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Irgebay Z, Glenney AE, Cheng L, Li R, Mocharnuk JW, Smetona J, Balasubramani GK, Losee JE, Goldstein JA. Fracture Patterns, Associated Injuries, Management, and Treatment Outcomes of 530 Pediatric Mandibular Fractures. Plast Reconstr Surg 2024; 154:556e-568e. [PMID: 37585805 DOI: 10.1097/prs.0000000000010996] [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: 08/18/2023]
Abstract
BACKGROUND Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture cause, pattern, management, and treatment outcomes in pediatric mandibular fracture patients. METHODS A retrospective review was performed of patients younger than 18 years who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, cause, medical history, associated facial fractures, other associated injuries, treatments, and outcomes. RESULTS A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy and rest ( n = 253 [47.7%]). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared with patients with a single facial fracture ( P < 0.0001). Older age ( P < 0.001), sex ( P = 0.042), mechanism ( P = 0.008) and cause of injury ( P = 0.002), and specific fractures (eg, isolated angle [ P = 0.001]) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with closed reduction and external fixation or open reduction and internal fixation compared with conservative management (OR, 1.8, 95% CI, 1.0 to 3.2; and OR, 2.1, 95% CI, 1.2 to 3.5, respectively). CONCLUSIONS Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large-scale studies characterizing these injuries are critical for guiding physicians in the management of these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Zhazira Irgebay
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Anne E Glenney
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Lucille Cheng
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Runjia Li
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
| | - Joseph W Mocharnuk
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - John Smetona
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - G K Balasubramani
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
| | - Joseph E Losee
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
| | - Jesse A Goldstein
- From the Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center
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2
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Roccia F, Sobrero F, Strada C, Bottini GB, Goetzinger M, Samieirad S, Vesnaver A, Birk A, de Oliveira Gorla LF, Pereira-Filho VA, Dediol E, Kos B, Pechalova P, Sapundzhiev A, Lazíc M, Konstantinovic VS, Dubron K, Politis C, Demo PG, Sivrić A, Kordić M, Rahman SA, Rahman T, Sohal KS, Aladelusi T, Rae E, Laverick S. Open reduction and internal fixation of paediatric maxillozygomatic complex fractures: An 11-year multicentric retrospective study. Dent Traumatol 2024. [PMID: 38899719 DOI: 10.1111/edt.12976] [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: 02/19/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND/AIM Paediatric maxillozygomatic complex (MZC) fractures are uncommon, and there is a scarcity of data regarding their surgical treatment. The aim of this study was to analyse choices and outcomes of open reduction and internal fixation (ORIF) for MZC fractures among 14 maxillofacial centers around the world. MATERIALS AND METHODS This multicentric retrospective observational study included patients ≤16 years of age with quadripod MZC fractures treated with ORIF from January 2011 and December 2022. The following data were collected: age, gender, dentition stage (deciduous, mixed, and permanent), cause of injury, type of fracture, surgical approach, site of osteosynthesis (infraorbital rim, zygomaticomaxillary buttress, frontozygomatic, and zygomaticotemporal sutures), material (titanium or resorbable) and number of plates used, and outcome. The minimum follow-up was 6 months. Statistical analyses were performed with Fisher's exact test or chi-squared test, as appropriate. RESULTS Sixty-four patients (mean age, 12.3 years) with quadripod MZC fractures were included. Seventy-two percent of patients received a single-point fixation. The zygomaticomaxillary buttress was the most common site for fixation, both in single-point and two-point fixation schemes, especially in combination with the frontozygomatic suture. Increasing age was associated with a higher rate of plate removal (p < .001). Postoperative complications included 5 (7.8%) cases of wound infections, 2 (3.1%) infraorbital paraesthesia, 1 (1.6%) ectropion. Residual facial asymmetry was found in 5 (7.8%) patients and was not associated with the type of fixation (p > .05). CONCLUSIONS This study highlights the possibility of using ORIF, even with a single point of fixation, for the treatment of displaced quadripod MZC fractures in the paediatric population. The zygomaticomaxillary buttress was the preferred site of fixation and allowed for adequate stabilization with no external scars and a low risk of tooth damage. Future prospective studies with long-term follow-up are needed to establish definitive surgical protocols and clarify the surgical decision-making.
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Affiliation(s)
- Fabio Roccia
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Federica Sobrero
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Carlo Strada
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Luis Fernando de Oliveira Gorla
- Division of Oral and Maxillofacial Surgery, Department of Diagnosis and Surgery, São Paulo State University, UNESP, São Paulo, Brazil
| | - Valfrido Antonio Pereira-Filho
- Division of Oral and Maxillofacial Surgery, Department of Diagnosis and Surgery, São Paulo State University, UNESP, São Paulo, Brazil
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Boris Kos
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Petia Pechalova
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Angel Sapundzhiev
- Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Marko Lazíc
- Clinic of Maxillofacial Surgery, School of Dentistry, University of Belgrade, Belgrade, Serbia
| | | | - Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Paolo Garzino Demo
- Division of Maxillofacial Surgery, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Sajjad Abdur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Tabishur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, India
| | - Karpal Singh Sohal
- Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Timothy Aladelusi
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Euan Rae
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
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Sudduth JD, Byrd R, Marquez JL, Bautista CH, Chen J, Battistini A, Yamashiro DK, Gociman B. Pediatric Mandibular Fracture Management: Intraoperative Thermoplastic Splint Fabrication and Circummandibular Wires, without Maxillomandibular Fixation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5883. [PMID: 38855133 PMCID: PMC11161274 DOI: 10.1097/gox.0000000000005883] [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: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 06/11/2024]
Abstract
Management of mandibular fractures often involves the use of maxillomandibular fixation (MMF) to attain immobility of the fractured segments. This can be used as a primary treatment modality or as an adjunct in fracture management. This technique, however, has its drawbacks due to the great burden of care imposed on patients. In the following case, fixation of a pediatric open mandibular body fracture was attained without the use of MMF, and bone union was achieved. Due to age, safety concerns, long-distance travel, and parent's preference, the routine management of this type of fracture with MMF using piriform aperture drop wires and circummandibular wires was not done. Instead, the fracture was reduced, and an intraoral mandibular impression was taken in the operating room, which was used to create a stone model. A 2-mm acrylic splint was designed and fabricated from the stone model, and two circummandibular wires were placed. The wires were tightened over the acrylic splint to achieve stabilization of the mandibular reduction. At 4 weeks postoperatively, the splint was removed, and the patient was maintained on a soft diet. At 6 weeks, bone union was appreciated clinically by immobility of the mandibular segments, and the patient was advanced to a regular diet. Occlusion was corrected to premorbid state by clinical findings and 6 months postoperative imaging. This technique represents an effective approach in managing pediatric mandibular fractures when MMF cannot be used.
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Affiliation(s)
- Jack D Sudduth
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Richard Byrd
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jessica L Marquez
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Catherine H Bautista
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joanna Chen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrea Battistini
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Duane K Yamashiro
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbu Gociman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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4
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Capote R, Preston K, Kapadia H. Craniofacial Growth and Development: A Primer for the Facial Trauma Surgeon. Oral Maxillofac Surg Clin North Am 2023; 35:501-513. [PMID: 37302949 DOI: 10.1016/j.coms.2023.04.007] [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: 06/13/2023]
Abstract
Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.
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Affiliation(s)
- Raquel Capote
- Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Cleft and Craniofacial Program, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
| | - Kathryn Preston
- Center for Cleft and Craniofacial Care, Phoenix Children's Hospital, Phoenix, AZ, USA; Department of Orthodontics, Arizona School of Dentistry & Oral Health, A.T. Still University, Mesa, AZ, USA
| | - Hitesh Kapadia
- Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA; Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA, USA; Department of Orthodontics, School of Dentistry, University of Washington, Seattle, WA, USA
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5
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Marschall JS, Barnes S, Kushner GM. Intermaxillary Fixation in the Primary and Mixed Dentition. Oral Maxillofac Surg Clin North Am 2023; 35:521-527. [PMID: 37270398 DOI: 10.1016/j.coms.2023.04.002] [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: 06/05/2023]
Abstract
Anatomic differences of the primary dentition may hinder traditional methods of intermaxillary fixation. Furthermore, the presence of both the primary and permanent dentition can complicate establishing, and maintaining, the preinjury occlusion. The treating surgeon must be aware of these differences for optimal treatment outcomes. This article discusses and illustrates methods that facial trauma surgeons can use to establish intermaxillary fixation in children aged 12 years and younger.
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Affiliation(s)
- Jeffrey S Marschall
- Department of Oral and Maxillofacial Surgery, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Suzanne Barnes
- Department of Oral and Maxillofacial Surgery, University of Louisville School of Dentistry, 501 South Preston Street, Louisville, KY 40202, USA
| | - George M Kushner
- Department of Oral and Maxillofacial Surgery, University of Louisville School of Dentistry, 501 South Preston Street, Louisville, KY 40202, USA
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6
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Shakir S, Ettinger RE, Susarla SM, Birgfeld CB. Pediatric Panfacial Fractures. Oral Maxillofac Surg Clin North Am 2023; 35:607-617. [PMID: 37280142 DOI: 10.1016/j.coms.2023.04.006] [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: 06/08/2023]
Abstract
Pediatric panfacial trauma is a rare occurrence with poorly understood implications for the growing child. Treatment algorithms largely mirror adult panfacial protocols with notable exceptions including augmented healing and remodeling capacities that favor nonoperative management, limited exposure to avoid disruption of osseous suture and synchondroses growth centers, and creative fracture fixation techniques in the setting of an immature craniomaxillofacial skeleton. The following article provides a review of our institutional philosophy in the management of these challenges injuries with important anatomic, epidemiologic, examination, sequencing, and postoperative considerations.
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Affiliation(s)
- Sameer Shakir
- Division of Plastic Surgery, Children's Wisconsin, Milwaukee, WI, USA.
| | - Russell E Ettinger
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Srinivas M Susarla
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
| | - Craig B Birgfeld
- Department of Surgery, Division of Plastic Surgery, University of Washington, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA; Craniofacial Center, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, Seattle, WA 98150, USA
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7
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Mouzourakis MM, Seo SS, Oral R. Case of Accidental Trauma Resulting in Condylar Fractures in 3-Month-Old. Case Rep Dent 2023; 2023:7611475. [PMID: 37830109 PMCID: PMC10567509 DOI: 10.1155/2023/7611475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023] Open
Abstract
While mandibular fractures represent the most common craniofacial injury in the pediatric population, craniofacial fractures in infants are rare. Diagnosis is challenging with nonspecific presenting symptoms and often limited radiographic imaging. We report a case of nondisplaced mandibular condylar head fractures in a 3-month-old patient as a result of a fall with impact onto the chin, with associated sublingual hematoma (Coleman's sign). Although the initially observed sole finding of sublingual hematoma raised concern for child physical abuse, detailed history, oral exam, and multidisciplinary review of radiologic records by pediatrics, otolaryngology, and child protection teams established the accidental trauma diagnosis. The patient was managed conservatively with normal resumption of feeding. Detailed history and multidisciplinary approach to the management of pediatric facial trauma are important in establishing diagnoses and management.
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Affiliation(s)
- Maggie M. Mouzourakis
- Section of Otolaryngology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
| | - Sarah S. Seo
- Section of Otolaryngology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Surgery, Geisel School of Medicine, Lebanon NH, USA
| | - Resmiye Oral
- Child Advocacy and Protection Program, Dartmouth-Hitchcock Medical Center, Lebanon NH, USA
- Pediatrics, Geisel School of Medicine, Lebanon NH, USA
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8
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Do Racial and Ethnic Disparities Exist in Management of Pediatric Mandible Fractures? A 30-Year Outcome Analysis. Ann Plast Surg 2023. [DOI: 10.1097/sap.0000000000003447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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9
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Khattak YR, Sardar T, Iqbal A, Khan MH, Khan A, Ullah U, Ahmad I. Treatment of pediatric bilateral condylar fractures: A comprehensive analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101339. [PMID: 36403929 DOI: 10.1016/j.jormas.2022.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.
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Affiliation(s)
| | - Tariq Sardar
- Oral and Maxillofacial Surgery, KMU-Institute of Dental Sciences, Kohat, Pakistan.
| | | | | | - Ajmal Khan
- Oral and Maxillofacial Surgery, Saidu Medical College, Swat, Pakistan
| | - Umer Ullah
- Oral and Maxillofacial Surgery, Rehman College of Dentistry, Peshawar, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan
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10
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Vercruysse M, Willaert R, Goormans F, Coropciuc R, Politis C. Indications and complications regarding titanium osteosynthesis in pediatric maxillofacial trauma: A scoping review and critical appraisal. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101284. [PMID: 36108919 DOI: 10.1016/j.jormas.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022]
Abstract
With the advent of biodegradable osteosynthesis material, titanium osteosynthesis for ORIF in pediatric maxillofacial trauma is not as indisputable as before. The aim of this study was to conduct a scoping review to assess the indications, complications of ORIF with titanium osteosynthesis material in pediatric maxillofacial trauma. A systematic search was conducted in PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, gray literature (ICTRP and clinicaltrials.gov) for studies published until April 2022. 3436 studies were screened and finally 13 articles, compromising a sample of 340 pediatric patients were included after full text reading. Reported complications were infection (6.5% of population), malocclusion (5% of population) and dental maleruption (8% of population). Influence on future growth could not be assessed due to short and heterogeneous follow-up periods. Eight of the thirteen studies concluded to a positive and predictable outcome using titanium ORIF for displaced/complex pediatric maxillofacial fractures. Results of this review suggest that titanium ORIF for maxillofacial fractures in the pediatric population is a reliable treatment. The surgeon must be committed to following these patients longitudinally. Interpreting the results should, however, be done with great care, as most articles have a medium to high risk of bias and limited follow-up.
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Affiliation(s)
- Maximilien Vercruysse
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Robin Willaert
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Faculty of Medicine, OMFS/IMPATH Research Group, KU Leuven, Leuven, Belgium
| | - Femke Goormans
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ruxandra Coropciuc
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Faculty of Medicine, OMFS/IMPATH Research Group, KU Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Faculty of Medicine, OMFS/IMPATH Research Group, KU Leuven, Leuven, Belgium
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11
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Sobrero F, Roccia F, Galetta G, Strada C, Gerbino G. Pediatric mandibular fractures: Surgical management and outcomes in the deciduous, mixed and permanent dentitions. Dent Traumatol 2023; 39:233-239. [PMID: 36606623 DOI: 10.1111/edt.12814] [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: 08/23/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIM Mandibular fractures are the most frequent type of pediatric facial traumatic injury, but their treatment remains controversial. The aim of this retrospective study was to analyze the surgical treatment and long-term outcomes of dentate mandibular fractures in children and adolescents. MATERIAL AND METHODS Patients with mandibular fractures in the dentate area who were surgically treated in the period from January 1, 2001, to December 31, 2020, were included. The following data were collected: age, gender, cause and mechanism of injury, fracture site and type, associated maxillofacial fractures, the timing of surgical treatment, Facial Injury Severity Scale (FISS) score, surgical approach, number and thickness of plates, hospitalization stay and outcome. Patients were divided into three groups: deciduous (≤6 years, group A), mixed (7-12 years, group B), and permanent (13-18 years, group C) dentitions. Statistical analyses were performed using SPSS software. RESULTS During the study 91 patients (male: female ratio, 3.8:1), 4 in group A, 12 in group B, and 75 in group C, with 65 single and 52 double fractures were included. An intraoral approach was used in 87% of patients. In group C, 90% of patients were treated with fixation schemes consistent with those suggested in the literature for adults, versus 75% in groups A and B. Median follow-up time was 20 months. No tooth germ injury or facial asymmetry was observed and only six group C patients had post-operative malocclusions. Hardware removal occurred in 22% of the patients. CONCLUSIONS This 20-year retrospective study shows that open reduction and internal fixation of pediatric dentate mandibular fractures caused no tooth germ damage or disturbances of mandibular growth in any dentition stage. Internal fixation schemes were similar to those used for adults, although it was necessary to adapt hardware size and position according to tooth and patient age.
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Affiliation(s)
- Federica Sobrero
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giovanni Galetta
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Carlo Strada
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Giovanni Gerbino
- Division of Maxillofacial Surgery (Head: Prof. G. Ramieri), Surgical Science Department, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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12
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Sabbagh H, Nikolova T, Kakoschke SC, Wichelhaus A, Kakoschke TK. Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101596. [PMID: 36295031 PMCID: PMC9605380 DOI: 10.3390/life12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. METHODS Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. RESULTS Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. CONCLUSIONS A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.
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Affiliation(s)
- Hisham Sabbagh
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-53223
| | - Trayana Nikolova
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Sara Carina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Andrea Wichelhaus
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, LMU Munich, Goethestrasse 70, 80336 Munich, Germany
| | - Tamara Katharina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany
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Akkoc MF, Bulbuloglu S. The Treatment Perspective of Pediatric Condyle Fractures and Long-Term Outcomes. Cureus 2022; 14:e30111. [PMID: 36381803 PMCID: PMC9643693 DOI: 10.7759/cureus.30111] [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: 10/08/2022] [Indexed: 06/16/2023] Open
Abstract
PURPOSE In our study, the characteristics, treatment approach and long-term outcomes of condyle fractures treated in the pediatric plastic surgery and reconstruction unit in the last 10 years were evaluated. MATERIALS AND METHODS This study consisted of two retrospective and prospective sections with the participation of pediatric patients with condylar fractures who were treated in the Plastic, Reconstructive and Aesthetic Surgery clinic of a university hospital in the last 10 years. In the retrospective section, data were obtained from the electronic patient records and patient files regarding the treatment applied, as well as the characteristics of the patient and condyle fractures. In the perspective section, patients were invited to the clinic and the effectiveness of the treatment was evaluated. Statistical analyses were performed with SPSS (Statistical Package for Social Sciences) for IBM 25 package program. RESULTS It was determined that 55.8% of the pediatric patients had accompanying facial fractures, and 72.4% had unilateral condyle fractures. It was determined that 59.5% of the pediatric patients underwent intermaxillary fixation (IMF). Physical complications were seen in 6.75% in the long term after treatment. CONCLUSION Falling from height and traffic accidents, which are the most important factors in the occurrence of condyle fractures, should be eliminated by increasing parental attention and awareness. Surgical treatment should be considered in the treatment of pediatric condyle fractures, especially if there are accompanying facial and mandible bone fractures.
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Affiliation(s)
- Mehmet Fatih Akkoc
- Plastic Reconstructive and Aesthetic Surgery, Dicle University Campus, Diyarbakir, TUR
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14
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Highland J, Dunya G, Teames C, Peacock J, Yamashiro D, Muntz H, Park A. Customizable interdental splinting for repair of pediatric mandibular fractures in children with mixed dentition: A novel technique. Int J Pediatr Otorhinolaryngol 2022; 157:111133. [PMID: 35462217 DOI: 10.1016/j.ijporl.2022.111133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/27/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Repair of pediatric mandibular fractures (PMFs) can be challenging due to the lack of permanent dentition for immobilization, and the presence of unerupted teeth and growth plates in the mandible limiting the space for fixation. Interdental splinting (IDS) has been advocated to provide temporary fixation without the need for mandibular plating; however, there is sparse description of the surgical methodology, and data on long term outcomes are even more limited. The aim of this study is to present our technique and outcomes using a novel technique for IDS repair of pediatric mandible fractures. STUDY DESIGN Observational retrospective chart review. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS Pediatric patients requiring operative repair for mandibular fracture at our tertiary care institution between 2004 and 2021 were included. Patients over 18 years of age, those who died due to associated injuries, or those who underwent non-IDS repairs were excluded. Subjects with at least 3 months of follow-up were assessed for efficacy of surgical repair and short-term adverse outcomes, and at least 1 year for long-term adverse events. Descriptive statistics were obtained. RESULTS Twenty-three children were included in the study with an average age of 7.4 years (range 2-17 years). Fifty-two percent (52.2%) were female. The most common fracture site was the condyle, occurring in 16 children (70%). The indication for operative repair in all cases was malocclusion. The average duration of maxillomandibular fixation (MMF) with the novel IDS was 21 days (range 12-42 days). The average length of follow up was 1.6 years (range 3 months-11 years). All children had restored, functional occlusion at follow up with none requiring further orthodontic or dental intervention. Three children of the total cohort (13.0%) had prolonged hospitalization beyond 48 h for poor oral intake. Five children (21.7%) experienced minor long-term complications including persistent temporomandibular joint pain (n = 1, 4.3%), infection (n = 2, 8.7%), hypertrophic scar (n = 1, 4.3%) and exposure of hardware (n = 1, 4.3%). CONCLUSION PMFs resulting in malocclusion are safely and effectively managed with operative repair utilizing a customizable IDS, with few observed short- and long-term complications.
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Affiliation(s)
- Julie Highland
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States.
| | - Gabriel Dunya
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States
| | - Charles Teames
- University of Utah School of Medicine, Eccles Health and Sciences Building, Suite 5900, 26 South 2000 East, Salt Lake City, UT, 84112, United States
| | - Jordan Peacock
- University of Utah School of Medicine, Eccles Health and Sciences Building, Suite 5900, 26 South 2000 East, Salt Lake City, UT, 84112, United States
| | - Duane Yamashiro
- Division of Plastic Surgery, University of Utah Health, 30N 1900 E, 3B400, Salt Lake City, UT, 84132, United States
| | - Harlan Muntz
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States
| | - Albert Park
- Division of Otolaryngology, University of Utah Health, 50N Medical Drive, SOM 3C120, Salt Lake City, UT, 84132, United States
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Mooney S, Gulati RD, Yusupov S, Butts SC. Mandibular Condylar Fractures. Facial Plast Surg Clin North Am 2021; 30:85-98. [PMID: 34809889 DOI: 10.1016/j.fsc.2021.08.007] [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: 11/16/2022]
Abstract
Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen the quality of outcomes research.
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Affiliation(s)
- Sean Mooney
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Steve Yusupov
- Staten Island University Hospital/Northwell Health, 256-C Mason Avenue, Staten Island, NY 10305, USA
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, SUNY Downstate Health Sciences University, Kings County Hospital Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA.
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16
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Hino S, Iizuka T, Saulacic N, Lang NP, Burkhard JPM. No apparent association between dental implants and mandibular fractures resulting from external forces. Clin Oral Investig 2021; 26:2065-2072. [PMID: 34559318 DOI: 10.1007/s00784-021-04188-w] [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: 06/29/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Dental implants are cylindrical metallic screws inserted into the jawbone to replace missing teeth. Their location may affect the pattern of fractures that occur as a result of the traumatic forces to the mandible. The aim of this study was to investigate possible influences of dental implants on the patterns of mandibular fractures triggered by external forces. MATERIAL AND METHODS In this observational cross-sectional study, a total of 390 patients with mandibular fractures diagnosed between February 2016 and December 2020 were examined and the presence or absence of dental implants in the fracture gap was noted. Clinical and radiological data were analyzed in relation to the fracture line, the dental status, and the location of any implants. RESULTS A total of 16 patients (4.1%) had previously placed dental implants in the mandible. Various fracture patterns were observed. Some yielded typical fracture lines located in the anatomically weak areas along the roots of the incisors, the mental foramina, and long-rooted molars. Occasionally, fracture lines were detected in combination with condylar fractures. Dental implants were not directly involved in any fracture line, except one. In that case, the fracture line extended from the alveolar process straight along the implant body, mimicking initial disintegration of the implant, with erosion of the surrounding bone. CONCLUSIONS Once dental implants have osseointegrated, mandibular fractures are rarely projected along the implant surface. CLINICAL RELEVANCE This observational retrospective cross-sectional study failed to associate mandibular fracture lines with the presence of dental implants.
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Affiliation(s)
- Shunsuke Hino
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama , 350-8550 , Japan.
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Niklaus P Lang
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - John-Patrik M Burkhard
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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17
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Lopez J, Lake IV, Khavanin N, Kachniarz B, Najjar O, Pourtaheri N, Redett RJ, Manson PN, Dorafshar AH. Noninvasive Management of Pediatric Isolated, Condylar Fractures: Less Is More? Plast Reconstr Surg 2021; 147:443-452. [PMID: 33565828 DOI: 10.1097/prs.0000000000007527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine injury patterns in pediatric mandibular condylar fractures and to propose and evaluate the validity of an institutional treatment algorithm for such fractures. METHODS A retrospective chart review was conducted on pediatric patients who presented to the authors' institution with isolated mandibular condylar fractures between 1990 and 2016. Patients were categorized by dentition, and information regarding demographics, injury characteristics, management, and complications was compiled. RESULTS Forty-three patients with 50 mandibular condylar fractures were identified. Twelve patients (27.9 percent) had deciduous dentition, 15 (34.9 percent) had mixed dentition, and 16 (37.2 percent) had permanent dentition. The most common fracture pattern in all groups was diacapitular [n = 30 (60 percent)]; however, older groups showed higher rates of condylar base fractures and bilateral fractures (p = 0.029 and p = 0.011, respectively). Thirty-one patients (72.1 percent) were treated with nonoperative management, 10 (23.2 percent) with closed treatment and mandibulomaxillary fixation, and two (4.7 percent) with open treatment and mandibulomaxillary fixation; nonoperative treatment was more common in younger patients (p = 0.008). Management for 10 patients (23.2 percent) was nonadherent to the treatment algorithm. Eight patients had complications (18.6 percent). Common complications included temporomandibular joint ankylosis (n = 2) and malocclusion (n = 2). Although complications were seen in all groups, adherence to the algorithm was associated with an 81.8 percent reduction in odds of complications (p = 0.032). CONCLUSIONS Nonoperative management has a low complication rate in deciduous children. Children with permanent/mixed dentition may undergo closed treatment and mandibulomaxillary fixation if they have malocclusion/contralateral open bite, significant condylar dislocation, and ramus height loss greater than 2 mm. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Joseph Lopez
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Isabel V Lake
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Nima Khavanin
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Bartlomiej Kachniarz
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Omar Najjar
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Navid Pourtaheri
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Richard J Redett
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Paul N Manson
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
| | - Amir H Dorafshar
- From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine; and Rush Medical College of Rush University
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18
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Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:177-183. [PMID: 34224922 DOI: 10.1016/j.jormas.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact. MATERIALS AND METHODS Young patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up. RESULTS One hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted. CONCLUSION Our study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.
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19
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Brown JS, Khan A, Wareing S, Schache AG. A new classification of mandibular fractures. Int J Oral Maxillofac Surg 2021; 51:78-90. [PMID: 34092451 DOI: 10.1016/j.ijom.2021.02.012] [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: 07/01/2020] [Revised: 11/11/2020] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Abstract
There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II+condyle, III; body/symphysis, IIIc; III+condyle, IV; multiple fractures not including condyle, IVc; IV+condyle, V; bilateral condyle±other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18-23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.
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Affiliation(s)
- J S Brown
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
| | - A Khan
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - S Wareing
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - A G Schache
- Liverpool Head and Neck Centre, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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Rodrigues MTV, Schueng FEA, Mendes BC, Vale DS, Souza FGD, Nóia CF. A Simple Method of Transoperative Maxillomandibular Fixation in Pediatric Facial Fractures. J Craniofac Surg 2021; 32:e375-e376. [PMID: 33252522 DOI: 10.1097/scs.0000000000007279] [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 Maxillomandibular fixation in pediatric facial fractures is quite challenging to be achieved, especially in mid-mixed dentition. Traditional well established intermaxillary devices have a lot of limitations in these patients. This article presents a case of a 9-year-old female patient with a displaced mandibular fracture in which orthodontic buttons were used for transoperative maxillomandibular fixation followed by internal fixation after adequate occlusion reestablishment and fracture reduction. The method showed high efficacy and celerity, allowing the success of treatment, with satisfactory evolution of the patient.
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Affiliation(s)
| | - Filipe E A Schueng
- Department of Dentistry, São Lucas University Center- UNISL, Porto Velho
| | - Bruno Coelho Mendes
- Department of Diagnosis and Surgery, Araçatuba School of Dentistry, São Paulo State University- UNESP, Araçatuba
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21
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Cleveland CN, Kelly A, DeGiovanni J, Ong AA, Carr MM. Maxillofacial trauma in children: Association between age and mandibular fracture site. Am J Otolaryngol 2021; 42:102874. [PMID: 33418178 DOI: 10.1016/j.amjoto.2020.102874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the association between age and location of facial fractures in the pediatric population. MATERIALS AND METHODS A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures. RESULTS A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (β=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (β=-0.090, p<0.001). CONCLUSIONS Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.
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22
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Som A, Santosa KB, Skolnick GB, Lapidus JB, Waljee JF, Patel KB. Opioid Use among Adolescents Undergoing Surgical Repair of Facial Trauma. Plast Reconstr Surg 2021; 147:690-698. [PMID: 33587556 DOI: 10.1097/prs.0000000000007643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND New persistent opioid use has been quantified among adults undergoing surgery; less is known about the risk among adolescents. The authors examine new persistent opioid use in opioid-naive adolescent patients who underwent operative repair of facial fractures. METHODS Using the IBM MarketScan Commercial Database, the authors performed a retrospective analysis of patients aged 11 to 17 years who underwent facial fracture repair between 2006 and 2015. The incidences of prolonged opioid use and potentially inappropriate opioid prescriptions were determined. RESULTS Of 4892 patients, 78.5 percent filled a prescription. Among these patients, 7.9 percent had prolonged opioid use. Significant risk factors included older age (i.e., age 15 to 17 years) (OR, 1.579; 95 percent CI, 1.173 to 2.126 compared to younger patients), multiple comorbidities (OR, 3.005; 95 percent CI, 1.193 to 7.568), mandible fracture (OR, 1.614; 95 percent CI, 1.213 to 2.146), and multiple fractures (OR, 1.542; 95 percent CI, 1.002 to 2.372). Overall, 24.1 percent received a potentially inappropriate opioid prescription. Mandible fracture repair was associated with increased risk (OR, 2.753; 95 percent CI, 2.275 to 3.331) of potentially inappropriate opioid prescription. CONCLUSIONS Nearly one in 12 adolescents met criteria for prolonged opioid use; nearly one in four received a potentially inappropriate opioid prescription. Significant risk factors included mandible fracture, older age, multiple comorbidities, and multiple fractures. Like adults, many adolescents are at high risk for potentially inappropriate opioid prescriptions and prolonged opioid use following surgical repair. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Avira Som
- From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan
| | - Katherine B Santosa
- From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan
| | - Gary B Skolnick
- From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan
| | - Jodi B Lapidus
- From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan
| | - Jennifer F Waljee
- From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan
| | - Kamlesh B Patel
- From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan
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Yadav P, Bhutia O, Bansal A, Lakshmanan S, Roychoudhury A. Does closed treatment of paediatric mandibular condyle fractures result in restitutional remodelling? Br J Oral Maxillofac Surg 2021; 59:798-806. [PMID: 34272113 DOI: 10.1016/j.bjoms.2021.01.016] [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: 10/19/2020] [Accepted: 01/30/2021] [Indexed: 11/25/2022]
Abstract
The treatment of paediatric mandibular condylar fracture (PMCF) is typically non-operative. The purpose of this study was to determine if non-operative management of PMCF results in a new condylar process of normal morphology to regenerate after closed treatment (restitutional remodelling). The specific aim of the study was to observe restitutional remodelling (RM) in PMCF and review the literature. The investigators designed and implemented a retrospective study on paediatric patients (age<12) with unilateral or bilateral condyle fractures treated with non-operative treatment between January 2005 and July 2015. Patients with complete records and at least 1-year follow-up were included in the study. Primary outcome variable was RM and secondary outcome variables were occlusion, maximal incisal opening (MIO), displacement, infection, facial asymmetry, and signs of temporomandibular joint ankylosis (TMJA). The study evaluated 41 patients {n=57 PMCF, (m:f-35:6)} of unilateral (n=25) and bilateral (n=16) PMCF. Fractured condyles remodelled to normal morphology in all the cases at follow-up. The Wilcoxon test revealed a statistically significant difference in MIO from the preoperative value to postoperative (p=0.001). Occlusion (except 1) was satisfactory in all cases, at follow-up with no gross facial asymmetry. There was no sign of infection at the surgical site (anterior mandible). None of the patients showed signs of TMJA at follow-up. The result of the present study demonstrates that RM of condylar fracture occurs with non-operative management. Non-operative management should be the point of care in PMCF, owing to the rapid RM, bone regeneration, and satisfactory outcome. Review of the literature also supports closed treatment.
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Affiliation(s)
- P Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - O Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - A Bansal
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - S Lakshmanan
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - A Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
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Friedrich RE, Kohlrusch FK. Preauricular Swelling Mimicking a Tumour: Dissolution of Mandibular Capitulum Following Trauma in a 15-Year Old Child. In Vivo 2021; 34:1235-1245. [PMID: 32354914 DOI: 10.21873/invivo.11897] [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: 03/17/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/10/2022]
Abstract
AIM The report is about diagnosis, therapy, and follow-up of a 15-year old boy, who experienced facial swelling and impaired mouth opening after a sport accident. CASE REPORT Diagnosis of mandibular damage was delayed due to inadequate clinical investigation and radiography after trauma and only became clear after a parotid swelling occurred sometime later resulting from the dissolution of the upper part of the articular process. Follow-up control over a period of three years showed a partial restoration of the articular process but some inhibition of mouth opening combined with slight deviation of the mandible to the affected side remained over the years. CONCLUSION This report reminds us that parotid swelling can be the result of mandibular trauma without a recent history of physical injury to this region. Therefore, the basic standards of radiologic diagnosis should be maintained and the limited restoring capacity of the condylar process in adolescence should be acknowledged.
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Affiliation(s)
- Reinhard E Friedrich
- Department of Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Felix K Kohlrusch
- Department of Oral and Cranio-Maxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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Bansal A, Yadav P, Bhutia O, Roychoudhury A, Bhalla AS. Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study. J Craniomaxillofac Surg 2021; 49:196-205. [PMID: 33483246 DOI: 10.1016/j.jcms.2020.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.
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Affiliation(s)
- Adity Bansal
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Yadav
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ajoy Roychoudhury
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Agbara R, Fomete B, Omeje K. Fractures of the mandible: Epidemiological study of 519 Nigerian cases. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:26-32. [PMID: 36188059 PMCID: PMC9516754 DOI: 10.4103/jwas.jwas_10_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
Background: Epidemiological studies despite their limitations provide information that is useful for the formulation of effective and efficient injury prevention strategies. Aim: The aim is to carry out epidemiology study of mandibular fracture in a Nigerian population. Setting: Department of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria. Materials and Methods: A retrospective observational study was carried out at the Ahmadu Bello University Teaching Hospital, Shika-Zaria. Data retrieved from patients’ case notes and operating records were subjected to statistical analysis involving frequencies (count, percent), measures of central tendency (mean), and measures of dispersion (standard deviation) using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL). Mandibular fracture was classified based on sites, and patients’ socioeconomic status was classified based on United Kingdom National Statistics Socio-economic Classification (NS-SEC, 2010). Results: There were 466 (89.9%) males and 53 (10.1%) females. Based on Socio-economic Classification (NS-SEC, 2010), there was a preponderance of analytical class 6 (n = 217; 54.9%) and 8 (n = 127; 32.2%). Road traffic–related accident (n = 385; 74.2%) was the most common aetiological factor, and a total of 215 (41.4%) patients had a record of loss of consciousness. The mandibular body (n = 225; 32.0%) followed by the parasymphyseal (n = 187; 26.6%) regions were the most fractured sites. Closed-reduction technique was the predominant treatment modality. Conclusions: A road traffic accident was the most common aetiological factor for mandibular fracture, and the mandibular body had the highest frequency of fractures. Measures aimed at injury prevention should be continually reviewed and updated to limit the morbidity and economic burden on individuals.
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Lee CC, Tannyhill RJ, Peacock ZS. What Factors Are Associated With Open Treatment of Pediatric Mandibular Fractures? J Oral Maxillofac Surg 2020; 79:1292-1301. [PMID: 33453160 DOI: 10.1016/j.joms.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE There is a paucity of data with respect to management of pediatric facial fractures. The purpose of this study was to describe the population of pediatric patients with mandibular fractures at our institution and to assess predictors of fractures requiring open reduction and internal fixation (ORIF). PATIENTS AND METHODS This was a retrospective cohort study of patients aged ≤17 years presenting with mandibular fractures. The primary predictor variable was age ≥13 years and <13 years. The primary outcome variable was ORIF (yes or no). Epidemiologic factors and complications were also assessed. Descriptive, bivariate, and multiple logistic regression statistics were computed to measure the association between predictor variables and ORIF. RESULTS The study sample was composed of 84 subjects with 61 subjects aged ≥13 years and 23 subjects aged <13 years. ORIF was used for 21.4% of subjects. Increased age was associated with ORIF (P = .009). After adjusting for the effects of concurrent variables, age (P = .047, OR = 2.30, 95% CI = 1.01 to 5.24), fracture displacement between 2 and 4 mm (P = .032, OR = 18.1, 95% CI = 1.29 to 254), fracture displacement >4 mm (P = .019, OR = 16.9, 95% CI = 1.60 to 179), and the presence of 3 fractures (P = .027, OR = 30.8, 95% CI = 0.001 to 0.641) were positive independent predictors of ORIF. Concomitant facial, skull, or skull base fractures (P = .039, OR = 0.027, 95% CI = 0.001 to 0.641) were a negative independent predictor of ORIF. Secondarily, both mechanism of injury and fracture location varied significantly by age and gender. Complication rate was 6.33%. CONCLUSIONS Most pediatric mandibular fractures were managed nonoperatively. Increased age, fracture displacement, presence of 3 fractures, and concomitant craniofacial injuries were independent predictors of ORIF. Complication rates were low regardless of treatment modality.
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Affiliation(s)
- Cameron C Lee
- Resident, Oral & Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - R John Tannyhill
- Instructor, Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA
| | - Zachary S Peacock
- Assistant Professor, Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
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Pediatric Mandibular Condylar Fractures With Concomitant Cervical Spine Injury. J Craniofac Surg 2020; 31:e248-e250. [DOI: 10.1097/scs.0000000000006178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Zhu Y, Zou Y, Wang S, Du C, Xu B, Zhu M. Three-dimensional evaluation of condylar morphology after closed treatment of unilateral intracapsular condylar fracture in children and adolescents. J Craniomaxillofac Surg 2020; 48:286-292. [DOI: 10.1016/j.jcms.2020.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
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Liu M, He Y, Lei J, Zhao Y, An J, Zhang Y. Acute Intra-Articular Soft Tissue Injury as Seen on Magnetic Resonance Imaging and Its Association With Condylar Fracture Dislocation in Children. J Oral Maxillofac Surg 2019; 77:2503-2511. [PMID: 31401026 DOI: 10.1016/j.joms.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE An intra-articular injury in growing patients should be well understood because it can interfere with normal temporomandibular joint (TMJ) function and even mandibular growth. The present study evaluated TMJ soft tissue injury after acute nondislocated and dislocated intracapsular condylar fractures (ICFs) in children. PATIENTS AND METHODS In the present cross-sectional study, we enrolled a sample of children younger than 12 years old with acute ICFs. The predictor variable was the position of the ICF in relationship to the articular fossa, grouped as nondislocated and dislocated. The primary outcome variable was the injury type, including anterior displacement and deformity of the disc, joint effusion, and retrodiscal attachment tear. The second outcome variable was the injury score classified according to the injury type. Other study variables included age, gender, laterality, and the presence of concomitant fractures. The data were analyzed using the χ2 test and logistic regression analysis. P values < .05 were considered to indicate statistical significance. RESULTS A total of 44 children with 63 ICFs were included, of which 28 and 35 were nondislocated and dislocated fractures, respectively. Of the 63 ICFs, 56 (88.9%) had anterior disc displacement, 2 (3.2%) had disc deformity, 59 (93.7%) had joint effusion, and 11 (17.5%) had a retrodiscal attachment tear. According to the injury type, 4 joints were given a score of as 0, 3 a score of 1, 45 a score of 2, and 11 a score of 3. The injury type and score were significantly associated with fracture dislocation (P < .05). CONCLUSIONS In children with ICF, the presence of a retrodiscal attachment tear and disc deformity were less frequent. The type and severity of the soft tissue injury were associated with fracture dislocation. Additional studies are warranted to evaluate how soft tissue injuries affect TMJ function and fracture healing.
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Affiliation(s)
- Meng Liu
- Resident, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Yang He
- Associate Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Jie Lei
- Resident, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Yuming Zhao
- Professor, Department of Paediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Jingang An
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China
| | - Yi Zhang
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China, Peking University School and Hospital of Stomatology, Beijing, People's Republic of China.
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Anatomical Examination of Mandibular Condyle Protrusion Into the Middle Cranial Fossa. J Craniofac Surg 2018; 29:1069-1071. [PMID: 29543680 DOI: 10.1097/scs.0000000000004425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Trauma to the mandible can occasionally be a life-threatening event. Although extremely rare with only 56 reported patients in the English language, fracture of the floor of the middle cranial fossa with protrusion of the mandibular condyle into the middle cranial fossa was first reported in 1963 by Dingman. The authors review the anatomy of the temporomandibular joint in relation to the middle cranial fossa and demonstrate the possible complications due to condylar intrusion with anatomical dissection.
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Abstract
Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.
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Affiliation(s)
- Brent B Pickrell
- Division of Plastic Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Renata S Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Bobrowski A, Torriani M, Sonego C, Carvalho PD, Post L, Chagas Júnior O. Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review. Int J Oral Maxillofac Surg 2017; 46:465-472. [DOI: 10.1016/j.ijom.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Liu S, Tian L, Ding M, Liu Y, Li G, Chen J, Ding Y. The effect of extracapsular injuries on growth and development of the mandible condyle: an experimental study in growing dogs. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e131-e145. [PMID: 27527388 DOI: 10.1016/j.oooo.2016.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 05/02/2016] [Accepted: 05/29/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effects of condylar extracapsular injuries on the development of the mandibular condyle and try to find a way to treat condylar hyperplasia by electively using such injuries to restrict the overdeveloped mandibular condyle. STUDY DESIGN Sixty 6-month-old beagle puppies were divided randomly into five groups: blank control; unilateral fracture to the condylar neck; unilateral fracture to the condylar neck treated with rigid internal fixation; unilateral periosteum injury; unilateral decortication of the condylar neck. Computed tomography, 99 mTc single-photon emission computed tomography, and tetracycline-calcein double-labeling were performed after surgery. The puppies were sacrificed 12 and 24 weeks after surgery. Morphologic analyses and examination of growth activity were done. RESULTS Unilateral fracture of the condylar neck without fixation caused local morphologic changes during the early postoperative period, but compensatory growth of the condyle altered such changes after healing. The other types of injury failed to inhibit the growth of the condyle and the mandible, whereas functional deviation of the chin was found after unilateral fracture of the condylar neck with or without fixation. CONCLUSIONS The four types of extracapsular injury described here failed to inhibit the growth of the mandibular condyle and could not be selected as alternatives to treat condylar hyperplasia.
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Affiliation(s)
- Siying Liu
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Lei Tian
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Mingchao Ding
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Yanpu Liu
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Guiyu Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Jinwu Chen
- State Key Laboratory of Military Stomatology, Department of Radiology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Yin Ding
- State Key Laboratory of Military Stomatology, Department of Orthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, PR China.
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Abstract
Severe pediatric facial trauma is characterized by multiple, comminuted, and unstable fractures, frequently necessitating operative intervention. Disruption of facial growth is a primary concern in the long-term sequelae of such conditions. Children suffering from midface fractures were followed over time in a long-term growth and development study. Lateral cephalograms at longest-term follow-up were traced, digitized, and averaged. Seven landmarks of the midface (A point, ANS, orbitale, bridge of nose, distal U6, upper lip, stomion superius) were identified for comparative measurements with age and sex-matched superimposed Bolton norms as controls. Differences in x and y axes between test and control metrics were measured. Clinical significance was defined as a 2-mm discrepancy from the norm. Statistical significance for each patient was determined using t tests of the x and y arrays of patient values versus normal controls. Seven patients met the inclusion criteria with mean age of 8.9 years at the time of injury. Mean cephalometric follow-up was 4.6 years (range 2-10 years). Six out of 7 patients (86%) showed clinically significant impairment in growth in horizontal (29%), vertical (29%), or both planes (29%). T Tests confirmed statistical significance (P ≤ 0.05) for all clinically significant differences. Mean deficiency in growth for all landmarks was 3.7 mm (range -4.0 to 13.7 mm) in the x axis and 2.9 mm (range -1.1 to 8.8 mm) in the y axis. Severe pediatric midface trauma often results in compromised bone growth and permanent facial deformity. New methodologies of management that better allow for growth are needed.
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Abstract
BACKGROUND The purpose of this study was to define patterns of injury and treatment for condylar and subcondylar fractures and evaluate short-term outcomes in the pediatric population. METHODS A retrospective chart review was performed on pediatric patients with mandibular condylar fractures who presented between 1990 and 2010. Computed tomographic imaging was reviewed for all patients to assess fracture characteristics. Mandibular fractures were codified using the Strasbourg Osteosynthesis Research Group and Lindahl classification methods. RESULTS Sixty-four patients with 92 condylar fractures were identified. Of these patients, 29 had isolated condylar fracture and 35 had a condylar fracture associated with an additional mandibular arch fracture. The most common fracture patterns were diacapitular fracture in the Strasbourg Osteosynthesis Research Group system (n = 46) and vertical condylar head fracture in the Lindahl system (n = 14). Condylar fracture with additional mandibular arch fractures were treated with maxillomandibular fixation more often than patients with condylar fracture [n = 40 (74.1 percent) versus n = 14 (25.9 percent); p = 0.004]. No condylar fracture was treated in an open fashion. Forty-three patients returned for follow-up. The median follow-up period was 81 days (interquartile range, 35 to 294 days). Ten patients had complications (23.3 percent). The most common complication was malocclusion (n = 5). Nine of 10 patients with complications had condylar fracture with an additional mandibular arch fracture. CONCLUSIONS Closed treatment of condylar fractures yields satisfactory results in pediatric patients. Pediatric patients with condylar fractures combined with additional arch fractures experience a higher rate of unfavorable outcomes.
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Owusu JA, Bellile E, Moyer JS, Sidman JD. Patterns of Pediatric Mandible Fractures in the United States. JAMA FACIAL PLAST SU 2016; 18:37-41. [DOI: 10.1001/jamafacial.2015.1456] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- James A. Owusu
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
- Department of Otorhinolaryngology, University of Texas Health Sciences Center at Houston
| | - Emily Bellile
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - Jeffrey S. Moyer
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
| | - James D. Sidman
- Department of Pediatric Otolaryngology and Facial Plastic Surgery, Children’s Hospitals and Clinics of Minnesota, Minneapolis
- Department of Otolaryngology, University of Minnesota, Minneapolis
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Afrooz PN, Bykowski MR, James IB, Daniali LN, Clavijo-Alvarez JA. The Epidemiology of Mandibular Fractures in the United States, Part 1: A Review of 13,142 Cases from the US National Trauma Data Bank. J Oral Maxillofac Surg 2015; 73:2361-6. [DOI: 10.1016/j.joms.2015.04.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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An Alternative Method of Intermaxillary Fixation for Simple Pediatric Mandible Fractures. J Oral Maxillofac Surg 2015; 74:582.e1-8. [PMID: 26679550 DOI: 10.1016/j.joms.2015.10.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/21/2015] [Accepted: 10/24/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Mandibular fractures represent a substantial portion of facial fractures in the pediatric population. Pediatric mandibles differ from their adult counterparts in the presence of mixed dentition. Avoidance of injury to developing tooth follicles is critical. Simple mandibular fractures can be treated with intermaxillary fixation (IMF) using arch bars or bone screws. This report describes an alternative to these methods using silk sutures and an algorithm to assist in treating simple mandibular fractures in the pediatric population. PATIENTS AND METHODS A retrospective chart review was performed and the records of 1 surgeon were examined. Pediatric patients who underwent treatment for a mandibular fracture in the operating room from 2011 to 2015 were identified using Common Procedural Terminology codes. Data collected included age, gender, type of fracture, type of treatment used, duration of fixation, and presence of complications. RESULTS Five patients with a mean age of 6.8 years at presentation were identified. Fracture types were unilateral fractures of the condylar neck (n = 3), bilateral fractures of the condylar head (n = 1), and a unilateral fracture of the condylar head with an associated parasymphyseal fracture (n = 1). IMF was performed in 4 patients using silk sutures, and bone screw fixation was performed in the other patient. No post-treatment complications or malocclusion were reported. Average duration of IMF was 18.5 days. CONCLUSIONS An algorithm is presented to assist in the treatment of pediatric mandibular fractures. Silk suture fixation is a viable and safe alternative to arch bars or bone screws for routine mandibular fractures.
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A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries. Case Rep Dent 2015; 2015:301013. [PMID: 26339511 PMCID: PMC4538768 DOI: 10.1155/2015/301013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022] Open
Abstract
The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.
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Application of the Mandible Injury Severity Score to Pediatric Mandibular Fractures. J Oral Maxillofac Surg 2015; 73:1341-9. [DOI: 10.1016/j.joms.2015.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/28/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the trends in management of preadolescent facial fractures - a challenging population because of the need to consider growth, dynamic changes in dentition, and evolving fracture patterns. RECENT FINDINGS Recent findings are a more thorough understanding of fracture patterns and distribution because of recent comprehensive studies isolating the preadolescent age cohort; the role of rigid internal fixation for significantly displaced fractures; and the potential applications and indications for the use of resorbable hardware for fracture fixation in the preadolescent. SUMMARY As preadolescent fractures occur in a period of growth and evolving dentition in the facial skeleton, it is mandatory for the treating surgeon to have a thorough knowledge of standard and alternative treatment options to optimally manage these patients.
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Changes in the characteristics of facial fractures in children and adolescents in Portugal 1993–2012. Br J Oral Maxillofac Surg 2015; 53:251-6. [DOI: 10.1016/j.bjoms.2014.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022]
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Functional outcomes of preauricular underparotid retrograde approach for mandibular condyle fractures. J Craniofac Surg 2014; 25:1078-81. [PMID: 24717314 DOI: 10.1097/scs.0000000000000514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Management of condyle fractures includes a wide spectrum of alternatives including analgesia alone, physiotherapy, intermaxillary fixation, and open reduction and internal fixation. Various approaches have been previously mentioned for the access to the mandibular condyle. The aim of this retrospective clinical study was to evaluate our clinical results on preauricular underparotid retrograde approach for condylar fractures. This retrospective study included 20 condylar fractures in 16 patients who were treated surgically using a preauricular transparotid retrograde approach between 2010 and 2013. Functional outcomes with this method were addressed in light of the results obtained in this clinical series. We suggest this method in the management of condylar fractures.
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The Safe and Efficacious Use of Arch Bars in Patients during Primary and Mixed Dentition. Plast Reconstr Surg 2014; 133:364-366. [DOI: 10.1097/01.prs.0000436842.07871.b6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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