trauma Management During the Coronavirus Disease 2019 Pandemic. J Craniofac Surg 2023; 34:955-958. [PMID: 36727751 PMCID: PMC10128424 DOI: 10.1097/scs.0000000000009177] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Facial trauma is managed with open or closed treatment modalities; however, the impact of the coronavirus disease 2019 (COVID-19) pandemic on facial trauma management remains unclear. OBJECTIVE To determine whether the management of facial trauma varied during the COVID-19 pandemic. DESIGN SETTING, PARTICIPANTS A retrospective review of 127 adults at The R Adams Cowley Shock Trauma Center at the University of Maryland between March 2019 and March 2021. Adults were stratified into pre-COVID (before March 2020) and post-COVID groups. MAIN OUTCOMES AND MEASURES Open reduction internal fixation alone, maxillomandibular fixation (MMF) alone, Open reduction internal fixation and MMF, and closed reduction. RESULTS Of the 127 patients, 66 were treated pre-COVID (52%) and 61 post-COVID (48%). While the prevalence of mandible fractures did not differ (pre-COVID, n = 39, 59%; post-COVID, n = 42, 69%; P = 0.33), the use of MMF alone decreased (pre-COVID, n = 9, 23%; post-COVID, n = 1, 2%; P = 0.005). In contrast, while the prevalence of displaced nasal bone fractures decreased (pre-COVID, n = 21, 32%; post-COVID, n = 4, 7%; P = 0.0007), management with closed reduction did not differ (pre-COVID, n = 23, 96%; post-COVID, n = 11, 85%; P = 0.27). CONCLUSIONS AND RELEVANCE Although the clinical characteristics of patients with facial fractures did not differ during the COVID-19 pandemic, the use of MMF for mandible fractures changed significantly. LEVEL OF EVIDENCE Level IV.
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17
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Pawar SS, Bhola ND, Agarwal A. Mandibular Ramus Fractures: A Case Series of Diversity in Rarity. Cureus 2022; 14:e30471. [PMID: 36415403 PMCID: PMC9673617 DOI: 10.7759/cureus.30471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023] Open
Abstract
Mandibular ramus fracture is usually minimally displaced as it is surrounded by the medial pterygoid medially, masseter laterally, and the pterygomasseteric sling inferiorly. They are commonly caused either by road traffic accidents or interpersonal violence. Ramus fracture is usually seen in conjunction with other mandibular fractures and is seldom found alone. The ramus is located at the congregation of the dentate and the non-dentate parts of the mandible. Ramus fractures are generally managed by closed reduction when minimally displaced but this technique has its disadvantages like poor maintenance of oral hygiene and prolonged healing time. It can get fractured in various patterns. Owing to the presence of anatomical structures on either side of the ramus and the orientation of the fracture line, the treatment plan varies in each case to prevent paresthesia by preserving the inferior alveolar nerve. This article has demonstrated four distinct kinds of mandibular ramus fractures and their management with open reduction internal fixation (ORIF).
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Affiliation(s)
- Shreya S Pawar
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Nitin D Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Anchal Agarwal
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Wardha, IND
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18
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Vityadewi N, Prawoto AN, Seswandhana MR, Wahdini SI, Ramli RN, Dachlan I. Treatment of extended comminuted mandibular fractures with infected cutaneous fistule Post-ORIF using a reconstruction plate: A case report. Ann Med Surg (Lond) 2022; 80:104319. [PMID: 36045761 PMCID: PMC9422384 DOI: 10.1016/j.amsu.2022.104319] [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: 05/25/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Case report Discussion Conclusion Extensively comminuted mandibular fractures are known to be difficult to manage and have high rates of complications such as cutaneous fistules. Infection of jaw fractures represents the most commonly encountered postoperative complication and mandibular fractures are reported to be associated with the highest rate of infections among other maxillofacial fractures. Open reduction allows the patient to have faster results with less complications in the future.
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Affiliation(s)
- Nurardhilah Vityadewi
- Corresponding author. Plastic Reconstructive and Aesthetic Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing/Dr. Sardjito General Hospital, Yogyakarta, 55281, Indonesia.
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19
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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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20
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Shurley CD, Abramowicz S, Manhan AJ, Roser SM, Amin D. Comprehensive analysis of patients with failure of mandibular hardware. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:15-19. [PMID: 35153183 DOI: 10.1016/j.oooo.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/09/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of the study was to characterize patients who had failure of mandibular hardware (FMH). STUDY DESIGN This retrospective cohort study consisted of patients with mandible fractures (MFs) that required surgical intervention from 2012 to 2020. Patients were included when mandibular hardware failed. Descriptive variables were collected. RESULTS During the study period, 57 patients (47 male, average age 38.7 years) met the inclusion criteria. Incidence of FMH was 7.4%. Most patients were African American (n = 45, 78.9%) with American Society of Anesthesiologists classification II (n = 40, 70.2%). Tobacco use (n = 31, 54.4%) and/or alcohol (n = 33, 57.9%). The most common etiology was assault (n = 28, 49.1%). The most common location was the angle of the mandible. Most mandibles had fracture at 1 location (n = 31, 54.4%) and a tooth was involved in the fracture line (n = 44, 77.2%). More than half of patients were treated with transoral surgical approach (n = 35, 61.4%). The majority of patients received preoperative antibiotics (n = 51, 89.4%). Patients had varying levels of compliance with postoperative care, and most were not compliant. Infection (n = 45) was the most common presentation of FMH. CONCLUSION High American Society of Anesthesiologists score, smoking, excessive alcohol use, parafunctional habits, and compliance with postoperative instructions may affect surgical outcome.
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Affiliation(s)
- Christine D Shurley
- Resident-in-training, Oral and Maxillofacial Surgery, Emory University School of Medicine
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University; Program Director of Oral and Maxillofacial Surgery and Service Chief of Oral and Maxillofacial Surgery, Grady Memorial Hospital
| | - Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA, USA.
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21
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Facial Reconstruction Following Self-Inflicted Gunshot Wounds: Predictors, Complications, and Acceptable Outcomes. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Self-inflicted gunshot wounds (SIGSWs) produce devastating facial defects that are challenging to reconstruct, but are rarely reported in large cohorts in the literature. This study sought to characterize these injuries, and identify parameters influencing complications and outcomes among survivors following facial reconstruction. Methods: A retrospective cohort study was performed identifying 22 patients with SIGSWs to the face reconstructed at our center from 2009 to 2019. Charts were reviewed for patient, injury, and reconstructive details and course. Outcomes were statistically compared to various parameters. Results: The most common firearm, orientation, and injured structure were the handgun (40.9%), submental (59.1%), and mandible (68.2%), respectively. Patients averaged a 21.7-day length of stay (LOS), 17.4 h to debridement, 2.6 days to bony fixation, 5.4 reconstructive surgeries, and 7 (31.8%) patients received at least one free flap. Fifteen (68.2%) patients had at least one major complication, although functional outcomes were ultimately relatively good overall. Notable outcome associations included submental orientation with a longer LOS (p = 0.027), external fixation with a longer LOS (p = 0.014), financial stressors with a shorter LOS (p = 0.031), and severe soft tissue injury with an increased total number of reconstructive surgeries (p = 0.039) and incomplete reconstruction (p = 0.031). There were no cases of suicidal recidivism. Conclusions: Reconstruction following facial SIGSW is challenging for both patient and surgeon, and carries a high rate of complications. However, patients can regain substantial function following reconstruction and the achievement of satisfactory outcomes.
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22
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Sheng K. Radiological investigation of acute mandibular injury. Natl J Maxillofac Surg 2022; 13:165-171. [PMID: 36051802 PMCID: PMC9426694 DOI: 10.4103/njms.njms_27_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/15/2019] [Accepted: 01/09/2020] [Indexed: 12/04/2022] Open
Abstract
This article focuses on the different imaging modalities used to evaluate acute mandibular fractures and explores important concepts relating to their diagnosis, investigation, and treatment. Significant focus will be given to exploring general management principles, considerations regarding first-line imaging, and recent technological advancement. Computed tomography (CT) is the preferred method when attempting to identify acute mandibular fractures, particularly in trauma patients, and has very high specificity and sensitivity. Multidetector CT now represents the standard of care, enabling fast scan times, reduced artifact, accurate reconstructed views, and three-dimensional (3D) reconstructions. Cone-beam CT is a newer advanced imaging modality that is increasingly being used worldwide, particularly in the ambulatory and intraoperative setting. It produces high-resolution images with submillimeter isotropic voxels, 3D and multiplanar reconstruction, and low radiation dose, however is less widely available and more expensive. Ultrasound is a valuable method in identifying a fracture in unstable patients, but is limited in its ability to detect nondisplaced fractures. Magnetic resonance imaging is useful in determining the presence of soft-tissue injury. CT angiography is invaluable in the assessment of potential vascular injury in condylar fracture dislocations.
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23
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Limitations of Coding and Reimbursement Systems for Surgical Correction of Mandibular Fractures: What Are They and How Can Craniofacial Surgeons Fix Them? Plast Reconstr Surg 2021; 149:357e-359e. [PMID: 34958653 DOI: 10.1097/prs.0000000000008734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nasreen S, Bansal A, Rela R, Rai G, Sah RP, Gupta AR. Inter Maxillary Fixation Versus Open Reduction for the Treatment of Mandibular Condyle Fractures: A Comparative Evaluation. J Pharm Bioallied Sci 2021; 13:S268-S271. [PMID: 34447090 PMCID: PMC8375891 DOI: 10.4103/jpbs.jpbs_729_20] [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: 11/03/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The treatment for fractured mandibular condyles aims at restoring the masticatory ability, occlusion, symmetry, and function as the bit were before the trauma. The treatment of the mandibular condylar fracture can be done based on the two protocols. Aims: The present clinical trial was conducted to collate aftertreatment upshot of closed treatment and open surgical treatment for mandibular condyle fractures. Materials and Methods: Forty-two patients were divided into two groups (n = 12) which were treated with either the closed reduction using intermaxillary fixation or open reduction and internal fixation. The following clinical parameters were assessed at 1st and 3rd day and at 1, 3, and 6 weeks: lateral excursion and protrusion, occlusion; interincisal opening, mandibular ramus height, deviation/deflection during jaw opening, and pain assessment using visual analog score. The collected data were subjected to statistical evaluation. Results: Interincisal opening was found to be 8.125 ± 0.3467 mm and 6.016 ± 0.1528 mm, respectively, for Group I and Group II which was statistically significant (P < 0.00001). At the 3 months and 6th week postoperatively, it was increased in the surgical groups to 17.433 ± 0.3822 mm and 19.175 ± 0.3696 mm, respectively. Conclusion: The present trial suggests surgical open reduction and internal fixation treatment of the mandibular condylar fracture is better than the nonsurgical closed reduction in terms of interincisal opening, lateral excursion, and protrusive mandibular movement range.
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Affiliation(s)
- Saba Nasreen
- Department of Dentistry, SKMCH, Muzaffarpur, Bihar, India
| | - Anupam Bansal
- Department of Oral and Maxillofacial Surgery, Darshan Dental College, Udaipur, Rajasthan, India
| | - Rathi Rela
- Department of Oral Medicine and Radiology, Nalanda Medical College and Hospital, Patna, Bihar, India
| | - Gaurav Rai
- Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Science, Patna, Bihar, India
| | - Ram Prasad Sah
- Department of Dentistry, Sri Krishna Medical College and Hospital. Muzaffarpur, Bihar, India
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25
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Morgan AC, Davis GL, Mehta IH, Stark P, Paap MK, Gosman AA. Analysis of Narcotic Use in Isolated Facial Fractures: Potential Targets for a Narcotic Reduction Protocol. J Craniofac Surg 2021; 32:1033-1036. [PMID: 33055561 DOI: 10.1097/scs.0000000000007185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Anecdotal evidence suggests that patients with isolated traumatic facial fractures have high narcotic usage, yet there is a lack of literature delineating this relationship. This study aimed to characterize total amount and factors predictive of narcotic usage following isolated traumatic facial fracture. Study participants (n = 35) were predominantly male (91.4%), mean age 40.5, Caucasian (34.3%), suffered some form of assault (62.9%), and remained hospitalized for an average of 3.0 days. Average morphine milligram equivalent (MME) use in the inpatient setting was 967.6 for operative (n = 30) and 37.5 for nonoperative (n = 5) patients. Average total narcotic use across inpatient and outpatient settings was 1256.6 MME for operative and 105 MME for nonoperative patients. Operative intervention predicted a significant difference in total inpatient narcotic usage (P = 0.009). For patients who underwent surgical intervention, significant variations in narcotic usage were found based on mechanism of injury (24-hour postoperative, P = 0.030), but not injury severity or number of procedures. Specifically, individuals suffering highly traumatic fractures (eg, gunshot wound) demonstrated increased total postoperative narcotic usage of 1194.1 MME (P = 0.004). Interestingly, non-narcotic analgesic use including acetaminophen and lidocaine-epinephrine resulted in significantly lower narcotic usage in the postoperative setting. These findings suggest a role for narcotic-reducing enhanced recovery after surgery protocols in the setting of isolated facial trauma.
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Affiliation(s)
- Austin C Morgan
- Division of Plastic Surgery, University of California, San Diego Health Center, La Jolla and San Diego
| | - Greta L Davis
- University of California, San Diego School of Medicine, La Jolla, CA
| | - Ishan H Mehta
- University of California, San Diego School of Medicine, La Jolla, CA
| | - Phoebe Stark
- University of California, San Diego School of Medicine, La Jolla, CA
| | - Michael K Paap
- University of California, San Diego School of Medicine, La Jolla, CA
| | - Amanda A Gosman
- Division of Plastic Surgery, University of California, San Diego Health Center, La Jolla and San Diego
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Nilsson J, Nysjö F, Nyström I, Kämpe J, Thor A. Evaluation of in-house, haptic assisted surgical planning for virtual reduction of complex mandibular fractures. Int J Comput Assist Radiol Surg 2021; 16:1059-1068. [PMID: 33905085 PMCID: PMC8166680 DOI: 10.1007/s11548-021-02353-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/16/2021] [Indexed: 11/11/2022]
Abstract
Purpose The management of complex mandible fractures, i.e. severely comminuted or fractures of edentulous/atrophic mandibles, can be challenging. This is due to the three-dimensional loss of bone, which limits the possibility for accurate anatomic reduction. Virtual surgery planning (VSP) can provide improved accuracy and shorter operating times, but is often not employed for trauma cases because of time constraints and complex user interfaces limited to two-dimensional interaction with three-dimensional data. Methods In this study, we evaluate the accuracy, precision, and time efficiency of the haptic assisted surgery planning system (HASP), an in-house VSP system that supports stereo graphics, six degrees-of-freedom input, and haptics to improve the surgical planning. Three operators performed planning in HASP on computed tomography (CT) and cone beam computed tomography (CBCT) images of a plastic skull model and on twelve retrospective cases with complex mandible fractures. Results The results show an accuracy and reproducibility of less than 2 mm when using HASP for virtual fracture reduction, with an average planning time of 15 min including time for segmentation in the software BoneSplit. Conclusion This study presents an in-house haptic assisted planning tool for cranio-maxillofacial surgery with high usability that can be used for preoperative planning and evaluation of complex mandible fractures.
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Affiliation(s)
- Johanna Nilsson
- Oral and Maxillofacial Surgery, Zealand University Hospital, Roskilde, Denmark.,Plastic and Oral and Maxillofacial Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Fredrik Nysjö
- Department of Information Technology, Centre for Image Analysis, Uppsala University, Uppsala, Sweden.
| | - Ingela Nyström
- Department of Information Technology, Centre for Image Analysis, Uppsala University, Uppsala, Sweden
| | - Johan Kämpe
- Plastic and Oral and Maxillofacial Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Thor
- Plastic and Oral and Maxillofacial Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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AlMofreh AlQahtani F, Bishawi K, Jaber M, Thomas S. Maxillofacial trauma in the gulf countries: a systematic review. Eur J Trauma Emerg Surg 2021; 47:397-406. [PMID: 32572511 DOI: 10.1007/s00068-020-01417-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this review was to determine the prevalence, major causative factors and the most common sites of Maxillofacial Trauma in the Gulf Cooperation Council (GCC) Countries. METHODS All articles that were published in the English language in the databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, COCHRANE, ELSEVIER and SCOPUS were reviewed for MFT from GCC during the last 23 years. RESULTS A total of 19,151 patients (16,567 males and 2584 females) (86-14%) with an age range between 0 and 97 years were included in the study. In all of the Gulf countries males outnumber females in terms of maxillofacial injuries with a ratio of 6.4:1. The mandible was the most common site of trauma followed by the maxilla. Road Traffic Accidents (RTA) was the most common cause of injury in the GCC followed by falls. CONCLUSION Maxillofacial injuries are highly prevalent, distributed among the Gulf countries, and is mainly caused by RTAs especially among males who are highly prone to MFT in the gulf. The reasons are due to lack of road safety culture and weak enactment of traffic legislation, other possible factors include intrinsic car safety features, high speed driving and the amount/use of highways in these societies.
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Affiliation(s)
| | - Khaled Bishawi
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
| | - Mohamed Jaber
- College of Dentistry, Ajman University, Ajman, United Arab Emirates. .,Department of Oral Surgery, College of Dentistry, Ajman University, P.O. Box 346, Ajman, United Arab Emirates.
| | - Sam Thomas
- College of Dentistry, Ajman University, Ajman, United Arab Emirates
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28
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Analysis using the finite element method of a novel modular system of additively manufactured osteofixation plates for mandibular fractures - A preclinical study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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29
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Selvaraj DSS, Oommen AG, Jenifer D, Vinitha G, Ebenezer J. Conservative Approach for Treatment of Isolated Mandibular Fractures, the Adaptations During COVID 19 Pandemic. J Maxillofac Oral Surg 2021; 21:426-432. [PMID: 33424183 PMCID: PMC7778838 DOI: 10.1007/s12663-020-01489-7] [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: 08/21/2020] [Accepted: 11/27/2020] [Indexed: 11/07/2022] Open
Abstract
Background The ongoing COVID 19 pandemic brought about a sudden disruption to the way medical services are rendered in our country. Management of maxillofacial injuries, especially isolated mandibular fractures by surgical methods, became near impossibility because of the restrictions and other concerns related to the pandemic. Methods The individuals who suffered isolated mandibular fracture because of trauma were included, to undergo conservative treatment methods with adaptations for the pandemic. Individuals with multiple bone fractures were excluded, and the selected patients were given the choice to opt out from this treatment plan. We followed a more conservative approach with adaptations, which we have discussed in this article. Result The fracture healing for all the patients was as expected, and none of our team members got infected with this virus from exposure to patients. Conclusion The adaptations helped in limiting the possible exposure of patients, relatives and health care providers to the virus and addressed other pressing concerns related to this pandemic. We present the guideline that we formulated in our unit, which we used to manage the patients who reported to us with isolated mandibular fractures during the ongoing pandemic.
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Affiliation(s)
| | - Ajish George Oommen
- Department of Dental and Oral Surgery-Unit 2, Christian Medical College and Hospital, Vellore, Tamil Nadu India
| | - D Jenifer
- Department of Dental and Oral Surgery-Unit 2, Christian Medical College and Hospital, Vellore, Tamil Nadu India
| | - G Vinitha
- Department of Dental and Oral Surgery-Unit 2, Christian Medical College and Hospital, Vellore, Tamil Nadu India
| | - Jagadish Ebenezer
- Department of Dental and Oral Surgery-Unit 2, Christian Medical College and Hospital, Vellore, Tamil Nadu India
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30
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Gupta S, Bansal V, Mowar A, Purohit J, Bindal M. Analysis between Retromandibular and Periangular Transmasseteric Approach for Fixation of Condylar Fracture - A Prospective Study. Ann Maxillofac Surg 2020; 10:353-360. [PMID: 33708579 PMCID: PMC7943978 DOI: 10.4103/ams.ams_28_20] [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: 01/30/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Condylar fractures make up for an average of 17.5%–52% of all mandibular fractures. The aim of the present study was to compare the ease, success, and complications between retromandibular and periangular transmasseteric approaches when used for open reduction and internal fixation of condylar fractures. Materials and Methods: A total 20 cases with condylar fracture, ten each for retromandibular and periangular transmasseteric approach, were included in the study. Patients were evaluated at 1 week, 1 month, 3 months, and 6 months. Postoperative occlusion, maximum mouth opening, range of movement, facial nerve function, visibility, convenience of plating, and time taken for exposure, fixation, and closure were recorded. Incidence of complications such as wound dehiscence, wound infection, hematoma, sialocele formation, Frey's syndrome, and hypertrophic scars were also evaluated. Results: The mean exposure time in the retromandibular approach was 10 min 31 s and 9 min 17 s in the periangular transmasseteric approach. The incidence of facial nerve injury was 2 of 10 patients in the retromandibular group and 3 of 10 patients in the periangular transmasseteric group, all of which resolved within 6 months. The incidence of sialocoele was 2 of 10 in the retromandibular group. The time taken for exposure of the fracture site was statistically significant between the two approaches (P = 0.048) with longer time required for retromandibular approach. Discussion: It can be summarized that both the approaches are comparable and well suited for surgical management of condylar fractures. It was observed that in displaced condylar neck fractures, greater difficulty was experienced in the periangular transmasseteric approach than the retromandibular approach.
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Affiliation(s)
- Saloni Gupta
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Apoorva Mowar
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Jayendra Purohit
- Department of Oral and Maxillofacial Surgery, College of Dental Science, Amargadh, Gujarat, India
| | - Mohit Bindal
- Department of Oral and Maxillofacial Surgery, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
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Jung BT, Kim WH, Park B, Lee JH, Kim B, Lee JH. Biomechanical evaluation of unilateral subcondylar fracture of the mandible on the varying materials: A finite element analysis. PLoS One 2020; 15:e0240352. [PMID: 33031474 PMCID: PMC7544122 DOI: 10.1371/journal.pone.0240352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
Fixation materials used in the surgical treatment of subcondylar fractures contribute to successful clinical outcomes. In this study, we simulated the mechanical properties of four fixation materials [titanium (Ti), magnesium alloy (Mg alloy), poly-L-lactic acid (PLLA), and hydroxyapatite/poly-L-lactide (HA-PLLA)] in a finite-element analysis model of subcondylar fracture. Two four-hole plates were fixed on the anterior and posterior surfaces of the subcondyle of the mandible. In the simulation model of a subcondylar fracture, we evaluated the stress distribution and mechanical deformation of fixation materials. The stress distribution conspicuously appeared on the condylar neck of the non-fractured side and the center of the anterior plate for all materials. More stress distribution to the biologic component appeared with HA-PLLA than with Ti or Mg alloy, but its effects were less prominent than that of PLLA. The largest deformation was observed with PLLA, followed by HA-PLLA, Mg alloy, and Ti. The results of the present study imply the clinical potential of the HA-PLLA fixation material for open reduction of subcondylar fractures.
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Affiliation(s)
- Bryan Taekyung Jung
- School of Dentistry, University of Detroit Mercy, Detroit, Michigan, United States of America
| | - Won Hyeon Kim
- Department of Mechanical Engineering, Sejong University, Seoul, Korea
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
| | - Byungho Park
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jong-Ho Lee
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Bongju Kim
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
- * E-mail: (BK); (JHL)
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
- * E-mail: (BK); (JHL)
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Mittal G, Agarwal A, Garg R, Sharma S, Rathi A, Kapse P. Efficacy of Microplates versus Miniplates in the Management of Maxillofacial Fractures. Ann Maxillofac Surg 2020; 10:31-36. [PMID: 32855911 PMCID: PMC7433951 DOI: 10.4103/ams.ams_30_20] [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: 01/31/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Increased facial trauma has led to advances in techniques of internal fixation, improvements in plating system, refinements in exposure of facial skeleton fueling the rapid use of internal fixation for the management of facial fractures. Evaluating 40 patients with confirmed midfacial (Le Fort I and II) and mandibular fractures, this study presents the efficacy of microplate in comparison with miniplate in terms of load bearing capacity, stability at the fracture site and postoperative palpability. Objectives: To evaluate the efficacy of microplates in comparison with miniplates in maxillofacial trauma. Materials and Methods: Study sample consists 40 subjects, 20 each in two groups clinically and radiographically diagnosed with Group 1 (maxillary) and Group 2 (mandibular fractures) which were subdivided into 10 each treated with miniplate and microplate respectively. Postoperatively, stability of fracture, bite force, need for postop MMF, pain, infection, wound dehiscence, mouth opening, occlusion and palpability was noted. All cases have been evaluated clinically for various parameters for minimum of 3 months to assess any postoperative complications. Results: We found microplates are stable enough and have adequate load bearing capacity. Due to close adaptability and less hardware, postoperative palpability is less but larger sample study with long term follow up is necessary to conclude its efficacy in load bearing fracture sites.
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Affiliation(s)
- Gaurav Mittal
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Anmol Agarwal
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Ritesh Garg
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Siddharth Sharma
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Abhishek Rathi
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
| | - Pooja Kapse
- Department of Oral and Maxillofacial Surgery, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India
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Open Reduction, Internal Fixation of Isolated Mandible Angle Fractures in Growing Children. J Craniofac Surg 2020; 31:1946-1950. [PMID: 32804826 DOI: 10.1097/scs.0000000000006892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mandible angle fractures can result in significant, long-term morbidity in children. However, management of this particular mandibular fracture type is not well-characterized in the pediatric population. This study investigated isolated mandibular angle fractures in the pediatric patients. METHODS This was a 30-year retrospective, longitudinal cohort study of pediatric patients presenting to a single institution with mandibular angle fractures. Patient data were abstracted from electronic medical records. Subgroup analyses were completed by dentition stage. RESULTS Seventeen patients met inclusion criteria, of whom 6 (35.3%) had deciduous, 4 (23.5%) had mixed, and 7 (41.2%) had permanent dentition. Deciduous/mixed dentition patients with mobile, displaced fractures underwent ORIF, whereas those with nondisplaced fractures underwent treatment with soft diet. Among permanent dentition patients, most patients (71.4%) underwent ORIF regardless of fracture severity. The post-ORIF complication rate was 55.6%; no complications were reported after soft diet or closed treatment (Fischer exact: P = 0.05). The most common post-ORIF complication was alveolar nerve paresthesia (17.6%) and post-ORIF complication rates did not vary by age (deciduous: 16.7%, mixed: 25.0%, permanent: 42.9%, Fischer exact: P = 0.80). ORIF patients who received a single upper border miniplate had a lower complication rate (42.9%) than other plating methods (upper and lower miniplates-100%). Fracture severity was predictive of post-ORIF complications (odds ratio: 2.23, 95% confidence interval: 2.22-2.24, P < 0.0001). CONCLUSIONS Isolated mandible angle fractures were relatively rare in children, and treatment requirements varied by injury severity and dentition stage. Although isolated angle fractures had substantial associated morbidity, this fracture pattern did not result in notable growth limitations/deformity.
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Chen YT, Chiu YW, Chang YC, Lin CW. Ten-year retrospective study on mandibular fractures in central Taiwan. J Int Med Res 2020; 48:300060520915059. [PMID: 32705932 PMCID: PMC7383631 DOI: 10.1177/0300060520915059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To analyse the epidemiology of mandibular fractures and the correlation between combined fractures during a 10-year period in central Taiwan. Methods This retrospective study analysed data collected from the medical records of patients that had mandibular fractures between January 2007 and October 2017. Data on age, sex, cause of injury, anatomical site of fracture, treatment and complications were obtained and analysed. Results A total of 265 patients who received treatment were included in the study. The mean ± SD age was 30.08 ± 13.47 years (range, 6–70 years) and the 21–30 years age group showed the highest incidence of mandibular fractures. The male-to-female ratio was 1.25:1. Road traffic accidents were the most common cause of fracture (206 of 265; 77.74%). The symphysis and parasymphysis area was the most common fracture site (169 of 420; 39.29%). Single-site fracture represented slightly more than 50% of the total 420 fractures. The most frequent combination of two fractures was an angle fracture combined with a symphysis and parasymphysis fracture (29 of 106 double fracture patients [27.36%]). There was a weak positive association between several combinations of fractures. Conclusions A better understanding of the influence of age and sex on the mechanism of injury is of great clinical importance in the assessment and diagnosis of fractures.
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Affiliation(s)
- Yi-Tzu Chen
- Department of Oral and Maxillofacial Surgery, Chung Shan Medical University Hospital, Taichung City.,School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung City
| | - Yu-Wei Chiu
- Department of Oral and Maxillofacial Surgery, Chung Shan Medical University Hospital, Taichung City.,School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung City
| | - Yu-Chao Chang
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung City.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung City
| | - Chiao-Wen Lin
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung City.,Graduate Institute of Oral Sciences, Chung Shan Medical University, Taichung City
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Seeley-Hacker BL, Holmgren EP, Harper CW, Lauer CS, Van Citters DW. An Anatomic Predisposition to Mandibular Angle Fractures. J Oral Maxillofac Surg 2020; 78:2279.e1-2279.e12. [PMID: 32649890 DOI: 10.1016/j.joms.2020.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate a predisposition to mandibular angle fractures, a retrospective study was performed in which fractured mandibles were compared with healthy mandibles with no history of fracture. Other investigations of angle fracture risk have exclusively studied patients with existing fractures. In addition, the risk has not been comprehensively explained in conjunction with the specific features of mandibular anatomy. We sought to characterize any anatomic variations between the jaws that had fractured and those that had never fractured. MATERIALS AND METHODS Healthy mandibles with no history of fracture were physically measured at the William M. Bass Skeletal Collection at the University of Tennessee, Knoxville and compared with fractured mandibles from computed tomography (CT) scans at the Dartmouth Hitchcock Medical Center. A total of 52 healthy mandibles and 44 CT scans were evaluated. MATLAB machine learning algorithms (MathWorks, Natick, MA) were used to compare the study populations and isolate those anatomic features that differed between healthy and fractured mandibles. RESULTS Machine learning classifiers were able to differentiate between male and female jaws, with the condylion-gnathion distance the most distinguishing feature. The 6 most common anatomic features that differed between healthy and fractured mandibles were the 1) retromolar space, 2) perimeter of the cross-section just proximal to the second molar, 3) breadth of the ramal cross-section, 4) thickness of the oblique ridge, 5) transgonial angle, and 6) location of the ipsilateral mental foramen. The presence of third molars was also related to fracture risk, with third molars present in 72.7% of the fractured mandibles versus 26.9% of unfractured mandibles. Of the fractured mandibles with third molars present, 87.5% had the fracture running directly through the tooth or its socket. CONCLUSIONS The results from the present study have provided evidence that anatomic differences exist between mandibles that sustain angle fractures and those that do not. Although much of the morphology was found to be interdependent, the fracture risk could be accurately predicted using 6 anatomic features. Understanding these mandibular variations and identifying patients vulnerable to mandibular fracture could provide clinicians with additional objective information. Furthermore, using the methods demonstrated in our study, future research could focus on developing an algorithm that includes these unique anatomic features in the hope of assisting surgeons in providing tailored treatment for mandibular angle fractures according to patient-specific morphology.
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Affiliation(s)
- Brett L Seeley-Hacker
- Student and Research Fellow, Thayer School of Engineering, Dartmouth College, Hanover, NH; and Medical Student, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Eric P Holmgren
- Assistant Clinical Professor, Department of Otolaryngology and Oral/Maxillofacial Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH.
| | - Christopher W Harper
- Resident, Department of Otolaryngology, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - Caroline S Lauer
- Graduate Engineering Student, Thayer School of Engineering, Dartmouth College, Hanover, NH
| | - Douglas W Van Citters
- Professor, Department of Mechanical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, NH
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Xu TQ, Wiegmann AL, Jarazcewski TJ, Ritz EM, Santos CAQ, Dorafshar AH. Patient Race and Insurance Status Do Not Impact the Treatment of Simple Mandibular Fractures. Craniomaxillofac Trauma Reconstr 2020; 13:15-22. [PMID: 32642027 DOI: 10.1177/1943387520905399] [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: 11/16/2022] Open
Abstract
Introduction Health-care disparities have been reported throughout medical literature for decades. While blatant explicit bias is not prevalent, a substantial body of research has been published suggesting that systemic biases related to sex, race, income, and insurance status likely exist. To our knowledge, no study has assessed the impact of patient race and insurance status on clinical decision-making in facial fracture repair in the United States. Thus, the objective of this project was to assess if race and insurance status impacted whether patients obtained open or closed treatment of simple mandibular fractures. Methods Patients who had either open or closed treatment of mandibular fractures were extracted from the 2012 and 2013 National Inpatient Sample and analyzed. Patients who had a length of stay longer than 3 days or died during their inpatient stay were excluded. These exclusion criteria were used to control for patients with polytrauma as well as complicated fractures. Univariate analysis was undertaken to elucidate different variable associations with the type of reduction performed. All covariates were then entered into a multivariable logistic regression model to test the variables simultaneously. Results Patients with simple condylar, alveolar border, and closed mandibular fractures were more likely to undergo closed reduction (CR) on univariate analysis, as were patients with female gender and a fall mechanism (P value < .05). African Americans, Hispanics, and patients without insurance were more likely to undergo open reduction on univariate analysis (P value < .05). Multivariate analysis demonstrated that patients with simple condylar, subcondylar, alveolar border, or closed mandibular fractures were more likely to undergo a CR, as were patients with female gender and a firearm or fall mechanism (P < .05). However, neither race nor insurance status demonstrated a statistically significant association with closed or open reduction. Conclusion Anatomic location and mechanism of injury were the variables found to be significantly associated with patients undergoing open reduction versus CR of simple mandibular fractures-not race or insurance status.
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Affiliation(s)
- Thomas Q Xu
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Aaron L Wiegmann
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Taylor J Jarazcewski
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ethan M Ritz
- Bioinformatics and Biostatistics Core at Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Carlos A Q Santos
- Bioinformatics and Biostatistics Core at Rush University, Rush University Medical Center, Chicago, IL, USA
| | - Amir H Dorafshar
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
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Pałka Ł, Kuryło P, Klekiel T, Pruszyński P. A mechanical study of novel additive manufactured modular mandible fracture fixation plates - Preliminary Study with finite element analysis. ✰. Injury 2020; 51:1527-1535. [PMID: 32362448 DOI: 10.1016/j.injury.2020.03.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/22/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
The paper presents an innovative osteofixation system designed for bone fracture stabilization. Its special feature, which makes it different from other similar systems, is the possibility to precisely adjust the implant to the shape of the bone. Such a precise adjustment is particularly important in the case of multiple fractures, where proper stabilization is a condition for restoring bone geometry and thus obtaining the biomechanical function of a given segment of the body lost due to fracture. Based on the tested properties of the implant material, the presented system structure was verified for loading, stress, and share forces in multi-site fractures of the mandible. Numerical tests were performed for three different fracture models: unilateral double fracture of the body of mandible, unilateral double fracture of the body and the angle of mandible, and bilateral fracture of the mandible at the angle and body of the mandible. The results indicate that the proposed system may be used to stabilize broken bone fragments successfully, and the obtained stabilization would allow unrestricted use of the chewing function during bone healing and remodeling. The authors point out the advantages of the proposed implantation method thanks to which it is possible to obtain any shape of the implant and thus stabilize bone fragments in any case.
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Affiliation(s)
- Ł Pałka
- Science BioTech Company, Daszyńskiego 31/13, 50-310 Wrocław, Poland; Private Dental Practice, Rzeszowska 2, 68-200 Żary, Poland.
| | - P Kuryło
- Faculty of Mechanical Engineering, University of Zielona Góra, 65-516 Zielona Góra, Poland.
| | - T Klekiel
- Faculty of Mechanical Engineering, University of Zielona Góra, 65-516 Zielona Góra, Poland.
| | - P Pruszyński
- 105 Borderland Military Hospital of Żary, 68-200 Żary, Poland.
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Versatility of the Berger-Tenenhaus Approach for Mandibular Fractures. J Craniofac Surg 2020; 31:1129-1132. [PMID: 32168128 DOI: 10.1097/scs.0000000000006298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Mandibular fractures between the angle and condyle can be difficult to access and treat. The authors sought to evaluate a small transcutaneous incision between the marginal mandibular and buccal nerve branches (Berger-Tenenhaus incision) to treat these fractures. METHODS Ten cadaveric hemi-faces were dissected. Surrounding facial nerve branches were identified and measured in relation to the discussed incision. Our clinical experience with the approach for mandibular angle, ramus, subcondylar, and condylar fractures was reviewed. Operative technique and postoperative outcomes were examined. RESULTS The incision is located in a safe interval between neighboring facial nerve branches. Marginal mandibular nerve branches maintained a consistent distance beneath the incision along its length (median distances of 0.95-cm (SD ± 0.5), 1.05-cm (SD ± 0.5), and 1.00-cm (SD ± 0.8) posterior to anterior, respectively). Buccal nerve branches increased in distance and ascended away from the incision line (median distances of 0.75-cm (SD ± 0.9), 1.4-cm (SD ± 0.8), and 1.45-cm (SD ± 0.9) respectively posterior to anterior). No nerves were injured. In our clinical experience, all postoperative patients (n = 9) have had successful fracture reduction with restoration of occlusion, intact facial nerve function and an acceptable cosmetic result. CONCLUSIONS The Berger-Tenenhaus incision can safely and efficiently be used to treat difficult to access mandible fractures between the angle and condyle. LEVEL OF EVIDENCE VI.
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Tan PG, Soh CL. Quality of life assessments in maxillofacial trauma patients – A systematic review. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2020. [DOI: 10.1016/j.ajoms.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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An Assessment of the Osteogenic Potential of Cissus quadrangularis in Mandibular Fractures: A Pilot Study. J Maxillofac Oral Surg 2020; 19:106-112. [PMID: 31988572 DOI: 10.1007/s12663-019-01230-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/27/2019] [Indexed: 10/26/2022] Open
Abstract
Background A routine mandibular fracture matures in about 12 weeks and hence hinders normal function significantly. Alternatives are being researched to hasten the healing and allow early function. This prospective study aimed to assess the osteogenic potential of the drug Cissus quadrangularis (CQ) on the mandibular fracture healing. Design Prospective randomized study. Results The study between the groups revealed a statistically significant increase in the alkaline phosphatase levels in CQ group in comparison with control group. The radiographic findings (increment in density and rate of change of density), clinical findings (mobility, swelling, reduction in pain) and other biochemical findings (serum calcium, serum phosphorous) did not differ statistically between the CQ and control groups. Conclusion Based on the lack of a statistically significant improvement in almost all parameters except for the alkaline phosphatase levels, we believe that a larger sample size is required to ascertain the absolute value of CQ before adding it to the mandibular fracture regimen.
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Zein Eddine SB, Cooper-Johnson K, Ericksen F, Brookes CC, Peppard WJ, Revolinski SL, Carver TW. Antibiotic Duration and Outcome Complications for Surgical Site Infection Prevention in Traumatic Mandible Fracture. J Surg Res 2019; 247:524-529. [PMID: 31668431 DOI: 10.1016/j.jss.2019.09.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/10/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The appropriate duration of antibiotic therapy for surgical site infection (SSI) prevention in traumatic mandibular fracture repair is unknown, and practices vary significantly. The objective of this study was to characterize antibiotic duration and outcomes after surgical repair of traumatic mandibular fracture. METHODS A single-center, retrospective analysis of all adult patients who underwent surgical fixation of a mandible fracture between January 2014 and December 2016 was performed. Operative service was categorized between otolaryngology (ear, nose, and throat surgery), plastic and reconstructive surgery, and oral and maxillofacial services. Primary outcomes were SSI and operative complications (including osteomyelitis, nonunion, malocclusion, and hardware infections). Differences in antibiotic prescription pattern were analyzed using analysis of variance test and Pearson chi-squared test. RESULTS A total of 75 patients were included in the study with 33 (44.0%), 26 (34.7%), and 16 (21.3%) managed by plastic and reconstructive surgery, ear, nose, and throat surgery, and oral and maxillofacial services, respectively. Median age was 30.0 y. Median injury severity score was 4.0. There was no significant difference in hospital length of stay (P = 0.44), intensive care unit length of stay (P = 0.53), or postoperative complications (P = 0.15). None of our patients developed an SSI or postantibiotics complications. Although the total inpatient duration of antibiotics was not significantly different among services (P = 0.37), there were significant differences in outpatient duration of antibiotics (P = 0.007) and total duration of antibiotics (P = 0.003). CONCLUSIONS Duration of antibiotics is not associated with postoperative SSI or antibiotics-related complications. The wide variation in prescribing practices and lack of any clear benefit for prolonged antibiotics provides an opportunity to explore the benefits of a standardized short course of antibiotics. LEVEL OF EVIDENCE Therapeutic study, III.
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Affiliation(s)
- Savo Bou Zein Eddine
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kaitlin Cooper-Johnson
- Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Forrest Ericksen
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carolyn C Brookes
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology and Communication Science, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William J Peppard
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sara L Revolinski
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thomas W Carver
- Division of Trauma and Acute Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Luciana L, Oggy BAR, Wiargitha IK, Irawan H. Management of Maxillofacial Fracture: Experience of Emergency and Trauma Acute Care Surgery Department of Sanglah General Hospital Denpasar Bali. Open Access Maced J Med Sci 2019; 7:3245-3248. [PMID: 31949524 PMCID: PMC6953928 DOI: 10.3889/oamjms.2019.701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Maxillofacial fracture is one of the major trauma; the cases were increasing because of the high number of motorcycles in Bali. The goal of the treatment is proper positioning of the occlusion, and it depends on rapid diagnosis and proper treatment. AIM: This study aims to know the characteristics of the maxillofacial fracture patients in Sanglah General Hospital Denpasar Bali. METHODS: A retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January to June 2015. Total recorded patient were 35 patients. The data obtained include age, gender, type of the fractures, and operation management. RESULTS: The injury was more common in male compared to female (80% vs 20%). Age 20 to 40 years old were more common (48.57%), followed by the child to adolescent (aged 0 to 20 years old) were 31.43%, and adult to elderly (aged 40 to 60 years old) was 20%. The mandibular fracture was most common (51.43%), other fractures such as a zygomatic fracture (31.43%) and maxillary fracture (17.14%). Internal fixation was the gold standard of the treatment (65.71%), and the other was an arch bar (34.29%). CONCLUSION: Diagnosing the right injury to the facial bone is a key step in determining a treatment plan. Rapid diagnosis and proper treatment lead to good occlusion, both internal fixation and arch bar were an effective treatment. The importance of dealing with almost all maxillofacial fracture problems in the first surgery.
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Affiliation(s)
- Luciana Luciana
- General Surgery Department, Medical Faculty, Udayana University, Sanglah General Hospital Denpasar, Bali, Indonesia
| | - Bramastha Aires Rosadi Oggy
- General Surgery Department, Medical Faculty, Udayana University, Sanglah General Hospital Denpasar, Bali, Indonesia
| | - I Ketut Wiargitha
- Department of Emergency and Acute Care Surgery, Medical Faculty, Udayana University, Sanglah General Hospital Denpasar, Bali, Indonesia
| | - Hendry Irawan
- General Surgery Department, Medical Faculty, Udayana University, Sanglah General Hospital Denpasar, Bali, Indonesia
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Evaluation of labial versus labio-inferior lines of osteosynthesis using 3D miniplate for fractures of anterior mandible: A finite element analysis with a pilot clinical trial. Chin J Traumatol 2019; 22:261-269. [PMID: 31493976 PMCID: PMC6823702 DOI: 10.1016/j.cjtee.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/29/2019] [Accepted: 07/10/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The fractures of anterior mandible are subject to severe torsional forces due to muscles acting in opposite directions. 3D miniplate has been suggested as a good alternative by some researchers. However, finite element model (FEM) studies indicate that labio-inferior positioning of two miniplates perpendicular to each other offers better stability as compared to labial positioning. This study aims at combining the advantages of a single 3D miniplate and labio-inferior positioning of two conventional miniplates, which was assessed by finite element analysis along with a pilot clinical trial. METHODS Two FEM models were created using CT data of a 24-year-old patient with Angle class I occlusion: control model with labial plating and study model with labio-inferior plating. The models were processed with MIMICS® (materialise, Leuven, Belgium), CATIA® (Dassault Systemes) and finite element analysis softwares. Parameters adopted for analysis were (1) displacement (mm) of fracture fragments during each screw fixation, (2) lingual splay and post fixation stability of fracture fragments with masticatory load, and (3) stress distribution (MPa) across fracture fragments. Moreover, a pilot clinical trial including five patients with anterior mandible fracture was conducted. The fractures were managed by intraoral open reduction and 3D miniplate fixation in labio-inferior position. Intraoperative interfragmentary gap, post fixation lingual splay and radiographic fracture union and complications were assessed clinically. RESULTS Labio-inferior plating demonstrated less displacement (mm) of fracture fragments during screw fixation (0.059 vs. 0.079) as well as after application of masticatory load (1.805 vs. 1.860). Negligible lingual splay and less stress distribution (MPa) across fracture fragments (1.860 vs. 1.847) were appreciated in the study group as compared to control group. Clinical trial support the favorable outcome related to intraoperative and postoperative assessment parameters. CONCLUSION FEM analysis and clinical trial reveal better results with labio-inferior positioning of 3D miniplate when compared to labial positioning.
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Yeoh M, Cunningham LL. Concepts of Rigid Fixation in Facial Fractures. Atlas Oral Maxillofac Surg Clin North Am 2019; 27:107-112. [PMID: 31345485 DOI: 10.1016/j.cxom.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Melvyn Yeoh
- Oral and Maxillofacial Surgery, University of Kentucky, College of Dentistry, 800 Rose Street, D-508, Lexington, KY 40536-0297, USA.
| | - Larry L Cunningham
- Oral and Maxillofacial Surgery, University of Kentucky, College of Dentistry, 800 Rose Street, D-508, Lexington, KY 40536-0297, USA
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Vertically unstable fractured mandibular segment with attached genial tubercles as a parameter for difficulty during intubation for general anaesthesia-substantiation with computed tomographic (CT) scan evidence. Oral Maxillofac Surg 2019; 23:215-219. [PMID: 31073651 DOI: 10.1007/s10006-019-00768-z] [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: 11/23/2018] [Accepted: 04/30/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To study and evaluate the anatomic alterations in the suprahyoid musculature, the hyoid bone, and the laryngeal inlet in patients with vertically unstable fractured mandibular segment with attached genial tubercles using computer tomography for substantiation of the clinical evidence and hypothesis of difficulty during intubation for general anaesthesia. MATERIALS AND METHOD Random sampling methodology was used to enrol patients with mandibular bilateral parasymphysis fracture qualifying for the classification of vertically unstable fractured mandibular segment with attached genial tubercles for group A patients. Patients with unilateral parasymphysis fracture with vertically stable mandibular segment were included in group B. Forty patients with parasymphysis fracture and no other associated facial fracture/injury were evaluated prospectively by comparing their pre-operative computer tomography (CT) images with post-operative CT images taken after the reduction of the fracture. Parameters evaluated were variation in the radiologic anatomy of the laryngeal inlet shape and alteration in the suprahyoid musculature after open reduction and internal fixation of the fracture when compared with pre-operative CT images. RESULTS The following were the results/observations from this study among group A patients: (1) The distance between the genial tubercles and the hyoid was found to be reduced. (2) Dorsal bodily movement of the hyoid was observed suggesting loss of anterior hyoid support. (3) The posttraumatic changes in the shape of the laryngeal inlet were observed in cases with vertically unstable bilateral parasymphysis fracture. (4) Restoration of morphology of the laryngeal inlet and anterior-posterior distance between genium and hyoid after reduction. CONCLUSION Computer tomographic findings confirm that the displacement of fractured mandible and resultant displacement of the genial musculature have their effect on the laryngeal morphology. These posttraumatic changes in cases with dorsally displaced vertically unstable fractured mandibular segment with attached genial tubercles should be considered as a vital parameter for assessing difficulty during intubation.
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Quality assurance in CT: implementation of the updated national diagnostic reference levels using an automated CT dose monitoring system. Clin Radiol 2018; 73:677.e13-677.e20. [DOI: 10.1016/j.crad.2018.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/13/2018] [Indexed: 11/19/2022]
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Kheirallah M, Ozzo S. Morbidity of Teeth in Mandibular Fracture Lines - A Retrospective Study. Dent Traumatol 2018; 34:284-289. [PMID: 29869831 DOI: 10.1111/edt.12413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Teeth in mandibular fracture lines is common in maxillofacial trauma, but their retention or extraction is a matter of controversy. The aim of this study was to determine the factors related to retaining or extracting teeth situated in mandibular fracture lines and to decide the best treatment option. METHODS The study included 115 patients with a single mandibular fracture that had a tooth in the line of fracture. All patients were evaluated for complications and pulp status. Patient distribution was analyzed according to the complications that occurred. Statistical analysis was performed using SPSS 13.0 software. RESULTS There were significant effects of tooth type and tooth location on the occurrence of complications. There were no significant differences in the occurrence of complications between the retained teeth group and the extracted teeth group irrespective of age and gender in adult patients. There were significant differences in treatment procedures between the retained teeth group and the extracted teeth group. CONCLUSION Mandibular anterior teeth involved in the fracture line should be retained, while in the mandibular angle area, they should be extracted because retaining teeth in this region increases the prediction of complications. There is no role of pulp testing in the assessment of pulp status, but root canal treatment of retained teeth helps to reduce the occurrence of complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mouetaz Kheirallah
- Maxillofacial Surgery Department College of Dentistry, Al-Andalus University for Medical Sciences, Al-Qadmous, The Syrian Arab Republic. Temporarily at Majma'ah University, KSA
| | - Sameer Ozzo
- Maxillofacial Surgery Department, College of Dental Medicine, Arab University of Science & Technology, Hama, Syrian Arab Republic
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Habib AM, Wong AD, Schreiner GC, Satti KF, Riblet NB, Johnson HA, Ossoff JP. Postoperative prophylactic antibiotics for facial fractures: A systematic review and meta-analysis. Laryngoscope 2018; 129:82-95. [DOI: 10.1002/lary.27210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/28/2018] [Accepted: 03/13/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Andy M. Habib
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
| | - Alexander D. Wong
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
| | - Geoffrey C. Schreiner
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Komal F. Satti
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Natalie B. Riblet
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire U.S.A
| | - Heather A. Johnson
- Dartmouth Institute for Health Policy and Clinical Practice; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire U.S.A
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Quality of Postoperative Pain Management After Maxillofacial Fracture Repair. J Craniofac Surg 2018; 29:720-725. [DOI: 10.1097/scs.0000000000004296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rowbotham SK, Blau S, Hislop-Jambrich J. The skeletal trauma resulting from a fatal B.A.S.E jump: A case study showing the impact of landing feet-first under extreme vertical deceleration. Forensic Sci Int 2018. [PMID: 29530624 DOI: 10.1016/j.forsciint.2018.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The term 'B.A.S.E jump' refers to jumping from a building, antenna, span (i.e., bridge) or earth (i.e., cliff) structure, and parachuting to the ground. There are numerous hazards associated with B.A.S.E jumps which often result in injury and, occasionally, fatality. This case report details the skeletal trauma resulting from a fatal B.A.S.E jump in Australia. In this case, the jumper impacted the ground from a fall of 439m in a feet-first landing position, as a result of a partially deployed parachute, under extreme vertical deceleration. Skeletal trauma was analyzed using full-body post mortem computed tomography (PMCT) and contextual information related to the circumstances of the jump as reported by the Coroner. Trauma to 61 skeletal elements indicates the primary impact was to the feet (i.e., feet-first landing), followed by an anterior impact to the body (i.e., fall forwards). Details of the individual fracture morphologies indicate the various forces and biomechanics involved in this fall event. This case presents the types of fractures that result from a B.A.S.E jump, and highlights the value of using PMCT and coronial data as tools to augment skeletal trauma interpretations.
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Affiliation(s)
- Samantha K Rowbotham
- Department of Forensic Medicine, Monash University, 65 Kavanagh St., Southbank, Victoria 3006, Australia.
| | - Soren Blau
- Victorian Institute of Forensic Medicine, 65 Kavanagh St., Southbank, Victoria 3006, Australia; Department of Forensic Medicine, Monash University, 65 Kavanagh St., Southbank, Victoria 3006, Australia
| | - Jacqueline Hislop-Jambrich
- Centre for Medical Research, Toshiba Medical ANZ, 12-24 Talavera Rd., North Ryde, New South Wales 2113, Australia
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