1
|
Aditya NK, Krishnan B. Factors contributing to non-union amongst dentate mandibular fractures treated by load-sharing miniplate osteosynthesis: A case-control study. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00110-4. [PMID: 38866687 DOI: 10.1016/j.bjoms.2024.05.003] [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: 01/22/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
The stability provided by load-sharing miniplate osteosynthesis (LSMO) in dentate mandibular fractures (DMF) is usually adequate for bony healing. Non-union following LSMO is an uncommon complication. We aimed to determine the incidence and identify contributing factors, if any, of non-union amongst DMFs that have undergone LSMO. This retrospective case-control study with an allocation ratio of 1:3 includes cases of non-union DMF following LSMO and controls with healed DMF following LSMO over a five-year period. Relevant sociodemographic data, mandibular fracture characteristics, and treatment variables were collected for both groups. Of the 381 patients who underwent LSMO for DMFs, 12 cases of non-union were identified. The control group included 36 patients with uncomplicated healing. A significant association was observed between non-union and teeth in the line of fracture, postoperative infections, and time from injury to LSMO. The odds ratio with chronic alcohol usage was 1.4. Vigilant follow up of patients with chronic alcohol use, those with teeth in the fracture line, and adherence to LSMO principles may help to minimise the non-union complication.
Collapse
Affiliation(s)
- N K Aditya
- Senior Resident, Oral and Maxillofacial Surgery, Dept of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - B Krishnan
- Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| |
Collapse
|
2
|
Rikhotso RE, Mohotlhoane GP. The Effect of Duration of Antibiotic Prophylaxis on Infections Following Open Reduction and Internal Fixation of Mandibular Fractures: A Prospective Randomized Clinical Trial. J Craniofac Surg 2024; 35:185-188. [PMID: 37870535 DOI: 10.1097/scs.0000000000009784] [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: 06/17/2023] [Accepted: 08/25/2023] [Indexed: 10/24/2023] Open
Abstract
AIM To evaluate the benefits of a long-term prophylactic antibiotic regimen following treatment of fractured mandibles with open reduction and internal fixation. MATERIAL AND METHODS A prospective, randomized controlled trial was undertaken at Wits Oral Health Centre. Patients with mandibular fractures who were managed with open reduction and internal fixation using miniplates were randomized into 2 groups. The control group, the perioperative antibiotic (POA) group, was composed of patients who received intravenous (IV) antibiotic cover intraoperatively and a further 3 IV doses 24 hours postoperatively. The study group, the extended postoperative antibiotic (EPOA), was composed of patients who received similar doses as the control group but with an additional 5 days of oral antibiotics upon discharge. The patients were then evaluated for evidence of infection 1, 4, and 6 weeks postoperatively. RESULTS A total of 77 patients were included in the study, 41 in the POA and 36 in the EPOA groups. Fourteen patients had evidence of infection noted within the 6-week follow-up period (10 in the POA and 4 in the EPOA groups). Statistical analysis with the Pearson Chi-square and Student t test showed no statistically significant difference ( P =0.399) between POA and EPOA groups. There were no significant differences between the groups with respect to site and etiology of fracture, duration of operation, and presence of infection ( P >0.05) during the 6-week review period. CONCLUSIONS The extended use of antibiotic prophylaxis when managing mandibular fractures with open reduction and internal fixation offers no additional benefit in reducing postoperative infections.
Collapse
Affiliation(s)
- Risimati E Rikhotso
- Department of Maxillofacial and Oral Surgery, School of Oral Health Science, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Kent S, Adatia A, James P, Bains K, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P. Risk factors associated with short-term complications in mandibular fractures: the MANTRA study-a Maxillofacial Trainee Research Collaborative (MTReC). Oral Maxillofac Surg 2023; 27:609-616. [PMID: 35788932 PMCID: PMC10684408 DOI: 10.1007/s10006-022-01096-5] [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: 03/14/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. METHODS The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. RESULTS Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. DISCUSSION We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.
Collapse
Affiliation(s)
- S Kent
- University Hospital of Wales, Cardiff, UK.
| | - A Adatia
- Aintree University Hospital, Liverpool, UK
| | - P James
- Aintree University Hospital, Liverpool, UK
| | - K Bains
- Aintree University Hospital, Liverpool, UK
| | - A Henry
- Swansea Bay University Health Board, Swansea, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, Stafford, UK
| | - B Dawoud
- North Manchester General Hospital, Manchester , UK
| | - D Kumar
- Liverpool Medical School, Liverpool, UK
| | - C Jefferies
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Kyzas
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Sundheepkumar V, Saravanan R, Krishnan B. INFECTIOUS COMPLICATIONS IN COMPOUND MANDIBULAR FRACTURES UNDERGOING A DELAYED SURGICAL INTERVENTION - A PROSPECTIVE OBSERVATIONAL STUDY. Br J Oral Maxillofac Surg 2023; 61:302-308. [PMID: 37061417 DOI: 10.1016/j.bjoms.2023.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
The aim of this prospective study was to analyse if a delay in the time from injury to definitive surgical intervention of open reduction and internal fixation (ORIF) of compound mandibular fractures predisposed to an increase in postoperative infectious complications. ORIF beyond 72 hours from injury was considered to be delayed intervention. Postoperative surgical site infections (SSI) and non-infectious complications (NIC) were recorded. The Mann-Whitney U test was used to compare the delay in ORIF with SSI. The chi squared test/Fisher's exact test was used to find the association of the infectious complication status with predetermined risk factors. Eighty-three patients underwent a delayed ORIF with a median (range) of 8 (4-19) days. SSI was documented in eight patients (9.6%) and could be managed as outpatient medical and surgical intervention. Two patients needed repeat surgical intervention due to non-union of the fracture. The median (range) time to ORIF was 6.5 (5-12) days in patients who developed SSI; the Mann-Whitney U test did not show a statistically significant association between delayed ORIF and SSI (p = 0.7). The univariate analysis did not establish a significant relationship between SSI and predetermined risk factors. The delay to definitive surgical intervention was not observed to be an independent attributing factor in postoperative infectious complications of compound mandibular fractures.
Collapse
|
7
|
Certa M, Chapple AG, Khalifa A, Christensen BJ. Does a Short Period of Maxillomandibular Fixation Decrease Complications in Open Reduction Internal Fixation of Mandibular Angle Fractures? J Oral Maxillofac Surg 2023; 81:406-412. [PMID: 36610701 DOI: 10.1016/j.joms.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE A short duration of postoperative maxillomandibular fixation (MMF) has the potential to reduce complications following open reduction and internal fixation (ORIF) of mandibular angle fractures. The purpose of this study was to determine if a short duration of MMF is associated with a reduced rate of postoperative inflammatory complications (POICs) in patients with mandibular angle fractures undergoing ORIF. METHODS The authors conducted a retrospective cohort study consisting of patients treated with ORIF for mandibular angle fractures from August 1, 2015 to May 31, 2020 at an urban, level 1 trauma center. Patients under the age of 18 years, bilateral angle fractures, those with MMF periods of more than 3 weeks, and those patients without documentation of the duration of MMF were excluded from the study. The primary predictor variable was the use of a short duration (less than 2 weeks) of postoperative MMF. The outcome variable of interest was the presence of POICs. Categorical covariates were compared using Fisher's exact tests, while continuous variables were compared using Wilcox rank-sum tests. Multivariable logistic regression adjustment was also performed. RESULTS There were 307 patients included in the study, 84.4% of which were men. The average age was 32.5 years. Patients with a short duration of MMF had a POIC rate of 8.3% compared to 18.2% for no MMF (P = .08). In the adjusted analysis, patients with a short duration of MMF time had a significant decrease in POIC risk compared to no MMF (adjusted odds ratio [aOR] = 0.32, 95% confidence interval [CI] = 0.11 to 0.97). Other significant variables in the regression analysis included plating type and noncompliance. Inferior border rigid fixation was associated with decreased POIC risk compared to ladder plates and lateral border plates (aOR 5.8, 95% CI = 1.8 to 18.4 and aOR 5.1, 95% CI = 1.4 to 18.7, respectively). CONCLUSION The findings from our study suggest that a short duration of postoperative MMF may reduce POICs following ORIF of mandibular angle fractures.
Collapse
Affiliation(s)
- Michael Certa
- Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Andrew G Chapple
- Assistant Professor, Department of Interdisciplinary Oncology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Ali Khalifa
- Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Brian J Christensen
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| |
Collapse
|
8
|
Bicsák Á, Abel D, Berbuesse A, Hassfeld S, Bonitz L. Evaluation of Mandibular Fractures in a German Nationwide Trauma Center Between 2015 and 2017. J Maxillofac Oral Surg 2022; 21:904-910. [PMID: 36274900 PMCID: PMC9474798 DOI: 10.1007/s12663-021-01513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022] Open
Abstract
Introduction This study analyses the treatment of isolated mandibular fractures between 1.1.2015 and 21.31.2017 at Dortmund General Hospital. Materials and Methods Patient documentation and radiological images have been assessed, and a descriptive statistical analysis has been performed. Results Three hundred and twenty-eight patients were identified with isolated mandibular fractures (259 male, 69 female). The male-to-female ratio is 3.75: 1. A total of 541 fracture sites have been identified (1.65 fractures/patient). Forty of these were observed in the dentoalveolar region (fracture of the alveolar process, dental injuries), and the other 501 injuries were distributed in the remaining parts of the lower jaw.A detailed analysis of the osteosynthesis implants is provided. A total of 20 serious complications were observed (6% in all primary cases, 4.5% without osseointegrated implants). Discussion The demographic data and the anatomical distribution of the fracture sites are comparable with international literature. Dentoalveolar injuries mostly occur in younger patients. The complication rate in this study (4.5%) is below the international data; however, we found a considerably higher rate than in the midfacial region (central midface: 0%, lateral midface: 1.43%). Despite this complication rate, the procedure can be considered safe. Supplementary information The online version of this article (10.1007/s12663-021-01513-4).
Collapse
Affiliation(s)
- Ákos Bicsák
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
- Department of Oral- and Maxillofacial Surgery, General Hospital Dortmund, Muensterstrasse 240, 4145 Dortmund, Germany
| | - Dietmar Abel
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| | - Anna Berbuesse
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| | - Stefan Hassfeld
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| | - Lars Bonitz
- Clinics of Oral- and Maxillofacial Surgery, Plastic Operations, General Hospital Dortmund, Department of the University of Witten-Herdecke, Dortmund, Germany
| |
Collapse
|
9
|
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: 0.7] [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.
Collapse
|
10
|
Ahmed A, Wu E, Sarai R, Williams R, Breeze J. Potentially modifiable patient factors in mandible fracture complications: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 60:266-270. [PMID: 35183372 DOI: 10.1016/j.bjoms.2021.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
The mandible is the most common bone to develop complications following treatment of facial fractures. This is due to a complex interaction of both fracture specific and patient factors. Our aim was to identify those patient factors, with a specific focus on those that may be potentially modifiable to reduce the incidence of complications. A systematic review of the literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology to identify patient factors ascribed to an increased risk of complications following the treatment of mandibular fracture. These were divided into non- modifiable and potentially modifiable factors. A meta-analysis was performed to weight those factors for which statistical analysis had been performed. Twenty-two pertinent papers were identified, of which eight described non-modifiable and seven potentially modifiable factors. The most common potentially modifiable factor identified was smoking. Meta-analysis established that tobacco smoking demonstrated an increased risk of complications in three studies (Odds Ratio: 4.04 - 8.09). Division of patient factors into those that are potentially modifiable and those that are not will enable clinicians to focus on those in which change within the immediate postoperative period can be instigated. This includes smoking cessation assistance, education as to the need for a soft diet, and facilitating postoperative clinic attendance. It also enables stratification of risk in terms of consent, and choice of treatment. Further research should use standardised terminology, particularly in stopping the use of generalisable terms such as patient compliance and instead describing its individual components.
Collapse
Affiliation(s)
- Asad Ahmed
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Eiling Wu
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Rupinder Sarai
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - Rhodri Williams
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| | - John Breeze
- Department of Maxillofacial Surgery, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom; Royal Centre for Defence Medicine, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom.
| |
Collapse
|
11
|
Certa M, Chapple AG, Christensen BJ. Is Screw-Fracture Proximity or Residual Fracture Displacement Correlated to Outcomes After Open Reduction and Internal Fixation of Mandibular Angle Fractures? J Oral Maxillofac Surg 2021; 79:2091-2102. [PMID: 34171226 DOI: 10.1016/j.joms.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Computed tomography (CT) imaging is commonly obtained following open reduction and internal fixation (ORIF) of mandibular fractures but the significance of common findings is unknown. The purpose of this study is to examine the relationship of screw-to-fracture proximity and residual fracture displacement to post-operative complications following ORIF of mandibular angle fractures treated with monocortical fixation techniques. METHODS The authors conducted a retrospective cohort study consisting of all patients with mandibular angle fractures treated with ORIF using monocortical fixation at the lateral surface of the mandible from the dates August 1, 2015 to May 31, 2020. The predictor variables were the distance measurements between the 2 closest screws to the fracture and the fracture line and the amount of residual fracture displacement, both measured on post-operative CT. The primary outcome variable was the presence of postoperative inflammatory complications (POICs). Statistical analysis was performed using logistic regression and Bayesian variable selection to calculate posterior probability of importance for the variables of interest. RESULTS Of the 285 patients included in the study, 84.6% were men and the average age was 30.8 years. POICs occurred in 22.1% of the patients. Age, smoking, homelessness, noncompliance and drug use were associated with POICs. However, none of the screw-to-fracture distances were associated with POICs, including linear, dichotomous or polynomial transformations of these variables. Additionally, the residual fracture displacement distances and transformations of these distances were also not associated with POICs. CONCLUSION The present study did not find any evidence to suggest that a closer screw-fracture distance or increased residual fracture displacement on postoperative CT imaging increased the risk of POICs for mandibular angle fractures treated with ORIF using monocortical fixation at the lateral border.
Collapse
Affiliation(s)
- Michael Certa
- Resident, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Andrew G Chapple
- Assistant Professor, Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Brian J Christensen
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| |
Collapse
|
12
|
Krastl G, Weiger R, Filippi A, Van Waes H, Ebeleseder K, Ree M, Connert T, Widbiller M, Tjäderhane L, Dummer PMH, Galler K. Endodontic management of traumatized permanent teeth: a comprehensive review. Int Endod J 2021; 54:1221-1245. [PMID: 33683731 DOI: 10.1111/iej.13508] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
The pulp plays a key role in the treatment of traumatic dental injuries (TDIs) and is strongly associated with the outcome, particularly in severe cases. A correct pulp diagnosis is essential as it forms the basis for developing the appropriate management strategy. However, many TDIs are complex, and their treatment requires a profound knowledge of the physiological and pathological responses of the affected tissues. This comprehensive review will look at the dentine-pulp complex and its interaction with the surrounding tissues following TDIs. The literature up to 2020 was reviewed based on several searches on PubMed and the Cochrane Library using relevant terms. In addition to the recently revised guidelines of the International Association of Dental Traumatology, this article aims to provide background information with a focus on endodontic aspects and to gather evidence on which a clinician can make decisions on the choice of the appropriate endodontic approach for traumatized permanent teeth.
Collapse
Affiliation(s)
- G Krastl
- Department of Conservative Dentistry and Periodontology, Center of Dental Traumatology, University Hospital of Würzburg, Würzburg, Germany
| | - R Weiger
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - A Filippi
- Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland.,Department of Oral Surgery, University School of Dental Medicine, Basel, Switzerland
| | - H Van Waes
- Department of Paediatric Dentistry, Clinic for Orthodontics and Paediatric Dentistry, University of Zürich, Zürich, Switzerland
| | - K Ebeleseder
- University Clinic of Dental Medicine and Oral Health, Medical University Graz, Graz, Austria
| | - M Ree
- Private Practice, Purmerend, Netherlands
| | - T Connert
- Department of Periodontology, Endodontology and Cardiology, University School of Dental Medicine, Basel, Switzerland.,Center of Dental Traumatology, University School of Dental Medicine, Basel, Switzerland
| | - M Widbiller
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| | - L Tjäderhane
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Research Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital, University of Oulu, Oulu, Finland
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - K Galler
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
13
|
Mahdian M, Talari H, Moussavi N, Hoseinzadeh A, Akbari H, Shaghaghi T. Wisconsin criteria and necessity for computed tomography in patients with maxillofacial trauma: A diagnostic value study. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
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: 9] [Impact Index Per Article: 2.3] [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.
Collapse
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
| |
Collapse
|
15
|
Murnan EJ, Christensen BJ. Risk Factors for Postoperative Inflammatory Complications After Maxillofacial Reconstruction Using Polyether-Ether-Ketone Implants. J Oral Maxillofac Surg 2020; 79:696.e1-696.e7. [PMID: 33121947 DOI: 10.1016/j.joms.2020.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Polyether-ether-ketone (PEEK) implants are increasingly used for the reconstruction of craniomaxillofacial deformities, but limited data exist on their limitations or risk factors for complications associated with their use. The purpose of the present study was to identify risk factors for postoperative inflammatory complications (POICs) after the use of PEEK implants in craniomaxillofacial reconstruction. METHODS A retrospective cohort study was conducted, incorporating all patients treated with patient-specific PEEK implants at the authors' institution from August 1, 2012 to June 30, 2019. The outcome variable was the presence of POICs. The potential predictor variables were demographic, medical, anatomic, and treatment related. Statistical analysis was performed using Fisher exact tests, t tests, and multivariable logistic regression analysis where appropriate. RESULTS The 32 patients included in the study were composed of 68.8% men; mean age was 40.6 years. The PEEK implant was placed adjacent to the paranasal sinuses in 56.3% of patients. The indication for use was malar depression in 50.0%, orbital dystopia in 46.9%, forehead or skull defects in 21.9%, and mandibular contour deformities in 6.2%; 8 patients had more than 1 indication. The overall rate of POICs was 28.1%. Of the POICs, 66.7% were managed with incision and drainage, revision surgery, or removal and 33.3% were managed with outpatient wound care or antibiotics. Tobacco use, the presence of an intraoral incision, and the presence of multiple incisions were all associated with POICs. On multivariable analysis, tobacco use approached significance (odds ratio, 17.3 [95% confidence interval, 0.98 to 306.7]) and multiple incisions (odds ratio, 6.9 [95% confidence interval, 1.5 to 32.3]) had a statistically significant association with the occurrence of complications. CONCLUSIONS The present study identified several variables potentially associated with complications after the use of PEEK implants in maxillofacial reconstruction. Consideration should be given in the preoperative evaluation when a smoker is identified and when multiple incisions are planned.
Collapse
Affiliation(s)
- Eric J Murnan
- Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Brian J Christensen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| |
Collapse
|
16
|
Hsieh TY, Funamura JL, Dedhia R, Durbin-Johnson B, Dunbar C, Tollefson TT. Risk Factors Associated With Complications After Treatment of Mandible Fractures. JAMA FACIAL PLAST SU 2020; 21:213-220. [PMID: 30676610 DOI: 10.1001/jamafacial.2018.1836] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Complications that arise after treatment of mandible fractures can result in significant morbidity. Identifying modifiable risk factors associated with these complications is valuable in guiding clinical practice for improved patient outcomes. Objective To describe the risk factors associated with complications in patients undergoing treatment for mandible fracture. Design, Setting, and Participants A retrospective review was conducted of 137 patients presenting to a tertiary care, level 1 trauma center with mandible fractures between January 1, 2014, and January 1, 2017. Outcomes and demographic characteristics for patients with at least 3 weeks of follow-up were compared using multivariate logistic regression analysis. Results Of the 137 patients meeting inclusion criteria, there were 113 males (82.5%) and 24 females (17.5%), with a mean (SD) age at presentation of 32.3 (15.7) years. Median follow-up was 71 days (range, 22-1189 days). Postoperative complications were identified in 29 patients (21.2%); complications included wound dehiscence or surgical site infection (n = 17), bony nonunion (n = 5), and hardware exposure (n = 13). Complications were managed surgically in 19 patients and nonsurgically in 10 patients. On univariate analysis, the initial surgery was completed later (mean [SD], 5.9 [6.6] days after injury) in patients who developed complications than in those who did not (mean [SD], 3.8 [4.0] days). On multivariate analysis, complications were associated with increased time from injury to treatment (odds ratio [OR], 1.60; 95% CI, 1.02-2.53; P = .04), tobacco use (OR, 8.10; 95% CI, 1.26-52.00; P = .03), and dental extraction (OR, 93.00; 95% CI, 1.19 to >999.00; P = .04). Residence in the same city as the medical center was associated with fewer complications (OR, 0.08; 95% CI, 0.01-0.69; P = .02). Conclusions and Relevance In a 3-year review of mandible fractures managed at a single academic center, complications were associated with an increased time to treatment, tobacco use, dental extraction, and living farther from the treatment facility. On a systems level, the results of this study suggest that expediting intervention for mandible fractures may improve outcomes. Level of Evidence 3.
Collapse
Affiliation(s)
- Tsung-Yen Hsieh
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | - Jamie L Funamura
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | - Raj Dedhia
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | | | - Chance Dunbar
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| | - Travis T Tollefson
- Department of Otolaryngology-Head & Neck Surgery, University of California, Davis, Sacramento
| |
Collapse
|
17
|
Khavanin N, Jazayeri H, Xu T, Pedreira R, Lopez J, Reddy S, Shamliyan T, Peacock ZS, Dorafshar AH. Management of Teeth in the Line of Mandibular Angle Fractures Treated with Open Reduction and Internal Fixation. Plast Reconstr Surg 2019; 144:1393-1402. [DOI: 10.1097/prs.0000000000006255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Song JM, Shin SH, Lee JY. Risk factors for hypesthesia after repair of facial fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:366-372. [PMID: 31227454 DOI: 10.1016/j.oooo.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/12/2019] [Accepted: 05/10/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the incidence of hypesthesia in patients with facial bone fractures and to identify the relationships between posttraumatic hypesthesia and risk factors, including general and fracture-related characteristics. STUDY DESIGN A total of 437 patients who underwent surgery for facial bone fractures were included. Clinical neurosensory testing was performed at different time points (immediately after trauma and 1 week, 1 month, and 6 months after surgery). The results of these assessments were compared with regard to characteristics and fracture sites. RESULTS The hypesthesia incidences were highest in the mandible (19.1%), maxilla (18.3%), and orbit (8.5%). Sensation was recovered by 97.3% of all patients by 6 months after surgery. Risk factors for hypesthesia were direct nerve injury (P = .002), distance (≤10 mm) between the fracture and nerve foramen (P = .002), the amount of bony displacement (P = .035), and age (P = .004). There were significant differences among the fracture sites. CONCLUSIONS Posttraumatic hypesthesia increased temporarily after surgery, but most patients recovered by 6 months postoperatively. Recovery from postoperative hypesthesia was related to the fracture site and pattern. Cases in which the patient did not recover involved direct nerve injury.
Collapse
Affiliation(s)
- Jae Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea; (Bio)medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Jae Yeol Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, Yangsan, Korea; Institute of Translational Dental Sciences & Dental Research Institute, Pusan National University, Yangsan, Korea.
| |
Collapse
|
19
|
Nishimoto RN, Dodson TB, Lang MS. Is the Mandible Injury Severity Score a Valid Measure of Mandibular Injury Severity? J Oral Maxillofac Surg 2019; 77:1023-1030. [DOI: 10.1016/j.joms.2018.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/26/2022]
|
20
|
|
21
|
Moura LB, Dos Santos Trento G, de Azambuja Carvalho PH, Granucci M, de Oliveira JCS, Pereira-Filho VA. Double unilateral, bilateral, and multiple mandibular fractures: an observational study. Oral Maxillofac Surg 2018; 22:315-321. [PMID: 30109520 DOI: 10.1007/s10006-018-0713-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/08/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Double and multiple mandibular fractures are associated to high morbidity and functional damage. This study aimed to evaluate the characteristics and outcomes of double unilateral, bilateral, and multiple mandibular fractures. METHODS A 7-year observational retrospective analysis was performed, and the injury-related data were collected from the medical records. Statistical analysis was performed using Fisher's exact test (p < 0.05). RESULTS In this period, 283 patients showed mandibular fractures. Of them, 83 (29.7%) had double or multiple mandibular fractures and were included in the study. Double bilateral fractures were more prevalent than multiple or double unilateral. Multiple fractures presented significant association with the combination of load-bearing and load-sharing fixation protocols. Most cases (94.0%) applied at least one type of internal fixation system. However, there was a positive association between condylar fractures and non-surgical treatment (p < 0.01). Moreover, mandibular body fractures were associated with load-bearing fixation (p < 0.01). In 56 cases, no complications were observed (67.5%). Complications were divided into treatment failure (10.8%) and transitory or minor complications (21.7%). There was no statistical association between complications and fracture pattern, fracture-tooth relation, and treatment modality. CONCLUSION Double and multiple mandibular fractures represented almost one third of all mandibular fractures, and regardless to treatment protocol, there was no difference about complications. Moreover, although a considerable complication rate was found, most of them were minor or transitory.
Collapse
Affiliation(s)
- Lucas Borin Moura
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil.
| | - Guilherme Dos Santos Trento
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Pedro Henrique de Azambuja Carvalho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Mariana Granucci
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Júlio César Silva de Oliveira
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| | - Valfrido Antonio Pereira-Filho
- Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, Dental School at Araraquara, UNESP - São Paulo State University, Rua Humaitá, 1680, Araraquara, SP, 14801-903, Brazil
| |
Collapse
|
22
|
Subramaniam S, Febbo A, Clohessy J, Bobinskas A. Retrospective analysis of postoperative interventions in mandibular fractures: a shift towards outpatient day surgery care. Br J Oral Maxillofac Surg 2018; 56:486-489. [PMID: 29754748 DOI: 10.1016/j.bjoms.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/08/2018] [Indexed: 11/16/2022]
Abstract
The management of fractured mandibles typically involves admission and operation at the time of presentation. While this should involve only a short stay in hospital these patients are surgically stable, and so priority is often given to more urgent cases. We retrospectively evaluated the postoperative medical requirements of patients who were operated on at Fiona Stanley Hospital, Perth, Western Australia between 1 January 2015 and 31 December 2016. Patients were excluded if they had had multiple facial fractures, multiple injuries, had fractures that were comminuted or in edentulous mandibles, and those who had been in hospital for preoperative medical investigations and care. We also excluded fractures in children aged 16 years and under. The results showed that of a total of 173 patients, 12 had had medical consultations during their hospital stay, and only four had required intervention. The mean (range) preoperative time was 37 (1 - 46) hours and that from operation to discharge 21.5 (2 - 93) hours. While traditional management involves emergency admission and open reduction and internal fixation as soon as possible, delays of up to five days were not associated with appreciably worse outcomes. This, together with the negligible requirements for medical management perioperatively, provides a strong argument for a selected group to be treated as outpatients.
Collapse
Affiliation(s)
- Shiva Subramaniam
- Consultant, Department of Oral and Maxillofacial Surgery, Fiona Stanley Hospital, Murdoch, WA, 6150.
| | - Anthony Febbo
- Registrar, Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth, WA, 6000.
| | - James Clohessy
- Medical Intern and Associate Lecturer, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052.
| | - Alexander Bobinskas
- Consultant, Department of Oral and Maxillofacial Surgery, Fiona Stanley Hospital, Murdoch, WA, 6150.
| |
Collapse
|
23
|
García Carricondo AR, Quesada Bravo FJ, Espín Gálvez F, Parrón Carreño T, Alarcón Rodriguez R. A comparative study between traditional fixation with miniplates and modified lag screws for the treatment of mandibular fractures. Clin Oral Investig 2017; 22:1503-1511. [PMID: 29038962 DOI: 10.1007/s00784-017-2243-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study is to investigate two internal fixation surgical techniques for mandibular fractures in order to compare modified lag screw techniques with standard miniplates. MATERIALS AND METHODS This is an observational prospective study. Three hundred eighteen patients were operated on for mandibular fractures. The patients were divided into two groups according to the type of surgical technique used: modified lag screws (155 patients) and traditional miniplates (163 patients). Analyses were made of sociodemographic and preoperative variables, the parameters related to the fracture type and postoperative data. RESULTS There were no differences between the two groups regarding their sociodemographic characteristics. The modified lag screws were primarily used with double fractures, while conventional miniplates were more often used with simple fractures. The number of complications was higher with the miniplate technique. The unfavorable fractures had an OR of 5.75 due to postoperative complications; double fractures had an OR of 8.87 and simple fractures an OR of 19.53, which, in both cases, were lower with conventional miniplates than with modified lag screws. CONCLUSION Modified lag screws provide a rigid fixation system that is as secure as miniplates, but with greater compression between the fragments, less postsurgical gap, faster ossification, and fewer postoperative complications. CLINICAL RELEVANCE The modified screw technique is a safe tool that does not require any specific osteosynthesis materials not found in a basic traumatology kit and has a lower cost, due to the reduced amount of material used.
Collapse
Affiliation(s)
- Ana Rocío García Carricondo
- Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital Complex, Avd. Torrecardenas No. 80, 04009, Almeria, Spain.
| | - Francisco Javier Quesada Bravo
- Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital Complex, Avd. Torrecardenas No. 80, 04009, Almeria, Spain
| | - Fernando Espín Gálvez
- Department of Oral and Maxillofacial Surgery, Torrecardenas Hospital Complex, Avd. Torrecardenas No. 80, 04009, Almeria, Spain
| | | | | |
Collapse
|