Prevalence of mandibular fractures reported at C.S.M.S.S Dental College, aurangabad from february 2008 to september 2009

Can the Mechanism of Injury Impact the Location of a Mandibular Fracture? A Systematic Review

Purpose

Mandible fractures are the second most common fractures of the facial skeleton because of the prominent position of the lower jaw. The purpose of this study was to calculate the prevalence of mandibular fractures based on their causes and locations.

Materials and Method

A systematic search of 3 electronic databases from January 2010 and January 2020 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 359 articles identified for screening against selection criteria. The search identified 39 articles to be included in our analysis.

Results

A total of 20,135 patients with 31,468 mandible fractures in this review. There was a 76% male predominance. The third decade was the most common age group (21-30). Motor vehicle accidents (39.89%) were the leading cause of mandible fractures, followed by falls (27.72%) and violence (25.35%). Condylar fractures are the most common cause of MVA and fall (33.11%, 50% respectively). Mandible body fractures are the second most common type of MVA injury (17.06%). When it came to violence, the angle of the mandible was the most common site (31.73%).

Conclusions

The prevalence of mandible fractures was higher in male patients in the current study, particularly in the second and third decades of life. Road traffic accidents were the most common cause, and the condylar process of the mandible was the most frequently affected region. Demographic data such as age, gender, and mechanism of injury can help surgeons predict and identify specific areas of mandibular fracture.

Discrimination between falls and blows from the localization and the number of fractures on computed tomography scans of the skull and the trunk

The distinction between falls and blows is a common and difficult task in forensic sciences. One of the most often used criteria to address this issue is the hat brim line (HBL) rule, which states that fall-related injuries do not lie above the HBL. Some studies, however, have found that the use of HBL rule is not so relevant. This study assesses the aetiologies, the number of fractures, and their location on the skull and the trunk in a sample of 400 individuals aged 20-49 years, which were CT scanned after traumas. This may facilitate the interpretation of such injuries in skeletonized or heavily decomposed bodies in which soft tissues are no longer available. Our aim is to improve the distinction rate between falls and blows by combining several criteria and assessing their predictability. Skeletal lesions were analysed using retrospective CT scans. Cases selected comprise 235 falls and 165 blows. We registered the presence and the number of fractures in 14 skeletal anatomical regions related to the two different aetiologies. We showed that the HBL rule should be used with caution, but there is nevertheless a possibility of discussing the aetiology of blunt fractures. Possibly, parameters like the anatomical location and the number of fractures by region can be used to distinguish falls and blows.

Temporal Pattern of micro-CT Angiography Vascular Parameters and VEGF mRNA Expression in Fracture Healing: a Radiograph and Molecular Comparison

Angiogenesis plays an important role in fracture healing with vascular endothelial growth factor (VEGF) as the main protein involved. Micro-computed tomography (CT) angiography may be used to analyze this revascularization with several parameters such as number of branches, total volume, and diameter. This systematic review is aimed to assess available studies on the temporal pattern of vascular imaging on micro-CT angiographs, especially in terms of the number of branches, total volume, and diameter as well as the temporal pattern of VEGF mRNA expression as the molecular comparison during bone fracture healing. This review was conducted according to the PRISMA guidelines. Electronic database searches were performed using PubMed, ProQuest, ScienceDirect, EBSCOhost, Taylor & Francis Online, and hand searching. The search strategy and keywords were adjusted to each database using the Boolean operators and other available limit functions to identify most relevant articles based on our inclusion and exclusion criteria. Screening and filtration were done in several stages by removing the duplicates and analyzing each title, abstract, and full-text in all included entries. Data extraction was done for syntheses to summarize the temporal pattern of each parameter. A total of 28 articles were eligible and met all criteria, 11 articles were synthesized in its angiograph's analysis, 16 articles were synthesized in its VEGF mRNA expression analysis, and 1 article had both parameters analyzed. The overall temporal pattern of both three micro-CT angiographic parameters and VEGF mRNA expression was in line qualitatively. The number of branches, total volume, and diameter of the blood vessels in micro-CT angiography showed an exponential rise at week 2 and decline at week 3 of fracture healing, with the VEGF mRNA expression concurrently showing a consistent pattern in the phase.

Management of Maxillofacial Trauma in Road Traffic Accident (RTA) at Tertiary Care Center

Road traffic accidents (RTA) are the major cause of maxillofacial injuries (MFIs) in developing countries (Akama et al. 2007). Road traffic accidents were reported to be the 9th most common cause of death and morbidity in the world and are expected to rise to 3rd position by 2020 (Peden et al. 2002). Maxillofacial injuries remain a serious clinical problem because of the involvement of complex anatomic region. Facial fractures occur most commonly in males in the third decade of life (Motamedi et al. 2014). The goal of treatment in facial fractures is to achieve anatomic reduction and restore function while increasing patient comfort and making postoperative care easier (Lachner et al. 1991). The aim of the study was to evaluate the cases of Maxillofacial injuries with the existing literature on its different presentation and management. An observational study was done from the patients of RTA with Maxillofacial injuries in ENT department and trauma centre of Sir T General hospital and Government Medical College, Bhavnagar for a period of 2 year. A total of 315 patients were included. Males are more commonly affected than females. The main etiological factor for RTA was motorcycle accidents. The trend of MFIs especially due to MCAs was on the rise after the age of 20 year. Anatomically the lower 1/3 section of the face was the most affected. Mandibular fractures were most common isolated fracture in MFIs. Open reduction and internal fixation (ORIF) by plating and screw was the treatment of choice for displaced, comminuted and multiple fractures of face. Facial trauma remains a major source of injury in all parts of the world. Its management involves many disciplines in the hospital setting, but knowledge of occlusion, the masticatory apparatus and anatomy is important for the best outcomes. This study was an analysis of demographic variables and outcome of the management adopted in patients presented to our department.

Prevalence of mandibular fracture in patients visiting a tertiary dental care hospital in North India

Background:

Injuries of the maxillofacial complex represent one of the most important health problems worldwide. At present, in developing India, due to poor traffic sense, maxillofacial trauma and fractures are most epidemiologic diseases. Mandible is the largest and strongest facial bone and it is the second most commonly fractured bone. Mandibular fractures can involve only one site or can often involve multiple anatomic sites simultaneously.

Aims:

The present study is aimed to know the age- and sex-related prevalence of parasymphyseal fracture, fracture of angle, condylar fracture, symphyseal fracture, and coronoid fracture of mandible in North Indian population. It also evaluates the correlation of prevalence of parasymphyseal fracture, angle of mandible, condylar fracture of mandible, symphyseal fracture of mandible, and coronoid fracture of mandible.

Materials and Methods:

All patients fulfilling the selection criteria and having mandible fracture were selected for the study. The data about mandibular fracture was collected by means of a structured questionnaire including age, sex, and anatomic site of fracture. Qualitative variables were compared using Chi-square test/Fisher's exact test as appropriate.

Results:

The study population consists of 1015 individuals aged between 7 and 68 years with the mean age of 33.49 ± 11.79 years. The most common anatomic site for mandibular fracture was parasymphyseal region (40.3%) followed by angle (28.8%), condyle (27.6%), and symphysis (12.5%) of mandible. The coronoid process of mandible (44, 4.3%) was least involved in mandibular fracture. Males (30.8%) are more predilected for condylar fracture than females (15.7%). The mandibular symphyseal fracture is more common in male (14.9%) than female (3.7%).

Conclusion:

Mandibular fractures occur in people of all ages and races, in a wide range of social settings. Their causes often reflect shifts in trauma patterns over time. The present assessments of mandibular fracture will be valuable to government agencies and health-care professionals involved in planning future programs of prevention and treatment.

Effect of Intravenous Ketorolac on Postoperative Pain in Mandibular Fracture Surgery; A Randomized, Double-Blind, Placebo-Controlled Trial

OBJECTIVE

To evaluate the effects of intravenous ketorolac on early postoperative pain in patients with mandibular fractures, who underwent surgical repair.

METHODS

This prospective, randomized, placebo-controlled clinical trial was conducted in Shahid Rajaei Hospital, affiliated with Shiraz University of Medical Sciences during a 1-year period from 2015 to 2016. We included a total number of 50 patients with traumatic mandibular fractures who underwent surgical repair. Patients with obvious contraindications to ketorolac such as asthma, renal dysfunction, peptic ulceration, bleeding disorders, cardiovascular disease, mental retardation, or allergy to ketorolac or NSAIDS, were excluded. The patients were randomly assigned to receive intravenous ketorolac (30 mg) at the end of operation in post anesthesia care unit immediately upon the onset of pain (n=25), or intravenous distilled water as placebo (n=25). Postoperative monitoring included non-invasive arterial blood pressure, ECG, and peripheral oxygen saturation. The postoperative pain was evaluated by a nurse using visual analog scale (VAS) (0-100 mm) pain score 4 hours after surgery and was compared between the two study groups.

RESULTS

Overall we included 50 patients (25 per group) in the current study. The baseline characteristics including age, gender, weight, operation duration, anesthesia duration and type of surgical procedure were comparable between two study groups. Those who received placebo had significantly higher requirements for analgesic use compared to ketorolac group (72% vs. 28%; p=0.002). Ketorolac significantly reduced the pain intensity 30-min after the operation (p<0.001). There were no significant side effects associated with ketorolac.

CONCLUSION

Intravenous single-dose ketorolac is a safe and effective analgesic agent for the short-term management of mild to moderate acute postoperative pain in mandibular fracture surgery and can be used as an alternative to opioids.

EXPERIENCE WITH miniplate osteosynthesis in THE MANAGEMENT OF mandibular fractures IN NORTHWEST NIGERIA

BACKGROUND

Fractures of the mandible are the commonest facial fractures and various treatment modalities exist like wire osteosynthesis and the use of miniplates and screw with most of the industrially developed world leaning towards the use of miniplates in the treatment of these fractures. The use has however been limited in developing countries (including Nigeria) mostly due to the cost of the plates and screws.

AIM AND OBJECTIVES

To identify the versatility of miniplates in the treatment of mandibular fractures at a tertiary care centre in a developing country.

METHODS

All Subjects aged 16 years and above in whom mandibular fractures were diagnosed were recruited over a two year period. Patients were treated under general anesthesia using either the miniplates and screws or wire osteosynthesis while some patients had both miniplates and maxillo-maxillary fixation.

RESULTS

A total of 94 patients were recruited for the study of which 89.4% were males while the age group 16 to 25 years constituted the majority. Though 29.8% of the study population was involved in business, only 9.6 % were professional motorcyclists. Motorcycle-related road traffic crashes constituted the commonest aetiologic agent with 41.5%, while combination fractures were the commonest fracture types seen in 54.3% of the study participants. Of the 94 patients, 77.7% had treatment of mandibular fractures by open reduction and immobilization with mini plates, while 7.4% had mini plates with Maxillo-maxillary fixation and 14.9% had wire osteosynthesis only. The site of fracture was significantly associated with the treatment modality (p= 0.02).

CONCLUSION

This study showed that the choice of fixation appliances in mandibular fractures was influenced by the number of fractures and the multiplicity of fracture sites. Miniplates offered functionally stable fixation with minimum complications.