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Sri Surya TP, Jaggannagari S, Danam RP, Colvenkar S, Alwala AM. Management of Comminuted Fracture of Mandible Using Titanium Mesh. Cureus 2023; 15:e35799. [PMID: 37025750 PMCID: PMC10073405 DOI: 10.7759/cureus.35799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
Abstract
Comminuted mandibular fractures are common following a high-velocity injury to the face and jaws. The inherent nature of injury and damage to the underlying hard and soft tissues often complicate the management of comminuted fractures. Traditionally, comminuted fractures were managed by closed reduction and external skeletal fixation. Titanium mesh serves as an excellent alternative in the management of comminuted mandibular fractures. The present case report presents the successful management of comminuted mandibular fractures using titanium mesh.
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Siddiqui SUD, Iqbal N, Baig MH, Mehdi H, Mahmood Haider S. Efficacy of open reduction and internal fixation in achieving bony union of comminuted mandibular fractures caused by civilian gunshot injuries. Surgeon 2019; 18:214-218. [PMID: 31806484 DOI: 10.1016/j.surge.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 08/21/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Comminuted fractures of the mandible caused by gunshot injuries were traditionally treated with closed reduction using maxillo-mandibular fixation (MMF).2,3 Open reduction and internal fixation (ORIF) has become a valuable treatment modality in the management of comminuted mandibular fractures due to low rate of complications and predictable healing 4, 5. OBJECTIVE To compare the efficacy of ORIF compared with MMF in achieving bony union of comminuted mandibular fractures in gunshot injury patients. METHOD ology: Randomized controlled trial conducted at the department of Oral & Maxillofacial Surgery, Abbasi Shaheed Hospital for a period of 3 years; total of 40 patients divided equally into two groups. Group A were treated with ORIF and group B were treated with MMF. Callus formation radiographically was confirmed by 8th week post operatively. Data was collected using proforma, entered on a statistical software SPSS version 20. Frequency percentages were computed for age and gender. Chi square and Fisher's exact tests were applied. P value ≤ 0.05 considered significant. RESULT A total of 40 patients of gunshot injuries were included in this study. 37 (92.5%) were males and 3 (7.5%) were Females with mean age of 36.35 ± 12.9 years SD. 19 (47.5%) patients showed callus formation, whereas, 21 (52.5%) did not. Out of 19 patients, 14 (70%) belonged to group A, and 5 (25%) from group B. The final healing considered by 8th week was in 16 (80%) of ORIF group A, and 8 (40%) group B (MMF) after calculating the clinical and radiographic evidences. CONCLUSION Comparative clinical trials have proven that ORIF is superior to MMF in the management of comminuted mandibular fractures. Early primary repair and internal fixation provides predictable and cost effective results.
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Affiliation(s)
- Saad-Ud-Din Siddiqui
- Civil Hospital Karachi, Opposite Allawala Market, M.A. Jinnah Road, Baba-e-Urdu Road, Nanakwara, Karachi, Pakistan.
| | - Naveed Iqbal
- Fatima Jinnah Dental College & Hospital Trust, Building No. 1, Street No. 1, 100 Foot Road, Azam Town, Karachi, Pakistan.
| | - Mirza Hamid Baig
- Fatima Jinnah Dental College & Hospital Trust, Building No. 1, Street No. 1, 100 Foot Road, Azam Town, Karachi, Pakistan.
| | - Hassan Mehdi
- Fatima Jinnah Dental College & Hospital Trust, Building No. 1, Street No. 1, 100 Foot Road, Azam Town, Karachi, Pakistan.
| | - Syed Mahmood Haider
- Principal Karachi Medical & Dental College, Consultant OMS Abbasi Shaheed Hospital, Pakistan.
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Datarkar A, Tayal S, Galie M. Novel design of miniplate for fixation of fractures at transition zone of parasymphysis-body region of mandible – A clinical randomised study. J Craniomaxillofac Surg 2019; 47:1551-1556. [DOI: 10.1016/j.jcms.2019.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/12/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022] Open
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Twenty-four years of experience in management of complex mandibular fractures with low cost, custom-made mandibular external fixation: A 65-patient series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:242-247. [PMID: 31476534 DOI: 10.1016/j.jormas.2019.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/15/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Ginestet introduced the first external device used to fix the mandible in 1936. In 1949, Morris introduced a biphasic fixation device. This "Joe Hall Morris fixation" design led to use of a self-crafted external fixator based on pins connected by a breathing tube filled with dental resin. The objective of this study was to present our surgical results with this device through a 65-patient series. METHODS This retrospective study included all the patients who benefited from the self-crafted mandibular external fixator at our Oral and Maxillofacial department from 1995 to 2019. Sixty-five patients were allocated into two groups. There were 39 patients in the temporary stabilisation (TS) group and 26 in the bone healing (BH) group. Functional criteria were investigated, including mouth opening limitations and occlusal abnormalities. Aesthetic evaluation focused on skin healing, evaluated by both surgeon and patient. RESULTS Twenty-three patients exhibited spontaneous bone healing during their immobilisation period and two patients developed a pseudoarthrosis in the BH group. Most TS group patients benefited from secondary management by bone graft, bone free flap, or distraction osteogenesis. Few complications were noted with our technique during the study period. CONCLUSION Our self-crafted external fixation with Joe Hall Morris fixation style is a valuable option for external stabilisation of the lower third of the face.
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Yadav S, Mittal HC, Dhupar V, Akkara F, Sachdeva A. Transoral approach alone in single miniplate osteosynthesis of angle fracture - our experience. Natl J Maxillofac Surg 2017; 7:71-75. [PMID: 28163483 PMCID: PMC5242079 DOI: 10.4103/0975-5950.196136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to determine the outcome of transoral approach alone to treat the mandibular angle fracture using single 2.0 mm miniplate. Materials and Methods: In this study, 28 patients were included and treated with 2.0 mm single miniplate osteosynthesis at upper border along Champy's line of osteosynthesis using transoral approach alone. Results: All the cases were treated successfully with 2.0 mm single miniplate with common complications such as infection (two cases) and plate exposure (one case) in a total of two cases. Conclusion: Use of single miniplates by transoral approach alone for superior border osteosynthesis is effective and simple approach without need of extra armamentarium.
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Affiliation(s)
- Sunil Yadav
- Department of Dentistry, BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India
| | - Hitesh Chander Mittal
- Department of Dentistry, BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India
| | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Francis Akkara
- Department of Oral and Maxillofacial Surgery, Goa Dental College and Hospital, Bambolim, Goa, India
| | - Akash Sachdeva
- Department of Oral and Maxillofacial Surgery, Inderprastha Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
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Li Z, Zhou Z, Li P, Zeng W, Qing H, Tang W. Retrospective Study on Multidrug-Resistant Bacterium Infections After Rigid Internal Fixation of Mandibular Fracture. J Oral Maxillofac Surg 2016; 74:770-7. [DOI: 10.1016/j.joms.2015.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/11/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
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Dai J, Shen G, Yuan H, Zhang W, Shen S, Shi J. Titanium Mesh Shaping and Fixation for the Treatment of Comminuted Mandibular Fractures. J Oral Maxillofac Surg 2015; 74:337.e1-337.e11. [PMID: 26529196 DOI: 10.1016/j.joms.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/01/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures. MATERIALS AND METHODS Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction-internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up. RESULTS Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis. CONCLUSIONS We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology.
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Affiliation(s)
- Jiewen Dai
- Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guofang Shen
- Professor, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Yuan
- Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenbin Zhang
- Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shunyao Shen
- Resident, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jun Shi
- Associate Professor, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Interrami intraoral fixation technique for severe mandibular rifle fragmented bullet injury management. J Craniofac Surg 2015; 24:1168-74. [PMID: 23851763 DOI: 10.1097/scs.0b013e31829538c8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Interrami intraoral Kirschner wire fixation technique is presented for the reduction, stabilization, and immobilization of a pulverized and avulsed lower jaw caused by rifle fragmented bullet injuries. This indirect mandibular war injury fixation technique was tolerated by the patients and tissue more than any indirect external fixation. In addition, it is easier than open reduction using large bone plates for disrupted ballistics mandibular injury defects. An interrami intraoral fixation is appropriate for severely disrupted mandibular hard and soft tissues, and has been adapted in cases of mass casualties and limited resources. Benefits of use include limited hospital beds and fewer follow-up visits. Rifle fragmented bullet injuries need more attention for several reasons: not only because of the higher mortality and devastating nature of the injuries, but also because these injuries are responsible for an unreported type of bullet biomechanism wounding in the craniofacial region. In turn, this necessitates specialized victim management. The survival rates depend on immediate proper execution of airway, breathing, and circulation, which become more complicated as it relates to airway compromise and oropharyngeal hemorrhage resuscitation. Survival is predicated on the implementation of feasible, sensible, life-saving techniques that are applied at the appropriate time.
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Li P, Tang W, Liao C, Tan P, Zhang J, Tian W. Clinical evaluation of computer-assisted surgical technique in the treatment of comminuted mandibular fractures. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2015. [DOI: 10.1016/j.ajoms.2014.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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CANSIZ EROL, DOGRU SUZANCANSEL, ARSLAN YUNUSZIYA. COMPARATIVE EVALUATION OF THE MECHANICAL PROPERTIES OF RESORBABLE AND TITANIUM MINIPLATES USED FOR FIXATION OF MANDIBULAR CONDYLE FRACTURES. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, comparative evaluation of the mechanical properties of resorbable and titanium miniplates, which are used for the fixation of the mandibular condyle fractures, was carried out using finite element analysis (FEA). To do so, first two-dimensional (2D) computed tomography (CT) images of mandibles recorded from 10 adult patients were converted into three-dimensional (3D) solid body models. Then these models were transferred to the finite element software. In the finite element stage of the study, a condyle fracture was created onto the mandible and double-titanium and double-resorbable miniplates were separately fixed to the mandible surface such that the fractured sites to be firmly attached. Stress distribution over the plates and interfragmentary displacements between adjacent surfaces, which stem from the clenching force applying to the mandible, were calculated using FEA. It was observed from the results that maximum tensile stresses occurred in the titanium miniplates were significantly higher than those obtained from resorbable miniplates (p < 0.01). Higher maximum displacements between fractured surfaces were observed in the case of resorbable plate systems (p < 0.01). Maximum stress and displacement values obtained from both titanium and resorbable plate systems were under clinically acceptable limits. According to results, resorbable plates showed a similar reliability with titanium miniplates in terms of withstanding various stress and strain deformations.
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Affiliation(s)
- EROL CANSIZ
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Capa 34093, Istanbul, Turkey
| | - SUZAN CANSEL DOGRU
- Faculty of Engineering, Department of Mechanical Engineering, Istanbul University, Avcilar 34320, Istanbul, Turkey
| | - YUNUS ZIYA ARSLAN
- Faculty of Engineering, Department of Mechanical Engineering, Istanbul University, Avcilar 34320, Istanbul, Turkey
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Kanno T, Sukegawa S, Nariai Y, Tatsumi H, Ishibashi H, Furuki Y, Sekine J. Surgical treatment of comminuted mandibular fractures using a low-profile locking mandibular reconstruction plate system. Ann Maxillofac Surg 2015; 4:144-9. [PMID: 25593862 PMCID: PMC4293833 DOI: 10.4103/2231-0746.147103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: The treatment of comminuted mandibular fractures is challenging due to the severity of associated injuries and the need for a careful diagnosis with adequate treatment planning. Recently, open reduction and stable internal fixation (OR-IF) with a load-bearing reconstruction plate have been advocated for reliable clinical outcomes with minimal complications. This clinical prospective study evaluated OR-IF in the surgical management of comminuted mandibular fractures with a new low-profile, thin, mandibular locking reconstruction plate. Materials and Methods: We prospectively assessed OR-IF of comminuted mandibular fractures with a low-profile locking mandibular reconstruction plate in 12 patients (nine men, three women; mean age 32.2 [range 16-71] years) between April 2010 and December 2011. The clinical characteristics and associated clinical parameters of patients were evaluated over a minimum follow-up period of 12 months. Results: Traffic accidents caused 50% of the fractures, followed by falls (25%). Four patients (33.3%) had associated midfacial maxillofacial fractures, while five patients had other mandibular fractures. Seven patients (58.3%) needed emergency surgery, mostly for airway management. Anatomical reduction of the comminuted segments re-established the mandibular skeleton in stable occlusion with rigid IF via extraoral (33.3%), intraoral (50%), or combined (16.7%) approaches. Immediate functional recovery was achieved. Sound bone healing was confirmed in all patients, with no complications such as malocclusion, surgical site infection, or malunion with a mean follow-up of 16.3 (range 12-24) months. Conclusions: OR-IF using a low-profile reconstruction plate system is a reliable treatment for comminuted mandibular fractures, enabling immediate functional recovery with good clinical results.
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Affiliation(s)
- Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan ; Division of Oral-Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Shintaro Sukegawa
- Division of Oral-Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Yoshiki Nariai
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hiroto Tatsumi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Hiroaki Ishibashi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshihiko Furuki
- Division of Oral-Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan
| | - Joji Sekine
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Biomechanical Evaluation of a Mandibular Spanning Plate Technique Compared to Standard Plating Techniques to Treat Mandibular Symphyseal Fractures. Surg Res Pract 2015; 2015:569030. [PMID: 26649332 PMCID: PMC4663366 DOI: 10.1155/2015/569030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. The purpose of this study is to compare the biomechanical behavior of the spanning reconstruction plate compared to standard plating techniques for mandibular symphyseal fractures.Materials and Methods. Twenty-five human mandible replicas were used. Five unaltered synthetic mandibles were used as controls. Four experimental groups of different reconstruction techniques with five in each group were tested. Each synthetic mandible was subjected to a splaying force applied to the mandibular angle by a mechanical testing unit until the construct failed. Peak load and stiffness were recorded. The peak load and stiffness were analyzed using ANOVA and the Tukey test at a confidence level of 95% (P<0.05).Results. The two parallel plates’ group showed statistically significant lower values for peak load and stiffness compared to all other groups. No statistically significant difference was found for peak load and stiffness between the control (C) group, lag screw (LS) group, and the spanning plate (SP1) group.Conclusions. The spanning reconstruction plate technique for fixation of mandibular symphyseal fractures showed similar mechanical behavior to the lag screw technique when subjected to splaying forces between the mandibular gonial angles and may be considered as an alternative technique when increased reconstructive strength is needed.
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Bede S. Mandibular fractures in iraq: an epidemiological study. Craniomaxillofac Trauma Reconstr 2014; 8:59-63. [PMID: 25709754 DOI: 10.1055/s-0034-1384742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/26/2013] [Indexed: 10/24/2022] Open
Abstract
The purpose of this study was to evaluate the epidemiological characteristics of the mandibular fractures relating to gender, age, the etiology of injury, and the rendered treatment modalities and complications. The data of the patients who sustained mandibular fractures were retrieved and were analyzed retrospectively, and based on these data a descriptive analysis was conducted. A total of 112 patients were included in this study; the most common cause was road traffic accidents (RTAs) followed by assaults and missile injuries. The most frequently involved age group was 11 to 20 years, treatment modalities included conservative, closed reduction and indirect fixation, and open reduction and internal fixation (ORIF) in 11.6, 79.5, and 8.9% of the cases, respectively. Most of the major complications were injury related. This study showed RTAs to be the most frequent cause followed by assaults, it also showed that a high percentage of assault victims were females mainly of low socioeconomic status. Another distinguishing feature in this study was the high incidence of missile injuries in the form of bullets and blasts. Closed reduction still has an important role in the treatment of fractures of mandible especially when the necessary equipments for ORIF are not readily available. A higher complication rate was observed in patients diagnosed with multiple and comminuted fractures as well as those caused by violence in the form of missile and assault injuries.
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Affiliation(s)
- Salwan Bede
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Goodday RH. Management of Fractures of the Mandibular Body and Symphysis. Oral Maxillofac Surg Clin North Am 2013; 25:601-16. [DOI: 10.1016/j.coms.2013.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schaller B, Soong PL, Zix J, Iizuka T, Lieger O. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomized, double-blind, placebo-controlled pilot clinical study. Part 2: Mandibular fractures in 59 patients. Br J Oral Maxillofac Surg 2013; 51:803-7. [PMID: 24012053 DOI: 10.1016/j.bjoms.2013.08.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the difference between a 5-day and a 1-day postoperative course of antibiotic on the incidence of infection after mandibular fractures involving the alveolus. Sixty-two patients with fractures of the mandible involving the dentoalveolar region were randomly assigned to 2 groups, both of which were given amoxicillin/clavulanic acid 1.2 g intravenously every 8 h from admission until 24 h postoperatively. The 5-day group were then given amoxicillin/clavulanic acid 625 mg orally every 8 h for another 4 days. The 1-day group was given an oral placebo at the same intervals. Follow-up appointments were 1, 2, 4, 6, 12 weeks and 6 months postoperatively. Development of an infection was the primary end point. Fifty-nine of the 62 patients completed this study. Six of the 30 patients in the 5-day group (20%) and 6 out of the 29 in the 1-day group (21%) developed local wound infections. Three of the 6 in the 1-day group developed purulent discharge and swelling. One patient in the 5-day group developed a rash on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. In fractures of the mandible involving the alveolus, a 1-day postoperative course of antibiotic is as effective in preventing infective complications as a 5-day regimen.
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Affiliation(s)
- Benoit Schaller
- Department of Cranio-Maxillofacial Surgery, Inselspital, Bern University Hospital, and University of Bern, Switzerland
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Duarte BG, Assis D, Ribeiro-Júnior P, Gonçales ES. Does the Relationship between Retained Mandibular Third Molar and Mandibular Angle Fracture Exist? An Assessment of Three Possible Causes. Craniomaxillofac Trauma Reconstr 2013; 5:127-36. [PMID: 23997857 DOI: 10.1055/s-0032-1313355] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 11/08/2011] [Indexed: 10/28/2022] Open
Abstract
The objective of this study is to discuss problems associated with dental retention through three clinical cases of mandible fractures related to the presence of retained lower third molars, emphasizing the possibility of mandible fractures resulting from this or from the extraction procedure. The three evaluated patients had a fracture in the mandible angle. The third molars were present in all the cases, as was the relationship of the fracture with the teeth. After evaluating the three cases and reviewing literature, it is believed that the presence of the retained lower third molars and the surgical procedures for their extraction increase the risk of mandible angle fractures.
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Affiliation(s)
- Bruno G Duarte
- Department of Stomatology, Discipline of Oral Surgery, Dental School of Bauru, Bauru, SP, Brazil
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Chrcanovic BR. Open versus closed reduction: comminuted mandibular fractures. Oral Maxillofac Surg 2013; 17:95-104. [PMID: 22842858 DOI: 10.1007/s10006-012-0349-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/18/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The purpose of the study was to review the literature regarding the evolution of current thoughts on management of comminuted mandibular fractures (CMFs). METHODS An electronic search in PubMed was undertaken in May 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies published in English or German reporting clinical series of CMFs. RESULTS The search strategy initially identified 409 studies. Fifteen studies were identified without repetition within the selection criteria. One case report article showing significance in the development of treatment techniques was included. Additional hand-searching yielded five additional papers. Thus, a total of 21 studies were included. CONCLUSIONS Open reduction and internal fixation (ORIF) in cases of CMFs are indicated in (a) severe injuries with significant displacement to allow restoration of pretraumatic anatomic relationships, (b) in the edentulous and semi-dentate patient, who may benefit from ORIF of CMFs when stable occlusal relationships are absent, and (c) in cases with multiple fractures of the midface, in which the mandible has to serve as a guide to reposition the midfacial bones. However, there is still a place for closed reduction/conservative treatment (CTR). ORIF in CMFs is not indicated in cases of minimally displaced comminuted fractures that could easily and adequately be treated with CTR. If the surgical team is not well versed in the nuances of rigid internal fixation, or the necessary equipment is not available, it is far better to do simple CTR. However, it would be more reasonable to refer the patient to a hospital that can provide means of ORIF in cases of clear indication of its use in CMFs. In cases where ORIF is indicated, stabilization by compression or any other form of load-sharing osteosynthesis is obviously contraindicated because small fragments cannot be compressed and are not capable of sharing loads. Thus, the ORIF of CMFs is best performed using load-bearing osteosynthesis; most experience has been gained with 2.7-mm reconstruction plates. External pin fixation could be used in cases when there is so much comminution, soft tissue disruption (mostly gunshot wounds), and there are inadequate teeth on either side of the comminuted fracture to control the spatial relationship of the remaining mandibular fragments with maxillomandibular fixation (MMF).
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Affiliation(s)
- Bruno Ramos Chrcanovic
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Kumaran PS, Thambiah L. Versatility of a single upper border miniplate to treat mandibular angle fractures: A clinical study. Ann Maxillofac Surg 2011; 1:160-5. [PMID: 23482950 PMCID: PMC3591017 DOI: 10.4103/2231-0746.92784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Mandibular fractures are among the most common of facial fractures. Fractures of the mandibular angle are associated with the highest incidence of postsurgical infection of all mandibular fractures. The treatment of facial fractures has traditionally involved reestablishment of a functional dental occlusion with various types of intermaxillary fixation. Treatment modalities range from simple maxillo-mandibular fixation to rigid internal fixation of the bone fragments. AIMS The aim of this study was to determine the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle with access via an intraoral route. MATERIALS AND METHODS Cases of unfavorable fractures of the mandibular angle were selected for the study of intraoral surgical management of mandibular angle fractures using a single 2.0-mm noncompression miniplate. STATISTICAL ANALYSIS AND RESULTS An observational study was carried out on treatment of fractures of the angle of the mandible, and the findings were recorded and presented. CONCLUSIONS We studied the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle and found no complications associated with superior border miniplate fixation of mandibular angle fractures.
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Affiliation(s)
- P Satish Kumaran
- Consultant Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Annaswamy Mudaliar General Hospital, Bourdillon Road, Off M. M. Road, Bangalore - 560005, India
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Clinical characteristics and treatment of multiple site comminuted mandible fractures. J Craniomaxillofac Surg 2011; 39:296-9. [DOI: 10.1016/j.jcms.2010.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 04/17/2010] [Accepted: 04/21/2010] [Indexed: 11/23/2022] Open
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Wang H, Ji B, Jiang W, Liu L, Zhang P, Tang W, Tian W, Fan Y. Three-dimensional finite element analysis of mechanical stress in symphyseal fractured human mandible reduced with miniplates during mastication. J Oral Maxillofac Surg 2010; 68:1585-92. [PMID: 20434254 DOI: 10.1016/j.joms.2009.07.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 05/12/2009] [Accepted: 07/29/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE In this study we tried to analyze the stress distribution in a symphyseal fractured human mandible reduced by 2 different methods--reduction with 1 miniplate or with 2 miniplates--by using finite element (FE) analysis, and then compared the results with an intact mandible. MATERIALS AND METHODS Three-dimensional FE models of an intact mandible and symphyseal fractured mandibles reduced by 2 fixation methods were developed to analyze mandibular stress distribution and bite forces under 2 basic loading conditions, namely, clenching in the intercuspal position and left unilateral molar clenching. Groups of parallel vectors were used to simulate 9 pairs of masticatory muscles involved in the 2 static biting tasks. RESULTS Stress distributions in reduced mandible with 1 or 2 miniplates were more or less different from that of the intact mandible. The maximum stress occurred at the biting point. Meanwhile, the subcondylar region was a stress-bearing area. During left unilateral molar clenching, bite forces obviously reduced after fracture. Bite force and the stress distribution pattern in the mandible reduced with 2 miniplates were closer to that in the intact mandible. CONCLUSIONS It is suggested that the effect of the miniplates in stabilizing the continuity-broken mandible influence the restorations of the stress distribution pattern and bite force. Two miniplates have a biomechanical advantage over 1 miniplate on these restorations.
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Affiliation(s)
- Hang Wang
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Ji B, Wang C, Liu L, Long J, Tian W, Wang H. A biomechanical analysis of titanium miniplates used for treatment of mandibular symphyseal fractures with the finite element method. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2010; 109:e21-7. [PMID: 20219581 DOI: 10.1016/j.tripleo.2009.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 10/17/2009] [Accepted: 11/08/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the stress distribution and stress shielding effect of titanium miniplates used for the treatment of symphyseal fractures using finite element (FE) analysis. STUDY DESIGN Two 3-D FE models of symphyseal fractured mandibles reduced by technique 1, reduction with a single miniplate, and technique 2, reduction with 2 miniplates, respectively, were developed. Three basic loading conditions were simulated. RESULTS The ratios of stress shielding of miniplates were different. Ratios of the lower miniplates in technique 2 were much higher than the upper miniplates and the miniplates in technique 1 during all conditions, and that value of the lower miniplate gained a maximum value of 83.34% during left unilateral molar clenching. The stress areas were concentrated on the central section of the miniplates. However, the stress distribution varied with masticatory conditions. CONCLUSION The study demonstrated that miniplate stress distribution and stress shielding effect ratio were affected not only by the way in which the mandible was loaded but also by the number of the miniplates fixing the fracture.
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Affiliation(s)
- Baohui Ji
- State Key Laboratory of Oral Disease, Sichuan University, Chengdu, PR China
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Abstract
PURPOSE The purpose of this study is to report four cases of mandibular fractures associated with endosteal implants and to discuss prevention and treatment of these types of fractures. DISCUSSION To evaluate whether the patient's anatomy allows insertion of implants, radiological exams that demonstrate the height and the labial-lingual width are needed. To reduce the potential fracture problem, the mandible can be restrengthened with bone grafting techniques. The treatment of a fracture in an atrophic mandible is always a challenge because of the diminished central blood supply, the depressed vitality of the bone, and the dependence on the periosteal blood supply. The basic principles in fracture treatment are reduction and immobilization of the fractured site for restoration of form and function. CONCLUSIONS If implants are placed in severe atrophic mandible, iatrogenic fracture of the mandible may occur during or after implant surgery because implant placement weakens the already-compromised mandible. A few millimeters of cortical bone should remain on both the labial and the lingual sites after the hole for insertion of an implant has been drilled. A 3-D surgical planning should be recommended at least in severe atrophic mandibles in order to prevent a severe reduction of bone tissue.
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Gerbino G, Boffano P, Bosco GF. Symphyseal Mandibular Fractures Associated With Bicondylar Fractures: A Retrospective Analysis. J Oral Maxillofac Surg 2009; 67:1656-60. [DOI: 10.1016/j.joms.2009.03.069] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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A biomechanical evaluation of plating techniques used for reconstructing mandibular symphysis/parasymphysis fractures. J Oral Maxillofac Surg 2008; 66:2012-9. [PMID: 18848096 DOI: 10.1016/j.joms.2008.06.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 05/15/2008] [Accepted: 06/16/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this investigation was to evaluate and compare the biomechanical behavior of 5 different methods used to repair mandibular symphysis/parasymphysis fractures. MATERIALS AND METHODS Sixty synthetic polyurethane mandible replicas (Synbone, Laudquart, Switzerland) were used in this investigation. Ten controls and 10 each of the experimental groups were tested by subjecting 5 constructs in each group to vertical loading at the incisal edge and 5 constructs to torsional loading at the molar region by an Instron 1331 (Instron, Canton, MA) servohydraulic mechanical testing unit. The 5 methods of reconstruction include: arch bars using 18-gauge stainless steel wire with an acrylic lingual splint, 2 2.4-mm lag screw technique, 2 2.0-mm 4-hole locking miniplates, 2 2.0-mm 6-hole nonlocking miniplates, and 2 2.4-mm 6-hole limited-contact dynamic-compression plates. Mechanical deformation data within a 0 to 900 N range were recorded. Yield load, displacement at yield load, and stiffness were determined. Means and standard deviations were derived and compared for statistical significance using a Fisher's protected least significant differences test with a confidence level of 95% (P < .05). Third-order polynomial best-fit curves also were created for each group to further evaluate and compare the mechanical behavior. RESULTS For incisal edge loading, statistically significant differences were noted between the lag screw technique and the arch bar, limited-contact dynamic-compression plate and locking miniplate; and between the nonlocking miniplate and the arch bar, limited-contact dynamic-compression plate and locking miniplate for stiffness. Additionally, statistically significant differences were noted between the lag screw technique and arch bar; and between the nonlocking miniplate and the arch bar, dynamic-compression plate and locking miniplate for yield load. For molar loading, statistically significant differences were noted between the lag screw technique and all other groups for both yield load and stiffness; as well as the arch bar and locking miniplate for stiffness. No statistically significant differences were noted between any groups for displacement at yield, for either incisal edge or molar loading. CONCLUSIONS Although statistically significant differences were noted between each of the fixation systems in their abilities to resist loads under the conditions tested, when placed in the context of functional parameters, all systems met the requirements for incisal edge loading. When molar loading was considered, the lag screw technique performed more favorably than the other systems.
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Sauerbier S, Schön R, Otten JE, Schmelzeisen R, Gutwald R. The development of plate osteosynthesis for the treatment of fractures of the mandibular body – A literature review. J Craniomaxillofac Surg 2008; 36:251-9. [DOI: 10.1016/j.jcms.2007.08.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 08/31/2007] [Indexed: 11/26/2022] Open
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Scolozzi P, Jaques B. Intraoral open reduction and internal fixation of displaced mandibular angle fractures using a specific ad hoc reduction-compression forceps: a preliminary study. ACTA ACUST UNITED AC 2008; 106:497-501. [PMID: 18547841 DOI: 10.1016/j.tripleo.2008.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 01/11/2008] [Accepted: 01/16/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To preliminarily evaluate prospectively the accuracy and reliability of a specific ad hoc reduction-compression forceps in intraoral open reduction of transverse and displaced mandibular angle fractures. STUDY DESIGN We analyzed the clinical and radiologic data of 7 patients with 7 single transverse and displaced angle fractures. An intraoral approach was performed in all of the patients without using perioperative intermaxillary fixation. A single Arbeitsgemeinschaft Osteosynthese (AO) unilock reconstruction plate was fixed to each stable fragment with 3 locking screws (2.0 mm in 5 patients and 2.4 mm in 2 patients) at the basilar border of the mandible, according to AO/American Society of Internal Fixation (ASIF) principles. Follow-up was at 1, 3, 6, and 12 months, and we noted the status of healing and complications, if any. RESULTS All of the patients had satisfactory fracture reduction as well as a successful treatment outcome without complications. CONCLUSION This preliminary study demonstrated that the intraoral reduction of transverse and displaced angle fractures using a specific ad hoc reduction-forceps results in a high rate of success.
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Affiliation(s)
- Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Yano H, Hirata R, Nakashima M, Hirano A. The split fracture of mandibular symphysis. THE JOURNAL OF TRAUMA 2007; 63:E55-8. [PMID: 17308487 DOI: 10.1097/01.ta.0000246894.84637.d3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Hiroki Yano
- Department of Plastic and Reconstructive Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Review the incidence and etiology of mandible fractures. 2. Discuss indications and techniques for closed and open treatment of mandible fractures. 3. Review complications of mandible fractures. BACKGROUND Mandible fractures are among the most common types of facial fractures treated by plastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. METHODS Current methods of management include combinations of soft diet, intermaxillary fixation, open reduction with plate fixation, and, rarely, external fixation. RESULTS Decision-making depends on the age of the patient, type of fracture identified, and concomitant medical conditions or injuries. CONCLUSION The authors review the diagnosis and current trends in management of mandible fractures.
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Affiliation(s)
- D Heath Stacey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin, USA.
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