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Leonhardt H, Matschke JB, Bräuer C, Remschmidt B, McLeod NMH, Lauer G, Franke A. Treatment of mandibular condyle fractures with a rhombic 3D condylar fracture plate - Does the surgical approach matter? J Craniomaxillofac Surg 2025; 53:533-542. [PMID: 39884909 DOI: 10.1016/j.jcms.2025.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 01/21/2025] [Accepted: 01/22/2025] [Indexed: 02/01/2025] Open
Abstract
Fractures involving the mandibular condyle are a significant subset of mandibular fractures, demanding specialized implant design considerations for effective surgical treatment. The core objective of this study was to assess the clinical and radiographic results in patients treated with a single rhombic-shaped implant according to the surgical approach used. This retrospective cohort investigation, spanning a ten-year recruitment window, included individuals with unilateral fractures who underwent surgical treatment with a rhombic-shaped implant. These patients were subject to follow-up examinations at one, three, and six months post-surgery, along with corresponding orthopantomograms and clinical assessments. Patients were allocated into four groups depending on the fracture pattern and level as well as the approach used for fracture treatment. The primary outcome variables under scrutiny encompassed parameters such as occlusion, maximum interincisal distance, mandibular excursion across different postoperative time points, and radiographic measurements of mandibular height and the gonion angle. A total of 236 patients, comprising 161 males and 75 females, with an average age of 40.2 ± 19.2 years, were included in the study. Satisfactory occlusion was exhibited in 99.6% of patients at the six-month follow-up. Furthermore, all parameters associated with mandibular excursion displayed significant enhancements (p < 0.01). These improvements were accompanied by a reduction in ramus height and increased gonion angle on the fractured side. The investigation of the clinical and radiographic results suggest a tendency of the choice of the approach depending on the fracture pattern, but no statistically significant recommendations could be identified.
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Affiliation(s)
- Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Christian Bräuer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Universitätsmedizin Rostock, Rostock, Germany
| | - Bernhard Remschmidt
- Division of Oral and Maxillofacial Surgery, Department of Dental Medicine and Oral Health, Medical University of Graz, 8036, Graz, Austria
| | - Niall M H McLeod
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
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Mao J, Du Y, Xue J, Hu J, Mai Q, Zhou T, Zhou Z. Automated detection and classification of mandibular fractures on multislice spiral computed tomography using modified convolutional neural networks. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:803-812. [PMID: 39384413 DOI: 10.1016/j.oooo.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 10/11/2024]
Abstract
OBJECTIVE To evaluate the performance of convolutional neural networks (CNNs) for the automated detection and classification of mandibular fractures on multislice spiral computed tomography (MSCT). STUDY DESIGN MSCT data from 361 patients with mandibular fractures were retrospectively collected. Two experienced maxillofacial surgeons annotated the images as ground truth. Fractures were detected utilizing the following models: YOLOv3, YOLOv4, Faster R-CNN, CenterNet, and YOLOv5-TRS. Fracture sites were classified by the following models: AlexNet, GoogLeNet, ResNet50, original DenseNet-121, and modified DenseNet-121. The performance was evaluated for accuracy, sensitivity, specificity, and area under the curve (AUC). AUC values were compared using the Z-test and P values <.05 were considered to be statistically significant. RESULTS Of all of the detection models, YOLOv5-TRS obtained the greatest mean accuracy (96.68%). Among all of the fracture subregions, body fractures were the most reliably detected (with accuracies of 88.59%-99.01%). For classification models, the AUCs for body fractures were higher than those of condyle and angle fractures, and they were all above 0.75, with the highest AUC at 0.903. Modified DenseNet-121 had the best overall classification performance with a mean AUC of 0.814. CONCLUSIONS The modified CNN-based models demonstrated high reliability for the diagnosis of mandibular fractures on MSCT.
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Affiliation(s)
- Jingjing Mao
- Ningxia Medical University, Ningxia Key Laboratory of Oral Disease Research, Yinchuan, P.R. China
| | - Yuhu Du
- College of Computer Science and Engineering, North Minzu University, Yinchuan, P.R. China
| | - Jiawen Xue
- Ningxia Medical University, Ningxia Key Laboratory of Oral Disease Research, Yinchuan, P.R. China
| | - Jingjing Hu
- Department of Oral and Maxillofacial Surgery, Guyuan People's Hospital, Guyuan, P.R. China
| | - Qian Mai
- Department of Stomatology, The First People's Hospital of Yinchuan, Yinchuan, P.R. China
| | - Tao Zhou
- College of Computer Science and Engineering, North Minzu University, Yinchuan, P.R. China
| | - Zhongwei Zhou
- Department of Oral and Maxillofacial Surgery, General Hospital of Ningxia Medical University, Yinchuan, P.R. China; Institution of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, P.R. China.
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Troise S, Carraturo E, Committeri U, Barone S, Norino G, De Riu G, Vaira LA, Abbate V, Mariniello D, Califano L, Piombino P. Epidemiological analysis of the facial fractures pattern in relation to motorcycle helmet type: A retrospective study on 282 patients. J Craniomaxillofac Surg 2024; 52:1319-1324. [PMID: 39245614 DOI: 10.1016/j.jcms.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/12/2024] [Indexed: 09/10/2024] Open
Abstract
Most maxillofacial traumas are caused by road traffic collisions and, in particular, by motorcycle accidents. Helmets represent an efficient protective tool in these traumas but they do not provide complete protection. The aim of this study was to perform an epidemiological analysis of facial fractures pattern in relation to the helmet type worn during the accident. The study was a retrospective analysis of 282 patients with a diagnosis of maxillofacial fracture caused by a motorcycle accident. The patients were divided in three groups based on helmet type (Group A: full-face helmet; Group B: modular [half-face] helmet; Group C: open-face helmet). For each group, fractures type and trauma severity, using the Comprehensive Facial Injury (CFI) scale, were recorded. Results showed that isolated midface fractures were strongly related to full-face helmet wearing (p < 0.001), while mandibular fractures and panfacial trauma/combined fractures were negatively correlated (p < 0.001). Mandibular fractures (p < 0.001) and panfacial trauma/combined fractures (p < 0.001) were strongly related to open helmet. Moreover, severe trauma (CFI 8.16) was recorded for open-face helmet wearing. In conclusion, full-face helmet wearing reduced the risk of facial fracture, in particular panfacial trauma/combined fractures, while open-face helmet wearing increased the risk of these fractures.
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Affiliation(s)
- Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
| | - Emanuele Carraturo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy.
| | - Umberto Committeri
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
| | - Simona Barone
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
| | - Giovanna Norino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Sassari, Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
| | - Domenico Mariniello
- Department of Plastic, Reconstructive, Aesthetic Surgery, Section of Plastic, Department of Public Health, Federico II University, Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Italy
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Gualtieri M, Scivoletto G, Pitino F, Pisapia F, Valentini V. Sports-related Mandibular Fractures in the Center of Italy: A Retrospective Study. J Craniofac Surg 2024:00001665-990000000-01743. [PMID: 38953584 DOI: 10.1097/scs.0000000000010442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/31/2024] [Indexed: 07/04/2024] Open
Abstract
The main causes of injuries to the lower and middle third of the facial skeleton are traffic accidents, accidental falls, assaults, and sport. Regarding sports-related maxillofacial trauma, an 8-year retrospective study was conducted at the Department of Oral and Maxillofacial Surgery of the Policlinico Umberto I in Rome, Italy. In all, 329 patients were included, of which we analyzed 35 patients with sports-related mandibular fractures. Specifically, we assessed the type of mandibular fracture reported, age, gender, number of fracture lines, association with other maxillofacial fractures, and treatment options. The causes of sports-related injuries are often multifactorial. Therefore, the aim of our study was to understand the correlation between the type of sport practiced and the most frequently reported pattern of mandibular fracture, highlighting how, depending on the sport, the mechanism of action is different and may correlate with a specific type of mandibular fracture.
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Affiliation(s)
- Matteo Gualtieri
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
- Unit of Maxillofacial Surgery and Otolaryngology, Floraspe Renzetti Hospital, Lanciano, Italy
| | - Giulia Scivoletto
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| | - Francesca Pitino
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| | - Francesco Pisapia
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
| | - Valentino Valentini
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome
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Sim YS, Park WJ, Jung S, Kook MS, Park HJ, Oh HK, Han JJ. Three-Dimensional Analysis of Bone Remodeling After Closed Treatment for Mandibular Condylar Head Fracture. J Craniofac Surg 2024:00001665-990000000-01520. [PMID: 38710039 DOI: 10.1097/scs.0000000000010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/20/2024] [Indexed: 05/08/2024] Open
Abstract
Closed treatment of mandibular condylar fractures has been used for its indications based on the fracture site, fracture status, and patient age. Posttreatment mandibular condyle size is associated with mandibular function; however, a few studies have reported bone remodeling patterns and volume changes in the condyle and glenoid fossa after mandibular condylar head fractures (CHFs). Therefore, volumetric changes in the mandibular condyle and glenoid fossa were analyzed in the present study, and bone remodeling patterns were evaluated after mandibular CHFs. The present study included 16 condyles from 12 patients who received closed treatment for CHF. After reconstruction of a 3-dimensional skull model, including the mandible, using computed tomography data taken immediately after injury and 6 months after treatment, volume changes in the mandibular condyle and glenoid fossa were analyzed. The condylar volume increased by 0.32±0.66 cm3 during the 6-month healing period without statistical significance (P=0.093). Regarding the glenoid fossa, the fossa showed a statistically significant volume increase of 0.41±0.59 cm3 (P=0.021), and 12 glenoid fossae (75%) showed downward bone apposition; however, no change or only mild bone resorption was observed in 4 glenoid fossae (25%). The results of this study indicated that the volume changes in the mandibular condyle after closed treatment of a mandibular CHF are not significant, and the glenoid fossa adapts to the displaced mandibular condyle through downward growth accompanied by volume increase.
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Affiliation(s)
- You Song Sim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju
| | - Won-Jong Park
- Department of Oral and Maxillofacial Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Republic of Korea
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Franke A, Matschke JB, Weiland B, Schröder TA, McLeod NMH, Lauer G, Leonhardt H. A single-centre retrospective 10-year experience of the rhombic 3D condylar fracture plate for open reduction and internal fixation of condylar neck and base fractures. J Craniomaxillofac Surg 2024; 52:622-629. [PMID: 38582680 DOI: 10.1016/j.jcms.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/16/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024] Open
Abstract
Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Weiland
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Tom Alexander Schröder
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Technische Universität Dresden, Dresden, Germany
| | - Niall M H McLeod
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany
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7
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Omeje KU, Famurewa BA, Agbara R, Fomete B, Suleiman A, Bardi M, Owobu T. Mandibular fractures in Kano, Northwest Nigeria: etiology and pattern of presentation. Minerva Dent Oral Sci 2024; 73:69-74. [PMID: 33929128 DOI: 10.23736/s2724-6329.21.04417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Mandibular fractures are universal in distribution, but its etiologies and presentation patterns differ from one country to another because of varying socioeconomic, cultural and geographical factors. We analyzed the etiological factors and presentation patterns of mandibular fractures in a tertiary hospital at Nigeria's second largest city. METHODS Patients with isolated mandibular fractures at Aminu Kano Teaching Hospital, Kano were prospectively reviewed over a 12-months period. Patients' demographic information and fracture characteristics (etiology, site, pattern and number of fracture) were recorded and analyzed. RESULTS One hundred and forty-eight patients presented with 180 mandibular fractures. There were eight-fold higher men with mandibular fractures than women (M: F =8.3:1) with highest incidence in third decade of life. Road traffic accidents (84.46%) was the major etiology while iatrogenic fracture (0.68%) was found in one patient. Mandibular body was the most fractured site (41.11%) with parasymphyseal and angle regions accounting for 27.78% and 23.89% of total recorded fractures respectively. CONCLUSIONS Mandibular fractures in Kano, Northwest Nigeria occurred predominantly in men in the third decade and are mostly caused by road traffic accidents. The majority of these fractures involved the mandibular body.
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Affiliation(s)
- Kelvin U Omeje
- Department of Oral/Maxillofacial Surgery, Bayero University, Kano, Nigeria
| | - Bamidele A Famurewa
- Department of Oral and Maxillofacial Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria -
| | - Rowland Agbara
- Department of Dental and Maxillofacial Surgery, University of Jos, Jos, Nigeria
| | - Benjamin Fomete
- Department of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Martins Bardi
- Department of Oral/Maxillofacial Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
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Franke A, Sequenc AF, Sembdner P, Seidler A, Matschke JB, Leonhardt H. Three-dimensional measurements of symmetry for the mandibular ramus. Ann Anat 2024; 253:152229. [PMID: 38367950 DOI: 10.1016/j.aanat.2024.152229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The study examines a sample of patients presenting for viscerocranial computer tomography that does not display any apparent signs of asymmetry, assesses the three-dimensional congruency of the mandibular ramus, and focuses on differences in age and gender. METHODS This cross-sectional cohort study screened viscerocranial CT data of patients without deformation or developmental anomalies. Segmentations were obtained from the left and right sides and superimposed according to the best-fit alignment. Comparisons were made to evaluate three-dimensional congruency and compared between subgroups according to age and gender. RESULTS Two hundred and sixty-eight patients were screened, and one hundred patients met the inclusion criteria. There were no statistical differences between the left and right sides of the mandibular ramus. Also, there were no differences between the subgroups. The overall root mean square was 0.75 ± 0.15 mm, and the mean absolute distance from the mean was 0.54 ± 0.10 mm. CONCLUSION The mean difference was less than one millimetre, far below the two-millimetre distance described in the literature that defines relative symmetry. Our study population displays a high degree of three-dimensional congruency. Our findings help to understand that there is sufficient three-dimensional congruency of the mandibular ramus, thus contributing to facilitating CAD-CAM-based procedures based on symmetry for this specific anatomic structure.
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Affiliation(s)
- Adrian Franke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany.
| | | | - Philipp Sembdner
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Alexander Seidler
- Chair of Virtual Product Development, Institute of Machine Elements and Machine Design, TU Dresden, Germany
| | - Jan Bernard Matschke
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
| | - Henry Leonhardt
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus Dresden, Germany
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Gualtieri M, Scivoletto G, Pisapia F, Priore P, Valentini V. Analysis of Surgical Complications in Mandibular Fractures in the Center of Italy: A Retrospective Study. J Craniofac Surg 2024; 35:e71-e74. [PMID: 37943052 DOI: 10.1097/scs.0000000000009851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Mandibular fractures are the second most common maxillofacial fractures. The prevalent treatment for this kind of fractures is either a surgical procedure such as maxillomandibular fixation or open reduction and internal fixation or a combination of both. Sometimes the patients might develop locoregional postoperative complications. The most frequently reported complications are trigeminal V3 injury and surgical site infection. A 4-year retrospective study was performed at the Department of Oral and Maxillofacial Surgery, Policlinico Umberto I of Rome, Italy, and the postoperative complications after mandibular fracture surgical treatment were collected. The authors studied the characteristics of each complication and the correlation with the type of mandibular fracture and the surgical treatment chosen.
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Affiliation(s)
- Matteo Gualtieri
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
- Unit of Maxillofacial Surgery and Otolaryngology, Floraspe Renzetti Hospital, Lanciano, Italy
| | - Giulia Scivoletto
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - Francesco Pisapia
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - Paolo Priore
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
| | - Valentino Valentini
- Department of Odontostomatology and Maxillofacial Surgery, Policlinico Umberto I, "Sapienza" University of Rome, Roma
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10
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Voss JO, Heiland M, Preissner R, Preissner S. The risk of osteomyelitis after mandibular fracture is doubled in men versus women: analysis of 300,000 patients. Sci Rep 2023; 13:20871. [PMID: 38012360 PMCID: PMC10682452 DOI: 10.1038/s41598-023-48235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023] Open
Abstract
Postoperative complications following mandibular fracture treatment vary from local wound infections to severe conditions including osteomyelitis and impaired fracture healing. Several risk factors have been associated with the development healing disorders, including fracture localisation, treatment modality and substance abuse. However, limited research on the sex-specific influence of these complications exists. A total of about 300,000 female and male patients with mandibular fractures were examined in two cohorts. After matching for confounders (age, nicotine and alcohol dependence, malnutrition, overweight, anaemia, diabetes, osteoporosis and vitamin D deficiency), two cohorts were compared with propensity-score-matched patients according to outcomes (osteomyelitis, pseudoarthrosis and disruption of the wound) within 1 year after fracture. There were significant differences between female and male patients regarding the occurrence of osteomyelitis (odds ratio [OR] [95% confidence interval]: 0.621 [0.563; 0.686]) and disruption of the wound (OR [95% confidence interval]: 0.703 [0.632; 0.782]). Surprisingly, matching for the expected confounders did not change the results substantially. Sex plays a dominant role in determining the risk stratification for postoperative osteomyelitis and disruption of the wound, after accounting for other potential confounding factors. Additional research is needed to understand the underlying mechanisms and to develop sex-specific strategies to prevent these complications.
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Affiliation(s)
- Jan Oliver Voss
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany.
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Preissner
- Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Philippstr. 12, 10115, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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11
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Sancar B, Çetiner Y, Dayı E. Evaluation of the pattern of fracture formation from trauma to the human mandible with finite element analysis. Part 2: The corpus and the angle regions. Dent Traumatol 2023; 39:437-447. [PMID: 36942890 DOI: 10.1111/edt.12841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND/AIMS Although the mandible is the largest and strongest bone of the facial skeleton, it is frequently broken. The fracture location in the mandible depends on the biomechanical features, direction and angle of the trauma, and masticatory muscles. This study aimed to evaluate the stresses caused by trauma to the corpus and angle regions from different angles. MATERIALS AND METHODS After computer-based mandible models were created using finite element analysis, a force of 2000 Newton(N) was simulated with the mouth open or closed to the corpus and the angle. To the corpus: at 90° (Model 1) in the lateromedial direction, 45° (Model 2) in the lateromedial-inferosuperior direction, and 90° (Model 3) in the inferosuperior direction. To angle: 90° (Model 4) in the lateromedial direction and 45° (Model 5) in the lateromedial-inferosuperior direction. The resulting stress intensity was assessed using FEA. RESULTS Following the simulated forces, the maximum stress in the mandible occurred in the condylar region, except in Model 3 (Left(L)Corpus2[36 megapascals(MPa)]) in the mouth-closed condition. After traumas in Model 1 (open-mouth: LCondyle2[547 MPa]) and Model 4 (closed-mouth: LCondyle2[607 MPa]), higher stress values occurred in the condyle. In the mouth open-closed state, there was no significant stress change in the condyle region in Model 1 (open-mouth: LCondyle2[547 MPa], closed-mouth:LCondyle2[546 MPa]) or in Model 2 (open mouth: Right(R)Condyle2[431 MPa], closed-mouth:LCondyle2[439 MPa]). In Model 3, lower stress values occurred in the closed-mouth rather than the open-mouth (LCondyle1[167 MPa]) state. In Models 4 and 5, the stress values increased in the mouth-closed condition compared with the mouth-open condition. CONCLUSIONS Stress in the mandible is affected by the location of the trauma and the angle of incidence of the blow. In trauma to both the corpus and the angle, the most common area to be fractured is the condyle.
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Affiliation(s)
- Bahadır Sancar
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Yunus Çetiner
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Ertunç Dayı
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Ataturk University, Erzurum, Turkey
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12
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Alassaf MS, Khan HK, Habib OA, Aboalkhair AE, Albeshir HA, Samman MM. Morpho-Volumetric Changes of the Pharyngeal Airway With Traumatic Maxillofacial Injuries: A Retrospective Radiographic Study. Cureus 2023; 15:e47081. [PMID: 38022114 PMCID: PMC10646614 DOI: 10.7759/cureus.47081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND When dealing with traumatized patients, it is crucial to prioritize securing their airway. However, intubating someone who has sustained significant facial injuries can pose difficulties, as the narrow and altered shape of their upper airway may impede their ability to open their mouth. In light of this, the purpose of this study is to evaluate the volumetric and morphological alterations to the upper airway resulting from facial trauma by utilizing computed tomography (CT) scans. METHOD This is a single-centered retrospective analytical study. This study included CT scans of patients with traumatic facial injuries admitted to King Fahad Hospital in Madinah, Saudi Arabia. Study variables included age, gender, body mass index (BMI), fractured bones, airway symmetry, and airway volume. Using the 3D Slicer software (Slicer Community, USA), a three-dimensional model of the pharyngeal airway was constructed from the CT scan to evaluate symmetry and volume. IBM SPSS Statistics for Windows, version 23 (released 2013; IBM Corp., Armonk, New York, United States) was used to analyze data. RESULTS Among the screened scans, 136 cases with traumatic facial injuries were included in the study. Age ranged from four to 91 years, with a mean of 28.26 (±14.9). Mandibular and zygomatic fractures were the most common, with 71 (52.2%) and 69 (50.7%) cases, respectively. The pharyngeal airway was symmetric in 111 (81.6%) cases and not symmetric in the other 25 (18.4%) cases. A significant association was found between the side of the fracture and airway asymmetry in mandibular fractures (p-value = 0.03). The total airway volume in the displaced mandibular fractures showed a statistically significant decrease (p-value = 0.019). The fracture sites were not statistically linked to airway asymmetry except for parasymphyseal and symphyseal fractures, with a p-value of 0.038 and 0.041, respectively. CONCLUSION The study findings suggest that the pharyngeal airway is not usually compromised in most facial bone fractures; however, bilateral displaced mandibular fractures have the potential to diminish the pharyngeal airway volume, especially in fractures involving the symphysis and parasymphysis area.
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Affiliation(s)
- Muath S Alassaf
- Orthodontics and Dentofacial Orthopedics, Taibah University, Madinah, SAU
| | - Hamza K Khan
- Oral and Maxillofacial Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Osama A Habib
- Oral and Maxillofacial Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Ayyob E Aboalkhair
- Oral and Maxillofacial Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Hasan A Albeshir
- Oral and Maxillofacial Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Mahmood M Samman
- Oral and Maxillofacial Surgery, King Faisal Specialist Hospital and Research Centre, Madinah, SAU
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13
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Minervini G, Franco R, Marrapodi MM, Di Blasio M, Isola G, Cicciù M. Conservative treatment of temporomandibular joint condylar fractures: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. J Oral Rehabil 2023; 50:886-893. [PMID: 37191365 DOI: 10.1111/joor.13497] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Fractures of the mandibular condyle are the most common jaw fractures. There are several treatment approaches. There is the non-surgical and surgical approach. The purpose of this systematic literature review is to evaluate the indications and contraindications of either method to help the clinician make the best treatment choice. METHODS Pubmed, Web of Science and Lilacs were systematically searched until 20 May 2023. Clinical trials were selected to compare the two treatments for condyle fracture and evaluate indications and contraindications. RESULTS Out of 2515 papers, four studies were included. The surgical approach allows faster functional recovery and decreases patient discomfort. The study analyses under what circumstances a surgical procedure is more practical than a non-surgical one. CONCLUSION There is no evidence regarding the reliability of either method. Both have superimposable results. However, age, type of occlusion and other factors direct the clinician towards a surgical choice.
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Affiliation(s)
- Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Rocco Franco
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Di Blasio
- Department of Medicine and Surgery, University of Parma, University Center of Dentistry, Parma, Italy
| | - Gaetano Isola
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
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14
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Ghezta NK, Bhardwaj Y, Ram R, Parmar M, Basi RN, Thakur P. Nine Years of Retrospective Study of Mandibular Fractures in Semi-urban Teaching Hospital, Shimla, Himachal Pradesh, India. Craniomaxillofac Trauma Reconstr 2023; 16:138-146. [PMID: 37222980 PMCID: PMC10201191 DOI: 10.1177/19433875221095984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Study Design Retrospective study. Objective To evaluate current trends in maxillofacial trauma, a retrospective study of mandibular fractures at Government Dental College and Hospital Shimla H.P was carried out. Methods In this retrospective study, records of 910 patients with mandibular fractures were reviewed between 2007 and 2015 in the Department of Oral and Maxillofacial Surgery out of total 1656 facial fractures. These mandibular fractures were assessed according to age, sex, aetiology in addition to monthly and yearly distribution. Post-operative complications such as malocclusion, neurosensory disturbances and infection were recorded. Results It was observed that mandibular fractures were most frequent in males (67.5%) and in the age group of 21-30 years; accidental fall was the most common etiological factor (43.8%) in the present study and in stark difference to already published reports. The most common fracture site was that of condylar region 239 (26.2%). Open reduction and internal fixation (ORIF) were done in 67.3% cases whereas 32.6% were managed by maxillomandibular fixation and circummandibular wiring. Miniplate osteosynthesis was the most favoured technique. The complication with ORIF was 16%. Conclusions To treat mandibular fractures, currently there are many techniques. However, in minimizing complications and in achieving satisfactory functional and aesthetic results experienced surgical team plays an important role.
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Affiliation(s)
- Narotam K. Ghezta
- Department of Oral and
Maxillofacial Surgery, H.P. Government Dental College and
Hospital, Shimla, India
| | - Yogesh Bhardwaj
- Department of Oral and
Maxillofacial Surgery, H.P. Government Dental College and
Hospital, Shimla, India
| | - Rangila Ram
- Department of Oral and
Maxillofacial Surgery, H.P. Government Dental College and
Hospital, Shimla, India
| | - Monika Parmar
- Department of Oral and
Maxillofacial Surgery, H.P. Government Dental College and
Hospital, Shimla, India
| | - Rowena N. Basi
- Department of Oral and
Maxillofacial Surgery, H.P. Government Dental College and
Hospital, Shimla, India
| | - Pooja Thakur
- Department of Oral and
Maxillofacial Surgery, H.P. Government Dental College and
Hospital, Shimla, India
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15
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Lakshmi Rathan AC, D P Somani S, Ramakrishnan K, Narayanan V, Chandran S, Gurram P. Classification of unusual fracture patterns of the mandible: A retrospective study. J Craniomaxillofac Surg 2023; 51:151-156. [PMID: 37032223 DOI: 10.1016/j.jcms.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
The aim of this study is to devise and summarize a classification of fracture patterns involving multiple anatomical sites of the mandible. A retrospective study was conducted by reviewing clinical case records, imaging records, and the surgical management of patients presenting with mandibular fracture. Demographic data were collected and causes of the fractures were studied. Following radiological evaluations based on the courses of fracture lines, these fractures were categorized into three components: horizontal (H), vertical (V), and sagittal (S). In case of horizontal components, the mandibular canal was used as a reference. For vertical components, the fracture lines were classified according to where they terminated. With sagittal components, the direction of the bicortical split at the base of mandible was used as a reference. Out of a total of 893 mandibular trauma patients, 30 unusual fractures were identified (21 in males and nine in females), which do not fit into existing classifications. These were mainly due to road traffic accidents. Horizontal components of fractures were classified as H-I, H-II, and H-III, and vertical components as V-I, V-II, and V-III. For sagittal components, two types were identified - S-I and S-II - resulting in a bicortical split of the mandible. This classification is proposed to help understanding the complex fractures and to allow standardized communication among clinicians. Moreover, it is designed in such a way that aids in the choice of fixation technique. Further studies are needed to establish standardized treatment algorithms for efficient management of these unusual fractures.
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Affiliation(s)
- A C Lakshmi Rathan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Sapna D P Somani
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Karthik Ramakrishnan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Saravanan Chandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Prashanthi Gurram
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
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Padmanaban K, Duraisamy D, Rajiah D, Raghavan P, Annamalai S. Single Versus Two Plate Osteosynthesis for Parasymphysis Fractures of the Mandible: A Prospective Comparative Study. Cureus 2023; 15:e35311. [PMID: 36968908 PMCID: PMC10038174 DOI: 10.7759/cureus.35311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/24/2023] Open
Abstract
Background The treatment of mandibular fractures has undergone a revolutionary change after the invention of miniplate osteosynthesis. There aren't many studies in the literature comparing the outcomes of treating mandibular parasymphysis fractures with two miniplates versus one miniplate. Aim To evaluate the outcomes of single vs. two plate osteosynthesis in the management of parasymphysis fractures of the mandible. Materials and methods Sixteen patients with parasymphysis fracture of the mandible treated with a single high-profile miniplate or with two miniplates were included in the study. Multiple outcome variables such as fracture union, wound infection, dehiscence, iatrogenic dental injury, intraoperative time, plate exposure, and need for plate removal were recorded and analyzed statistically using the Student's t-test. Results The occurrence of iatrogenic dental injury (P= 0.021) and the mean operating time showed a statistically significant difference between the groups, whereas variables such as osseous healing, plate exposure, wound dehiscence, and postoperative paresthesia had no significant difference (P > 0.05). Conclusion Despite both systems providing enough stability for osseous healing, the use of a single high-profile miniplate demonstrated fewer post-operative problems, such as iatrogenic injury to the dental roots and occurrence of infection/dehiscence and plate exposure, than the use of two miniplates.
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17
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Sancar B, Çetiner Y, Dayı E. Evaluation of the pattern of fracture formation from trauma to the human mandible with finite element analysis. Part 1: Symphysis region. Dent Traumatol 2023. [PMID: 36807491 DOI: 10.1111/edt.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND/AIM The mandible is the largest, strongest bone in the maxillofacial region. When a fracture occurs in the mandible, its location depends on several factors: the direction of the trauma, the angle of the trauma, masticatory muscles and the quality of the bone. The aim of this study was to evaluate the stresses caused by trauma to the symphysis region from different angles. MATERIALS AND METHODS Computer-based mandible models were created, and a 2000 N force was applied to the symphysis at three different angles using finite element analysis. Six trauma situations were simulated with the mouth open or closed. Forces were applied to the symphysis at 90° (Model 1) in the anteroposterior direction, 45° (Model 2) in the anteroposterior-inferosuperior direction and 90° (Model 3) in the inferosuperior direction, when the mouth was open or closed. The resulting stress intensity was assessed using finite element analysis. RESULTS As a result of trauma applied to the symphysis region, maximum stresses were found where the impact originated and at the condyle region (Model 2, open mouth: condyle 1 [1172 MPa]). The open mouth position caused higher stress values than the closed mouth position (Model 2, open mouth: condyle 1 [1172 MPa]; closed mouth: symphysis 4 [82 MPa]). The Model 2, open-mouth state (Model 2, open mouth: condyle 1 [1172 MPa]) sustained higher stresses than all the other models. CONCLUSION The stress values in the mandible were affected by the force applied to the symphysis region, the angle of impact arrival and the open or closed state of the mouth. Keeping the mouth closed at the time of trauma reduced the stress value. A closed mouth during trauma directed at the symphysis reduced the possibility of mandible fractures.
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Affiliation(s)
- Bahadır Sancar
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Yunus Çetiner
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Inonu University, Malatya, Turkey
| | - Ertunç Dayı
- Dentistry Faculty, Department of Oral and Maxillofacial Surgery, Ataturk University, Erzurum, Turkey
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18
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Shikara M, Bridgham K, Ludeman E, Vakharia K, Justicz N. Current Management of Subcondylar Fractures: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:956-969. [PMID: 36939481 DOI: 10.1002/ohn.185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this study is to review the current literature on treatment of subcondylar fractures using traditional open reduction internal fixation (ORIF), closed reduction with maxillomandibular fixation (MMF), and endoscopic open approaches. DATA SOURCES PubMed, Embase, Cochrane CENTRAL, Clinicaltrials.gov, and WHO ICTRP. REVIEW METHODS A comprehensive database search was performed in accordance with PRISMA guidelines. All English-only texts published in the last 20 years with ≥10 patients were included. Studies that included patients <16 years old were excluded. RESULTS Thirty-two studies met the final inclusion criteria. Nine studies compared ORIF with closed reduction using MMF, 12 studies evaluated ORIF via different approaches, and 10 studies evaluated outcomes after endoscopic approaches. Five studies reported significant improvement in mouth opening with ORIF compared to closed reduction. In 1 study that recorded patient-reported outcomes measure (FACE-Q scale), quality of life scores and patient satisfaction were significantly higher in the ORIF group. Among the 10 studies that used the endoscopic approach, transient facial nerve injury ranged from 0% to 10%. CONCLUSION Several studies report better mouth opening, dental occlusion, and functional outcomes after ORIF compared to closed reduction, while some found no significant difference. Endoscopic approaches provide ease of access to the condyle with a low incidence of facial nerve injury. However, limitations include special equipment, longer operative times, and a steep learning curve using an endoscope. This review provides surgeons with an overview of the current literature on subcondylar fractures to allow for an individualized management approach for each patient.
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Affiliation(s)
- Meryam Shikara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Kelly Bridgham
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emilie Ludeman
- Health Sciences and Human Services Library, University of Maryland Graduate School, Baltimore, Maryland, USA
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie Justicz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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19
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Ebrahimi S, Navabazam A, Salemi F, Khaleghi F, Barzegar M, Saghafi F, Fallahzadeh H. The efficacy of teriparatide (Cinnopar®) on bone repair in mandibular fractures: A single blinded randomized clinical trial. J Craniomaxillofac Surg 2022; 50:923-928. [PMID: 36646571 DOI: 10.1016/j.jcms.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
This study focused on the effects of teriparatide (CinnoPar) on healing and postoperative complications in mandibular bone fractures. In this single-blind randomized controlled trial, 30 patients with a mandibular fracture hospitalized for open reduction internal fixation were randomly assigned to the intervention (I) (n = 15) and control (C) (n = 15) groups. Both groups received daily acetaminophen and cephalexin for 1 week. For 1 month, Group I received daily subcutaneous teriparatide injections. The Radiographic Union Scale of the Mandible (RUSM) was used to assess mandibular bone fusion subjectively, and the Hounsfield unit (HU) was used to objectively assess radiodensity in a computed tomography (CT) scan. In both groups, the visual analog scale (VAS) score was used to assess postoperative complications such as pain, swelling, wound opening, pus secretion, and bitter taste. There was no significant difference in bone repair between the two groups in this study (P > 0.05). Teriparatide also had no effect on the postoperative complication rate in the control group (P > 0.05). Within the limitations of the study it seems that in mandibular fractures, teriparatide did not affect bone fusion or postoperative complications, so its use is not recommended for better bone fusion and fewer postoperative complications of mandibular fracture during the first month.
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Affiliation(s)
- Somayyeh Ebrahimi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, 8914815667, Iran.
| | - Alireza Navabazam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, 8914815667, Iran.
| | - Fateme Salemi
- Islamic Azad University of Medical Sciences, School of Medicine, Yazd, 19395/1495, Iran.
| | - Fatemeh Khaleghi
- Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, 8916978477, Iran
| | - Mohsen Barzegar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, 8914815667, Iran.
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, 8915173149, Iran.
| | - Hossien Fallahzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, 8915173160, Iran
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Uppada UK, Sinha R, Susmitha M, Praseedha B, Kiran BR. Mandibular Fracture Patterns in a Rural Setup: A 7-Year Retrospective Study. J Maxillofac Oral Surg 2022; 21:1349-1354. [PMID: 36896075 PMCID: PMC9989092 DOI: 10.1007/s12663-020-01358-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022] Open
Abstract
Aim This study is designed to outline the probable patterns of mandibular fracture based on patient demographics and mechanism of injury in a rural setup. Materials and Methods The data from the record section in our unit belonging to patients who sustained fractures in the maxillofacial skeleton and were treated in our unit between the period June 2012-May 2019 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. Results A total of 224 patients with maxillofacial fractures were diagnosed, of which 195 were male and 29 were female. The ages ranged from 7 to 70 years. Road traffic accidents are noted to be the most common cause of mandibular fractures. The maximum cases were in the age group of 21-30 years with 85 (38%) patients. In a total of 224 patients, there were 278 mandibular fractures. The maximum incidence of fractures was in the mandibular parasymphysis region with 90 fractures accounting for 32.3% of the mandibular fractures. Males were more susceptible to mandibular fractures. Majority of them sustained mandibular fracture at more than one anatomical area. Conclusion It can be concluded that mandibular fractures are seen predominantly in the second and third decades of life due to road traffic accidents with high-speed vehicles and lack of protective safety accessories. Mandible when it fractured, it usually involved more than one anatomical location.
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Affiliation(s)
- Uday Kiran Uppada
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India
| | - Ramen Sinha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India
| | - M. Susmitha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India
| | - B. Praseedha
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India
| | - B. Ravi Kiran
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, India
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21
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Can Frailty Indices Predict Surgical Risk in Open Reduction and Fixation of Facial Fractures? J Craniofac Surg 2022; 33:2573-2577. [DOI: 10.1097/scs.0000000000008825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022] Open
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22
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Maxillofacial Fractures in the Province of Terni (Umbria, Italy) in the Last 11 Years: Impact of COVID-19 Pandemic. J Craniofac Surg 2022; 33:e853-e858. [PMID: 35882250 PMCID: PMC9612422 DOI: 10.1097/scs.0000000000008786] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
The main purpose of this retrospective study is to analyze the main causes and the main anatomical structures involved in maxillofacial traumas in the province of Terni, Umbria. From January 2009 to July 2021, 603 patients were admitted with a maxillofacial trauma diagnosis and underwent surgery at “Santa Maria Hospital” in Terni, Italy. The collected data included sex, age, nationality, cause of trauma, type of fractures, comorbidities, clinical signs, symptoms, date of admission, and date of discharge from the hospital. Causes were divided into 5 categories: road traffic accidents, accidental falls, physical assault, sport accidents, and occupational injuries. Men were more involved than women, with a male:female ratio of 325:1. The mean age of the population was 41.7 years. The main cause of trauma were road traffic accidents (36%), followed by accidental falls (27%), an increasing phenomenon during the current SARS-CoV-2 global pandemic. The orbital floor was the most fractured anatomical site, followed by zygoma and nasal bones.
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23
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Blunt force trauma in the human mandible: An experimental investigation. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2022. [DOI: 10.1016/j.fsir.2021.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mandibular fractures – what a difference 30 years has made. Br J Oral Maxillofac Surg 2022; 60:1202-1208. [DOI: 10.1016/j.bjoms.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022]
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Neuhaus MT, Gellrich NC, Sander AK, Lethaus B, Halama D, Zimmerer RM. No Significant Bone Resorption after Open Treatment of Mandibular Condylar Head Fractures in the Medium-Term. J Clin Med 2022; 11:jcm11102868. [PMID: 35628994 PMCID: PMC9142930 DOI: 10.3390/jcm11102868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Open treatment of condylar head fractures (CHF) is considered controversial. In this retrospective cohort study our primary objective was therefore to assess bone resorption and remodeling as well as patients function after open treatment of CHF in a medium-term follow-up (15.1 ± 2.2 months). We included 18 patients with 25 CHF who underwent open reduction and internal fixation, between 2016 and 2021, in our analysis. The clinical data and cone-beam computed tomography (CBCT) datasets were analyzed. The condylar processes were segmented in the postoperative (T1) and follow-up (T2) CBCT scans. Volumetric and linear bone changes were the primary outcome variables, measured by using a sophisticated 3D-algorithm. The mean condylar head volume decreased non-significantly from 3022.01 ± 825.77 mm3 (T1) to 2878.8 ± 735.60 mm3 (T2; p = 0.52). Morphological alterations indicated remodeling and resorption. The pre-operative maximal interincisal opening (MIO) was 19.75 ± 3.07 mm and significantly improved to 40.47 ± 1.7 mm during follow-up (p = 0.0005). Low rates of postoperative complications were observed. Open reduction of CHF leads to good clinical outcomes and low rates of medium-term complications. This study underlines the feasibility and importance of open treatment of CHF and may help to spread its acceptance as the preferred treatment option.
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Affiliation(s)
- Michael-Tobias Neuhaus
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (A.K.S.); (B.L.); (D.H.); (R.M.Z.)
- Correspondence: ; Tel.: +49-(0)-341-97-21866
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany;
| | - Anna Katharina Sander
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (A.K.S.); (B.L.); (D.H.); (R.M.Z.)
| | - Bernd Lethaus
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (A.K.S.); (B.L.); (D.H.); (R.M.Z.)
| | - Dirk Halama
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (A.K.S.); (B.L.); (D.H.); (R.M.Z.)
| | - Rüdiger M. Zimmerer
- Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany; (A.K.S.); (B.L.); (D.H.); (R.M.Z.)
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Sarepally G, Seethamsetty S, Karpe T, Nasyam FA, Fatima U, Fatema R. A Comparative Evaluation of 2.0mm Two-Dimensional Miniplates Versus 2.0mm Three-Dimensional Miniplates in Mandibular Fractures. Cureus 2022; 14:e21325. [PMID: 35186584 PMCID: PMC8849431 DOI: 10.7759/cureus.21325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 11/08/2022] Open
Abstract
Background: In the past few decades, there has been an increasing interest in obtaining a more instantaneous return to normal function using diverse methods of direct fixation. Aims and Objectives: To compare the conventional 2-mm 2D (two-dimensional) miniplates and 2-mm 3D (three-dimensional) miniplates in terms of treatment outcome, stability, duration of surgery, and complications of treatment of symphysis and parasymphysis mandibular fractures. Materials and Methods: 16 patients with clinical and radiological evidence of fractures of the mandible in symphysis and parasymphysis areas treated by open reduction and internal fixation with 2D miniplates and 3D miniplates. The patients were followed up for three months and assessed clinically and radiographically by taking orthopantomograms. The assessment was made on the immediate postoperative day, third day, fifth day, the seventh day, two weeks, three weeks, four weeks, two months, and three months. Results: Mean intraoperative time taken for 2D miniplate was 54.8 min and for 3D miniplate was 40.6 min. Mild paraesthesia at the soft tissue region supplied by mental nerve was noticed in two patients (25%) of group I, whereas there was no such paraesthesia observed in group II patients. Wound dehiscence and infection were noticed in one patient in group I. Conclusion: 3D plates seem to be better than conventional 2-mm miniplates for symphysis and parasymphysis fractures.
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Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures. J Clin Med 2021; 10:jcm10245975. [PMID: 34945272 PMCID: PMC8708228 DOI: 10.3390/jcm10245975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [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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Neuhaus MT, Zeller AN, Desch L, Dhawan A, Jehn P, Gellrich NC, Zimmerer R. Endoscopically Assisted Treatment of Condylar Base and Neck Fractures: A Single Institution Analysis of Outcomes and Complications. J Maxillofac Oral Surg 2021; 20:665-673. [PMID: 34776701 DOI: 10.1007/s12663-020-01398-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Conservative treatment, including observation and closed treatment, as well as open reduction and internal fixation are existing options for treating condylar process fractures. Extraoral approaches are widely preferred for open reduction and internal fixation. Transoral access for condylar base and neck fractures is not yet commonly used as it is technically demanding and requires special equipment. Purpose In this study, the transoral endoscopically assisted approach is described, and its outcomes and complications were investigated. Imaging data and clinical records of 187 patients with condylar process fractures, treated via endoscopically assisted transoral approach between 2007 and 2017 were analyzed. Parameters included diagnosis and fracture classification, treatment, osteosynthesis configuration and postoperative complications. Results Early complications, including infection, transient postoperative malocclusion, pain and limited mouth opening, occurred in 35 patients (18.7%). Late onset complications, such as screw loosening were documented in only 4 patients (2.1%). Revision surgery following postoperative 3D imaging was required in only 3 cases (1.6%). Fragment length ranged from 15.5 to 38.3 mm. In 57.7% of patients with condylar fragment length < 20 mm, a single osteosynthesis plate was used, with no elevated complication rate. Two osteosynthesis plates with 4 screws each was used as standard in longer fragments. Conclusion Endoscopically assisted transoral treatment of condylar process fractures is a reliable, yet technical demanding technique. It allows for reduction and fixation of fractures with a condylar fragment length of > 15 mm with low postoperative complication and revision rates.
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Affiliation(s)
- Michael-Tobias Neuhaus
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Alexander-Nicolai Zeller
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Lena Desch
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Amit Dhawan
- Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, India
| | - Philipp Jehn
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Rüdiger Zimmerer
- Department for Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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#facialtraumasurgery: Educational Content of Instagram as a Social Media Source for Facial Trauma Surgery. J Craniofac Surg 2021; 32:2794-2797. [PMID: 34677037 DOI: 10.1097/scs.0000000000007951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT With an uprising influence of social media platforms like Instagram during the last decade, medical and healthcare related posts have accumulated majorly. In particular the head and face characterizes and signifies each individual's human character, which may be the reason why numerous posts are shared on social media platforms. The purpose of this investigation was to assess the content associated with facial trauma surgery and evaluate its educational quality.The authors performed a retrospective investigation on 550 Instagram posts by #facialtraumasurgery due to number of "likes," comments, type of post, language, its purpose, and source. Furthermore, posts were evaluated due to their educational quality by 3 examiners of different educational levels.The majority of posts showed 0 to 50 "likes" and 0 to 5 comments in English language. The major post type were single photographs (289; 52.5%), multiple photographs (188; 34.2%), videos (73; 13.3%) and predominantly case reports (233; 42.4%). The source was 322 (58.5%) posts by surgeons, followed by 185 (33.6%) clinic posts. Only 10% to 18% of the posts were rated "excellent." Interrater reliability between all 3 examiners presented a high concordance with 89% (P = 0.000).Our study presents an analysis of quantity and quality of social media content according to facial trauma surgery. It supports the deduction that most of the content on Instagram is shared by patients and unclear sources and thus is limited informative. Nevertheless, influence of social media on medical information is increasing and practitioners have to face its effect on their patients.
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Huang CM, Chan MY, Hsu JT, Su KC. Biomechanical analysis of subcondylar fracture fixation using miniplates at different positions and of different lengths. BMC Oral Health 2021; 21:543. [PMID: 34674692 PMCID: PMC8532336 DOI: 10.1186/s12903-021-01905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Many types of titanium plates were used to treat subcondylar fracture clinically. However, the efficacy of fixation in different implant positions and lengths of the bone plate has not been thoroughly investigated. Therefore, the primary purpose of this study was to use finite element analysis (FEA) to analyze the biomechanical effects of subcondylar fracture fixation with miniplates at different positions and lengths so that clinicians were able to find a better strategy of fixation to improve the efficacy and outcome of treatment. Methods The CAD software was used to combine the mandible, miniplate, and screw to create seven different FEA computer models. These models with subcondylar fracture were fixed with miniplates at different positions and of different lengths. The right unilateral molar clench occlusal mode was applied. The observational indicators were the reaction force at the temporomandibular joint, von Mises stress of the mandibular bone, miniplate and screw, and the sliding distance on the oblique surface of the fracture site at the mandibular condyle. Results The results showed the efficacy of fixation was better when two miniplates were used comparing to only one miniplates. Moreover, using longer miniplates for fixation had better results than the short one. Furthermore, fixing miniplates at the posterior portion of subcondylar region would have a better fixation efficacy and less sliding distance (5.46–5.76 μm) than fixing at the anterolateral surface of subcondylar region (6.10–7.00 μm). Conclusion Miniplate fixation, which was placed closer to the posterior margin, could effectively reduce the amount of sliding distance in the fracture site, thereby achieving greater stability. Furthermore, fixation efficiency was improved when an additional miniplate was placed at the anterior margin. Our study suggested that the placement of miniplates at the posterior surface and the additional plate could effectively improve stability.
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Affiliation(s)
- Chao-Min Huang
- Department of Stomatology, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Man-Yee Chan
- Department of Dentistry, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan.,School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Jui-Ting Hsu
- School of Dentistry, China Medical University, Taichung, 404, Taiwan
| | - Kuo-Chih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, 407, Taiwan. .,Department of Biomedical Engineering, Hungkuang University, Taichung, 433, Taiwan. .,Department of Chemical and Materials Engineering, Tunghai University, Taichung, 407, Taiwan.
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Is Open Reduction Internal Fixation Using Titanium Plates in the Mandible as Successful as We Think? J Craniofac Surg 2021; 33:1032-1036. [PMID: 34608010 DOI: 10.1097/scs.0000000000008258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Titanium plats are the gold-standard for fracture fixation. Titanium is considered biocompatible, corrosion resistant with an elasticity-modulus closest to bone. Nonetheless, titanium plates are not always as inherent as hoped. The authors investigated morbidity associated with titanium plates in mandibular fractures. A retrospective study of mandibular fractures treated between 2000 and 2018 using internal-fixation was conducted. Data included age, gender, complications, and location. Predictor-variable was location. Outcome-variable was plate removal. A total of 571 patients were included, 107 resulted in plate removal (18.7%). Body was the most prevalent location of fracture (29.3%). Symphysis/para-symphysis showed the highest removal rate (24.1%), followed by body and angle (21.3/19.8%). A total of 23.4% of double-plating cases resulted in plate removal, upper-border in 15% and lower-border in 8.8%, all reconstruction-plates. Exposure was the most frequent complication leading to removal. Although titanium plates are the gold standard, almost every fifth patient returns for plate removal. Age-distribution emphasizing 41 to 50 with decrease towards extremities may imply better healing in the young and soft-tissue elasticity and less complaints in the elderly. Significantly more complications in double-plating compared to lower border suggests proximity to the oral-cavity as a risk-factor for removal. Complication rates and patterns are not negligible and perhaps should encourage clinicians to consider using biodegradable-systems for upper-border plates.
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Mandibular Fractures Epidemiology and Treatment Plans in the Center of Italy: A Retrospective Study. J Craniofac Surg 2021; 32:e346-e349. [PMID: 33170830 DOI: 10.1097/scs.0000000000007118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The epidemiology of maxillofacial fractures is variable in different geographic regions. Economic and social conditions, laws and types of behavior can be considered the most important factors influencing these differences.Mandibular fractures were first cited in 1650 BC in an Egyptian papyrus. Today, these fractures are one of the most prevalent facial skeletal injuries.A 4-year retrospective study was performed and the trauma - related data were collected from medical and radiological archives. The analysis comprised patients admitted for mandibular fracture at Sapienza University of Rome - Policlinico Umberto I between January 1, 2016 and December 31, 2019. The data include age, sex, etiology, anatomical sites of the fractures, eventual maxillofacial associated fractures and treatment.We collected 172 patients, 138 males (80.2%) and 34 females (19.8%) with 270 mandibular fractures. The average age was 35.4 years. The youngest and oldest patients were aged 6 and 90 years, respectively. The age group 20 to 29 years was the most represented with 52 patients (30.2% of the total sample). Assaults were the most common etiology (n = 53, 30.8%), followed by falls (n = 45, 26.2%). The condyle was the most involved region (n = 86, 32%), followed by parasymphysis region (n = 72, 26.6%) and angle (n = 62, 23%).154 patients (89.5%) reported only mandibular fractures. Eighteen patients (10.5%) had other associated maxillofacial fractures; the most frequently encountered maxillofacial fractures associated with mandibular fractures were the zygomatic complex fractures (n = 9, 5.2%). Open reduction and internal fixation was the most preferred surgical treatment (n = 115, 66.9%).This study showed that mandibular fractures predominate in 20 to 29 years group and in the male sex. Assaults are the most frequent cause. The prevalent fracturing site is condylar process. Orbital - maxillary - zygomatic complex fractures were the most common associated maxillofacial fractures and open reduction and internal fixation was the preferred surgical strategy.The results of this analysis agree to other studies and provide important clinical information that will help in study of these injuries.
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Melek L. Comparison of lag screws and double Y-shaped miniplates in the fixation of anterior mandibular fractures. World J Methodol 2021; 11:88-94. [PMID: 34026582 PMCID: PMC8127419 DOI: 10.5662/wjm.v11.i3.88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/02/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mandibular fractures constitute about 80.79% of maxillofacial injuries in Alexandria University, either as isolated mandibular fractures or as a part of panfacial fractures. The combination of symphyseal and parasymphyseal fractures represent 47.09% of the total mandibular fractures.
AIM To compare the effectiveness of lag screws vs double Y-shaped miniplates in the fixation of anterior mandibular fractures.
METHODS This study is a prospective randomized controlled clinical trial, performed on sixteen patients with anterior mandibular fractures. Patients were divided equally into two groups, each consisting of eight patients. Group 1: Underwent open reduction and internal fixation using two lag screws. Group 2: Underwent open reduction and internal fixation using double Y-shaped plates. The following parameters were assessed: operating time in minutes, pain using a visual analog scale, edema, surgical wound healing for signs and symptoms of infection, occlusion status and stability, maximal mouth opening, and sensory nerve function. Cone beam computed tomography was performed at 3 and 6 mo to measure bone density and assess the progression of fracture healing.
RESULTS The study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years (mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidents in 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and other causes in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures (62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except for the mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).
CONCLUSION Both lag screws and double Y-shaped miniplates provide favorable means of fixation for mandibular fractures in the anterior region. Fractures fixed with lag screws show greater mean bone density at 3 mo post-operation, indicative of higher primary stability and faster early bone healing. Further studies with larger sample sizes are required to verify these conclusions.
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Affiliation(s)
- Lydia Melek
- Department of Oral and Maxillofacial Surgery, Alexandria University, Alexandria 21411, Egypt
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Zimmerli W. Osteomyelitis of the Jaws. BONE AND JOINT INFECTIONS 2021:353-366. [DOI: 10.1002/9781119720676.ch22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Mandible Fractures Associated With the Introduction of an E-Scooter-Sharing System. J Craniofac Surg 2021; 32:1405-1408. [PMID: 33538446 DOI: 10.1097/scs.0000000000007518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT With the introduction of an e-scooter-sharing system in Germany, standing electric scooters became popular modes of transportation in many urban areas. But the increase in popularity has resulted in an increase in traumatic injuries associated with e-scooter accidents. The purpose of this investigation was to determine the common fracture pattern of patients with mandible fractures as a result of an electric scooter accident. The authors performed a retrospective investigation of 52 patients who were admitted to the trauma unit of an oral and maxillofacial department from June until November 2019 with a fracture of the mandible. Our study investigated the first 6 months of e-scooter sharing system in a major city with more than 1 million inhabitants. Our cohort consists of 52 patients, 38 males, and 14 females with a mean age of 37 years. E-scooter related mandible fractures were with 21% the third biggest group, after physical assault and falls. 45% of these patients were intoxicated by alcohol. Furthermore, the majority of e-scooter patients presented more than one fracture of the mandible (73%). For our cohort, a typical combination of a symphysis or body fracture and bilateral affected ramus and/or condyle was the prevalent recorded fracture combination (55%) of e-scooter related traumata. Small scooter wheels, a speed of 15 miles or 20 kilometers per hour and the individual clinging to the handlebar falling predestinate these vehicles for accidents with craniofacial trauma. Among all cranio-facial traumas mandible fractures were mostly documented for e-scooter accidents. The severity of e-scooter related mandible fractures and their fracture pattern should be recognized by trauma units.
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Scott C, Ramakrishnan K, Vivek N, Saravanan C, Prashanthi G. Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study. J Oral Maxillofac Surg 2020; 79:1330.e1-1330.e12. [PMID: 33524326 DOI: 10.1016/j.joms.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures. MATERIALS AND METHODS A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ2 test and student's t test with P value less than 0.05 indicating statistical significance. RESULTS Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6 ± 0.9 minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively. CONCLUSIONS Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.
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Affiliation(s)
- Cynthia Scott
- Assistant Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
| | - Karthik Ramakrishnan
- Associate Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Narayanan Vivek
- Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Chandran Saravanan
- Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Gurram Prashanthi
- Associate Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
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Amjad S, Kalim Ansari MD, Ahmad SS, Rahman T. Comparative study of outcomes between locking plates and three-dimensional plates in mandibular fractures. Natl J Maxillofac Surg 2020; 11:263-269. [PMID: 33897192 PMCID: PMC8051647 DOI: 10.4103/njms.njms_53_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/03/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives The objective was to compare the efficiency and assess postoperative complications of 2.00 mm unicortical locking plates and three-dimensional (3D) plates in surgical correction of uncomplicated mandibular fracture. Materials and Methods A prospective cohort study of twenty patients of uncomplicated mandibular fractures, who were operated either by noncompression unicortical 2-mm locking mini-plate or by noncompression unicortical 2-mm 3D mini-plate, were enrolled and followed up for the study outcomes such as operative time, postoperative infection, and postoperative occlusion. Results Majority of the patients (90%) were male who had road traffic accident. In 80% of cases, mandibular fracture site was parasymphysis. The mean operating time for 3D plates (43.20 min) was significantly lower than that for locking plates (54.82 min), P < 0.001. All cases operated by 3D plates compared to 60% by locking mini-plates did not need intermaxillary fixation, P = 0.025. The 80% of cases operated by 3D plates did not require postoperative occlusion correction compared to 30% in another group, P = 0.01. For other parameters such as postoperative sensory disturbance, postoperative infection, incidence tooth damage, vertical displacement of mandible, feeling of plate after platting, and chewing efficiency after 1 week, there were no statistical significant differences between the two groups. Conclusions The outcome of 2.0mm 3D mini-plate is better in terms of operating time required, post-operative need of intermaxillary fixation and occlusal correction. While the outcome is similar to the use of non-compression unicortical 2.00mm locking miniplate in parameters like infection rate and incidence of tooth damage etc.
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Affiliation(s)
- Shaikh Amjad
- Department of Dentistry, Indian Institute of Medical Sciences and Research, Jalna, Maharashtra, India
| | - M D Kalim Ansari
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed S Ahmad
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Tabishur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Perez D, Ellis E. Complications of Mandibular Fracture Repair and Secondary Reconstruction. Semin Plast Surg 2020; 34:225-231. [PMID: 33380907 PMCID: PMC7759430 DOI: 10.1055/s-0040-1721758] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mandibular fractures are common facial injuries. Their treatment varies as do postoperative complications. This paper discusses the common complications that are associated with the treatment of mandibular fractures and presents management strategies.
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Affiliation(s)
- Daniel Perez
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Tiwari P, Bera RN, Chauhan N. Magnitude of Gonial Angle Influence on the Commonness of Mandibular Angle Fractures. Ann Maxillofac Surg 2020; 10:190-194. [PMID: 32855939 PMCID: PMC7433963 DOI: 10.4103/ams.ams_23_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/07/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The aim of the study was to review the literature on the influence of gonial angle on mandibular angle fracture. The present systematic review addresses the following focus question: Does the magnitude of gonial angle influence the incidence of mandibular angle fractures? Materials and Methods: Electronic and manual literature searches were conducted on databases: PubMed/MEDLINE, Embase, Science direct, the Cochrane Library, and clinicaltrials.gov for studies published up to August 2019 to collect information about the effect of gonial angle, a skeletal morphological parameter with an incidence of fracture of the angle of the mandibular arch. Systematic literature review was performed to identify studies evaluating the effect of gonial angle in patients suffering from mandible fractures. Large retrospective studies were included and case reports were excluded. Results: Fifteen hundred articles published before August 2019 were identified. One hundred and sixteen articles met the inclusion criteria. Two articles remained when exclusion criteria were applied. As measured in the two included studies containing 280 panoramic radiographs of mandibular fractures, the mean gonial angle of patients in the angle fracture group ranged from 126.8° ± 7.9° to 128.5° ± 5.4°. The mean gonial angle of patients in the nonangle fracture group ranged from 118.5° ± 4.4° to 122.3° ± 4.9°. The mean gonial angle of patients in the angle fracture group displayed a range from 118.9° to 134.7° (confidence interval [CI] 95% 5.89–8.05), whereas the mean gonial angle of patients in nonangle fracture group displayed a range from 114.1° to 127.2° (CI 95% 3.89–4.95). Conclusion: A high gonial angle is an important factor influencing the occurrence of mandibular angle fractures owing to the poorer quality of bone and reduced height at the ramus angle region, all of which necessitate a modification of osteosynthesis techniques.
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Affiliation(s)
- Preeti Tiwari
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rathindra Nath Bera
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nishtha Chauhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Management of Angle Mandible Fractures by 3D Rectangular Grid Plate: A Prospective Study. J Maxillofac Oral Surg 2020; 19:420-424. [PMID: 32801538 DOI: 10.1007/s12663-019-01286-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/12/2019] [Indexed: 10/26/2022] Open
Abstract
Aim This study aims to evaluate the clinical outcomes of treatment of mandibular angle fractures using 3D rectangular grid plate. Materials and Methods A total of 10 patients with mandibular angle fractures with or without associated facial fractures requiring open reduction and internal fixation were included in the study. Fixation was done using 3D rectangular grid plate. Results The mean age of the patients in the study is 34.7 years. In all the cases, fracture was adequately reduced (100%) intraoperatively and confirmed through postoperative radiographs. The mean mouth opening by the end of 3 months is 38.60 mm. Four patients had paresthesia of inferior alveolar nerve pre- and postoperatively, and normal sensation was regained by the end of the third month. There were no reported cases of infection and hardware failure during the 9-month follow-up period. Conclusion The results of the study suggest that 3D rectangular grid plate is a feasible alternative to conventional miniplate systems with good clinical outcome and fewer complications related to paresthesia, infection and hardware failure.
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Soós B, Janovics K, Tóth Á, Di Nardo MD, Szalma J. Association Between Third Molar Impaction Status and Angle or Condylar Fractures of the Mandible: A Retrospective Analysis. J Oral Maxillofac Surg 2020; 78:1162.e1-1162.e8. [PMID: 32151652 DOI: 10.1016/j.joms.2020.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of our study was to evaluate the correlations between mandibular third molar impaction status and mandibular angle and condylar fractures. MATERIALS AND METHODS This retrospective cross-sectional study included patients with unilateral and isolated angle or condylar fractures. Patient records and panoramic radiographs were evaluated. The predictor variables included the presence, impaction status (Pell and Gregory [P&G] classification), and angulation (Winter classification) of the third molar. The outcome variable was the type of fracture, whereas other predictor variables included demographic factors such as age, gender, and fracture etiology. Bivariate (χ2 test) and logistic regression analyses were conducted to estimate the associations between variables and the outcome. RESULTS The sample was composed of 164 angle fracture (mean age, 31.6 ± 12.3 years; 83.5% male) and 115 condylar fracture (mean age, 41.9 ± 16.8 years; 76.5% male) patients. A third molar was present in 72.6% of the angle fracture group and 54.8% of the condylar fracture group (P = .002). Deep impactions (classes IC, IIC, IIIB, and IIIC) exhibited an odds ratio (OR) of 3.60 for angle fractures (P < .001). No association was found between tooth angulations and the type of fracture. According to logistic regression analysis, older age (adjusted OR, 1.05; 95% confidence interval [CI], 1.03 to 1.07), P&G class I impaction (OR, 1.86; 95% CI, 1.09 to 3.20), and P&G class A impaction (OR, 1.91; 95% CI, 1.12 to 3.24) were significantly associated with condylar fractures whereas the presence of a third molar (OR, 0.46; 95% CI, 0.28 to 0.76) or P&G class B impaction (OR, 0.287; 95% CI, 0.12 to 0.69) was associated with angular fractures. CONCLUSIONS P&G class II or III and class B impaction status was significantly associated with angle fractures, whereas missing or fully erupted (class IA) third molars significantly correlated with condylar fractures.
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Affiliation(s)
- Balázs Soós
- PhD Student and Assistant Lecturer, Department of Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Kata Janovics
- Assistant Lecturer, Department of Conservative Dentistry and Periodontology, University of Pécs, Pécs, Hungary
| | - Ákos Tóth
- Assistant Professor, Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary
| | | | - József Szalma
- Associate Professor and Department Head, Department of Oral and Maxillofacial Surgery, Medical School, University of Pécs, Pécs, Hungary.
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Agarwal P, Mehrotra D. Mandibular Ramus Fractures: A Proposed Classification. Craniomaxillofac Trauma Reconstr 2020; 13:9-14. [PMID: 32642026 DOI: 10.1177/1943387520903159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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Kaushik S, Ali I, Dubey M, Bajpai N. 2 mm Conventional Miniplates with Three-Dimensional Strut Plate in Mandibular Fractures. Ann Maxillofac Surg 2020; 10:10-15. [PMID: 32855908 PMCID: PMC7433946 DOI: 10.4103/ams.ams_73_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/05/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022] Open
Abstract
AIM The aim of this study was to compare 2 mm conventional miniplates with three-dimensional (3D) strut plates in the treatment of mandibular fractures treated in the Department of Oral and Maxillofacial Surgery of a college in India, during 2012-2015. MATERIALS AND METHODS All 20 patients with mandible fracture requiring open reduction and internal fixation of the fracture were reported and reviewed in the Department of Oral and Maxillofacial Surgery of the same dental college in India, during 2012-2015. We classified the data according to the gender, age, etiology, fracture site, and method of treatment of the fractures. Fixation done in 10 patients with 2 mm conventional miniplates kept in Group I, while 10 patients with 3D strut miniplate system considered in Group II. RESULTS Assessment of patient was done under the following parameters with follow-up at regular intervals at 2nd day postoperatively and at 1st, 3rd, and 6th weeks postoperatively: pain, swelling, infection, interincisal mouth opening in millimeters, paresthesia/anesthesia, mobility between fracture fragments, overall occlusion, need for any supplemental fixation, fate of implant, and complications. CONCLUSIONS 3D titanium miniplates showed similar results when compared to standard titanium miniplates with advantages such as reduction in operative time, ease of placement, and cost-effective over the conventional plate system.
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Affiliation(s)
- Shishir Kaushik
- Department of Oral and Maxillofacial Surgery, ITS Dental College, Greater Noida, Lucknow, Uttar Pradesh, India
| | - Iqbal Ali
- Department of Oral and Maxillofacial Surgery, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India
| | - Manish Dubey
- Department of Dentistry, TS Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Neha Bajpai
- Department of Dentistry, TS Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Tükel HC, Benlidayı ME. Mandibula kırıklarının prevalansı, tedavisi ve komplikasyonları. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.469210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hassanein AG. Trends and Outcomes of Management of Mandibular Fractures. J Craniofac Surg 2019; 30:1245-1251. [DOI: 10.1097/scs.0000000000005469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Menon S, Sham ME, Kumar V, Archana S, Nath P, Shivakotee S, Hoda M. Maxillofacial Fracture Patterns in Road Traffic Accidents. Ann Maxillofac Surg 2019; 9:345-348. [PMID: 31909013 PMCID: PMC6933960 DOI: 10.4103/ams.ams_136_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of this study is to analyze the maxillofacial fracture pattern from road traffic accidents (RTAs) in cases treated surgically in a tertiary hospital during July 2008–June 2018. Materials and Method: Data available in the department of oral and maxillofacial surgery of the institution of patients with maxillofacial fractures sustained due to RTAs that were treated in the department between the period July 2008 and June 2018 were collected and analyzed. The variables analyzed for the study were etiology, gender, age, and type of fracture. All cases were treated by open reduction and rigid internal fixation. Results: A total of 348 patients with maxillofacial fractures were diagnosed, of which 335 were male and 13 were female. The ages ranged from 7 to 70 years. The maximum cases were in the age group of 16–30 years with 181 fractures followed by 31–45 group with 133 fractures, 45–60 years with 21 fractures, 0–15 years with 8 fractures, and >60 years with five fractures. The maximum incidence of fractures was in the mandible with 168 cases followed by 92 in zygomatic complex, combination of fractures in 53 cases, 13 LeFort I fractures, nine frontal bone fractures, three fractures in other areas, five nasal fractures, and five LeFort II fractures. Males predominated the cases of mandibular fractures involving multiple sites and cases involving multiple bones. Conclusion: A maximum number of maxillofacial fractures cases were in the second and third decades of life, and the high-speed vehicles and lack of protective safety accessories such as helmets and seatbelts were responsible for the wide variety of pattern fractures of facial bones.
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Affiliation(s)
- Suresh Menon
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - M E Sham
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Veerendra Kumar
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - S Archana
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Priyangana Nath
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Satyapriya Shivakotee
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
| | - Mahbubul Hoda
- Department of Oral and Maxillofacial Surgery, Vydehi Institute of Dental Sciences, Bengaluru, Karnataka, India
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Ferrari R, Lanzer M, Wiedemeier D, Rücker M, Bredell M. Complication rate in mandibular angle fractures-one vs. two plates: a 12-year retrospective analysis. Oral Maxillofac Surg 2018; 22:435-441. [PMID: 30327980 DOI: 10.1007/s10006-018-0728-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/09/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Treatment of mandibular angle fractures using one or two osteosynthesis plates is still a controversial topic. Fracture, treatment, and patient-dependent influencing factors could affect the overall outcome. In the present retrospective study, complication rates of mandibular angle fractures treated by open reduction were assessed according to type of treatment. MATERIALS AND METHODS We analyzed retrospective medical records using the search terms "mandibular angle fracture." We included all patients presenting with a mandibular angle fracture treated by open reduction and internal fixation at our department between 2002 and 2012. RESULTS We included 186 patients treated with open reduction and miniplate fixation (84 one plate; 102 two plates). The early complication rate was significantly higher for the double-plate group (72.5% vs. 47.6%, respectively; p = 0.001). Most common findings in the postoperative period were transient hypoesthesia and tissue swelling. In the two-plate group, a significantly increased operation time of 183 min versus 150 min in the one-plate group was found (p < 0.001). Late complications did not differ significantly between both groups (21.4% single-plate group; 30.4% two-plate fixation group; p = 0.32). CONCLUSION We found a significantly increased early complication rate in the two-plate group. Long-term complications did not differ between both groups.
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Affiliation(s)
- Raphael Ferrari
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - M Lanzer
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - D Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Craniomaxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bredell
- Cantonal Hospital Winterthur, Winterthur, Switzerland
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A comparison of panoramic radiography and cone beam computed tomography in the detection of osteosynthesis complications in sheep mandibular angle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:167-174. [PMID: 30415905 DOI: 10.1016/j.oooo.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic efficacy of panoramic radiography (PANO) and cone beam computed tomography (CBCT) in detecting simulated complications of plate osteosynthesis applied to mandibular angle fractures (MAFs). STUDY DESIGN Unfavorable MAFs were created in 100 fresh sheep hemimandibles. Fractures were fixed with 4-hole titanium miniplates and screws. Bone necrosis around the screws, penetration of the screw into the inferior alveolar canal, screw loosening, and plate breakage were simulated. The diagnostic efficacy of the imaging techniques was compared by using intra- and interobserver agreement scores and area under the receiver operating characteristic curve (AUC) values. Examination time (ET), confidence scores (CS), and planar preference (PP) in CBCT evaluation were assessed. RESULTS Intra- and interobserver agreement scores varied between 0.61 and 0.91. AUCs for screw penetration into the inferior alveolar canal and screw loosening were significantly higher in CBCT than in PANO (P < .05). CBCT presented significantly higher ET and CS values compared with PANO (P < .05). PP showed significant differences among types of complications (P < .05). CONCLUSIONS PANO provided acceptable outcomes in the detection of bone necrosis and broken plates around the screw, but CBCT was more likely to enable detection of all simulated types of complications with higher confidence.
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