Treatment of Mandibular Angle Fractures with Single Three-Dimensional Locking Miniplates without Maxillomandibular Fixation: How Much Fixation Is Required?

Factors Affecting the Duration of Surgery in the Management of Condylar Head Fractures

Prolonged operation times should be avoided due to the associated complications and negative effects on the efficiency of the use of operating room resources. Surgical treatment of mandibular condylar head fractures is a well-established routine procedure at our department, nevertheless, we recognized fluctuating operating times. This study aims to pinpoint the influencing factors, in particular the hypothesis whether the efficiency of intraoperative muscle relaxation may decisively affect the duration of surgery. It analyses 168 mandibular condylar head fractures that were surgically treated in the period from 2007 to 2022 regarding the duration of the surgery and potential factors affecting it. The potential predictors' influence on the dependent variable operation time was mainly calculated as a bivariate analysis or linear regression. Efficiency of relaxation (p ≤ 0.001), fragmentation type (p = 0.031), and fracture age (p = 0.003) could be identified as decisive factors affecting the duration of surgery, as the first surgeon was a constant. In conclusion, surgical intervention should start as soon as possible after a traumatic incident. In addition, a dosage regimen to optimize the efficiency of relaxation should be established in future studies. Fragmentation type and concomitant fractures should also be considered for a more accurate estimation of the operating time.

Prevalence of surgical site infections after open reduction and internal fixation for mandibular fractures: a systematic review and meta-analysis

Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.

Biomechanical evaluation of magnesium plates for management of mandibular angle fracture

The aim of this study was to evaluate the efficacy of magnesium plates for the management of fractures of the mandibular angle. Fresh sheep hemimandibles were divided into 7 groups and a biomechanical cantilever bending test was used for the groups: Group 1 included fractured hemimandibles fixed at the angle with a single 1mm magnesium miniplate; Group 2 had fixation with a 1mm double magnesium miniplate; Group 3 used a 2mm thick single magnesium miniplate; Group 4 used double 2mm magnesium plates; Group 5 each had a single 1mm thick titanium plate; Group 6 used 1mm thick double titanium plates; and Group 7 comprised intact hemimandibles. Each group was tested using universal testing machine yield loads; yield displacements and stiffness were compared using one way analysis of variance (ANOVA) Group 1 (1mm single magnesium plate) and Group 2 (1mm double magnesium plates) showed lower stability than other groups, while the 2mm magnesium plate showed stability similar to the corresponding 1mm titanium plate. Pure magnesium has good mechanical properties and when it is designed properly it can be used for the management of mandibular fracture.