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Abdou Ata MAER, Marzook HAEM, Tawfik MAM, Elmissiry ZMA. Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures. J Contemp Dent Pract 2023; 24:761-770. [PMID: 38152909 DOI: 10.5005/jp-journals-10024-3578] [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] [Indexed: 12/29/2023]
Abstract
AIM The aim of this study was to evaluate a clinically and radiographically Z-shaped miniplate for the fixation of the parasymphyseal fractures. PATIENTS AND METHODS Twenty patients (10 patients in each group) who had parasymphseal mandibular fractures were randomly selected for this study. In this study, open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using two miniplates as group I, and open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using a newly designed Z-shaped miniplate as group II. Clinical and radiographic evaluations were made. Each patient was evaluated: (1) clinically evaluated preoperatively and postoperatively for operating time, ease of placement of the miniplate, and occlusion and (2) radiological: postoperative reduction of fracture was evaluated radiologically at 5-day, 1-month, 2-month, and 3-month intervals with orthopantomogram, and lingual splaying was evaluated by cone-beam computed tomography (CBCT) immediately postoperatively and at an interval of 3 months. The collected data were subjected to statistical analysis. Data analysis was performed by SPSS software, version 25 (SPSS Inc., PASW statistics for Windows version 25). Chicago: SPSS Inc. RESULTS There was a statistically significant difference (p < 0.001) between the mean intraoperative time. This indicates that group I had a longer time for fracture fixation than group II. Group I had a longer time elapsed for plate adaptation and definitive fixation than group II. Occlusion and reduction stability in both groups were similar. There was a statistically significant difference in postoperative lingual display control after 5 days and 3 months between the studied groups. This indicates that lingual display control in group II is better than in group I. CONCLUSION The Z-shaped miniplate is effective and provides three-dimensional stability for the fixation of parasymphyseal fractures, ease of use, easily adapted in cases of fractures near the mental nerve reduced operative time, and better control of lingual splaying than conventional miniplates. CLINICAL SIGNIFICANCE The newly designed Z-shaped miniplate is a valuable option for fixation parasymphysis fractures that need open reduction and internal fixation instead of using conventional miniplates, which are less successful in controlling lingual splaying.
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Affiliation(s)
- Mohamed Abd El-Rahman Abdou Ata
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Phone: +201001706755, e-mail: , https://orcid.org/0009-0009-0298-8335
| | | | - Mohamed Abdel-Monem Tawfik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ziad Mohamed Amr Elmissiry
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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Rivis M, Juncar RI, Moca AE, Moca RT, Juncar M, Țenț PA. Patterns of Mandibular Fractures through Human Aggression: A 10-Year Cross-Sectional Cohort Retrospective Study. J Clin Med 2023; 12:4103. [PMID: 37373796 DOI: 10.3390/jcm12124103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
The World Health Organization considers the victims of interpersonal violence to be a medical priority. In order to provide services at the highest level, we aimed to evaluate the patterns of maxillofacial fractures caused by interpersonal violence, in order to treat, counsel and guide these patients. This retrospective study was conducted in 478 patients with mandibular fractures caused by interpersonal violence over 10 years in a university clinic. The most affected were male patients (95.19%), 20-29 years of age (46.86%), under the influence of alcohol (83.26%) and without education (43.9%). The majority of mandibular fractures were displaced (89.3%) and intraorally open (64.0%). The most frequent location was the mandibular angle (34.84%). The most frequent soft tissue lesions were hematomas (45.04%) and abrasions (34.71%), being associated frequently with closed (p = 0.945/p = 0.237), displaced (p = 0.001/p = 0.002), single angle fractures (p = 0.081/p = 0.222). Educating the population and fighting alcohol consumption would decrease the occurrence of mandibular fractures through aggression. Clinical diagnosis should be made, keeping in mind that the severity of associated soft tissue lesions is directly proportional to the pattern and number of underlying fracture lines.
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Affiliation(s)
- Mircea Rivis
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeș" University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 30041 Timișoara, Romania
| | - Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Rahela Tabita Moca
- Doctoral School of Biomedical Sciences, University of Oradea, 1 Universității Street, 410087 Oradea, Romania
| | - Mihai Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
| | - Paul Andrei Țenț
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania
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Pankratov AS, Gotsiridze ZP, Karalkina MA. Experience Of Using Internal Fixation In The Treatment Of Patients With Inflammatory Complications Of Mandibular Fractures: A Retrospective Study. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Study goal — To evaluate the efficacy of plate osteosynthesis in the treatment of patients with inflammatory complications of mandibular fractures on a large sample. Material and Methods — We conducted a retrospective analysis of medical records collected over 15 years in a group of patients with inflammatory complications of mandibular fractures. The analysis included medical records of patients who underwent plate osteosynthesis operations performed according to the surgical algorithm adopted in the clinic, in combination with a simultaneous directed antibacterial effect on the microflora of the pathological focus and osteoplastic replacement of defects. We identified 164 medical records meeting the search criteria distributed among two study groups. Group A included hospitalized patients with developed abscesses and phlegmons of soft tissues surrounding the fracture area. For them, two-stage surgical intervention was performed. Group B consisted of patients who had no suppurative process in soft tissues, which allowed them undergoing one-stage surgical treatment. Results — Good, satisfactory, and unsatisfactory surgical outcomes were obtained in 82.6%, 14.9%, and 2.4% of the patients, respectively. The differences between the comparison groups were not statistically significant. Conclusion — The clinical effectiveness of an integrated approach to the surgical treatment of patients with inflammatory complications of mandibular fractures, based on providing stable fixation of connected fragments as a critical factor in bone wound healing via osteosynthesis, was confirmed on large samples in both comparison groups.
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Affiliation(s)
- Alexander S. Pankratov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | | | - Maria A. Karalkina
- A.L. Myasnikov Research Institute of Clinical Cardiology, Moscow, Russia
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Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia. Saudi Dent J 2022; 34:772-778. [PMID: 36570582 PMCID: PMC9767832 DOI: 10.1016/j.sdentj.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Maxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center. Methods A retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period. Results Among the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females. Conclusion Our study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.
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Retrospective clinical study of mandible fractures. Maxillofac Plast Reconstr Surg 2022; 44:36. [PMID: 36322224 PMCID: PMC9628403 DOI: 10.1186/s40902-022-00365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background As society becomes more complex, the incidence of mandibular fractures is increasing. This study aimed to analyze the incidence and type and identify etiological factors of mandibular fractures to use them in future treatments. Material and methods Data were collected from 224 patients who visited the department of oral and maxillofacial surgery at the Kyung Hee Medical Center dental hospital during a 6-year period (2016 to 2021). A logistic regression model was used for data analysis. Results In a total of 224 patients, 362 fractures were appeared. The average age of the patients was 34.1 years, with the highest incidence in the 20s. And the ratio between male and female was 4.09:1. Symphysis fractures were the most prevalent of all patients (52.7%), followed by unilateral condyle (37.1%), angle (36.2%), bilateral condyle (9.4%), body (8%), and coronoid (2.2%). The most common cause of fracture was daily-life activity (57.6%), followed by violence (30.4%), traffic accidents (8.5%), and syncope (3.6%). Patients with symphysis fracture were at low risk (OR < 1) of angle, body, and unilateral condyle fractures. Similarly, patients with unilateral fracture were at low risk (OR < 1) of symphysis, angle, body, and others site fractures. In contrast, patient with bilateral condyle fracture were at high risk (OR > 1) of coronoid fractures. And younger patients were high risk of mandibular angle fractures. Conclusion Through this study, it was confirmed that etiological factors of mandibular fractures were like those of previous studies.
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Aleksanyan LV, Poghosyan AY, Misakyan MS, Minasyan AM, Bablumyan AY, Tadevosyan AE, Muradyan AA. Epidemiology of maxillofacial injuries in "Heratsi" No 1 university hospital in Yerevan, Armenia: a retrospective study. BMC Oral Health 2022; 22:123. [PMID: 35413822 PMCID: PMC9002220 DOI: 10.1186/s12903-022-02158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to perform a retrospective analysis of the prevalence, etiologies, types of maxillofacial injuries (MFIs), sites of maxillofacial fractures (MFFs) and their management in Yerevan, Armenia.
Methods A retrospective cross-sectional study was conducted. The extracted data included age, sex, date of referral, mode of injury, etiology, radiology records and treatment methods. Study outcomes were measured using percentages, means, standard deviations and tests of proportions. P < .05 was considered significant. Results A total of 204 patients had a mean age of 36.26 ± 1.08 years (156 males and 48 females), and a total of 259 MFIs were recorded between 2017 and 2020. Interpersonal violence was found to be the most common etiology of MFFs in this study (42.1%), followed by road traffic accidents (RTAs) (27.9%) and falls (18.6%). The nasal bone was the most common injury site (47.5%), followed by the mandible (31.4%) and zygomatic complex (11.7%). The most common fracture site was the mandibular angle (37.9%), followed by the symphysis/parasymphysis (28.1%) and body (12.6%). Isolated soft tissue injuries were reported in 5.9% of the cases. The majority of MFFs were treated by open reduction and internal fixation. Conclusion Interpersonal violence, followed by RTAs and falls, was the most common cause of MFIs. Males in the 21–30 years age group had the highest MFI incidence rate. The nasal bone was the most common injury site, followed by the mandible and zygomatic complex. Social education with the objective of reducing aggression and interpersonal conflict should be improved, and appropriate RTA prevention strategies should be strengthened and implemented.
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Affiliation(s)
- Lusine V Aleksanyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia
| | - Anna Yu Poghosyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia.
| | - Martin S Misakyan
- Department of ENT and Maxillofacial Surgery, Yerevan State Medical University, "Heratsi" No 1 Hospital, 60 Abovyan Str., 0025, Yerevan, Armenia
| | - Armen M Minasyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Aren Yu Bablumyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Artashes E Tadevosyan
- Department of Public Health and Healthcare, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
| | - Armen A Muradyan
- Administrative Department, Yerevan State Medical University, 2 Koryun Str., 0025, Yerevan, Armenia
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Hino S, Iizuka T, Saulacic N, Lang NP, Burkhard JPM. No apparent association between dental implants and mandibular fractures resulting from external forces. Clin Oral Investig 2021; 26:2065-2072. [PMID: 34559318 DOI: 10.1007/s00784-021-04188-w] [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: 06/29/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Dental implants are cylindrical metallic screws inserted into the jawbone to replace missing teeth. Their location may affect the pattern of fractures that occur as a result of the traumatic forces to the mandible. The aim of this study was to investigate possible influences of dental implants on the patterns of mandibular fractures triggered by external forces. MATERIAL AND METHODS In this observational cross-sectional study, a total of 390 patients with mandibular fractures diagnosed between February 2016 and December 2020 were examined and the presence or absence of dental implants in the fracture gap was noted. Clinical and radiological data were analyzed in relation to the fracture line, the dental status, and the location of any implants. RESULTS A total of 16 patients (4.1%) had previously placed dental implants in the mandible. Various fracture patterns were observed. Some yielded typical fracture lines located in the anatomically weak areas along the roots of the incisors, the mental foramina, and long-rooted molars. Occasionally, fracture lines were detected in combination with condylar fractures. Dental implants were not directly involved in any fracture line, except one. In that case, the fracture line extended from the alveolar process straight along the implant body, mimicking initial disintegration of the implant, with erosion of the surrounding bone. CONCLUSIONS Once dental implants have osseointegrated, mandibular fractures are rarely projected along the implant surface. CLINICAL RELEVANCE This observational retrospective cross-sectional study failed to associate mandibular fracture lines with the presence of dental implants.
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Affiliation(s)
- Shunsuke Hino
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama , 350-8550 , Japan.
| | - Tateyuki Iizuka
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Nikola Saulacic
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Niklaus P Lang
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - John-Patrik M Burkhard
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Hino S, Yamada M, Araki R, Kaneko T, Iizuka T, Horie N. What Are Possible Contributors to Associated Dental Injury in Mandibular Fractures? J Oral Maxillofac Surg 2021; 80:127-136. [PMID: 34627743 DOI: 10.1016/j.joms.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries. METHODS This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables. RESULTS Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P = .003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P = .02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P = .045). CONCLUSIONS A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries.
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Affiliation(s)
- Shunsuke Hino
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan; Clinical and Scientific Fellow, Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Miki Yamada
- Instructor, Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Ryuichiro Araki
- Adjunct Assistant Professor, Medical Education Center, Saitama Medical University, Saitama, Japan
| | - Takahiro Kaneko
- Professor and Chair, Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tateyuki Iizuka
- Professor and Chair, Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Norio Horie
- Professor, Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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