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Sneha A, Pendem S, Krishnan M, Dhasarathan P, Aravindan V. Impacted Mandibular Fracture: A Report of a Rare Case. Cureus 2023; 15:e38999. [PMID: 37323316 PMCID: PMC10262923 DOI: 10.7759/cureus.38999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/17/2023] Open
Abstract
Representing unusual fracture patterns is extremely important to understand. A 27-year-old male patient with a known history of a road traffic accident with sustained injury reported to the Department of Oral and Maxillofacial Surgery in Saveetha Dental College with pain in the left and right lower jaw region of three days duration. The patient provided a history of frontal impact in the symphysis region after a fall from a two-wheel vehicle. Clinical examination revealed a laceration of 2 cm in the chin region with bilateral pre-auricular swelling and trismus with an anterior open bite. The computed tomography scan revealed a bilateral dicapitular condyle fracture with an oblique impacted fracture of the symphysis with a displaced inferior border and left lingual cortical displacement. Apart from this, an incomplete fracture was evidenced, extending along the inferior border to the right body of the mandible. The fracture site was exposed through the laceration. The impacted mandibular fracture segments were mobilized and fixation was done using a 2 mm five-hole plate at the lower border across the sagittally split segment after placement of maxillomandibular fixation with an arch bar at the alveolar border as a part of tension banding. The oblique lingual fracture was reduced and fixed with a 2 x 14 mm bicortical screw. The primary objective of the current case report is to elucidate an unusual fracture of the mandible and discuss the management of such impacted mandibular fractures.
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Affiliation(s)
- Alladi Sneha
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Sneha Pendem
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Murugesan Krishnan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Pradeep Dhasarathan
- Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, IND
| | - Vedha Aravindan
- Oral and Maxillofacial Surgery, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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Beckstrom TO, Dodson TB, Lang MS. Measuring Adherence to Antibiotic Use Guidelines in Managing Mandible Fractures. J Oral Maxillofac Surg 2023; 81:287-291. [PMID: 36581312 DOI: 10.1016/j.joms.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/29/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Due to variability in practice patterns when managing patients with facial fractures, the Surgical Infection Society's Therapeutics and Guidelines Committee (SIS) released guidelines in June 2020 concerning antibiotic use in the treatment of patients with facial fractures. The purpose of this study was to measure adherence to SIS guidelines among patients treated for isolated mandibular fractures and to identify factors associated with deviation from SIS guidelines. MATERIALS AND METHODS The authors designed and implemented a retrospective cohort study and enrolled a sample derived from the population of patients treated for isolated mandibular fractures at Harborview Medical Center (Seattle, WA) and University of Washington Medical Center-Montlake (Seattle, WA) from June 2020 through October 2021. The primary outcome variable was adherence to SIS antibiotic guidelines (yes or no). Covariates were grouped into the following categories: demographic (age, gender), treatment (operative treatment, primary service, transfer status), and risk factor (Charlson Comorbidity Index, tobacco use, alcohol use, drug use other than marijuana, mandibular injury severity score). Descriptive and bivariate statistics were computed to measure the association between adherence and the study variables. The level of statistical significance was set at a P-value ≤.05. RESULTS The study sample was composed of 114 patients with a mean age of 41.8 ± 19.0 years and 72% were males. The frequency of adherence to SIS antibiotic protocol was 91.2%. Variables associated with deviation from SIS antibiotic protocol were operative treatment (P-value = .03 - relative risk (RR) not calculable), current drug use other than marijuana (RR = 4.1; 95% confidence interval, 1.3-12.8; P-value = .01), and transfer from an outside facility (RR = 4.1; 95% confidence interval, 1.3-12.8; P-value = .01). CONCLUSIONS The findings of this study suggest that the SIS antibiotic guidelines in the management of isolated mandible fractures were translated well into practice at our institution as evidenced by the high level of compliance (>90%). To improve adherence, additional research is indicated to better understand how factors such as treatment choice, drug exposure, and transfer status adversely affect adherence to guidelines.
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Affiliation(s)
- Thomas O Beckstrom
- Resident, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA.
| | - Thomas B Dodson
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
| | - Melanie S Lang
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, University of Washington School of Dentistry, Seattle, WA
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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]
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Hagopian T, Parelli J, Tran L, Abt B, Steed M. A retrospective analysis of mandibular trauma radiology dictations. Oral Radiol 2014. [DOI: 10.1007/s11282-014-0176-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Chambers DW, LaBarre EE. Why Professional Judgment Is Better Than Objective Description in Dental Faculty Evaluations of Student Performance. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.5.tb05720.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Eugene E. LaBarre
- Integrated Reconstructive Dental Sciences; University of the Pacific Arthur A. Dugoni School of Dentistry
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Shankar DP, Manodh P, Devadoss P, Thomas TK. Mandibular fracture scoring system: for prediction of complications. Oral Maxillofac Surg 2012; 16:355-360. [PMID: 22538545 DOI: 10.1007/s10006-012-0326-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 04/11/2012] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Mandibular fractures are one of the most commonly encountered injuries in trauma clinics. Although several widely accepted classification systems exist, these are mostly region specific, differ in the classification criteria used, and are sometimes only correlated with specific treatment modalities, thereby making it impossible to uniformly and comprehensively document facial fracture patterns. In this study, we developed a modified scoring system for mandibular fractures and analyzed the relationship between scoring of fractures that were treated and the incidence of complications after surgical treatment. MATERIALS AND METHODS To evaluate the suitability of the proposed scoring system, a prospective study on a series of 116 patients was performed. All the fractures were classified using the proposed scoring system. The scoring was based on clinical and radiological evaluation of each fracture. Patients were followed up postoperatively for presence of complications. RESULTS A good correlation between the proposed scoring system and the incidence of complications was detected. DISCUSSION This scoring system for mandibular fractures facilitates an objective and standardized assessment of the degree of severity of a fracture, thereby allowing for systematic evaluation of facial fracture outcomes, including assessment of complications. However, it is our understanding that a multicenter study should be performed before the effectiveness of the proposed classification can be clearly stated.
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Affiliation(s)
- D Prabhu Shankar
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College & Hospital, Alapakkam Main Road, Maduravoyal, Chennai 600095, Tamil Nadu, India.
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Lima CJ, Silva LCF, Melo MRS, Santos JASS, Santos TS. Evaluation of the agreement by examiners according to classifications of third molars. Med Oral Patol Oral Cir Bucal 2012; 17:e281-6. [PMID: 22143711 PMCID: PMC3448327 DOI: 10.4317/medoral.17483] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 05/16/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study recorded and evaluated the intra- and inter-group agreement degree by different examiners for the classification of lower third molars according to both the Winter's and Pell & Gregory's systems. STUDY DESIGN An observational and cross-sectional study was realized with forty lower third molars analyzed from twenty digital panoramic radiographs. Four examiner groups (undergraduates, maxillofacial surgeons, oral radiologists and clinical dentists) from Aracaju, Sergipe, Brazil, classified them in relation to angulation, class and position. The variance test (ANOVA) was applied in the examiner findings with significance level of p<0.05 and confidence intervals of 95%. RESULTS Intra- and inter-group agreement was observed in Winter's classification system among all examiners. Pell & Gregory's classification system showed an average intra-group agreement and a statistical significant difference to position variable in inter-group analysis with greater disagreement to the clinical dentists group (p<0.05). CONCLUSIONS High reproducibility was associated to Winter's classification, whereas the system proposed by Pell & Gregory did not demonstrate appropriate levels of reliability.
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Affiliation(s)
- C-J Lima
- Universidade Federal de Sergipe, Hospital Universitário, Departamento de Odontologia, Rua Cláudio Batista s/n, Bairro Sanatório, Aracaju, SE, Brasil
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Almendros-Marqués N, Berini-Aytés L, Gay-Escoda C. Evaluation of Intraexaminer and Interexaminer Agreement on Classifying Lower Third Molars According to the Systems of Pell and Gregory and of Winter. J Oral Maxillofac Surg 2008; 66:893-9. [PMID: 18423277 DOI: 10.1016/j.joms.2007.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 07/27/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
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Cai HX, Long X, Cheng Y, Li XD, Jin HX. Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report. Dent Traumatol 2007; 23:181-3. [PMID: 17511841 DOI: 10.1111/j.1600-9657.2006.00404.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.
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Affiliation(s)
- Heng-Xing Cai
- Department of Oral Maxillofacial Surgery, College and Hospital of Stomatology, Key Laboratory for Oral Biomedical Engineering, Ministry of Education, Wuhan University, Wuhan, China
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Shetty V, Atchison K, Der-Matirosian C, Wang J, Belin TR. The mandible injury severity score: development and validity. J Oral Maxillofac Surg 2007; 65:663-70. [PMID: 17368361 DOI: 10.1016/j.joms.2006.03.051] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 02/24/2006] [Accepted: 03/16/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To develop and validate a clinical method for characterizing and scoring mandible injury severity. MATERIALS AND METHODS Constituent fracture variables (fracture type, location, occlusion, soft tissue involvement, infection, and interfragmentary displacement [FLOSID]) were used to develop the FLOSID taxonomy for characterizing injury. Each component was assigned an empirical weight to help derive a summary measure of injury severity called the UCLA Mandible Injury Severity Score (MISS). Subsequently, MISS values were calculated for a group of 336 patients treated for mandible fractures. The validity of the summary score was evaluated by relating the MISS measure to the treatment modality used and to various variables, related as well as unrelated to injury outcomes. RESULTS Each of the FLOSID components correlated significantly with the MISS (P < .001). Unrelated variables, including ethnicity, education, and gender, had no correlation to the MISS. On average, patients treated with rigid internal fixation had a higher MISS than patients treated with maxillomandibular fixation (P < .001). The MISS had a statistically significant association with surrogate markers of injury severity such as sensory nerve deficit, need for hospitalization, and pain at 1-month follow-up (P < .001). However, there was no significant association between MISS and indicators of postoperative complications (infection, nonunion, malunion, malocclusion). CONCLUSIONS The FLOSID taxonomy offers a useful alternative to narrative summarization of mandible injury. The MISS is readily derived from clinical parameters obtained at the initial patient encounter and appears to be a valid index of mandible injury severity across important clinical domains.
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Affiliation(s)
- Vivek Shetty
- UCLA Facial Injury Research, University of California, Los Angeles, USA.
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Lanning SK, Best AM, Temple HJ, Richards PS, Carey A, McCauley LK. Accuracy and Consistency of Radiographic Interpretation Among Clinical Instructors Using Two Viewing Systems. J Dent Educ 2006. [DOI: 10.1002/j.0022-0337.2006.70.2.tb04071.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sharon K. Lanning
- Department of Periodontics; Virginia Commonwealth; University School of Dentistry; University of Michigan School of Dentistry
| | - Al M. Best
- Department of Biostatistics; Virginia Commonwealth University
| | - Henry J. Temple
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry
| | - Philip S. Richards
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry
| | - Allison Carey
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry
| | - Laurie K. McCauley
- Department of Periodontics and Oral Medicine; University of Michigan School of Dentistry
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Roth FS, Kokoska MS, Awwad EE, Martin DS, Olson GT, Hollier LH, Hollenbeak CS. The Identification of Mandible Fractures by Helical Computed Tomography and Panorex Tomography. J Craniofac Surg 2005; 16:394-9. [PMID: 15915103 DOI: 10.1097/01.scs.0000171964.01616.a8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The introduction of computed tomography (CT) in 1972 revolutionized the radiographic evaluation of patients who have experienced trauma. However, panoramic tomography (PT) continued to be superior in sensitivity to CT in the identification of mandible fractures and has been considered the gold standard for the past 3 decades. In 1989, a faster, higher-resolution spiral or helical CT (HCT) became widely available, and its efficacy in multiplanar evaluation and diagnosis of fractures of the upper two thirds of the face has been well established. The sensitivity of this new-generation HCT in comparison to PT in the detection of mandible fractures has not been determined. The purpose of this study was to compare the sensitivity, physician interpretation error, and interphysician agreement of HCT and PT in the identification of mandible fractures. The number and anatomical location of mandible fractures identified by HCT and PT was not significantly different. However, the number and location of 96% of fractures identified by HCT was agreed on by neuroradiologists compared with only 91% of fractures identified by PT. Furthermore, the interphysician agreement when no fracture was identified was 96% by HCT versus only 81% by PT. In conclusion, HCT has enhanced imaging quality, equivalent sensitivity in identification of fractures, decreased interpretation error, and greater interphysician agreement in the identification of mandible fractures. HCT has surpassed PT as the current gold standard for the radiographic evaluation and diagnosis of mandible fractures.
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Affiliation(s)
- Forrest S Roth
- Department of Plastic and Reconstructive Surgery, Baylor College of Medicine, Texas Medical Center, Houston, Texas 77030, USA.
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Gassner R, Tuli T, Hächl O, Moreira R, Ulmer H. Craniomaxillofacial trauma in children: a review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg 2004; 62:399-407. [PMID: 15085503 DOI: 10.1016/j.joms.2003.05.013] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Trauma is the leading cause of diseases and death in children. The goal of this study was to assess the impact of the main causes of accidents among children resulting in pediatric craniomaxillofacial trauma. PATIENTS AND METHODS Between 1991 and 2000, data for 3,385 patients younger than 15 years of age who sustained a total of 6,060 craniomaxillofacial injuries were recorded for cause of injury, age and gender distribution, frequency and type of injury, injury mechanisms, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, and concomitant injuries. Univariate statistical analyses were followed by logistic regression analyses for the 3 injury types to determine the impact of the main injury causes on the type of injury at different ages in pediatric facial trauma patients. RESULTS Play (58.2%), sport (31.8%), and traffic accidents (5%), acts of violence (3.9%), and other causes (1.1%) were noted. A total of 389 patients (11.5%) had 615 fractures, 2,582 patients (76.3%) had 3,384 dentoalveolar injuries, and 1,697 patients (50.1%) had 2,061 soft tissue injuries. The girl-to-boy ratio was 3:5, and the mean age was 7 +/- 4.4 years. For children sustaining facial trauma, logistic regression analyses revealed increased risks for fractures (+238%) and soft tissue lesions (+89%) in children involved in traffic accidents. Dental trauma was more frequent (>+38%) in both sport and play accidents (all P <.001). CONCLUSIONS This study dissected the distinct impact of injury mechanisms in pediatric craniomaxillofacial trauma. Logistic regression analyses revealed statistically highly significant outcome differences in pediatric facial trauma depending on the injury mechanism.
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Affiliation(s)
- Robert Gassner
- Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria.
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Shetty V, Atchison K, Der-Martirosian C, Wang J, Belin TR. Determinants of surgical decisions about mandible fractures. J Oral Maxillofac Surg 2003; 61:808-13. [PMID: 12856255 DOI: 10.1016/s0278-2391(03)00156-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The study goal was to explore contextual patient- and surgeon-related characteristics that influence the perception of injury severity and treatment strategy for mandible fractures. METHODS After reviewing plain radiographs of 22 patients with mandible fractures, 18 oral and maxillofacial surgeons were queried on summary severity ratings and treatment decisions for each injury. Subsequently, they were asked to indicate how various hypothetical fracture and patient-specific factors would alter their perception of injury severity and original treatment recommendations. The effect of the level of clinician trauma expertise on perception of injury severity and treatment choice was also assessed. RESULTS Each of the fracture-specific characteristics-number of constituent fractures, fracture complexity, degree of displacement, and summary injury severity-influenced the choice of treatment modality. Surgeon-specific characteristics were related to both perception of injury severity and treatment choice. Although clinicians with greater trauma loads tended to provide higher summary severity ratings for the same range of injuries (P <.001), they appeared to recommend maxillomandibular fixation for a much broader spectrum of injury severity (R = -0.42). Surgeons' perception of injury severity appeared to escalate with increasing damage to the soft tissue envelope; the influence of patient-related risk factors was less distinct. More than half of the surgeons suggesting maxillomandibular fixation for a particular case changed their treatment recommendation to rigid internal fixation on learning that the patient was noncompliant. CONCLUSIONS Clinical decision making for mandible fractures is not a precise and fully reliable activity. Contextual factors (fracture, patient, and surgeon related) appear to influence the clinical decision and may be responsible for the existing variations in practice patterns.
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Affiliation(s)
- Vivek Shetty
- Section of Oral and Maxillofacial Surgery, 23-009 UCLA School of Dentistry, 10833 Le Conte Ave, , Los Angeles, CA 90095-1668 , USA.
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