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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] [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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Khiabani K, Amirzade-Iranaq MH. Maxillomandibular fixation miniplate, alternative management for condylar fractures in complete/partial edentulous mandible. ORAL AND MAXILLOFACIAL SURGERY CASES 2023. [DOI: 10.1016/j.omsc.2023.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Guo J, Yao H, Li X, Chang L, Wang Z, Zhu W, Su Y, Qin L, Xu J. Advanced Hydrogel systems for mandibular reconstruction. Bioact Mater 2023; 21:175-193. [PMID: 36093328 PMCID: PMC9413641 DOI: 10.1016/j.bioactmat.2022.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/16/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022] Open
Abstract
Mandibular defect becomes a prevalent maxillofacial disease resulting in mandibular dysfunctions and huge psychological burdens to the patients. Considering the routine presence of oral contaminations and aesthetic restoration of facial structures, the current clinical treatments are however limited, incapable to reconstruct the structural integrity and regeneration, spurring the need for cost-effective mandibular tissue engineering. Hydrogel systems possess great merit for mandibular reconstruction with precise involvement of cells and bioactive factors. In this review, current clinical treatments and distinct mode(s) of mandible formation and pathological resorption are summarized, followed by a review of hydrogel-related mandibular tissue engineering, and an update on the advanced fabrication of hydrogels with improved mechanical property, antibacterial ability, injectable form, and 3D bioprinted hydrogel constructs. The exploration of advanced hydrogel systems will lay down a solid foundation for a bright future with more biocompatible, effective, and personalized treatment in mandibular reconstruction.
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Affiliation(s)
- Jiaxin Guo
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hao Yao
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xu Li
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liang Chang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zixuan Wang
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Wangyong Zhu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Yuxiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Corresponding author. Director of Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Jiankun Xu
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Corresponding author. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Kahveci K, Ayranci F. Finite element analysis of different internal fixation methods for the treatment of atrophic mandible fractures. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 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] [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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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.
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Affiliation(s)
- Daniel Perez
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abstract
Soft and hard tissue engineering has expanded the frontiers of oral/maxillofacial augmentation. Soft tissue grafting enhancements include improving flap prevascularization and using stem cells and other cells to create not only the graft, but also the vascularization and soft tissue scaffolding for the graft. Hard tissue grafts have been enhanced by osteoinductive factors, such as bone morphogenic proteins, that have allowed the elimination of harvesting autogenous bone and thus decrease the need for other surgical sites. Advancements in bone graft scaffolds have developed via seeding with stem cells and improvement of the silica/calcium/phosphate composite to improve graft characteristics and healing.
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Affiliation(s)
- Dolphus R Dawson
- Division of Periodontology, Department of Oral Health Practice, College of Dentistry, University of Kentucky, 800 Rose Street, D-444 Dental Sciences Building, Lexington, KY 40536-0297, USA.
| | - Ahmed El-Ghannam
- Department of Mechanical Engineering and Engineering Science, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223-0001, USA
| | - Joseph E Van Sickels
- Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0297, USA
| | - Noel Ye Naung
- Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0297, USA
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Maloney KD, Rutner T. Virtual Surgical Planning and Hardware Fabrication Prior to Open Reduction and Internal Fixation of Atrophic Edentulous Mandible Fractures. Craniomaxillofac Trauma Reconstr 2019; 12:156-162. [PMID: 31073367 DOI: 10.1055/s-0039-1677723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
Mandibular fractures are a common injury encountered by facial trauma surgeons. A majority of these cases are in dentate patients and can predictably be treated with several different open or closed techniques. Edentulous mandible fractures can be challenging as maxillomandibular fixation, either as the sole treatment or used for fracture reduction and stabilization prior to internal fixation, is not possible. The atrophic edentulous mandible fracture poses an even greater challenge, as there is more sclerotic bone present and less bone volume for bony contact, both of which can impair healing. In addition, with less bone mass, available plate adaptation and fixation are difficult. In recent years, virtual surgical planning (VSP) has been increasingly used in craniofacial and maxillofacial surgeries as well as in dentistry. Utilizing VSP to fabricate the necessary hardware prior to open reduction and internal fixation of atrophic edentulous mandible fractures can be helpful in treating these cases. Two cases where this method was used are presented.
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Affiliation(s)
- Karl Daniel Maloney
- Department of Oral and Maxillofacial Surgery, Morristown Medical Center, Morristown, New Jersey
| | - Torin Rutner
- Department of Oral and Maxillofacial Surgery, Morristown Medical Center, Morristown, New Jersey
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Van Camp P, Gemels B, Heijsters G, Schepers S. Case report of maxillofacial fracture in a patient under bisphosphonates in the absence of ONJ disease: Guidelines? Int J Surg Case Rep 2018; 51:318-322. [PMID: 30245353 PMCID: PMC6153396 DOI: 10.1016/j.ijscr.2018.08.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/20/2018] [Accepted: 08/28/2018] [Indexed: 12/03/2022] Open
Abstract
Case consisting of traumatic fracture in patient under bisphosphonates. No MRONJ, so no pathological fracture. No guidelines available for patients ‘at risk’. Best treatment avoids periosteal stripping. Fixation using external fixation or locking reconstruction plate.
Introduction Inspired by the presented case, this paper investigates treatment options for patients under active bisphosphonate therapy, suffering from a traumatic fracture in the absence of MRONJ (patients classified as ‘at risk’). We review literature in search of standardized protocols and in combination. Presentation of case A 75-year-old woman, suffering from osteoporosis for over a decade and being treated with alendronate for about 10 years, stumbled and fell and ended up with a displaced fracture on the right side of her extremely atrophied mandible. Under general anesthesia, using a limited submandibular approach with minimal reflecting of the periosteum, an external fixation device was placed. The patient recovered well from surgery and was discharged after 2 days. Long term follow-up shows good healing with a mouth opening of 46 mm in the absence of any sensory of functional deficits. Discussion We conclude from our literature review that there are no clear guidelines regarding fixation of traumatic (non-pathologic) maxillofacial fractures in patients under active antiresorptive therapy. Literature suggests that damaging the periosteum needs to be avoided since this would endanger the already fragile blood supply in the area. This could make an intra-oral approach unfavourable. Conclusion We prefer an extra-oral approach whenever possible. The choice between the use of supraperiostally placed locking reconstruction plates or external fixation should be based on the overall medical condition of the patient, the regional osseous anatomy and the specific fracture morphology.
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Batbayar EO, Bos RRM, van Minnen B. A Treatment Protocol for Fractures of the Edentulous Mandible. J Oral Maxillofac Surg 2018; 76:2151-2160. [PMID: 29746839 DOI: 10.1016/j.joms.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The incidence of fractures of edentulous mandibles is relatively low. Knowledge about the management of these fractured edentulous mandibles relies heavily on case reports and observational studies. On the basis of the current literature, we compiled a treatment protocol for fractures of the edentulous mandible and hypothesized that this protocol would result in fewer complications. PATIENTS AND METHODS We conducted a retrospective cohort study of edentulous patients with mandibular fractures. The predictor variable was the fulfillment of the treatment protocol (yes or no). The outcome variables were postoperative complications and reoperations. Patient demographic characteristics were collected from patient records. The χ2 test was used for statistical analysis between predictor and outcome variables. RESULTS Of 61 edentulous mandibular fractures (36 patients), 53 were treated according to the protocol and 8 were not. We observed 4 complications in the first group (complication rate, 7.5% [4 of 53]) and 4 in the second group (complication rate, 50% [4 of 8]). The fracture treatments that followed the protocol had a significantly lower postoperative complication rate (P = .001; odds ratio, 0.082) and needed fewer reoperations (P = .0001; odds ratio, 0.019) compared with the treatments that did not follow the protocol. CONCLUSIONS The results of this study show that following the compiled treatment protocol for fractures of edentulous mandibles significantly reduces postoperative complications and reoperations.
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Affiliation(s)
- Enkh-Orchlon Batbayar
- Research Assistant, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruud R M Bos
- Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Baucke van Minnen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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A historical perspective with current opinion on the management of atrophic mandibular fractures. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:e276-e282. [PMID: 29066066 DOI: 10.1016/j.oooo.2017.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 11/23/2022]
Abstract
The management of atrophic mandibular fractures has been a challenge for maxillofacial surgeons for decades. During the past 70 years, various techniques for treating edentulous mandibular fractures have been advocated. These techniques have been praised, criticized, abandoned, improved, and used in combination with other methods. Although some of the principles of management outlined before the end of World War II are still valid in today's technological era, other concepts did not survive the test of time. The aim of this paper is to examine the evolution of treatment modalities for the management of atrophic mandibular fractures that have been employed over the years. Debates and discussions generated by this topic are included. Current techniques and treatment philosophies with thoughts for future therapies are provided.
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