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Ramos EAA, Munhoz L, Milani BA, Arita ES. Bone quality assessment in patients with healing mandibular fracture sites: a computed tomography investigation. Gen Dent 2024; 72:50-55. [PMID: 38640006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
The objective of this retrospective study was to assess the bone quality of healing mandibular fracture sites by measuring the Hounsfield units (HU) on computed tomographic (CT) images obtained presurgery and postsurgery in patients treated with rigid internal fixation (RIF). The HU values of healing fracture sites were compared to those of corresponding nonfractured (control) sites on the opposing side and cervical vertebrae sites in the same patients. In total, 31 patients with 45 mandibular fractures treated with RIF underwent presurgical and postsurgical CT examinations. The scans performed after surgery (1, 3, 6, 12, or 18 months) were taken only when there was a need for radiographic evaluation due to a complaint of discomfort from the patient or when the surgeon needed to verify the postsurgical outcome, and each patient underwent only a single postsurgical CT. At the presurgical CT examination, the HU values were lower in the fracture sites than in the control sites. At 3 months postsurgery, the HU values in the fracture sites had increased as the mandibular bone healed. At 6 months postsurgery, the HU values in the fracture sites were higher than those of the control sites. At 12 and 18 months postsurgery, the HU values of both sites were similar. The HU values of the cervical vertebrae remained constant with time. These results suggest that, in patients who have been treated with RIF for mandibular bone fracture, HU values measured by CT vary across time, expressing the physiologic bone healing process.
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Gontarz M, Bargiel J, Gąsiorowski K, Marecik T, Szczurowski P, Zapała J, Wyszyńska-Pawelec G. "Air Sign" in Misdiagnosed Mandibular Fractures Based on CT and CBCT Evaluation. Diagnostics (Basel) 2024; 14:362. [PMID: 38396403 PMCID: PMC10888197 DOI: 10.3390/diagnostics14040362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Diagnostic errors constitute one of the reasons for the improper and often delayed treatment of mandibular fractures. The aim of this study was to present a series of cases involving undiagnosed concomitant secondary fractures in the mandibular body during preoperative diagnostics. Additionally, this study aimed to describe the "air sign" as an indirect indicator of a mandibular body fracture. METHODS A retrospective analysis of CT/CBCT scans conducted before surgery was performed on patients misdiagnosed with a mandibular body fracture within a one-year period. RESULTS Among the 75 patients who underwent surgical treatment for mandibular fractures, mandibular body fractures were missed in 3 cases (4%) before surgery. The analysis of CT/CBCT before surgery revealed the presence of an air collection, termed the "air sign", in the soft tissue adjacent to each misdiagnosed fracture of the mandibular body. CONCLUSIONS The "air sign" in a CT/CBCT scan may serve as an additional indirect indication of a fracture in the mandibular body. Its presence should prompt the surgeon to conduct a more thorough clinical examination of the patient under general anesthesia after completing the ORIF procedure in order to rule-out additional fractures.
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Affiliation(s)
- Michał Gontarz
- Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, 30-688 Cracow, Poland; (J.B.); (K.G.); (T.M.); (P.S.); (J.Z.); (G.W.-P.)
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Rojas F, Tapia S, Campolo A, Vargas A, Ramírez H, Benitez BK, Teuber C. Simulating A Subcondylar Mandibular Fracture With Intraoral Open Reduction and Internal Fixation: A Novel Education Tool for Residents. Craniomaxillofac Trauma Reconstr 2023; 16:275-280. [PMID: 38047143 PMCID: PMC10693264 DOI: 10.1177/19433875221129673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design Face and content validation of a surgical simulation model. Objective Open reduction and internal fixation in displaced subcondylar mandibular fractures is standard care. This requires an extraoral (eg: retromandibular, transparotideal) or intraoral approach. An intraoral approach requires further training since specialized instrumentation such as the 90° screwdriver system and endoscopes might be needed. Currently, no simulation models are available for training residents in intraoral reduction and fixation of subcondylar mandibular fractures. Therefore, we present a validated simulation model for intraoral treatment of subcondylar mandibular fractures. Methods Based on a computer tomography data set, we designed and printed a 3D model of a mandible with a unilateral subcondylar fracture. To simulate intraoral work depth, it was positioned inside a dental phantom. We tested the model by a group of experts (n = 8), simulating intraoral reduction and fixation of a unilateral subcondylar fracture, using a 90° screwdriver system, a 1.0 subcondylar plate (lambda), and 5-6 mm screws.We assessed Face and Content validity by survey. Results We provided an open-source printable fracture model. Printing costs were approximately US $10. Experts "Agreed" the model resembling the real scenario and its use for training intraoral reduction and fixation of subcondylar mandibular fractures. Conclusions We developed a low cost, reproducible, open-source simulator for subcondylar mandibular fractures. Face and Content validity was achieved through evaluation by a group of experts.
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Affiliation(s)
- Francisco Rojas
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastian Tapia
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Campolo
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alex Vargas
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán Ramírez
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Benito K. Benitez
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel, Switzerland
| | - Cristian Teuber
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Sobrero F, Roccia F, Vilaplana V, Roig AM, Raveggi E, Ramieri G, Goetzinger M, Bottini GB, Rizvi AO, Laverick S, Knežević P, Dediol E, Kordić M, Sivrić A, Ganasouli D, Zanakis SN, Jelovac D, Konstantinovic VS, Birk A, Vesnaver A, Rabufetti A, Scolozzi P, Derkuş FE, Yilmaz UN, Politis C, Dubron K. Manual versus rigid intraoperative maxillo-mandibular fixation in the surgical management of mandibular fractures: A European prospective analysis. Dent Traumatol 2023; 39:448-454. [PMID: 37140473 DOI: 10.1111/edt.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/18/2023] [Accepted: 04/11/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Intraoperative stabilisation of bony fragments with maxillo-mandibular fixation (MMF) is an essential step in the surgical treatment of mandibular fractures that are treated with open reduction and internal fixation (ORIF). The MMF can be performed with or without wire-based methods, rigid or manual MMF, respectively. The aim of this study was to compare the use of manual versus rigid MMF, in terms of occlusal outcomes and infective complications. MATERIALS AND METHODS This multi-centric prospective study involved 12 European maxillofacial centres and included adult patients (age ≥16 years) with mandibular fractures treated with ORIF. The following data were collected: age, gender, pre-trauma dental status (dentate or partially dentate), cause of injury, fracture site, associated facial fractures, surgical approach, modality of intraoperative MMF (manual or rigid), outcome (minor/major malocclusions and infective complications) and revision surgeries. The main outcome was malocclusion at 6 weeks after surgery. RESULTS Between May 1, 2021 and April 30, 2022, 319 patients-257 males and 62 females (median age, 28 years)-with mandibular fractures (185 single, 116 double and 18 triple fractures) were hospitalised and treated with ORIF. Intraoperative MMF was performed manually on 112 (35%) patients and with rigid MMF on 207 (65%) patients. The study variables did not differ significantly between the two groups, except for age. Minor occlusion disturbances were observed in 4 (3.6%) patients in the manual MMF group and in 10 (4.8%) patients in the rigid MMF group (p > .05). In the rigid MMF group, only one case of major malocclusion required a revision surgery. Infective complications involved 3.6% and 5.8% of patients in the manual and rigid MMF group, respectively (p > .05). CONCLUSION Intraoperative MMF was performed manually in nearly one third of the patients, with wide variability among the centres and no difference observed in terms of number, site and displacement of fractures. No significant difference was found in terms of postoperative malocclusion among patients treated with manual or rigid MMF. This suggests that both techniques were equally effective in providing intraoperative MMF.
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Affiliation(s)
- Federica Sobrero
- Division of Maxillofacial Surgery, Department of Surgical Science, University of Turin, Turin, Italy
| | - Fabio Roccia
- Division of Maxillofacial Surgery, Department of Surgical Science, University of Turin, Turin, Italy
| | - Valentines Vilaplana
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Antonio Mari Roig
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Elisa Raveggi
- Division of Maxillofacial Surgery, Department of Surgical Science, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Department of Surgical Science, University of Turin, Turin, Italy
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Ali O Rizvi
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, UK
| | - Predrag Knežević
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Dimitra Ganasouli
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Stylianos N Zanakis
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Drago Jelovac
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vitomir S Konstantinovic
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Alessandro Rabufetti
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Fatma Eriş Derkuş
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Utku Nezih Yilmaz
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Constantinus Politis
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Kathia Dubron
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
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Park H, Lee SH, Lee Y, Choi DJ, Lee J, Jo H, Jung W, Kim SD, Sim HA, Lee YJ, Ha IH. Integrative Korean Medicine Treatments for Traumatic Facial Palsy Following Mandibular Fracture: A Case Report and Literature Review. Healthcare (Basel) 2023; 11:2546. [PMID: 37761743 PMCID: PMC10530994 DOI: 10.3390/healthcare11182546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Prior studies exploring the effectiveness of traditional Korean medicine (TKM) treatment for facial palsy have mainly focused on Bell's palsy, and there are few studies on the effectiveness of TKM treatments for traumatic facial palsy following mandibular fracture. The patient was a 24-year-old Korean man with left-sided facial paralysis following a left mandibular fracture. Surgery was performed for the fracture and the facial palsy was treated using conventional medicine (CM) treatments for approximately 3 months, but there was no improvement observed in the patient's condition. Subsequently, the patient underwent an integrative Korean medicine treatment regimen consisting of acupuncture, pharmacopuncture, cupping, moxibustion, and herbal medication for a duration of 2 months. After 2 months of treatments, the House-Brackmann facial grading scale changed from Ⅴ to II and Yanagihara's unweighted grading score increased from 9 to 34. This case presentation and previous studies of traumatic facial palsy using TKM treatment show that TKM treatment may be considered a complementary or alternative treatment method to CM treatment in patients with traumatic facial palsy. PROSPERO registration number: CRD42023445051.
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Affiliation(s)
- Hyunsuk Park
- Department of Korean Medicine Rehabilitation, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea; (H.P.); (D.J.C.); (J.L.)
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul 06110, Republic of Korea; (S.-H.L.); (Y.J.L.)
| | - Yeonsun Lee
- Department of Acupuncture and Moxibustion, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea; (Y.L.); (H.J.)
| | - Dong Joo Choi
- Department of Korean Medicine Rehabilitation, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea; (H.P.); (D.J.C.); (J.L.)
| | - Jonghyun Lee
- Department of Korean Medicine Rehabilitation, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea; (H.P.); (D.J.C.); (J.L.)
| | - Hyeri Jo
- Department of Acupuncture and Moxibustion, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea; (Y.L.); (H.J.)
| | - Woojin Jung
- Department of Obstetrics & Gynecology of Korean Medicine, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea;
| | - Soo-Duk Kim
- Department of Internal Korean Medicine, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea;
| | - Hyun A. Sim
- Department of Oriental Neuropsychiatry, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea;
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul 06110, Republic of Korea; (S.-H.L.); (Y.J.L.)
| | - In-Hyuk Ha
- Department of Korean Medicine Rehabilitation, Bucheon Jaseng Hospital of Korean Medicine, Bucheon 14598, Republic of Korea; (H.P.); (D.J.C.); (J.L.)
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul 06110, Republic of Korea; (S.-H.L.); (Y.J.L.)
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Grippaudo C, Lo Giudice A, Saponaro G, Todaro M, Moro A, D’Addona A. The Use of a CAD/CAM Thermoformed Splints System in Closed Reduction of Condylar Fractures. Bioengineering (Basel) 2023; 10:1023. [PMID: 37760125 PMCID: PMC10525750 DOI: 10.3390/bioengineering10091023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Mandibular fractures are very common. Common indications of closed treatment for mandibular fractures are non-displaced or minimally displaced simple fractures in adult compliant patients with good dentition, the absence of occlusal disruption, and fractures in growing children. In closed treatment, the mandible is maintained in centric occlusion with a maxillomandibular fixation (MMF) with orthodontic elastics. Many methods of MMF have been described, often using orthodontic appliances. In recent years, CAD-CAM technology has improved many procedures used in maxillofacial surgery and orthodontics. The device we present is manufactured following a digital workflow, and was designed specifically for MMF. (2) Materials: Two patients with mandibular fractures were treated with an MMF method whose procedure comprised scanning of the dental arches, followed by construction of thermoformed splints on which buttons for the elastics and retention holes are made. The splints were fixed on the dental arches with composite resin at the level of the holes, and were kept in place for the period of healing of the fracture, with the intermaxillary elastics hooked to the buttons. (3) Results: The application time of the splints was very quick. The splints remained stable for the necessary time, without causing particular discomfort to the patients. (4) Conclusions: From our experience, this technique has proved to be reliable and reproducible and could represent a valid tool in the closed treatment of mandibular fractures.
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Affiliation(s)
- Cristina Grippaudo
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
| | - Antonino Lo Giudice
- Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, 95123 Catania, Italy;
| | - Gianmarco Saponaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Mattia Todaro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alessandro Moro
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Maxillo Facciale, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio D’Addona
- Dipartimento di Neuroscienze, Organi di Senso e Torace, UOC di Chirurgia Odontostomatologica e Implantologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy;
- Odontoiatria e Protesi Dentaria, Dipartimento Universitario Testa Collo ed Organi di Senso, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.T.); (A.M.)
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kadanthode M, Chaudhary Z, Sharma P, Mohanty S, Sharma C. Single Institute Audit of Maxillofacial Trauma Cases Before and During COVID-19 Pandemic. Craniomaxillofac Trauma Reconstr 2023; 16:102-111. [PMID: 37222976 PMCID: PMC10201186 DOI: 10.1177/19433875211064514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design In the year 2020, we saw the emergence of severe acute respiratory syndrome coronavirus 2 causing COVID-19 into a full blown pandemic. This resulted in constraints on healthcare resources, and the attention was shifted to reduce cross contamination and prevent spreader events. Maxillofacial trauma care was also affected similarly, and most of the cases were managed by closed reduction whenever possible. A retrospective study was conducted to document our experience in treating maxillofacial trauma cases before and after nationwide lockdown due to COVID-19 pandemic in India. Objective The objective of the study was to compare the effect of pandemic in reported pattern of mandibular trauma and the result of closed reduction procedures in the management of single or multiple fractures in mandible during this time period. Methods The study was conducted in the Department of Oral and Maxillofacial Surgery, Maulana Azad institute of Dental Sciences, Delhi, for a period of 20 months, that is, 10 months before and after nationwide lock down which was effective from 23rd March 2020 due to COVID-19 pandemic. The cases were grouped into Group A (those reporting from 1st June 2019 to 31st March 2020) and Group B (those reporting from 1st April 2020 to 31st January 2021). Primary objectives were assessed and compared according to etiology, gender, location of the mandibular fractures, and treatment provided. Quality of life (QoL) associated with the treatment outcome by closed reduction was assessed after 2 months as a secondary objective using General Oral Health Assessment Index (GOHAI) in Group B. Results A total of 798 patients sought treatment for mandibular fractures and included 476 patients in Group A and 322 in Group B. The groups showed similar age and male: female ratio. Cases showed a steep fall during first wave of pandemic, and most of the cases occurred as result of RTA followed by fall and assault. The fractures due to fall and assault showed an obvious rise during the lockdown period. There were 718 (89.97%) patients having exclusive mandibular fractures and 80 (10.03%) patients having involvement of both mandible and maxilla. Single fractures of mandible constituted 110 (23.11%) and 58 (18.01%) in Group A and B, respectively. 324 patients (68.07%) and 226 patients (70.19%) had multiple fractures involving mandible in respective groups. Parasymphysis of mandible was most commonly involved (24.31%) followed closely by unilateral condyle (23.48%) then Angle and Ramus of mandible (20.71%) with coronoid being the least fractured. During the initial 6 months after lockdown, all the cases were treated successfully using closed reduction. GOHAI QoL assessment conducted in cases having exclusive mandibular fracture (210 Multiple, 48 Single) showed favorable results with significant (P < .05) difference between the single and multiple fractures. Conclusions After one and half years and recovering from the second wave of pandemic that hit the country, we have come to understand COVID-19 better and embraced better management protocol. The study reveals that IMF remains the gold standard for the management of most of the facial fractures in pandemic situations. It was evident from the QoL data that most of the patients were able to carry out their day-to-day functions adequately. As the country prepares for a third wave of pandemic, management of maxillofacial trauma by closed reduction will remain the norm for most unless indicated otherwise.
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Affiliation(s)
- Mithilesh Kadanthode
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Zainab Chaudhary
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Pankaj Sharma
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Sujata Mohanty
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
| | - Chayanika Sharma
- Department of Oral and
Maxillofacial Surgery, Maulana Azad Institute of Dental
Sciences, New Delhi, India
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Sneha A, Pendem S, Krishnan M, Dhasarathan P, Aravindan V. Impacted Mandibular Fracture: A Report of a Rare Case. Cureus 2023; 15:e38999. [PMID: 37323316 PMCID: PMC10262923 DOI: 10.7759/cureus.38999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/17/2023] Open
Abstract
Representing unusual fracture patterns is extremely important to understand. A 27-year-old male patient with a known history of a road traffic accident with sustained injury reported to the Department of Oral and Maxillofacial Surgery in Saveetha Dental College with pain in the left and right lower jaw region of three days duration. The patient provided a history of frontal impact in the symphysis region after a fall from a two-wheel vehicle. Clinical examination revealed a laceration of 2 cm in the chin region with bilateral pre-auricular swelling and trismus with an anterior open bite. The computed tomography scan revealed a bilateral dicapitular condyle fracture with an oblique impacted fracture of the symphysis with a displaced inferior border and left lingual cortical displacement. Apart from this, an incomplete fracture was evidenced, extending along the inferior border to the right body of the mandible. The fracture site was exposed through the laceration. The impacted mandibular fracture segments were mobilized and fixation was done using a 2 mm five-hole plate at the lower border across the sagittally split segment after placement of maxillomandibular fixation with an arch bar at the alveolar border as a part of tension banding. The oblique lingual fracture was reduced and fixed with a 2 x 14 mm bicortical screw. The primary objective of the current case report is to elucidate an unusual fracture of the mandible and discuss the management of such impacted mandibular fractures.
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Affiliation(s)
- Alladi Sneha
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Sneha Pendem
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Pradeep Dhasarathan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Vedha Aravindan
- Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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10
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Arcila VG, Correa CR, Castellar-Mendoza C. Tooth in the line of a mandibular fracture: Retain it or remove it? Clinical case report. Dent Traumatol 2023; 39:179-183. [PMID: 36263458 DOI: 10.1111/edt.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022]
Abstract
Defining the prognosis and treatment plan for teeth in the line of a mandibular fracture is a challenge for the maxillofacial surgeon. The periodontal ligament may provide a communication with the oral cavity and become a pathway for infection. There is currently no consensus on the management of teeth in mandibular fracture lines. This report outlines a case where a tooth was successfully retained in the line of fracture as well as providing a review of the literature on the best-accepted treatments for this scenario.
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Affiliation(s)
- Verónica Gómez Arcila
- Hospital Universitario del Valle, Teacher of Oral y Maxilofacial Surgery, Universidad del Valle, Cali, Colombia
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Avelino SG, de Assis Santos VP, Palmieri CF, Luz JGC. Characteristics and management of teeth in the line of mandibular fractures treated with internal fixation. Dent Traumatol 2023; 39:25-30. [PMID: 36214744 DOI: 10.1111/edt.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/06/2022] [Accepted: 08/14/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIMS The ideal management of teeth in the line of mandibular fractures is unclear and controversial. The aim of this study was to analyze the characteristics and management of teeth in the line of mandibular fractures treated with open reduction and internal fixation. MATERIAL AND METHODS Medical records of patients with mandibular fractures in the symphysis, body and angle regions seen between July 2019 and January 2021 were evaluated. Personal data, etiology, location of fractures, characteristics of the teeth involved in the fracture lines and management were collected. The relationship between the fracture lines and the periodontium was classified according to Kamboozia & Punnia-Moorthy. Fractures were divided into two groups according to the management of the tooth in the fracture line: removal and retention. The likelihood ratio test was used (p < .050). RESULTS During the study period, 52 patients with mandibular fractures were seen, of which 42 patients (83.3% men) with a mean age of 29.6 years and 54 fractures were included. The most frequent location was the angle of the mandible (41.3%) (p < .001). The removal group represented 35.2% of the fractures, and the retention group represented 64.8%. The most frequently removed tooth was the third molar (p < .001), and the most frequent classification of dental involvement in the fracture line was type II (p = .047). There was no correlation between age, gender, or etiology and the management of the teeth involved. CONCLUSION The retention of teeth in the fracture line predominated, and the third molar in angle fractures was the most often removed tooth when the fracture line followed the root surface but did not cross the apical region, probably due to the greater frequency of this type of relationship between the fractures and the periodontium.
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Affiliation(s)
- Sabrina Gardiano Avelino
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Vinícius Paes de Assis Santos
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Department of Oral and Maxillofacial Surgery, Hospital M. Dr. Arthur R. de Saboya, São Paulo, Brazil
| | - Celso F Palmieri
- Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - João Gualberto C Luz
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of São Paulo, São Paulo, Brazil
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yehorov R, Yakovenko L, Primak I. Paediatric Mandibular Fracture Management - A Seven Year Retrospective Study. Ann Maxillofac Surg 2023; 13:44-48. [PMID: 37711520 PMCID: PMC10499298 DOI: 10.4103/ams.ams_158_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/08/2023] [Accepted: 04/18/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Mandibular fractures are one of the most frequent and complex types of traumatic injuries of the maxillofacial region in children. Given significant long-term sequelae of inappropriate healing, adequate diagnosis and choice of management, which takes into account the patient's age and fracture characteristics, are paramount. Methods The data for this study were obtained from the medical records of patients treated in the Department of Surgical Dentistry and Paediatric Maxillofacial Surgery of the Bogomolets National Medical University from 2014 to 2020. Age, gender, fracture pattern and surgical treatment methods performed in these patients were recorded and analysed. Results A total of 302 children with 376 traumatic fractures of the mandible were managed during the study period. The largest number of fractures was found in the condylar processes region, 42%, and in the body of the mandible, 40%. The majority of patients were males and in the 13-17 age group (147 [49%] cases). Tigerstedt's maxillary-mandibular fixation splint was used in the majority of cases, alone or in the combination with open or internal fixation. Discussion Whilst the most common type of immobilisation in children in our series was Tigerstedt's maxillary-mandibular fixation splint, its use is limited to the variable bite period. Alternative fixation options are discussed.
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Affiliation(s)
- Rostyslav Yehorov
- Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, Kyiv, Ukraine
| | - Lyudmila Yakovenko
- Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, Kyiv, Ukraine
| | - Irina Primak
- Department of Surgical Dentistry and Maxillofacial Surgery of Childhood, Bogomolets National Medical University, Kyiv, Ukraine
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Shahnavazi M, Mohamadrahimi H. The application of artificial neural networks in the detection of mandibular fractures using panoramic radiography. Dent Res J (Isfahan) 2023; 20:27. [PMID: 36960025 PMCID: PMC10028573 DOI: 10.4103/1735-3327.369629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/06/2022] [Accepted: 12/20/2022] [Indexed: 03/25/2023] Open
Abstract
Background Panoramic radiography is a standard diagnostic imaging method for dentists. However, it is challenging to detect mandibular trauma and fractures in panoramic radiographs due to the superimposed facial skeleton structures. The objective of this study was to develop a deep learning algorithm that is capable of detecting mandibular fractures and trauma automatically and compare its performance with general dentists. Materials and Methods This is a retrospective diagnostic test accuracy study. This study used a two-stage deep learning framework. To train the model, 190 panoramic images were collected from four different sources. The mandible was first segmented using a U-net model. Then, to detect fractures, a model named Faster region-based convolutional neural network was applied. In the end, a comparison was made between the accuracy, specificity, and sensitivity of artificial intelligence and general dentists in trauma diagnosis. Results The mAP50 and mAP75 for object detection were 98.66% and 57.90%, respectively. The classification accuracy of the model was 91.67%. The sensitivity and specificity of the model were 100% and 83.33%, respectively. On the other hand, human-level diagnostic accuracy, sensitivity, and specificity were 87.22 ± 8.91, 82.22 ± 16.39, and 92.22 ± 6.33, respectively. Conclusion Our framework can provide a level of performance better than general dentists when it comes to diagnosing trauma or fractures.
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Affiliation(s)
- Maryam Shahnavazi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aja University of Medical Sciences, Tehran, Iran
- Address for correspondence: Dr. Maryam Shahnavazi, School of Dentistry, Aja University of Medical Sciences, Misaq Complex, 13th East Street, Ajoudanieh, Tehran, Iran. E-mail:
| | - Hosein Mohamadrahimi
- Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Popov VL, Egorova OA, Beleshnikov IL. [On the issue of forensic evaluation of mandibular fractures complicated with infections]. Sud Med Ekspert 2023; 66:45-48. [PMID: 37078677 DOI: 10.17116/sudmed20236602145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
The analysis of 387 cases of mandibular fractures complicated by posttraumatic infections is presented. These infections were quite diverse - from local suppuration of soft tissues surrounding the fracture to widespread processes affecting fatty tissue planes, including the anterior and posterior mediastinum. Infectious complications determine the injury outcome in each case - recovery, disability, or death. Two clinical observations with lethal outcomes are described.
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Affiliation(s)
- V L Popov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - O A Egorova
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
- City Hospital No. 15, St. Petersburg, Russia
| | - I L Beleshnikov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
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16
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Ray A, Soni SL, Singh A, Naik BN, Ghimire A, Ganesh V, Gorla D. Apparent missing tooth due to traumatic dental intrusion during airway management. Anaesth Rep 2022; 10:e12168. [PMID: 35669717 DOI: 10.1002/anr3.12168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Ray
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
| | - S L Soni
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
| | - A Singh
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
| | - B N Naik
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
| | - A Ghimire
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
| | - V Ganesh
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
| | - D Gorla
- Department of Anaesthesia and Intensive Care Nehru Hospital Chandigarh India
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17
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Fuessinger MA, Gass M, Woelm C, Cornelius CP, Zimmerer RM, Poxleitner P, Schlager S, Metzger MC. Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures. J Clin Med 2021; 10:5975. [PMID: 34945272 DOI: 10.3390/jcm10245975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The known preformed osteosynthesis plates for the midface are helpful tools for a precise and fast fixation of repositioned fractures. The purpose of the current study is to analyze the precision of newly developed prototypes of preformed osteosynthesis plates for the mandible. Methods: Four newly designed preformed osteosynthesis plates, generated by a statistical shape model based on 115 CT scans, were virtually analyzed. The used plates were designed for symphyseal, parasymphyseal, angle, and condyle fractures. Each type of plate has three different sizes. For analysis, the shortest distance between the plate and the bone surface was measured, and the sum of the plate-to-bone distances over the whole surface was calculated. Results: A distance between plate and bone of less than 1.5 mm was defined as sufficient fitting. The plate for symphyseal fractures showed good fitting in 90% of the cases for size M, and in 84% for size L. For parasymphyseal fractures, size S fits in 80%, size M in 68%, and size L in 65% of the cases. Angle fractures with their specific plate show good fitting for size S in 53%, size M in 60%, and size L in 47%. The preformed plate for the condyle part fits for size S in 75%, for size M in 85%, and for size L in 74% of the cases. Conclusion: The newly developed mandible plates show sufficient clinical fitting to ensure adequate fracture reduction and fixation.
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Wozniak L, Ratajczak-Wrona W, Borys J, Antonowicz B, Nowak K, Bortnik P, Jablonska E. Levels of Biological Markers of Nitric Oxide in Serum of Patients with Mandible Fractures. J Clin Med 2021; 10:2832. [PMID: 34206954 DOI: 10.3390/jcm10132832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Nitric oxide is a small gaseous molecule with significant bioactivity. It has been observed that NO may have a dual role dependent on its production and concentrations in the bone microenvironment. The objective of the study was to assess the concentration of total nitric oxide malonyldialdehyde, nitrotyrosine, and asymmetric dimethylarginine in the serum of patients with mandibular fractures and to understand the relationship between these compounds, in order to expand the knowledge base of the role of nitric oxide and its activity indicators in the process of bone fracture healing. Material and Methods: The study included 20 patients with mandibular fractures who were undergoing inpatient and outpatient treatments and a control group of 15 healthy people. Results were analyzed with respect to the measurement time. Total nitric oxide concentration in the blood serum was determined according to the Griess reaction, while the concentration of malonyldialdehyde, nitrotyrosine, and asymmetric dimethylarginine was estimated using the immunoenzymatic method (i.e., enzyme-linked immunosorbent assay). Results: Before the procedure, as well as on the first day and 2 and 6 weeks after the procedure, higher concentrations of total nitric oxide and lower concentrations of malonyldialdehyde were observed in the blood serum of patients with mandibular fractures compared to the control group. No statistically significant differences were found in nitrotyrosine concentrations in the blood serum of patients throughout the measurement period. However, a significantly higher asymmetric dimethylarginine concentration was observed in the patient serum before the procedure and on the first day of operation as compared with the control group. Analysis of the results observed in patient serum with respect to the number of fractures within the mandible demonstrated the same trend of concentrations for the tested compounds for the entire study group. Conclusions: In summary, our results revealed that the intensity of local processes resulting from mandibular fractures is associated with the concentration of nitric oxide, confirming its significant role, as well as that of its indicators, in the process of bone fracture healing in this patient population.
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Palani T, Panchanathan S, Rajiah D, Kamalakaran A, Hafeez AA, Raghavan P. Evaluation of 3D Trapezoidal Plates in Open Reduction and Internal Fixation of Subcondylar Fractures of Mandible: A Clinical Trial. Cureus 2021; 13:e15537. [PMID: 34268055 PMCID: PMC8266688 DOI: 10.7759/cureus.15537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
Background Fractures of the mandibular condyle are common and account for 25% to 50% of all fractures of the mandible. Various methods exist for open reduction and internal fixation (ORIF) of condylar fractures. This study was done to explore three-dimensional (3D) plates as a viable option. Aim This study aims to evaluate the effectiveness of 3D trapezoidal plates in open reduction and internal fixation of subcondylar fractures. Materials and methodology This was a non-randomized clinical trial conducted on 20 patients who reported at the Department of Oral and Maxillofacial Surgery, Tamil Nadu Government Dental College and Hospital, Chennai, India. The ORIF was done under general anesthesia. A retromandibular transmasseteric approach was used to expose the fracture site, and the fracture was stabilized using 3D titanium trapezoidal plates. Parameters, such as mouth opening, mandibular deviation, occlusion, surgical accessibility, fracture reduction, adaptability, the difference in ramal height, angulation of the fractured condyle, operative time, facial nerve weakness, implant failure, complications, and scar formation were assessed. Statistical analysis was done using Statistical Package for Social Sciences (SPSS), version 21 (IBM SPSS Statistics for Windows, Armonk, NY). Results There was an improvement in mouth opening and occlusion in the immediate postoperative period. The surgical accessibility ranged from good to excellent. The fracture reduction was excellent in 60% of patients and good in 40%. In one patient, there was a transient weakness of the marginal mandibular nerve which recovered by three months. Another patient had a wound infection that subsided within the first postoperative week. None of the patients had a device failure during the six-month follow-up period. Conclusion The trapezoidal 3D plates could be considered as a viable option for treating subcondylar fractures of the mandible in terms of surgical accessibility, stability, ease of device placement, stability of reduced fracture, reduced osteosynthesis material requirement, and minimal damage to the surrounding tissues.
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Affiliation(s)
- Triveni Palani
- Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, IND
| | - Srimathi Panchanathan
- Department of Oral and Maxillofacial surgery, Tamilnadu Government Dental College and Hospital, Chennai, IND
| | - Davidson Rajiah
- Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, IND
| | - Arunkumar Kamalakaran
- Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, IND
| | - Abdul A Hafeez
- Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, IND
| | - Priyadharshini Raghavan
- Department of Oral and Maxillofacial Surgery, Tamilnadu Government Dental College and Hospital, Chennai, IND
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Younas S, Riaz N, Ehsan-Ul-Haq M, Mubeen S. Healing of a large avulsed mandibular bony segment: report of a unique case. Int J Oral Maxillofac Surg 2021; 50:1606-1608. [PMID: 34103241 DOI: 10.1016/j.ijom.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/01/2022]
Abstract
This case report puts an emphasis on retaining and re-fixing any avulsed bony segments in the maxillofacial region and maintaining the periosteal layer whenever possible, especially in young patients. Adequate bony fixation and watertight soft tissue closure are vital components for bone healing. The healing potential of facial bones is much higher as compared to the long bones, due to the superior blood supply.
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Affiliation(s)
- S Younas
- Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
| | - N Riaz
- Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - M Ehsan-Ul-Haq
- Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - S Mubeen
- Department of Oral and Maxillofacial Surgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
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21
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Abstract
OBJECTIVE The aim of this study was to evaluate the prognosis of the teeth in the mandibular fracture line and to analyze the relationship between the degree of displacement of fracture fragments, the relationship of the fracture line to the periodontium, and the relationship between the condition of the teeth at the first postoperative (post-op) year. METHODS A total of 60 teeth from 38 patients (11 female and 27 male) who had erupted teeth in the line of mandibular fracture and were treated with open reduction were examined. The data were collected from the patients' clinical records and radiographs. Age at the time of injury, gender, cause of trauma, site of fracture, the relationship of the fracture line to the periodontium, the degree of displacement of fracture fragments, and the condition of the teeth in the line of the fracture at the first post-op year were evaluated. RESULTS The degree of displacement of fracture fragments had an effect on the condition of the teeth at the first post-op year (P = .036) and the regions of the mandible had an effect on the degree of displacement of the fracture fragments (P = .000). The survival rate of the pulp of the teeth was 69.8%. CONCLUSIONS A preventive approach should be preferred for teeth in the mandibular fracture line. Retained teeth in the fracture line should be monitored clinically and radiologically for at least 1 year, and unnecessary endodontic treatments should be avoided.
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Affiliation(s)
- Hatice Hosgor
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Fatih Mehmet Coskunses
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| | - Deniz Akin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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Sadhu Reddipogu J, Lightfoot E, Scott C, Thomas M. Recurrent mandibular fractures: a retrospective study over 17 years on aetiology, demographics, fracture patterns, and management. Int J Oral Maxillofac Surg 2021:S0901-5027(21)00169-7. [PMID: 34074576 DOI: 10.1016/j.ijom.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
Recurrent fractures of the mandible are rare, however in Darwin, Australia, their occurrence is relatively frequent. This retrospective study identified 127 patients with 148 recurrent mandibular fractures treated at Royal Darwin Hospital between 2000 and 2017. Age, sex, ethnicity, marital status, aetiology, risk factors, anatomical location of the fractures, fracture patterns, and management of the fractures were analysed. The majority of patients were male (85.8%) (P < 0.001); 62.8% were unmarried (P < 0.001) and 72.4% were indigenous (P < 0.001). Alcohol was involved in 79.1% of cases (P < 0.001) and assault was the most common mechanism of injury (84.5%) (P < 0.001). The angle of the mandible was the most common site (P < 0.001), and recurrent fractures were more likely to occur at sites different to a previous fracture fixation site (P < 0.001). Smoking, alcohol abuse, and diabetes were strongly associated with recurrent fractures (all P < 0.001). Most patients were managed with open reduction internal fixation. In conclusion, recurrent fractures of the mandible frequently involved the angle of the mandible and occurred at different sites. Their incidence was more common among the unmarried, male, and indigenous population, and smoking, alcohol abuse, and diabetes were found to be significant risk factors.
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Hwang K. Effect of Smoking on the Healing of a Mandibular Condyle Fracture. Eplasty 2021; 21:e3. [PMID: 33747337 PMCID: PMC7941144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: We experienced a case of malunion of condylar fracture after miniplate fixation in a patient with a 40 pack-year smoking history who restarted smoking at 5 weeks postoperatively. Case: A 64-year-old man lost consciousness and fell down, hitting his chin on the floor. He had malocclusion and open bite bilaterally. The mouth opening was 1.5-finger breadths. He had a 40 pack-year smoking history. Radiology revealed a bilateral condylar fracture and a fracture of the parasymphysis. Intermaxillary fixation was done using the skeletal anchorage system on the first post-trauma day. On the third post-trauma day, vertical ramus osteotomy, miniplate fixation of the fractured condylar neck, and free grafting were performed. When the wire was changed to a rubber band at 5 weeks postoperatively, he started smoking (half-pack a day). At 7 weeks postoperatively, the skeletal anchorage system was removed and some absorption of the condylar head was observed. At 3 months postoperatively, his mouth opening was 24 mm and no malocclusion was present, although the condylar head was distorted and malunion was observed. At 4 months postoperatively, his mouth opening was 30 mm but he complained of pain on do so. Distortion of the condylar head was aggravated. At 5 months postoperatively, his pain continued but was endurable. He continued smoking (half-pack a day) since 5 weeks postoperatively. Conclusion: In smokers, a longer period of immobilization is needed in bone grafting of the fractured condylar head. Longer immobilization provides sufficient time for healing and prevents smoking, since the patient cannot smoke easily when the intermaxillary fixation is applied.
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Affiliation(s)
- Kun Hwang
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea,Correspondence:
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Falci SGM, de Souza GM, Fernandes IA, Galvão EL, Al-Moraissi EA. Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2021; 50:1450-1463. [PMID: 33676800 DOI: 10.1016/j.ijom.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/14/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
The aim of this review was to compare mandibular angle fracture fixation methods that were evaluated through randomized clinical trials considering postoperative complications. Additionally, different treatment methods were ranked based on their performance. A systematic review was performed based on the Cochrane and PRISMA guidelines. The quality of evidence and network meta-analysis were conducted using the GRADE tool and R software, respectively. Four databases were searched, and the papers were selected based on the PICOS strategy. A total of 3584 papers were found. After screening 15 papers were included. One plate placed on lateral border (tension zone) presented lower risk than one plate placed on superior border (tension zone) for infection [risk ratio (RR): 0.48, 95% confidence interval (CI): 0.33 to 0.71] and plate removal necessity (RR: 0.44, 95% CI: 0.28 to 0.69), with moderate quality of evidence. There were no significant differences among the mandibular angle fracture treatments for malocclusion and paraesthesia outcomes. In conclusion, one plate placed on the lateral border in the tension zone is the best choice regarding postoperative infection and plate removal necessity when fixing mandibular angle fractures. None of the tested fixation methods were associated with a significant risk of malocclusion and paraesthesia events.
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Affiliation(s)
- S G M Falci
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.
| | - G M de Souza
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - I A Fernandes
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E L Galvão
- Oral and Maxillofacial Section, Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
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25
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Lee WB, Kim YD, Shin SH, Lee JY. Prognosis of teeth in mandibular fracture lines. Dent Traumatol 2021; 37:430-435. [PMID: 33421357 DOI: 10.1111/edt.12647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Teeth in a jaw fracture line, because of the presence of the periodontal ligament, may communicate with the oral cavity. There are no guidelines for the management of teeth in mandibular fracture lines. The aim of this study was to investigate the factors related to dental problems with teeth involved in mandibular fracture lines and to determine the best treatment option. MATERIAL AND METHODS This retrospective study was based on the medical and radiographic records of patients with mandibular fractures. The relationships among the patient's age, gender, smoking history, amount of bony displacement, surgery, trauma-surgery period, apical involvement, tooth mobility, and periodontal status were investigated. Group comparisons were performed using the chi-squared test, Fisher's exact test, and Mann-Whitney U-test. RESULT A total of 238 patients (247 fracture lines) with mandibular fractures including a tooth in the line of the fracture were examined. Post-operative dental complications occurred in 42 cases (17.0%). Extraction of related teeth occurred in 34 cases (80.9%) compared to eight cases (19.0%) related to root canal therapy. This study defined "dental problem" as "a case with a tooth extracted or endodontically treated after trauma." The variables associated with an increased risk of dental problems were the amount of bony displacement (p < .01), tooth mobility (p < .01), and pre-existing marginal alveolar bone loss (p = .027). CONCLUSION The prognosis of teeth in mandibular fracture lines was related to tooth mobility, periodontal state, and the amount of bony displacement.
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Affiliation(s)
- Won-Bum Lee
- Department of Oral and Maxillofacial surgery, School of Dentistry, Pusan National University, Yangsan, South Korea.,Dental and Life Science Institute & Dental Research Institute, School of Dentistry, Pusan National University, Yangsan, South Korea
| | - Yong-Deok Kim
- Department of Oral and Maxillofacial surgery, School of Dentistry, Pusan National University, Yangsan, South Korea.,Dental and Life Science Institute & Dental Research Institute, School of Dentistry, Pusan National University, Yangsan, South Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial surgery, School of Dentistry, Pusan National University, Yangsan, South Korea.,Dental and Life Science Institute & Dental Research Institute, School of Dentistry, Pusan National University, Yangsan, South Korea
| | - Jae-Yeol Lee
- Department of Oral and Maxillofacial surgery, School of Dentistry, Pusan National University, Yangsan, South Korea.,Dental and Life Science Institute & Dental Research Institute, School of Dentistry, Pusan National University, Yangsan, South Korea
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26
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Marra PM, Itro A, Santoro R, Itro A. Management of an anterior mandibular fracture in a 13-year-old patient. J BIOL REG HOMEOS AG 2020; 34:1585-1588. [PMID: 32883063 DOI: 10.23812/20-227-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P M Marra
- Complex Operative Unit of Stomatological Surgery in Developmental age, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A Itro
- Complex Operative Unit of Stomatological Surgery in Developmental age, University of Campania Luigi Vanvitelli, Naples, Italy
| | - R Santoro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - A Itro
- Complex Operative Unit of Stomatological Surgery in Developmental age, University of Campania Luigi Vanvitelli, Naples, Italy
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Muddassar M, Arshad R, Rabbani S, Qureshi IS, Khattak IK, Rana Z. Management of Gunshot Injuries of Mandible with Open Reduction and Internal Fixation versus Closed Reduction and Maxillo-mandibular Fixation. Cureus 2020; 12:e7830. [PMID: 32467805 PMCID: PMC7249769 DOI: 10.7759/cureus.7830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background/objectives Gunshot injuries are known to cause severe morbidity and mortality when facial regions are involved. Management of the gunshot wounds of the face comprises of securing an airway, controlling hemorrhage, identifying other injuries and definite repair of the traumatic facial deformities. The objective of the present study was to compare the clinical outcome (infection and nonunion) of open reduction and internal fixation versus closed reduction and maxillo-mandibular fixation (CR-MMF) in the treatment of gunshot injuries of the mandible. Materials & methods This study was conducted at Oral and Maxillofacial Surgery Department of Shaheed Zulfiqar Ali Bhutto Medical University/Pakistan Institute of Medical Sciences Islamabad, Pakistan. Ninety gunshot mandibular fractures were randomly allocated in two equal groups. In group-A, 45 patients were treated by open reduction and internal fixation while in group-B, 45 patients were also managed by closed reduction and maxillo-mandibular fixation. Post-operative complications (infection, non-union) were evaluated clinically and radiographically in both groups. Results Patients treated by open reduction and internal fixation were having more complications in terms of infection (17.8%) as compared to closed reduction (4.4%) with a p-value 0.044. Whereas non-union was more in closed reduction (15.6%) as compared to open reduction and internal fixation group (2.2%) with a significant p-value 0.026. Conclusion Both the treatment modalities can be used in the management of gunshot injuries of mandible and there is need for further studies to have clear guideline in this regard in best interest of patients, community and health care providers.
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Affiliation(s)
- Muhammad Muddassar
- Oral Medicine / Oral and Maxillofacial Surgery, Islam Dental College, Sialkot, PAK
| | - Rizwan Arshad
- Oral and Maxillofacial Surgery, Bahria University Medical and Dental College, Karachi, PAK.,Dentistry, PNS Shifa Hospital, Karachi, PAK
| | - Sarah Rabbani
- Oral Pathology, Sharif Medical and Dental College, Lahore, PAK
| | - Imran S Qureshi
- Operative Dentistry, Frontier Medical and Dental College, Abbottabad, PAK
| | - Imran K Khattak
- Community Dentistry, Frontier Medical and Dental College, Abbottabad, PAK
| | - Zahoor Rana
- Oral and Maxillofacial Surgery, Shaheed Zulfiqar Ali Bhutto Medical University/Pakistan Institute of Medical Sciences (PIMS), Islamabad, PAK
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Famurewa BA, Oginni FO, Aregbesola SB, Erhabor GE. Effects of maxillomandibular fixation and rigid internal fixation on pulmonary function in patients with mandibular fractures. Int J Oral Maxillofac Surg 2020; 49:1193-1198. [PMID: 32061431 DOI: 10.1016/j.ijom.2020.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/02/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
Closed reduction and maxillomandibular fixation (MMF) is associated with airway obstruction. The ventilatory effect of open reduction and rigid internal fixation (ORIF) as an alternative treatment has not been determined. The aim of this study was to compare the effects of MMF and ORIF on pulmonary function (PF) in patients with mandibular fractures. Using a computer-generated simple randomization protocol, 40 eligible participants were allocated to MMF and ORIF treatment groups. PF tests were done preoperatively and at 24hours, 1, 6, and 7 weeks postoperative in all participants in both groups, using a portable office spirometer (Spirobank G). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, and peak expiratory flow rate (PEFR) were determined. At 6 weeks postoperative, PF tests were performed after the release of MMF. PF tests in the MMF and ORIF groups were similar preoperatively. At 24hours postoperative, FEV1/FVC was significantly lower in the MMF group than in the ORIF group (p<0.001). Values of FEV1 (p=0.022), FEV1/FVC (p=0.001) and PEFR (p<0.001) were significantly lower in the MMF group than in the ORIF group at 1 week postoperative. While MMF negatively impacted on PF, ORIF had no adverse effect on PF.
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Affiliation(s)
- B A Famurewa
- Department of Oral/Maxillofacial Surgery and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria.
| | - F O Oginni
- Department of Oral/Maxillofacial Surgery and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - S B Aregbesola
- Department of Oral/Maxillofacial Surgery and Oral Pathology, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - G E Erhabor
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Abstract
Aims The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management. Methods Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification. Results A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients. Conclusion The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.
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Affiliation(s)
- Padmanidhi Agarwal
- Department of Dentistry and Cranio-Maxillofacial Surgery All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Divya Mehrotra
- Department of Oral and Maxillofacial Surgery King George's Medical University, Lucknow, Uttar Pradesh, India
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30
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Lesko R, De Ruiter B, Kamel G, Davidson E. The Management of a Pediatric Condylar Fracture With Dynamic Elastic Therapy. Eplasty 2019; 19:ic16. [PMID: 31555395 PMCID: PMC6752114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robert P. Lesko
- aDivision of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Brandon J. De Ruiter
- aDivision of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - George N. Kamel
- aDivision of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Edward H. Davidson
- bDepartment of Plastic Surgery, Case Western Reserve University, Cleveland, Ohio,Correspondence:
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Abstract
Traumas are a major problem worldwide. A considerable proportion of traumas are located in the cephalic extremity. Neglect of these disorders by patients or those responsible for patient management may result in particularly serious consequences. This paper presents the case of a 58-year-old male patient with an intraorally open mandibular fracture, which left untreated for 3 days, was complicated by Ludwig's angina. Following aggressive surgical treatment during which the mandibular fracture was manually reduced and immobilized with a metal splint fixed with circumdental wires and effective antibiotic therapy, the septic process was terminated and the patient's fracture and infected wound were healed. The correct and rapid treatment of open mandibular fractures is mandatory in order to avoid severe septic complications.
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Affiliation(s)
- Mihai Juncar
- Oral and Maxillofacial Surgery, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Raluca-Iulia Juncar
- Department of Prosthetics, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Florin Onisor-Gligor
- Department of Oral and Maxillofacial Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Cluj, Romania
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Ravikumar C, Bhoj M. Evaluation of postoperative complications of open reduction and internal fixation in the management of mandibular fractures: A retrospective study. Indian J Dent Res 2019; 30:94-96. [PMID: 30900664 DOI: 10.4103/ijdr.ijdr_116_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mandible is one of the most prominent bones of the facial skeleton leading to high prevalence of fracture during facial trauma. The management of mandibular fractures has evolved from intermaxillary fixation (IMF) to a combination of IMF and wire osteosynthesis, lag screw, and plate fixation. Despite the evolution in techniques, no technique including open reduction and internal fixation (ORIF) has proven to be completely devoid of complications. However, ORIF has many advantages and has resulted in better outcome when compared with the closed reduction methods. Aim The aim of this retrospective study is to assess the incidence of postoperative complications in 98 patients treated with ORIF for mandibular fractures. Materials and Methods A sample size of 98 patients with mandibular fractures reporting to Saveetha Dental College and Hospital, Chennai, from January 2014 to November 2016, treated by ORIF was included in the study and was split into three groups. The patient's records were analyzed for deriving the number and type of complications that occurred during the postoperative period of ORIF. Results Patients with fractures in the condyle region reported with the highest number of complications when compared to the angle and parasymphysis regions. The most common complications that the patients reported were infection that led to plate removal and paresthesia. Others were wound dehiscence, occlusal disturbances, and facial nerve paralysis which were less common. Conclusion The most common postoperative complication of the procedure in this retrospective study was found to be infection of the plates that are preventable with better aseptic techniques.
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Affiliation(s)
- Chandini Ravikumar
- Graduate Student, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Mimansa Bhoj
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
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Mittermiller PA, Bidwell SS, Thieringer FM, Cornelius CP, Trickey AW, Kontio R, Girod S. The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study. Craniomaxillofac Trauma Reconstr 2019; 12:254-265. [PMID: 31719949 DOI: 10.1055/s-0038-1677459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022] Open
Abstract
The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss' kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal-Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.
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Affiliation(s)
- Paul A Mittermiller
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Department of Surgery, Stanford University, Stanford, California
| | - Serena S Bidwell
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Department of Surgery, Stanford University, Stanford, California
| | - Florian M Thieringer
- Department of Cranio-Maxillofacial Surgery, University Hospital of Basel, Basel, Basel-Stadt, Switzerland
| | - Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Department of Surgery, Stanford University, Stanford, California
| | - Risto Kontio
- Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sabine Girod
- Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Department of Surgery, Stanford University, Stanford, California
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Abstract
Background: Mandibular fractures contribute to a substantial proportion worldwide. Various variables related to mandibular fractures such as demographics, etiology, pattern of fracture, and treatment have been studied, but fewer reports on their correlations are published. Hence, this study attempts to understand these factors which can be useful for setting up clinical and research priorities. Aim: The purpose of this retrospective study is to establish a correlation between different factors associated with mandibular fractures. Materials and Methods: A database of 277 patients between July 2011 and October 2018 with mandibular fractures was retrospectively retrieved. Information on age, gender, etiology, pattern of fracture, and treatment done was obtained, tabulated, and analyzed statistically. Entities such as age and gender, age and cause, gender and cause, site of fracture and cause, site of fracture and side, site of fracture and treatment done, and site of fracture and gender were correlated. Statistical Analysis Used: Descriptive and analytical statistics were calculated using the SPSS version 20 using Chi-square tests which include Pearson's Chi-square and likelihood ratio. Results: In a total of 277 patients, a statistically significant correlation was found between age and the etiologic agent, site and side of fracture, and site of fracture and the treatment done with value of P < 0.05. Conclusion: A definite correlation between multitude of overlooked relevant co-factors has been studied which can provide an operating surgeon, a valuable impetus to be more vigilant in terms of medicolegal record maintenance, diagnosis, and possible clinical strategy for the treatment of mandibular fractures.
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Affiliation(s)
- Naiya Shah
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Ahmedabad, Gujarat, India
| | - Shital Patel
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Ahmedabad, Gujarat, India
| | - Ramita Sood
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Ahmedabad, Gujarat, India
| | - Yusra Mansuri
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Ahmedabad, Gujarat, India
| | - Mruga Gamit
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Ahmedabad, Gujarat, India
| | - Taher Rupawala
- Department of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College, Ahmedabad, Gujarat, India
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Srinivasan B, Balakrishna R, Sudarshan H, Veena GC, Prabhakar S. Retrospective Analysis of 162 Mandibular Fractures: An Institutional Experience. Ann Maxillofac Surg 2019; 9:124-128. [PMID: 31293940 PMCID: PMC6585192 DOI: 10.4103/ams.ams_36_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives: The objective was to evaluate the age, gender distribution, side and site distribution, etiology, and common patterns of the mandibular fractures. Materials and Methods: This was a systematic retrospective review of records of 94 patients with 162 mandibular fractures treated in a single institution. Results: Of 94 patients, 72 male and 22 female patients belong to the age group of 4–62 years (average 31.57 years). Among the various etiologies, i.e., assault, road traffic accident (RTA), self-fall, workplace injury, and sports-related injury, RTA accounts for 62.76% and self-fall for 18.08% of cases. Of the 100 fractures analyzed, 46% are unilateral fractures and 54% are bilateral. Sides affected among these are left (58%), right (39%), and symphysis or midline (3%). The site distribution is as follows: symphysis – 5; parasymphysis – 64; body – 13; angle – 43; and subcondylar – 37. The most common fracture pattern is the ipsilateral parasymphysis with contralateral angle (21 cases). Open reduction and internal fixation was the predominant modality of treatment. Complications were observed in 27.65% of patients. Conclusion: Surveys play a vital role in better understanding the biomechanics of the mandible fractures. Furthermore, analysis of the treatment modalities used and their respective outcomes are of paramount importance in guiding surgeons to evaluate their efficacy.
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Affiliation(s)
- Bhuvaneshwari Srinivasan
- Department of Oral and Maxillofacial Surgery, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Ramdas Balakrishna
- Department of Oral and Maxillofacial Surgery, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - H Sudarshan
- Department of Oral and Maxillofacial Surgery, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - G C Veena
- Department of Oral and Maxillofacial Surgery, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Suhas Prabhakar
- Department of Oral and Maxillofacial Surgery, K.L.E Society's Institute of Dental Sciences, Bengaluru, Karnataka, India
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Lv GH, Jiang L, Man C, Xiang XB. [The effect of nerve growth factor on the expression of BMP-2 in the healing of rabbits' mandibular fracture with partial nerve injury]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 30:535-537. [PMID: 29871063 DOI: 10.13201/j.issn.1001-1781.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 11/12/2022]
Abstract
Objective:To observe the effect of NGF on the expression of BMP-2 in rabbit model and explore the molecular mechanism of NGF which might promote the healing of mandibular fracture with nerve injury. Method:The 48 New-Zealand white rabbits were randomly divided into the experimental group (mandibular fracture+to cut off the nerve bundle+NGF by GS), the control group (mandibular fracture+to cut off the nerve bundle+NS by GS), the blank group (mandibular fracture+to cut off the nerve bundle) and the full-set group (mandibular fracture+retains the nerve bundle). After 2 weeks, 4 weeks, 6 weeks and 8 weeks, 3 rabbits were sacrificed in each group for HE staining and RT-PCR, respectively. Result:HE staining showed the osteogenesis phenomenon: the experimental group was clearer than control group, the full-set group was clearer than the blank group and the control group is similarly to the blank group. RT-PCR results revealed that there was a statistically significance in the early stage. The expression of BMP-2 peaked in 2 weeks and decreased later with time. Conclusion:The local application of NGF can prompt BMP-2 expression in the early stages of the mandibular fracture with partial nerve injury healing and this may be one of the molecular mechanisms.
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Affiliation(s)
- G H Lv
- Stomatological Hospital Affiliated to Zunyi Medical College, Zunyi, Guizhou, 563003, China
| | - L Jiang
- Stomatological Hospital Affiliated to Zunyi Medical College, Zunyi, Guizhou, 563003, China
| | - C Man
- Stomatological Hospital Affiliated to Zunyi Medical College, Zunyi, Guizhou, 563003, China
| | - X B Xiang
- Stomatological Hospital Affiliated to Zunyi Medical College, Zunyi, Guizhou, 563003, China
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Cazzolla AP, Montaruli G, Testa NF, Favia G, Lacaita MG, Lo Muzio L, Ciavarella D. Non-surgical Treatment of Condylar Fracture in an 11-Year-Old Patient: a Case Report. J Oral Maxillofac Res 2018; 9:e5. [PMID: 30116517 PMCID: PMC6090249 DOI: 10.5037/jomr.2018.9205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
Background Mandibular condylar fractures commonly occur after trauma and account for 25 to 35% of all mandibular fractures; its appropriate therapy still remains a point of controversy in children. The purpose of this paper is to describe the treatment of an 11-years-old male patient affected by neck-condylar fracture as result of trauma in evolutive age. Methods No surgical treatment was performed. A functional therapy was applied with a jaw splint. A closed treatment for mandibular condyle fractures was preferred because the amount of condylar displacement wasn’t considerable. Results The early treatment with functional therapy generated a functional adaptation of the condyle in the glenoid fossa and a normal mandibular function. After a 12-month follow-up the fracture resolution and an optimal condylar position were recorded. Conclusions The current case report and literature review showed that non-surgical therapy of neck-condylar fracture in a child with lower resin splint can restore mandibular movements and aesthetics. Facial growth after one year treatment resulted normal. A conservative treatment may be appropriate for children in selected cases with minimally displaced condyle.
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Affiliation(s)
- Angela Pia Cazzolla
- Department of Surgical Sciences, Faculty of Medicine, School of Dentistry, University of Bari, BariItaly
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, Faculty of Medicine, School of Dentistry, University of Foggia, FoggiaItaly
| | - Nunzio Francesco Testa
- Department of Clinical and Experimental Medicine, Faculty of Medicine, School of Dentistry, University of Foggia, FoggiaItaly
| | - Gianfranco Favia
- Department of Surgical Sciences, Faculty of Medicine, School of Dentistry, University of Bari, BariItaly
| | - Maria Grazia Lacaita
- Department of Surgical Sciences, Faculty of Medicine, School of Dentistry, University of Bari, BariItaly
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, Faculty of Medicine, School of Dentistry, University of Foggia, FoggiaItaly
| | - Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Faculty of Medicine, School of Dentistry, University of Foggia, FoggiaItaly
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Rastogi S, Ahmed T, Giri K, Dandriyal R, Indra B NP, Joshi A, Choudhury S, Mall S. Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable? Craniomaxillofac Trauma Reconstr 2018; 11:118-123. [PMID: 29892326 DOI: 10.1055/s-0037-1603453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
Abstract
The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t -test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.
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Affiliation(s)
- Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Tousif Ahmed
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Kolli Giri
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Ramakant Dandriyal
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Niranjana Prasad Indra B
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Ankur Joshi
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Shouvik Choudhury
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Kothiwal Dental College and Research Center, Moradabad, Uttar Pradesh, India
| | - Sunil Mall
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Gupta A, Babu AK, Bansal P, Sharma R, Sharma SD. Changing trends in maxillofacial trauma: A 15 years retrospective study in the Southern Part of Haryana, India. Indian J Dent Res 2018; 29:190-195. [PMID: 29652013 DOI: 10.4103/ijdr.ijdr_202_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective The aim is to analyze the pattern of maxillofacial injuries and treatment outcomes in the past 15 years (2002-2016). Materials and Methods: One thousand eight hundred and fifty patients from two tertiary referral center hospitals were studied retrospectively in which the age, sex, etiology, site of fracture, and treatment modality was recorded. Results One thousand two hundred and twenty-eight males and 622 females were operated between 2002 and 2016. Mean age was 29 ± 17.2 years. Maximum incidence was seen in the age group of 16-30 years in males, whereas in females, the predominance of trauma was seen in both 16-30 and 31-45 age groups. Road traffic accidents were responsible for the majority of fractures (42.2%), followed by assaults (26.4), sports injuries (17.6%), and fall (10.7%). Maximum fractures were of the mandible (53.5%) followed by midface (25.6%) and panfacial trauma (20.8%). Nearly 53.6% of patients underwent open reduction, and internal fixation (ORIF), 34.2% managed by the closed method and 12.1% were kept under observation. Conclusion This study verified a young male predominance, a shift toward more assault related fractures, especially in females. Mandibular fractures were the most common of all. Moreover, the changing trend toward ORIF in the past 15 years.
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Affiliation(s)
- Ashish Gupta
- Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Aby K Babu
- Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Pankaj Bansal
- Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Rahul Sharma
- Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
| | - Sneha D Sharma
- Department of Oral and Maxillofacial Surgery, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
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Abstract
Aim: The aim of this study was to give an insight into the retrospective analysis of a number of maxillofacial trauma cases reported to our institute and research center. Materials and Methods: The data for this study was obtained from the medical records and outpatient prescription slips of cases treated at the Oral and Maxillofacial Surgery Department from 2010 to 2016. Etiology, age, gender, pattern of fracture, and surgical treatment modalities undertaken in these patients were recorded. Results: A total of 353 maxillofacial trauma patients with mean age of 40 years, treated at our institute were evaluated from 2010 to 2016. Mandible was the most commonly fractured bone with parasymphysis as the most frequent site. Majority of victims were males (male:female ratio of 4:1) and also in the third decade of life. This study showed that 73% patients were treated by open reduction and internal fixation (ORIF), 25.8% by intermaxillary fixation (IMF) and Stabilization of fracture mandible with acrylic splint and circummandibular wiring was done in 0.8% pediatric patients. Conclusion: It was concluded that road traffic accidents were reported as the leading cause of maxillofacial fractures followed by assault, falls, and familial dispute. Maxillofacial surgeons as health care providers must continue their ‘face it’ campaign to decrease the incidence of road traffic accidents. Open reduction and internal fixation remains the gold standard treatment modality.
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Affiliation(s)
- Sameer Kaura
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Paramjot Kaur
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Rashi Bahl
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Sumit Bansal
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Prineet Sangha
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
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Blatt S, Rahimi-Nedjat R, Sagheb K, Piechowiak L, Walter C, Brüllmann D. Coincidence of mandibular fractures with isolated posterior maxillary sinus fractures. Dent Traumatol 2017; 33:345-349. [PMID: 28429855 DOI: 10.1111/edt.12345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM There are no data available to show whether there is a relationship between mandibular fractures and isolated fractures of the posterior and/or lateral walls of the maxillary sinus. The aim of this study was to determine whether there is a coincidence between these fracture patterns. METHODS Four hundred large volume cone beam computed tomography scans (CBCT) of patients with a fracture of the mandible between 2008 and 2013 were analyzed retrospectively. Patients with multiple midfacial fractures were excluded. The radiographic findings were correlated with epidemiological and clinical data of the patients such as gender, age, treatment methods, or complications. RESULTS The most frequent fracture sites of the mandible were the jaw angle, the parasymphysis region, and the condyle. Nineteen of the 400 patients (4.75%) had an isolated fracture of the lateral and/or posterior maxillary sinus. Odds-ratio analysis revealed a high tendency for significant correlation of condylar process fractures with isolated maxillary sinus fractures. Chi-square test demonstrated a P-value near statistical significance (P=.054). No other fracture site of the mandible could be associated with an isolated fracture of the maxillary sinus. CONCLUSION A condylar process fracture of the mandible after trauma without any further injury of the midface may be associated with an isolated fracture of the lateral and/or posterior maxillary sinus.
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Affiliation(s)
- Sebastian Blatt
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Roman Rahimi-Nedjat
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Lisa Piechowiak
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany.,Oral and Maxillofacial Surgery of the Mediplus Clinic, Mainz, Germany
| | - Dan Brüllmann
- Department of Oral Surgery and Oral Radiology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany.,Private Practice, Oral Surgery Weißliliengasse, Mainz, Germany
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Ribeiro-Junior PD, Vago TM, da Silva WS, Padovan LEM, Tiossi R. Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients. Cranio 2017; 36:234-242. [PMID: 28553749 DOI: 10.1080/08869634.2017.1330799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF). METHODS Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study. RESULTS Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used. CONCLUSIONS The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.
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Affiliation(s)
| | - Thessio Miná Vago
- a Department of Oral and Maxillofacial Surgery , Sacred Heart University , Bauru , SP , Brazil
| | | | | | - Rodrigo Tiossi
- b Department of Restorative Dentistry , School of Dentistry, State University of Londrina , Londrina , PR , Brazil
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Gupte SH, Chaddva S, Jethwani Y, Mohandas A, Kumavat DP, Jhaveri N. Evaluation of Efficacy of Three-dimensional Stainless Steel Mini-Plates in the Treatment of Fractures of the Mandible: A Prospective Study. J Orthop Case Rep 2017; 6:35-40. [PMID: 28507963 PMCID: PMC5404159 DOI: 10.13107/jocr.2250-0685.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The purpose of the study was to analyze whether adequate fracture fixation can be achieved by three-dimensional (3D) stainless steel mini-plates its ease of placement, whether the patient can resume function early and to find out the need to do intermaxillary fixation. MATERIALS AND METHODS In the prospective study, we treated 12 patients and 17 fractured sites using 3D mini-plates. Once fracture reduction was achieved temporary intermaxillary fixation (IMF) was done occlusion was achieved and the fractured segments were fixed using 3D plates either 4-holed or 6-holed of 2.5 mm thickness and 6-8 mm length screws. IMF was removed subsequently. CONCLUSION In none of the cases non-union or malocclusion was noted. Similarly except for 2 cases which had associated subcondylar fractures IMF was not done postoperatively. The patients were able to achieve function immediately with a reasonable level of success. The interincisal opening ranged from 18 to 23 mm in the first week to 40-56 mm after 1 month.
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Affiliation(s)
- Shreyas H Gupte
- Department of Oral and Maxillofacial Surgery. YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Shruti Chaddva
- Department of Oral and Maxillofacial Surgery. YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Yash Jethwani
- Department of Oral and Maxillofacial Surgery. YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Aditi Mohandas
- Department of Oral and Maxillofacial Surgery. YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Digvijay P Kumavat
- Department of Oral and Maxillofacial Surgery. YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Nirali Jhaveri
- Department of Oral and Maxillofacial Surgery. YMT Dental College and Hospital, Navi Mumbai, Maharashtra, India
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da Silva AP, Sassi FC, Bastos E, Alonso N, de Andrade CRF. Oral motor and electromyographic characterization of adults with facial fractures: a comparison between different fracture severities. Clinics (Sao Paulo) 2017; 72:276-283. [PMID: 28591339 PMCID: PMC5439110 DOI: 10.6061/clinics/2017(05)04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/13/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES: To characterize the oral motor system of adults with facial injuries and to compare the oral motor performance/function between two different groups. METHODS: An observational, descriptive, cross-sectional study was conducted in 38 patients presenting with facial trauma who were assigned to the Division of Orofacial Myology of a Brazilian School Hospital. Patients were divided into two groups: Group 1 (G1) consisted of 19 patients who were submitted to open reduction of at least one facial fracture, and Group 2 (G2) consisted of 19 individuals who were submitted to closed fracture reduction with maxillomandibular fixation. For comparison purposes, a group of 19 healthy volunteers was recruited. All participants underwent a clinical assessment that included an oral motor evaluation, assessment of the mandibular range of motions, and electromyographic assessment of the masticatory muscles. RESULTS: Clinical assessment of the oral motor organs indicated that G1 and G2 presented deficits related to the posture, position, and mobility of the oral motor organs. Patients also presented limited mandibular ranges of movement. Deficits were greater for individuals in G1, especially for maximal incisor opening. Additionally, patients in G1 and G2 presented a similar electromyographic profile of the masticatory muscles (i.e., patients with facial fractures presented lower overall muscle activity and significant asymmetrical activity of the masseter muscle during maximum voluntary teeth clenching). CONCLUSION: Patients in G1 and G2 presented similar functional deficits after fracture treatment. The severity of facial fractures did not influence muscle function/performance 4 months after the correction of fractures.
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Affiliation(s)
- Amanda Pagliotto da Silva
- Divisao de Miologia Orofacial, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Endrigo Bastos
- Divisao de Cirurgia Plastica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, BR
| | - Nivaldo Alonso
- Divisao de Cirurgia Plastica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, BR
| | - Claudia Regina Furquim de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Castro-Núñez J, Shelton JM, Snyder S, Sickels JV. Virtual Surgical Planning for the Management of Severe Atrophic Mandible Fractures. Craniomaxillofac Trauma Reconstr 2017; 11:150-156. [PMID: 29892332 DOI: 10.1055/s-0037-1601865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/05/2017] [Indexed: 10/19/2022] Open
Abstract
Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.
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Affiliation(s)
- Jaime Castro-Núñez
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky.,Institución Universitaria Colegios de Colombia. Bogotá, Colombia
| | - Jared M Shelton
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Susan Snyder
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
| | - Joseph Van Sickels
- Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky
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Ali IK, Sansare K, Karjodkar FR, Salve P, Vanga K, Pawar AM. Maxillofacial trauma patterns associated with external auditory canal fractures: Cone beam computed tomography analysis. Dent Traumatol 2017; 33:276-280. [PMID: 28296040 DOI: 10.1111/edt.12336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS There is a paucity of literature on external auditory canal (EAC) fractures secondary to maxillofacial trauma, with most of the literature on EAC fractures consisting of isolated case reports. To the authors' best knowledge, this is the first study to use cone beam computed tomography to evaluate the EAC region. The aim of this study was to assess the prevalence of external auditory canal (EAC) fracture following maxillofacial trauma and to evaluate the association between EAC fracture and other maxillofacial fractures and the region of trauma. MATERIALS AND METHODS One hundred patients were prospectively evaluated over 6 months from February to August 2016. The patients were referred for CBCT regarding temporomandibular joint or condylar fractures following maxillofacial trauma. Two observers (both experienced radiologists) assessed the EAC and associated fractures in the maxillofacial region. RESULTS External auditory canal (EAC) fracture was confirmed in 32% of the patients. Of the EAC fractures, 68.75% and 31.25% were associated with mandibular fractures and non-mandibular fractures, respectively. Of the EAC fractures, 68.75% were single fractures and 31.25% of patients had multiple comminuted fractures. Significant association was observed on cross-tabulation of the fractured region and region of trauma with the presence of EAC fracture using chi-square test. CONCLUSION External auditory canal (EAC) fracture is associated with maxillofacial fractures with increased incidence in mandibular fractures compared to non-mandibular fractures.
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Affiliation(s)
- Ibrahim K Ali
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Kaustubh Sansare
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Freny R Karjodkar
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Prashant Salve
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Kavita Vanga
- Department of Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Ajinkya M Pawar
- Department of Conservative Dentistry and Endodontics, Nair Hospital Dental College, Mumbai, Maharashtra, India
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Abstract
BACKGROUND/AIM The decision to retain or extract teeth in the line of mandibular fractures has been a subject of debate in the scientific literature, and there is a need for further evidence to clear this issue. Thus, the aim of this study was to investigate the effects on healing of teeth in the line of mandibular fractures in order to contribute to the field. MATERIAL AND METHODS The case notes of 100 patients with teeth in the line of 106 mandibular fractures were reviewed. Open reduction and rigid internal fixation (ORIF) was used if elastic intermaxillary reduction failed to achieve a satisfactory occlusion and/or anatomical reduction in the fragments as assessed by orthopantomogram (OPG) and clinical examination. The remaining cases had maxillomandibular fixation (MMF) with an arch bar and bridle wire. RESULTS Three of the 106 teeth involved in the fracture lines healed with complications. In the cases where the teeth had been removed prior to fracture treatment, or in cases of delayed extractions, no complications were noted. CONCLUSION The factors which should be considered for removal include the condition of the teeth and alveolar bone, the timing and the type of treatment. This decision should be made on an individual basis considering potential risks to avoid complications.
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Affiliation(s)
- Aylin Sipahi Calis
- Oral Surgery Department, School of Dentistry, Ege University, Izmır, Turkey
| | - Candan Efeoglu
- Oral Surgery Department, School of Dentistry, Ege University, Izmır, Turkey
| | - Huseyin Koca
- Oral Surgery Department, School of Dentistry, Ege University, Izmır, Turkey
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Kinra PK, Jayakumar K, Soumithran CS, Michael MJ, Passi D, Singh M. Comparative evaluation of bite force analytical study following mandibular osteosysthesis using three-dimensional and conventional locking miniplates. Natl J Maxillofac Surg 2017; 8:34-40. [PMID: 28761274 PMCID: PMC5512406 DOI: 10.4103/njms.njms_76_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES The aim is to study the effectiveness of 2 mm three-dimensional (3D) titanium miniplates and 2 mm conventional titanium miniplates in osteosynthesis of mandibular fractures by comparing the change in bite force. METHODOLOGY The study comprised forty patients of age group 20-40 years, weighing 55-75 kg having mandibular fractures. Patients were randomly divided into two equal groups In Group A, twenty patients underwent osteosynthesis using 3D titanium miniplates (2.0 mm system), whereas in Group B, twenty patients underwent osteosynthesis using conventional titanium miniplates (2.0 mm system). After fixation of fracture segments with miniplates, the patients were assessed on the basis of evaluation of bite force at incisor, right molar and left molar region after 1, 3, 6 , and 8 weeks. Comparison of change in bite force was done between Group A and Group B at different follow-ups at incisor, right molar, and left molar. RESULTS Bite force recordings showed increasing values at subsequent follow-ups, corresponding to the healing of the fracture in both groups. At follow-up III (6 weeks) and IV (8 weeks), bite force values reached near to those in healthy individuals. A significant difference was observed in change in bite force of Group A and Group B at incisor left molar and right molar on subsequent followups. 3D titanium miniplate requires less surgical exposure of the underlying fracture site, with a minimal traction of the surrounding soft tissue. INTERPRETATION AND CONCLUSION 3D miniplates in mandibular fractures are efficacious enough to bear masticatory loads during the osteosynthesis of fractures. It gives the advantage of greater stability, increased bite force, reduced implant material, and 3D stability.
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Affiliation(s)
- Pallav Kumar Kinra
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - K Jayakumar
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - C S Soumithran
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - Manoj Joseph Michael
- Department of Oral and Maxillofacial Surgery, Government Dental College, Kozhikode, Kerala, India
| | - Deepak Passi
- Department of Oral and Maxillofacial Surgery, ESI Dental College and Hospital, New Delhi, India
| | - Mahinder Singh
- Department of Oral and Maxillofacial Surgery, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand, India
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Pires WR, Bonardi JP, Faverani LP, Momesso GAC, Muñoz XMJP, Silva AFM, Panzarini SR, Bassi APF, Ponzoni D. Late mandibular fracture occurring in the postoperative period after third molar removal: systematic review and analysis of 124 cases. Int J Oral Maxillofac Surg 2016; 46:46-53. [PMID: 27688170 DOI: 10.1016/j.ijom.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/02/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
Abstract
Factors associated with the diagnosis, aetiology, and treatment of mandibular fractures occurring during the postoperative period following the removal of a lower third molar are discussed. The following databases were searched using specific key words: PubMed/MEDLINE, LILACS, Embase, and Scopus. The search yielded 124 cases. Sex, age, side, tooth position and angulation, bone impaction, relationship between the tooth and the inferior alveolar nerve, local pathological conditions, aetiology of the fracture, symptomatology, and time between surgery and fracture, as well as any displacement of the fracture and the treatment of the fracture, were evaluated. Data were tabulated and the χ2 statistical test was applied (P<0.05). Male patients aged >35 years, with teeth in positions II/III and B/C, complete bony impaction, and local bone-like alterations, were found to have a higher frequency of fracture and pericoronitis (P<0.05). Late fractures generally occurred between the second and fourth postoperative weeks (P<0.05). They were generally not displaced and the typical treatment was the non-surgical approach (P<0.05). It is concluded that the risk of mandibular fracture after extraction is associated with excessive ostectomy and/or local alterations. At-risk patients should be thoroughly briefed on the importance of a proper postoperative diet.
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Affiliation(s)
- W R Pires
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - J P Bonardi
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil.
| | - L P Faverani
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - G A C Momesso
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - X M J P Muñoz
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - A F M Silva
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - S R Panzarini
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - A P F Bassi
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
| | - D Ponzoni
- Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP, Araçatuba, São Paulo, Brazil
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Castillo-Cardiel G, López-Echaury AC, Saucedo-Ortiz JA, Fuentes-Orozco C, Michel-Espinoza LR, Irusteta-Jiménez L, Salazar-Parra M, González-Ojeda A. Bone regeneration in mandibular fractures after the application of autologous mesenchymal stem cells, a randomized clinical trial. Dent Traumatol 2016; 33:38-44. [PMID: 27513920 DOI: 10.1111/edt.12303] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIM Facial injury in adults can commonly result in fractures of the mandible. Autologous mesenchymal stem cells (AMSCs) transplantation is proposed as an alternative to conventional graft treatment to improve bone regeneration. The aim was to evaluate the effectiveness of AMSCs application in mandibular fractures to reduce regeneration time and increase bone quality. MATERIALS AND METHODS This study was a single-blind controlled clinical trial conducted in patients with mandibular angle fractures. Patients were divided into two groups: study group fracture reduction plus application of AMSCs and control group only fracture reduction. AMSCs were obtained from adipose tissue 24 h before the procedure. Intensity and density were evaluated in normal bone and fractured bone at 4 and 12 weeks after surgery using panoramic radiography and computed tomography. RESULTS A total of 20 patients, 10 in each group, were included. The study group had a mean age of 31.2 ± 6.3 years, and the control group mean age was 29.7 ± 7.2 years. All patients were male. Bone quality measured in grey levels at week 4 was 108.82 ± 3.4 vs 93.92 ± 2.6 (P = 0.000) using panoramic radiography and 123 ± 4.53 vs 99.72 ± 5.72 (P = 0.000) using computed tomography. At week 12, the measurements were 153.53 ± 1.83 vs 101.81 ± 4.83 (P = 0.000) using panoramic radiography and 165.4 ± 4.2 vs 112.9 ± 2.0 (P = 0.000) using tomography in the study and control groups, respectively. CONCLUSION Similar ossification values were obtained after 4 weeks when the use of AMSCs was compared to simple fracture reduction. However, after 12 weeks, the AMSCs group had a 36.48% higher ossification rate.
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Affiliation(s)
- Guadalupe Castillo-Cardiel
- Maxillofacial Surgical Department, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Alejandro César López-Echaury
- Plastic and Reconstructive Surgery Department, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - José Antonio Saucedo-Ortiz
- Plastic and Reconstructive Surgery Department, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Luis Rodrigo Michel-Espinoza
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Leire Irusteta-Jiménez
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Marcela Salazar-Parra
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, México
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