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Nakamura T, Sukegawa S, Masui M, Ono K, Hasegawa K, Fujimura A, Okui T, Furuki Y. Risk factors for postoperative facial nerve injury in retromandibular-approach surgery: A retrospective study including CT measurements of maxillofacial bone structure. J Craniomaxillofac Surg 2024; 52:953-958. [PMID: 39048494 DOI: 10.1016/j.jcms.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/27/2023] [Accepted: 01/16/2024] [Indexed: 07/27/2024] Open
Abstract
The purpose of this retrospective study was to identify risks of postoperative facial nerve injury (FNI) in mandibular condylar fractures. A total of 59 consecutive cases of condyle fracture or plate removal with a retromandibular transparotid approach (RMTA) were divided into FNI and non-FNI groups that were evaluated for associations with age, sex, laterality, fracture type, height, weight, body mass index (BMI), and maxillofacial bone height and width diameters on computed tomography (CT). FNI occurred in 11 of 59 patients (18.64%), all of them female (p = 0.0011). Other statistically significant factors on univariate analysis for FNI included a short height (156.95 ± 8.16 cm vs. 164.29 ± 9.89 cm, p = 0.04), low weight (46.08 ± 8.03 kg vs. 58.94 ± 11.79 kg, p = 0.003), low BMI (18.64 ± 2.63 kg/m2 21.68 ± 3.02 kg/m2, p = 0.007), short condylion-anterior fracture distance (19.34 ± 3.15 mm vs. 22.26 ± 3.96 mm, p = 0.04) and short condylion-posterior fracture distance (20.12 ± 3.98 mm vs. 25.45 ± 5.02 mm, p = 0.009). Our retrospective study suggested that FNI with RMTA surgery occurs particularly in female patients and may occur more frequently in patients who are short, lean or have high condyle fractures.
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Affiliation(s)
- Tomoya Nakamura
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1- 2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1- 2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan; Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Miki, Kagawa, 761-0793, Japan.
| | - Masanori Masui
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1- 2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Kisho Ono
- Department of Oral and Maxillofacial Surgery, Okayama University Hospital, Okayama, 700-0914, Japan
| | - Kazuaki Hasegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1- 2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan; Department of Oral and Maxillofacial Surgery, Okayama University Hospital, Okayama, 700-0914, Japan
| | - Ai Fujimura
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1- 2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, 693-8501, Japan
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1- 2-1, Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan
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Savani R, Weihsin H, Patel S, Shah N, Chauhan S, Chavda Y. Effective strategies in the management of anterior mandibular fractures: a comprehensive systematic review. Br J Oral Maxillofac Surg 2024; 62:349-360. [PMID: 38604919 DOI: 10.1016/j.bjoms.2024.02.006] [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] [Received: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 04/13/2024]
Abstract
This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures.
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Affiliation(s)
- Rajan Savani
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India.
| | - Hu Weihsin
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
| | - Shital Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
| | | | - Shyam Chauhan
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
| | - Yashasvi Chavda
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Dental College and Hospital, Ahmedabad, India
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Rivis M, Juncar RI, Moca AE, Moca RT, Juncar M, Țenț PA. Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study. J Clin Med 2023; 12:4103. [PMID: 37373796 DOI: 10.3390/jcm12124103] [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: 05/06/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20-29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines.
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Affiliation(s)
- Mircea Rivis
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeș" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 30041 Timișoara, Romania
| | - Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Rahela Tabita Moca
- Doctoral School of Biomedical Sciences, University of Oradea, 1 Universității Street, 410087 Oradea, Romania
| | - Mihai Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Paul Andrei Țenț
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
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Cavalcanti SCSXB, Taufer B, Rodrigues ADF, Luz JGDC. Endoscopic surgery versus open reduction treatment of mandibular condyle fractures: A meta-analysis. J Craniomaxillofac Surg 2021; 49:749-757. [PMID: 33663963 DOI: 10.1016/j.jcms.2021.02.019] [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: 08/08/2020] [Revised: 08/30/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022] Open
Abstract
The aim of the study was to compare open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) in adults in terms of reducing both needing of reoperation and/or facial nerve injury. An electronic search was undertaken (PubMed/MEDLINE, Web of Science, SCOPUS, and The Cochrane Library). The inclusion criteria were full text, published from their inception to June 2020, clinical trials, randomized or not, and retrospective studies, that compared ORIF and EORIF. The estimates of an intervention were expressed as the risk ratio (RR). From the 1338 articles found, 5 publications were included. There was no statistically significant difference between ORIF and EORIF regarding needing of reoperation (RR = 2.46, p = 0.42) or facial nerve injury (RR = 0.45, p = 0.14). Meta-analysis suggests that there is no difference between open reduction with internal fixation (ORIF) and endoscopic open reduction with internal fixation (EORIF) of condylar fractures (CF) regarding facial nerve injury risk or need for reoperation.
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Affiliation(s)
- Samantha Cristine Santos Xisto Braga Cavalcanti
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil; School of Dentistry, Centro Universitário Das Faculdades Metropolitanas Unidas (FMU), Sao Paulo, Brazil.
| | - Bianca Taufer
- School of Dentistry, Centro Universitário Das Faculdades Metropolitanas Unidas (FMU), Sao Paulo, Brazil
| | - Alex de Freitas Rodrigues
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil
| | - João Gualberto de Cerqueira Luz
- Department of Maxillofacial Surgery, Prosthetics and Traumatology, School of Dentistry, Universidade de São Paulo (USP), Sao Paulo, Brazil
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Complications after mandibular setback with intraoral vertical ramus osteotomies: a retrospective cohort analysis of 133 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:638-642. [PMID: 33737017 DOI: 10.1016/j.oooo.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In the present study, we assessed the rate of complications and morbidity after mandibular setback with bilateral intraoral vertical ramus osteotomy (IVRO). STUDY DESIGN In total, 133 patients were included. The prevalence of neurosensory disturbance (NSD), surgical site infection (SSI), and other complications were registered 2 months and 1 year after surgery. The correlations between complications and age, sex, American Society of Anesthesiologists classification, body mass index, blood loss, and operative time were evaluated. RESULTS NSD was reported for 6.8% of the patients (9 of 133) 2 months after surgery (3.8% of the operated sites). The prevalence was significantly higher in female patients (P < .05). Two patients described persistent unilateral reduced sensibility after 1 year (1.5%). In total, 0.8% of the operated sites (2 of 266) had persistent NSD after 1 year. None of the patients required prolonged hospitalization, and 95.5% (127 of 133) were discharged the day after surgery. None of the patients experienced severe bleeding, and only 1 patient developed SSI. There were no significant correlations between patient-specific or intraoperative parameters evaluated and registered complications. CONCLUSIONS This study shows that IVRO is a safe surgical technique associated with a low complication rate. IVRO can be an alternative technique for mandibular setback in patients who can tolerate postoperative maxillomandibular fixation.
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