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Shi LL, Pudney J, Brangman S, Parham K, Nuara M. Head & Neck Trauma in the Geriatric Population. Otolaryngol Clin North Am 2023; 56:1183-1201. [PMID: 37385861 DOI: 10.1016/j.otc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Craniofacial trauma in the geriatric population is increasing as our population ages. Due to loss of bone quality and medical comorbidities, injuries for minor trauma can be severe. A more extensive medical evaluation is usually warranted in this population before proceeding with surgery. In addition, unique surgical considerations exist in the repair of atrophic and edentulous bony fractures. Some quality improvement measures have already been undertaken but more is needed to help standardize care in this vulnerable population.
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Affiliation(s)
- Lucy L Shi
- Division of Facial Plastic & Reconstructive Surgery, Virginia Mason Franciscan Health, 1201 Terry Avenue 9th Floor, Seattle, WA 98101, USA
| | - Jacey Pudney
- Department of Geriatrics, SUNY Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Sharon Brangman
- Department of Geriatrics, SUNY Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Kourosh Parham
- Department of Otolaryngology-Head & Neck Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA
| | - Michael Nuara
- Division of Facial Plastic & Reconstructive Surgery, Virginia Mason Franciscan Health, 1201 Terry Avenue 9th Floor, Seattle, WA 98101, USA.
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Bera RN, Tiwari P. Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review. Craniomaxillofac Trauma Reconstr 2023; 16:317-332. [PMID: 38047145 PMCID: PMC10693259 DOI: 10.1177/19433875221115585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Study Design PRISMA-SWiM guided systematic review. Objective 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts. Methods A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and non-human studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence. Results Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation. Conclusions There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures.
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Affiliation(s)
- Rathindra N. Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Preeti Tiwari
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Jin R, Georges K, Jasti S, Ahsanuddin S, Cadwell JB, Paskhover B. Impact of Age on Surgical Outcomes Following Mandible Fracture Repair. Laryngoscope 2023; 133:287-293. [PMID: 35638520 DOI: 10.1002/lary.30208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Open repair of mandibular fractures are frequently performed surgical procedures. Increasing rates of such fractures are seen in older adults following falls. This study assesses the impact of older age on early complications following mandible fracture repair. STUDY DESIGN Retrospective analysis of national registry. METHODS The 2013-2018 National Surgical Quality Improvement Program database was queried for all cases of open mandible fracture repair and cases were categorized into younger (18-40), middle (41-65), and older (>65) age cohorts. Demographics and comorbidities were compared between the age groups. Rates of surgical, medical, and wound complications within 30-days of surgery were determined. Multivariable logistic analyses were performed to assess the relationship between age and complications. RESULTS Altogether, 1818 cases were included for analysis, of which 1269 (69.8%) were younger, 459 (25.2%) were middle, and 90 (5.0%) were older age. Increased rates of complications were seen in the older groups, including unplanned reoperation, unplanned readmission, wound disruption, and medical complications (p < 0.01). On unadjusted analysis, the older (>65) age group had an increased odds of experiencing a complication compared to the younger (18-40) group (OR: 4.19, p < 0.001). The older age group continued to have a significantly increased odds of medical complications after multivariable adjustment (adjusted OR: 8.64, p < 0.001). CONCLUSIONS On this analysis of a national database, advanced age was associated with an increased frequency of early postoperative complications following open mandibular fracture repair. Following multivariable adjustment, advanced age continued to be associated with increased odds of postoperative medical complications within 30 days of surgery. LEVEL OF EVIDENCE 3 Laryngoscope, 133:287-293, 2023.
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Affiliation(s)
- Ryan Jin
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kirolos Georges
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shravya Jasti
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Salma Ahsanuddin
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joshua B Cadwell
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Boris Paskhover
- Department of Otolaryngology, Head & Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Kahveci K, Ayranci F. Finite element analysis of different internal fixation methods for the treatment of atrophic mandible fractures. J Stomatol Oral Maxillofac Surg 2023; 124:101276. [PMID: 36058534 DOI: 10.1016/j.jormas.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022]
Abstract
The aim of this study is to evaluate different plate systems and contribute to revealing the most appropriate treatment option for severe atrophic edentulous mandible fractures. A total of 8 different types of rigid internal fixation methods, which were a 4-hole miniplate on the crest, a 4-hole miniplate on the basis, a 6-hole miniplate on the crest, a 6-hole miniplate on the basis, two 4-hole mini plates on both the crest and basis, two 6-hole mini plates on both crest and basis, a 6-hole reconstruction plate on the crest and a 6-hole reconstruction plate on the basis, were simulated. Stress analysis on plates and screws and the displacement between fragments were evaluated using finite element analysis. The lowest von Mises stress was observed on the basis plate in Group 6. The highest von Mises stresses were measured on the screws closes to the fracture line. Values exceeding the boundary conditions were observed only in Groups 3 and 4 under molar loading. The highest compressive stresses were measured in Group 1, and the lowest compressive stresses were measured in Group 6. Under molar loading, the highest displacement was observed in Group 3, and the lowest displacement was observed in Group 6. When all groups are evaluated in terms of stress distributions and stability, a 1.5 mm thick six-hole reconstruction plate can be a reliable method in the treatment of severe atrophic edentulous mandible fractures.
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Affiliation(s)
- Kadircan Kahveci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Giresun University, Giresun, Turkey.
| | - Ferhat Ayranci
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
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Panesar K, Susarla SM. Mandibular Fractures: Diagnosis and Management. Semin Plast Surg 2021; 35:238-249. [PMID: 34819805 DOI: 10.1055/s-0041-1735818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Accurate evaluation, diagnosis, and management of mandibular fractures is essential to effectively restore an individual's facial esthetics and function. Understanding of surgical anatomy, fracture fixation principles, and the nuances of specific fractures with respect to various patient populations can aid in adequately avoiding complications such as malocclusion, non-union, paresthesia, and revision procedures. This article reviews comprehensive mandibular fracture assessment, mandibular surgical anatomy, fracture fixation principles, management considerations, and commonly encountered complications. In addition, this article reviews emerging literature examining 3-dimensional printing and intraoperative imaging.
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Affiliation(s)
- Kanvar Panesar
- Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington
| | - Srinivas M Susarla
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.,Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, Washington.,Divisions of Plastic and Craniofacial Surgery and Oral-Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
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Boffano P, Pau A, Dosio C, Ruslin M, Forouzanfar T, Rodríguez-Santamarta T, de Vicente JC, Tarle M, Dediol E, Pechalova P, Pavlov N, Daskalov H, Doykova I, Kelemith K, Tamme T, Kopchak A, Yu RA, Corre P, Bertin H, Bourry M, Guyonvarc'h P, Jezdić Z, Konstantinovic VS, Starch-Jensen T, Brucoli M. Quality of life following maxillofacial trauma in the elderly: a multicenter, prospective study. Oral Maxillofac Surg 2021. [PMID: 34499265 DOI: 10.1007/s10006-021-01003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/AIMS When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients. MATERIALS AND METHODS This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile - 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results. RESULTS A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too. CONCLUSIONS Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.
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Sindel A, Özalp Ö, Bilgin B. Extraoral approach to a bilateral unfavourable mandibular fracture under local anaesthesia: A case report. Gerodontology 2021; 38:228-231. [PMID: 34013564 DOI: 10.1111/ger.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present a feasible treatment method for fractures of severely atrophic mandibles in high-risk patients undergoing general anaesthesia (GA). CASE REPORT A 77-year-old man presented with bilateral unfavourable fractures in an atrophic mandible. Pre-anaesthetic consultation revealed that the patient was at high risk for GA due to significant medical comorbid conditions of the patient, such as advanced age, chronic obstructive respiratory disease, diabetes mellitus and atherosclerosis. Thus, a modified treatment, consisting of open reduction and internal fixation using a combination of reconstruction plates and miniplates via an extraoral approach, was planned under local anaesthesia. The patient tolerated the surgical procedure well, without the need for sedation, and uneventful healing was achieved during postoperative period. CONCLUSION Local anaesthesia may be considered as the anaesthetic technique of choice when managing atrophic mandible fractures to reduce the risk of complications and shorten the time needed for recovery, especially in elders with significant medical comorbidities.
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Affiliation(s)
- Alper Sindel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Öznur Özalp
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Busehan Bilgin
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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de Amorim Rocha LL, Rodrigues MFB, da Franca Acioly R, do Carmo Carvalho D, da Rocha CCL. Augmentation of the Atrophic Mandible with a Block Corticomedullary Graft. Case Rep Dent 2020; 2020:6837519. [PMID: 32685219 DOI: 10.1155/2020/6837519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/14/2020] [Accepted: 06/13/2020] [Indexed: 11/29/2022] Open
Abstract
The gradual loss of the dental alveolus leads to bone resorption, which may cause atrophy of the maxilla and mandible. One of the most complex procedures in reconstructive surgery is the rehabilitation of patients with atrophic mandibles. Herein, we present a clinical case study of atrophic mandible augmentation with grafts obtained from the iliac crest. The use of reconstruction plates may represent a feasible mechanism for treatment as well as fracture prevention. Mandible augmentation performed by grafting the donor site of the iliac crest showed satisfactory results and resolution of the aesthetic and functional impairments.
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