[Mandibular fractures: analysis of 166 cases]

A Peculiar Case of Isolated Bilateral Tympanic Plate Fractures

Tympanic plate fractures are uncommon injuries and carry the risk of external auditory canal stenosis. These injuries are often associated with fractures of adjacent bones like the mandible, maxilla, and temporal bone. Isolated bilateral tympanic bone fractures have rarely been reported. The most frequently advocated treatment for these injuries is surgical to prevent canal stenosis in the future. The effectiveness of non-operative management has been seldom reported. In the current case report, we present an uncommon injury with isolated bilateral tympanic plate fractures secondary to trauma to the mandible with no associated mandible or condylar fractures that were treated non-operatively. The functional outcomes were favorable at one year of follow-up.

Occlusal Instability Results in Increased Complication Rates After Treatment of Mandibular Fractures

PURPOSE

It is important to understand the factors that can increase the incidence of complications after mandibular fracture (MF) treatment. The objective of the present study was to investigate whether occlusal stability influences the occurrence of postoperative complications in MFs treated with internal rigid fixation.

PATIENTS AND METHODS

We performed a prospective cohort study of patients treated for MF by osteosynthesis with plate and screw fixation. The primary predictor variable was the occlusal stability (yes vs no). Occlusion was scored as stable (group 1) if the patients had all their teeth and no free ends in either dental arch. Occlusion was coded as unstable (group 2) if the patients were partially edentulous with free ends in either dental arch or had edentulism involving more than 6 dental elements. The primary outcome variable was postoperative complication (yes vs no). The secondary outcome variables were the osteosynthesis system used (2.0 or 2.4 mm), local factors, age, and gender. Statistical analysis was performed using the χ² statistical test at 5% significance.

RESULTS

Of 115 patients with 121 MFs, 73 (63.48%) had stable occlusion (group 1) and 42 (36.52%) had unstable occlusion (group 2). The mean age was 34.11 years, and 71.3% were men. The postoperative complication rate was 8.70% (10 patients). Of the 10 patients with complications, 3 (2.6%) were in group 1 and 7 (6.1%) were in group 2 (P = .021 and P < .05, respectively). The 2.0-mm system was used in 107 cases (93%). All the complications were associated with use of the 2.0-mm osteosynthesis plates, occurring in 3 of 69 patients in group 1 (4.34%) and 7 of 38 patients in group 2 (18.42%; P = .032 and P < .05, respectively). The greatest number of complications was associated with unilateral MF (9 of 109). The occurrence of postoperative complications in angle and symphysis/parasymphysis fracture sites was equal.

CONCLUSIONS

The results of the present study suggest that unstable occlusion could increase the rate of postoperative complications in MFs treated with plates and screws. Future studies are required with occlusal stability included as a variable.

Factors Associated With the Complexity of Facial Trauma

INTRODUCTION

Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication.

OBJECTIVE

The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents.

METHOD

A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors.

RESULTS

As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%).

CONCLUSIONS

It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures.

Isolated tympanic plate fracture detected by cone-beam computed tomography: report of four cases with review of literature

The tympanic plate is a small part of the temporal bone that separates the mandibular condyle from the external auditory canal. Fracture of this small plate is rare and usually associated with other bony fractures, mainly temporal and mandibular bone. There is a limited amount of literature on this subject, which increases the chance of cases being overlooked by physicians and radiologists. This is further supported by purely isolated cases of tympanic plate fracture without evidence of other bony fractures. Cone-beam computed tomography is an investigative three-dimensional imaging modality that can be used to detect fine structures and fractures in maxillofacial trauma. This article presents four cases of isolated tympanic plate fracture diagnosed by cone-beam computed tomography with no evidence of fracture involving other bones and review of the literature.

Maxillofacial trauma patterns associated with external auditory canal fractures: Cone beam computed tomography analysis

BACKGROUND/AIMS

There is a paucity of literature on external auditory canal (EAC) fractures secondary to maxillofacial trauma, with most of the literature on EAC fractures consisting of isolated case reports. To the authors' best knowledge, this is the first study to use cone beam computed tomography to evaluate the EAC region. The aim of this study was to assess the prevalence of external auditory canal (EAC) fracture following maxillofacial trauma and to evaluate the association between EAC fracture and other maxillofacial fractures and the region of trauma.

MATERIALS AND METHODS

One hundred patients were prospectively evaluated over 6 months from February to August 2016. The patients were referred for CBCT regarding temporomandibular joint or condylar fractures following maxillofacial trauma. Two observers (both experienced radiologists) assessed the EAC and associated fractures in the maxillofacial region.

RESULTS

External auditory canal (EAC) fracture was confirmed in 32% of the patients. Of the EAC fractures, 68.75% and 31.25% were associated with mandibular fractures and non-mandibular fractures, respectively. Of the EAC fractures, 68.75% were single fractures and 31.25% of patients had multiple comminuted fractures. Significant association was observed on cross-tabulation of the fractured region and region of trauma with the presence of EAC fracture using chi-square test.

CONCLUSION

External auditory canal (EAC) fracture is associated with maxillofacial fractures with increased incidence in mandibular fractures compared to non-mandibular fractures.

Traumatic Fractures of the Tympanic Plate: A Literature Review and Case Report

Fracture of the tympanic plate resulting from posterior dislocation of the mandibular condyle is an uncommon diagnosis. Presented is a clinical case in which computerized tomography was used as a diagnostic resource in a conservative therapeutic and clinical controlled one-year study. A review of the literature revealed 23 cases clinically reported with symptoms, diagnosis, and types of therapy utilized.

The Use of 2.4-mm Locking Plate System in Treating Comminuted Mandibular Fracture by Firearm

Maxillofacial trauma caused by firearms has considerably increased, in which the mandibular body is the site of highest incidence of firearm projectiles. In these cases, the use of titanium plates and screws allows the early restoration of form and function of the mandible with stable and predictable results. Recently, conventional plates have been extensively used to treat comminuted mandibular fractures. Nevertheless, the conventional system presents several limitations such as screw compression against the bone interface and the necessity of precise fit of plate to the bone. To overcome such drawbacks, the locking plates have emerged. The present clinical case reported the operative treatment of mandibular fracture caused by firearm projectiles with the use of locking plate. The indications, advantages, and disadvantages of this system are presented.

Caracterização funcional da mímica facial na paralisia facial em trauma de face: relato de caso clínico

TEMA: mímica facial na paralisia facial ocasionada por trauma de face. PROCEDIMENTOS: estudo de caso da mímica facial de um paciente com paralisia facial periférica no lado direito com sequelas decorrente de trauma por projétil de arma de fogo, adulto jovem do sexo masculino, comerciante autônomo. Foi realizada análise documental e fotográfica por meio de anamnese, avaliação e escala de graduação de da paralisia facial House e Brackmann. RESULTADOS: na avaliação da paralisia facial em repouso encontrou-se no lado direito (lesado): desvio de comissura labial, desvio de filtro, narina mais elevada e olho mais aberto. Em movimento, ainda no lado da lesão, observou-se: abolição de rugas frontais, incompetência no fechamento ocular natural e fechamento completo ao forçar, ausência de elevação de narina, rima naso-labial mais pronunciada, protrusão labial desviada para este lado, pouca retração labial, eversão de lábio inferior, comissura labial elevada, desvio de filtro, reduzida capacidade de inflar bochechas. O paciente apresentou sincinesia de olho/lábios e contratura com hipertonia de frontal, prócero, levantador da asa do nariz, risório, zigomático maior, zigomático menor, levantador do lábio superior, depressor do lábio inferior, mentual no lado da lesão e a fratura ocorreu em côndilo direito e o paciente referiu dor orofacial ao dormir e ao mastigar no lado comprometido. CONCLUSÃO: a lesão do nervo facial associada ao trauma de face provocou a alteração da mímica facial no lado direito o que gerou desfiguramento e distúrbios da mastigação.

Estudo epidemiológico das fraturas mandibulares em hospital público da cidade de São Paulo

OBJETIVO: Analisar a frequência epidemiológica de fraturas mandibulares correlacionando gênero, faixa etária, fatores etiológicos, localização anatômica, e tipos de traços de fratura. MÉTODOS: Estudo retrospectivo nos prontuários de 883 pacientes portadores de fraturas faciais, atendidos no Pronto Socorro do Hospital Geral de Vila Penteado, pelo Serviço de Cirurgia e Traumatologia Buco Maxilo Facial (São Paulo - Brasil), num período de três anos (janeiro de 2004 a dezembro de 2006). RESULTADOS: Dos 883 pacientes avaliados, 270 apresentaram fraturas mandibulares (30,5 %). O gênero masculino foi o mais acometido (76,7%) na faixa etária de 20 a 29 anos (33,0%), o fator etiológico de maior freqüência foi acidente com veículos automotores (35,2%), o corpo da mandíbula foi a localização anatômica mais atingida (47,4%) e os traços únicos prevaleceram (76,7%). CONCLUSÃO: As fraturas, em sua maioria, foram simples (traço único), localizadas em corpo mandibular, e destacadas no sexo masculino, na faixa etária de 20 a 29 anos, além do que o fator etiológico mais comum foi acidente com veículos automotores.

Fratura de mandíbula: análise de 293 pacientes tratados no Hospital de Clínicas da Universidade Federal de Uberlândia

A fratura de mandíbula ocupa o segundo lugar entre as fraturas dos ossos da face, tendo havido aumento significativo de casos nos últimos anos. A não-identificação e o tratamento inadequado podem levar à deformidade estética ou funcional permanente. OBJETIVO: Avaliar os casos submetidos à redução de fratura de mandíbula no Hospital de Clínicas da Universidade Federal de Uberlândia, entre janeiro de 1974 e dezembro de 2002. FORMA DE ESTUDO: coorte historica. PACIENTES E MÉTODO: Duzentos e noventa e três pacientes foram submetidos à redução de fratura de mandíbula e retrospectivamente foram avaliados segundo fatores relacionados a: paciente, trauma, quadro clínico e tratamento cirúrgico. RESULTADOS: Houve uma clara tendência de aumento do número de fraturas de mandíbula ao longo dos anos. Houve um predomínio no sexo masculino (4:1), com pico de ocorrência entre 20 a 29 anos. As principais causas de fratura da mandíbula neste estudo foram acidentes de trânsito e violência, perfazendo juntas 72,4%. Cento e trinta e cinco pacientes apresentavam fratura única. Os sítios mais acometidos foram, em ordem decrescente, sínfise, côndilo, ângulo, corpo, ramo e processo coronóide. Foram realizadas redução incruenta (28), cruenta (213) e associação das duas (11 pacientes), sendo que 56,8% dos pacientes foram tratados nos primeiros 3 dias e 50,4% recebeu a alta hospitalar até o primeiro pós-operatório. Cerca de 10% dos pacientes apresentaram complicações, sendo osteomielite a mais freqüente. CONCLUSÃO: A incidência de fraturas de mandíbula foi marcadamente maior no sexo masculino, durante a terceira década de vida. A causa mais comum foi o acidente de trânsito e as regiões mais atingidas foram sínfise e côndilo. As fraturas isoladas de mandíbula ocorreram em mais de metade dos casos. A maioria dos pacientes foi tratada nos primeiros três dias e recebeu alta até o primeiro pós-operatório. A redução cruenta foi tratamento mais comumente empregado. A complicação mais freqüente foi a osteomielite.

Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia

Mandibular fracture is the second most common facial fracture and there has been a significant increase in number of cases in the last years. Misidentification and inadequate treatment can take to permanent aesthetic or functional deformity. Aim: Evaluate cases of mandibular fracture reduction in the Hospital of Clinics of the Federal University of Uberlândia, from January of 1974 to December of 2002. Study design: historical cohort. Patient and Method: Two hundred and ninety-three cases of reduction of mandibular fractures were retrospectively analyzed according to factors related to: patient, trauma, signs and symptoms, and surgical treatment. Results: There has been a clear tendency of increase of the number of mandibular fractures along the years. There was higher prevalence in male (4:1), with occurrence peak between 20 to 29 years old. The principal causes of fracture in this study were traffic accidents and violence, representing 72.4%. One hundred and thirty-five patients presented only one fracture. The most injured sites were, in decreasing order, symphysis, condyle, angle, body, ramus, and coronoid. We performed closed reduction (28), open reduction (213) and association of the two (11 patients); 56.8% of the patients were treated within the first 3 days; and, 50.4% were discharged from the hospital until the first postoperative day. About 10% of the patients presented complications, being osteomyelitis the most frequent one. Conclusion: The incidence of mandibular fractures was remarkably larger in the male sex, during the third decade of life. The most common cause was traffic accident, and symphysis and condyle were the most injured sites. Isolated fractures occurred in over half of the cases. Most of the patients were treated in the first three days and were discharged until the first postoperative visit. Closed reduction was the treatment most commonly employed. The most frequent complication was osteomyelitis.