Open reduction and internal fixation of mandibular condylar fractures: A national inpatient sample analysis, 2005-2014

Surgical Guide Splint Fabrication via Virtual Surgical Planning for Complex Mandible Fractures in the Trauma Setting

INTRODUCTION

In cases of significantly displaced or comminuted mandible fractures, surgical guide splints can be developed to create the normal preinjury occlusion rather than placing patients in maxillomandibular fixation. Standard fracture fixation involves bending of plates intraoperatively based on surgeon-constructed dental splints which is prone to error.

METHODS

A 38-year-old male experienced a gunshot wound to the face that resulted in mandibular angle fractures bilaterally causing severely deranged occlusion and free-floating anterior mandible segment. Virtual surgical planning (VSP) software was used to recreate the injury-induced anatomy and anticipated postoperative anatomy. It also provided a surgical guide splint and a framework to preoperatively bend reconstruction plates to assist in achieving proper occlusion.

RESULTS

He underwent open reduction internal fixation of comminuted mandible fractures with lingual guide splint placement 10 days after injury. Following lingual splint application, the reconstruction plate was applied from angle to angle. The lingual splint was maintained for 3 weeks postoperatively to support the stabilization, and he was able to tolerate a regular diet and showed no evidence of wound breakdown.

DISCUSSION

Virtual surgical planning has had important implications in craniofacial surgery, orthognathic surgery, maxillomandibular reconstruction, and orbital reconstruction after tumor resection, temporomandibular joint surgery, and others. However, there have only been isolated reports describing the role of VSP in the facial trauma setting. In this technical study, the authors demonstrate the benefits of VSP and surgical guide splinting in trauma settings.

Transoral Endoscopic-Assisted Reduction and Internal Fixation of Mandibular Condylar Fractures in Children

PURPOSE

Extraoral approaches for open reduction and fixation of condylar fractures in children are associated with serious risks of complications, including facial nerve injury, facial scarring, parotid fistula, and auriculotemporal nerve injury. The purpose of this study was to retrospectively evaluate the outcomes of transoral endoscopic-assisted open reduction and internal fixation of condylar fractures and hardware removal in pediatric patients.

MATERIAL AND METHODS

This study was designed as a retrospective case series. The study included pediatric patients admitted with condylar fractures that were indicated for treatment with open reduction and internal fixation. The patients were clinically and radiographically evaluated with regard to occlusion, mouth opening, lateral and protrusive movement of the mandible, pain, chewing and speech difficulties, and bone healing at the fracture site. Computed tomography images were used to assess the reduction of the fractured segment, the stability of fixation and progress of healing of the condylar fracture at follow-up visits. The same surgical treatment approach was applied to all patients. The data from the study were analyzed for a single group without any comparison to other groups.

RESULTS

The technique was used for the treatment of 14 condylar fractures in 12 patients between the ages of 3 to 11 years. A total of 28 transoral endoscopic-assisted approaches to the condylar region either for reduction and internal fixation or hardware removal were applied. The mean operating time was 53.1 (±11.3) minutes for the fracture repair and 20 (±2.6) minutes for hardware removal, respectively. The mean follow-up time of the patients was 17.8 (±2.7) months (median: 18) months. All patients regained stable occlusion, satisfactory mandibular motion, stable fixation, and complete bone healing at the fracture site at the end of their follow-up period. There was no transient of permanent facial nerve or trigeminal nerve injury in any of the patients.

CONCLUSIONS

Endoscopically assisted transoral approach is a reliable technique for reduction and internal fixation of condylar fracture and hardware removal in pediatric patients. The serious risks of extraoral approaches including facial nerve injury, facial scar, and parotid fistula can be eliminated by using this technique.

Use of intraoperative C-arm fluoroscopy in open reduction and internal fixation of mandibular condyle fracture - A case report

The Rationale:

Condyle fractures are a common type of mandibular fracture that can result in malocclusion. Open reduction and internal fixation (ORIF) in condylar fracture is considered as the most acceptable treatment modality.

Patient Concerns:

The patient complained of pain and difficulty in the jaw while chewing.

Diagnosis:

An orthopantomogram and reverse Towne’s view can lead to diagnosis of the condylar fracture.

Treatment:

Open reduction and internal fixation using intraoperative real-time visualisation of subcondylar fracture reduction utilising the C-arm fluoroscopic approach were used to allow for adequate anatomical repositioning and fast restoration of function to meet the patient’s concerns.

Outcomes:

We were able to achieve correct reduction of the fracture fragments with restoration of function and occlusion.

Take-away Lessons:

When this procedure is used to treat condylar fractures, surgeons can get a better view of the fracture segments while eliminating the need for postoperative intermaxillary fixation and also reduces the complications from inappropriate reduction and fixation.

Head and neck injuries after leopard attack: Presentation and management

Leopard attacks on humans are reported most often from the Indian subcontinent. The bite wounds are complex injuries infected with polymicrobial inoculum and may present as punctures, abrasions, lacerations or avulsions. The presentation and acceptable treatment of these injuries vary according to the wound. We hereby describe the clinical presentation and treatment of a male victim with leopard bite injuries on the head and neck region. As bite injuries are commonly found on and around the face, maxillofacial surgeons should be familiar with the therapy. Through thorough clinical and radiological examination, it is essential to prevent missing any hidden injuries, which can easily turn lethal. To benefit the rural population, more health facilities need to be established in remote areas.

Inter Maxillary Fixation Versus Open Reduction for the Treatment of Mandibular Condyle Fractures: A Comparative Evaluation

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 1^st and 3^rd 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 6^th 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.

Does magnitude of deformity correlate with functional outcome following closed reduction in unilateral condylar fracture?

Introduction: Condyle fracture can be treated surgically (ORIF) or conservatively (CTR). When treated by CTR, the fracture might not heal in a morphologically ideal shape. The severity of the deformity and its effects on the functional outcome is not known. This study would investigate the anatomical outcome of CTR and its effect on the functional outcome. Methods: Using a cross-sectional study design, we enrolled patients identified from our trauma census that meets the pre-determined inclusion criteria. Patient underwent assessment which involves clinical and radiographic evaluation. Clinical examination was done by using Helkimo Index. Radiographic evaluation by using cone beam computed tomography (CBCT) scan were traced and digitized, and the position and morphology of the fractured mandibular condyle was measured and compared with those of the contralateral non-fractured condyle in the axial, coronal and sagittal planes. Radiographic data was then compared with data from clinical examination. Results: 25 patients with unilateral condyle fracture and met the inclusion criteria were identified. Eight patients were successfully recalled and included in the study. Assessment was done on average of 40 months post-treatment. Clinical assessment with Helkimo Index showed that 63% had at least mild temporomandibular symptoms or dysfunction. CBCT examinations revealed that most patients had morphologically deformed healed condyle. No pattern can be seen in the magnitude of deformity with functional outcome. Conclusions: Following CTR, condyle fracture would heal in a morphologically deformed shape. Satisfactory functional outcome is still attainable despite this. The magnitude of the deformity does not appear to influence the functional outcome.

Patient Race and Insurance Status Do Not Impact the Treatment of Simple Mandibular Fractures

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.