Complications after jaw fractures

Time-Lapse Between Presentation and Treatment of Mandibular Fractures: Is There a Correlation With Sensory Loss Recovery or No Recovery?

ABSTRACT

A prospective cohort study composed of 43 patients treated for unilateral mandibular fracture. The primary study variables were the post-traumatic IAN neurosensory score and the score after fracture reduction in two different groups on the basis of time lapse between presentation and treatment and displacement of mandible fracture. Appropriate descriptive and bivariate statistics were computed. The sample was analyzed over a one year period. It was observed that the recovery percentage (80%) was good in Group-A (n = 20) patients as compared to Group-B (n = 23) patients (43.47%) with significant P value of 0.015. Patients with displacement of ≥9 mm have neurosensory deficit of 80% while fracture displacement ≥ 5 mm to 8 mm have the neurosensory deficit of 34.21% which is significant with P value of 0.049. With each millimeter increase of displacement of fracture segments, more neurosensory deficit will be manifested. Delay in seeking in the treatment increases the risk because of continued movement. Where the injury is more severe, excessive displacement with increased time lapse from injury to surgical intervention, there is a higher possibility neurosensory deficit or no recovery. Early management can reduce the risk of permanent neurosensory deficits.

Jaw fractures in the county of Stockholm (1978-1980) (I). General survey

The material comprised patients from the Stockholm region with jaws fractured during the years 1978-1980. It is the first time a total material is reported from this area. The following data were registered from case sheets and radiographs: age, sex and nationality, time of injury, admittance clinic, time spent in hospital, delay before treatment, aetiology of injury, associated consumption of alcohol or narcotics, localisation and number of fractures, additional injuries, treatment complications and cooperation.

Transosseous wiring in the treatment of condylar fractures of the mandible

During 1973-1975, 27 patients with condylar fractures at the lower or middle level were operated on via the submandibular approach; 5 patients were under 14 years of age. The condyles were medially dislocated or severely displaced, leading to malocclusion. Various kinds of transosseous wirings were used and the mean time of intermaxillary fixation was 22.6 days. The follow-up study of the 27 patients was made on average 11.6 months after the operation. Postoperatively the mouth opening averaged 41.5 mm. There was a slight deviation of the chin (mean 2mm) to the operated side in half the cases. Lateral excursions were within normal limits. Slight motor weakness in the lower lip on the operated side was noted in 3 cases and mild pain in the operated joint in 8 cases. A radiograph revealed some shortening of the condyle in most cases, and some kind of angulation, mostly posterior, in half the cases. No tendency to ankylosis was found and totally normal and symmetric function of the joints was noted in 24 cases. In the light of the results of this follow-up study the method presented, which is not a very easy one, seems to be useful.

Mandibular fractures. II. A follow-up study of 229 patients

During the period 1964-73, 286 patients were treated for mandibular fractures. 229 patients (80%) attended the follow-up examination. The length of observation was from 1 to 9 years. The treatment and the follow-up evaluations in the 229 patients are described. Early fracture treatment has been the objective, also in patients who have undergone severe cerebral traumas. Antibiotic prophylaxis was implemented in cases of compound fractures. Preservation of teeth and tooth buds in the line of fracture was attempted. Clinical infection occurred in 0.4% of the patients. At the follow-up examination 1 patient presented with a fracture displacement outside the condylar process. Neither malocclusion nor pseudarthrosis following fracture or after treatment were seen. Permanent sensory disturbances in the innervation area of the mental nerve following fracture occurred in 8%. Radiological examination of the teeth in the line of fracture revealed unnoticed apical bone lesions in 17% of 118 patients. In a further 23% there was a negative response to the vitality test. Follow-up control of mandibular fractures is advised at 12 to 18 months after treatment.