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Aditya NK, Krishnan B. Factors contributing to non-union amongst dentate mandibular fractures treated by load-sharing miniplate osteosynthesis: A case-control study. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00110-4. [PMID: 38866687 DOI: 10.1016/j.bjoms.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
The stability provided by load-sharing miniplate osteosynthesis (LSMO) in dentate mandibular fractures (DMF) is usually adequate for bony healing. Non-union following LSMO is an uncommon complication. We aimed to determine the incidence and identify contributing factors, if any, of non-union amongst DMFs that have undergone LSMO. This retrospective case-control study with an allocation ratio of 1:3 includes cases of non-union DMF following LSMO and controls with healed DMF following LSMO over a five-year period. Relevant sociodemographic data, mandibular fracture characteristics, and treatment variables were collected for both groups. Of the 381 patients who underwent LSMO for DMFs, 12 cases of non-union were identified. The control group included 36 patients with uncomplicated healing. A significant association was observed between non-union and teeth in the line of fracture, postoperative infections, and time from injury to LSMO. The odds ratio with chronic alcohol usage was 1.4. Vigilant follow up of patients with chronic alcohol use, those with teeth in the fracture line, and adherence to LSMO principles may help to minimise the non-union complication.
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Affiliation(s)
- N K Aditya
- Senior Resident, Oral and Maxillofacial Surgery, Dept of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - B Krishnan
- Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
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2
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Gualtieri M, Scivoletto G, Pisapia F, Priore P, Valentini V. Analysis of Surgical Complications in Mandibular Fractures in the Center of Italy: A Retrospective Study. J Craniofac Surg 2024; 35:e71-e74. [PMID: 37943052 DOI: 10.1097/scs.0000000000009851] [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: 07/03/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Mandibular fractures are the second most common maxillofacial fractures. The prevalent treatment for this kind of fractures is either a surgical procedure such as maxillomandibular fixation or open reduction and internal fixation or a combination of both. Sometimes the patients might develop locoregional postoperative complications. The most frequently reported complications are trigeminal V3 injury and surgical site infection. A 4-year retrospective study was performed at the Department of Oral and Maxillofacial Surgery, Policlinico Umberto I of Rome, Italy, and the postoperative complications after mandibular fracture surgical treatment were collected. The authors studied the characteristics of each complication and the correlation with the type of mandibular fracture and the surgical treatment chosen.
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Affiliation(s)
- Matteo Gualtieri
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
- Unit of Maxillofacial Surgery and Otolaryngology, Floraspe Renzetti Hospital, Lanciano, Italy
| | - Giulia Scivoletto
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - Francesco Pisapia
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - Paolo Priore
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - Valentino Valentini
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
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Hijazi KM, Dixon SJ, Armstrong JE, Rizkalla AS. Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction. MATERIALS (BASEL, SWITZERLAND) 2023; 17:140. [PMID: 38203994 PMCID: PMC10779528 DOI: 10.3390/ma17010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.
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Affiliation(s)
- Khaled M. Hijazi
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
| | - S. Jeffrey Dixon
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - Jerrold E. Armstrong
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Amin S. Rizkalla
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
- Chemical and Biochemical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
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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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Gibson AC, Merrill TB, Boyette JR. Complications of Mandibular Fracture Repair. Otolaryngol Clin North Am 2023; 56:1137-1150. [PMID: 37353369 DOI: 10.1016/j.otc.2023.05.008] [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] [Indexed: 06/25/2023]
Abstract
Mandible fracture management has evolved dramatically. Therefore, the variety of surgical complications associated with mandibular fractures, and their incidences, have continued to change as well. This article aims to assess the most common and most concerning complications that can occur secondary to management of mandibular fractures by examining categories of complication types. This article also explores factors and techniques associated with reduced rates of complications as well as the management of complications.
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Affiliation(s)
- Anna Celeste Gibson
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA.
| | - Tyler Branch Merrill
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
| | - Jennings Russell Boyette
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #543, Little Rock, AR 72205, USA
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Ahamed AS, G VL, Vm N, Kumar KD, Syed M. Surgical Correction of Post-traumatic Residual Deformity of the Mandible: A Case Report. Cureus 2023; 15:e46710. [PMID: 38021596 PMCID: PMC10630716 DOI: 10.7759/cureus.46710] [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] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Mandibular fractures are the most common trauma cases that we often come across in our day-to-day practice of oral and maxillofacial surgery. Various factors can lead to deformities and make those cases more challenging, which includes a delay in surgical treatment, resulting in non-union or malunion of the fracture site causing occlusal disturbances and functional abnormalities in the temporomandibular joint.
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Affiliation(s)
- A Saneem Ahamed
- Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Chennai, IND
| | - Vijaya Lakshmi G
- Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Chennai, IND
| | - Nithin Vm
- Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Chennai, IND
| | - Kapil Dev Kumar
- Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Chennai, IND
| | - Mubeena Syed
- Dentistry, Priyadarshini Dental College and Hospital, Chennai, IND
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Sahoo NK, Dubey P, Vaswani H, Pandey S. Incidence and Management of Tooth Root Fracture in Mandibular Fracture Line - A Retrospective Study. Ann Maxillofac Surg 2023; 13:216-219. [PMID: 38405552 PMCID: PMC10883222 DOI: 10.4103/ams.ams_136_23] [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: 07/25/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction In cases of trauma, the most common fractures of the facial region are the nasal bone fractures followed by mandibular fractures. About 60% of mandible fractures are associated with teeth in the fracture line; however conversely, the dentulous mandible has a higher susceptibility of fracture in any impact. Whenever a tooth is involved in the fracture line, it is not unlikely that the tooth root fracture will be associated with it. The prognosis and treatment of such a tooth persistent in a fracture line depends upon the level of tooth root fracture. Materials and Methods This retrospective study was conducted in the Department of Oral and Maxillofacial Surgery in a Meerut hospital. The eligibility criteria were based on the cases involving fracture line passing through the teeth bearing area of mandible. Total of 56 cases of mandibular fracture treated from January 2021 till December 2022 by open reduction and fixation were included in the study. Results A total of 56 patients (66 fracture lines) with mandibular fractures were selected, out of which 18 (32%) patients had fracture of the root of the tooth in the fracture line. Third molar root fracture were present in 12 cases (66.6%), first premolars in 4 cases (22.2%), and first molars in 2 cases (11.1%). There were 14 multi rooted teeth (77.7%) and 4 single rooted teeth (22.2%) involvement. All the multi rooted teeth fracture were treated by extraction during open reduction and fracture fixation. The single rooted teeth were successfully treated by endodontic treatment postoperatively. Discussion The fracture line passing through the dentate segment may fracture the tooth crown and/or root or propagate through the socket without any injury to the root. Root fracture at cervical and middle third is constantly exposed to oral fluids. The affected tooth may be mobile and lose vitality. Teeth in the line of fracture must be removed when they preclude the correct reduction of the segments or if they represent a risk for infection. If the tooth or root does not cause any hindrance during reduction or it is not infected, the tooth can be salvaged by endodontic therapy. The incidence of root fracture was seen in 32% of cases. Fracture of the third molar roots was the single largest group (66.6%). No root fracture was observed in the anterior segment.
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Affiliation(s)
- Nanda Kishore Sahoo
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Prajesh Dubey
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Himani Vaswani
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Swati Pandey
- Department of Oral and Maxillofacial Surgery, Subharti Dental College, Meerut, Uttar Pradesh, India
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Sarai RK, Wu E, Ahmed A, Williams R, Breeze J. The impact of patient-related factors on complications when treating mandible fractures by load-sharing and load-bearing osteosynthesis. Br J Oral Maxillofac Surg 2023; 61:284-288. [PMID: 37031044 DOI: 10.1016/j.bjoms.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/14/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
The decision about the choice of load-sharing (LS) or load-bearing (LB) osteosynthesis is determined by an interplay of fracture-related and patient-related factors. In some situations a similar fracture in two different patients may be treated successfully by either of these methods. Our aim was to identify preoperative patient-related factors that may assist in deciding which form of osteosynthesis is employed. All adult patients who underwent open reduction and internal fixation of mandibular fractures (excluding condyle) between 1 October 2018 and 1 June 2021 were retrospectively identified. The odds of developing postoperative complications and requiring a return to theatre (RTT) were calculated for each method of fixation together with the following patient factors: smoking, excess alcohol, substance misuse, and severe mental health issues. Of 337 fractures treated using LS principles, 27 (8%) developed complications, of which 20 (6%) required a RTT for repeat osteosynthesis. Of 74 fractures treated using LB principles, seven (10%) developed complications and two (3%) required a RTT for repeat osteosynthesis. The only patient factor that had statistically significant increased odds of a complication requiring RTT was LS osteosynthesis in patients who admitted drinking excess alcohol (OR = 7.83, p = 0.00, 95% CI = 3.13 to 19.60). Complications when treating mandibular fractures are rarely reported in the literature, and lack standardisation in their clinical significance. Figures generally represent overall numbers of patients, whereas the number of individual fractures treated is more accurate. In our study complications occurred in 8% of treated fractures and 10% of patients. The RTT rate was 7% of patients, which compares favourably with a recently stated standard of 10% of patients, as suggested by the Getting it Right First Time (GIRFT) report.
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Affiliation(s)
- Rupinder K Sarai
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
| | - Eiling Wu
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Asad Ahmed
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rhodri Williams
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - John Breeze
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK; Royal Centre for Defence Medicine, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
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Vinayahalingam S, van Nistelrooij N, van Ginneken B, Bressem K, Tröltzsch D, Heiland M, Flügge T, Gaudin R. Detection of mandibular fractures on panoramic radiographs using deep learning. Sci Rep 2022; 12:19596. [PMID: 36379971 PMCID: PMC9666517 DOI: 10.1038/s41598-022-23445-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Mandibular fractures are among the most frequent facial traumas in oral and maxillofacial surgery, accounting for 57% of cases. An accurate diagnosis and appropriate treatment plan are vital in achieving optimal re-establishment of occlusion, function and facial aesthetics. This study aims to detect mandibular fractures on panoramic radiographs (PR) automatically. 1624 PR with fractures were manually annotated and labelled as a reference. A deep learning approach based on Faster R-CNN and Swin-Transformer was trained and validated on 1640 PR with and without fractures. Subsequently, the trained algorithm was applied to a test set consisting of 149 PR with and 171 PR without fractures. The detection accuracy and the area-under-the-curve (AUC) were calculated. The proposed method achieved an F1 score of 0.947 and an AUC of 0.977. Deep learning-based assistance of clinicians may reduce the misdiagnosis and hence the severe complications.
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Affiliation(s)
- Shankeeth Vinayahalingam
- grid.10417.330000 0004 0444 9382Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Postal Number 590, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands ,grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Niels van Nistelrooij
- grid.10417.330000 0004 0444 9382Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Postal Number 590, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Bram van Ginneken
- grid.10417.330000 0004 0444 9382Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Postal Number 590, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Keno Bressem
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Tröltzsch
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tabea Flügge
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.512225.3Einstein Center for Digital Future, Wilhelmstraße 67, Berlin, Germany
| | - Robert Gaudin
- grid.7468.d0000 0001 2248 7639Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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10
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Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures? J Craniofac Surg 2022; 33:2573-2577. [DOI: 10.1097/scs.0000000000008825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
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