Retrospective Analysis of 162 Mandibular Fractures: An Institutional Experience

Stability and Clinical Outcomes of Angle Fracture Fixation Using Sagittal Split Plate (SSOP) Versus Two Miniplates: Randomized Clinical Trial

The aim of this study was to compare the stability and clinical outcomes between the two miniplates and sagittal split plate (SSOP) in angle fracture fixation. Thirty-eight patients with a mandibular angle fracture were selected and divided randomly into two groups. Intervention was treated with SSOP, and the control group was treated with conventional two miniplates. Clinical evaluation included occlusion, edema, nerve affection, wound dehiscence and mouth opening. Radiographic parameters included the measurement of inter-ramus distance, inter-mental distance and bone density. All clinical parameters were evaluated at one week, one month and three months intervals. Radiographic parameters were evaluated immediately postoperative, and after three months. Results showed that SSOP had less postoperative complications (10.50%) than the two miniplates (31.60%). It can be concluded that both methods offered high performance in management of mandibular angle fractures. However, SSOP group had a significantly shorter operating time, increased bone density and less edema. Clinical trial registration number: NCT03839368.

Single Versus Two Plate Osteosynthesis for Parasymphysis Fractures of the Mandible: A Prospective Comparative Study

Background The treatment of mandibular fractures has undergone a revolutionary change after the invention of miniplate osteosynthesis. There aren't many studies in the literature comparing the outcomes of treating mandibular parasymphysis fractures with two miniplates versus one miniplate.  Aim To evaluate the outcomes of single vs. two plate osteosynthesis in the management of parasymphysis fractures of the mandible. Materials and methods Sixteen patients with parasymphysis fracture of the mandible treated with a single high-profile miniplate or with two miniplates were included in the study. Multiple outcome variables such as fracture union, wound infection, dehiscence, iatrogenic dental injury, intraoperative time, plate exposure, and need for plate removal were recorded and analyzed statistically using the Student's t-test. Results The occurrence of iatrogenic dental injury (P= 0.021) and the mean operating time showed a statistically significant difference between the groups, whereas variables such as osseous healing, plate exposure, wound dehiscence, and postoperative paresthesia had no significant difference (P > 0.05). Conclusion Despite both systems providing enough stability for osseous healing, the use of a single high-profile miniplate demonstrated fewer post-operative problems, such as iatrogenic injury to the dental roots and occurrence of infection/dehiscence and plate exposure, than the use of two miniplates.

Paediatric Mandibular Fracture Management - A Seven Year Retrospective Study

Introduction

Mandibular fractures are one of the most frequent and complex types of traumatic injuries of the maxillofacial region in children. Given significant long-term sequelae of inappropriate healing, adequate diagnosis and choice of management, which takes into account the patient's age and fracture characteristics, are paramount.

Methods

The data for this study were obtained from the medical records of patients treated in the Department of Surgical Dentistry and Paediatric Maxillofacial Surgery of the Bogomolets National Medical University from 2014 to 2020. Age, gender, fracture pattern and surgical treatment methods performed in these patients were recorded and analysed.

Results

A total of 302 children with 376 traumatic fractures of the mandible were managed during the study period. The largest number of fractures was found in the condylar processes region, 42%, and in the body of the mandible, 40%. The majority of patients were males and in the 13-17 age group (147 [49%] cases). Tigerstedt's maxillary-mandibular fixation splint was used in the majority of cases, alone or in the combination with open or internal fixation.

Discussion

Whilst the most common type of immobilisation in children in our series was Tigerstedt's maxillary-mandibular fixation splint, its use is limited to the variable bite period. Alternative fixation options are discussed.

An In Vitro Evaluation of a Novel Design Z Plate for Fixation of Mandibular Symphysis and Parasymphysis Fractures-A Finite Element Analysis

Aim

Surgical management of mandibular symphysis and parasymphysis fractures has evolved from rigid fixation to semi-rigid fixation with miniplate osteosynthesis. Various miniplate systems have been developed in recent years including three-dimensional miniplate, microplates and bioresorbable plate, and their advantages and disadvantages have been compared and studied. To overcome the shortcomings of 3D plating system such as difficulty in adaptation and fixation in fractures involving the mental nerve, a novel Z plate has been designed by our institute.

Material and Methodology

An in vitro study was performed to evaluate the biomechanical behaviour of the newly designed Z plate with 3D plate and two-miniplate system using finite element analysis.

Results

Our study showed total structural deformation of 0.17 mm and 0.31 mm of newly designed Z plate after canine loading and molar loading, respectively. The equivalent von Mises force for plate after canine loading had shown the following results-Z plate showed values of 121.3 MPa and 58.40 MPa after molar loading.

Conclusion

Our study concluded that the Z plate produces lowest stresses, lesser total structural deformation, superior stability and support in comparison with the 3D plate and two-miniplate system.

A retrospective analysis of mandibular fractures in Mewat, India

Objectives

Mandibular fractures vary significantly with respect to epidemiological and demographic parameters among populations. To date, no study has evaluated these aspects of mandibular fractures in Nuh, Mewat, Haryana, India. To retrospectively analyze the incidence, age and sex distributions, etiology, anatomic distribution, occlusal status, treatment modality provided, and their correlation in patients who suffered isolated mandibular fractures.

Materials and Methods

The records of maxillofacial injury patients who reported to the Department of Dentistry, SHKM Government Medical College from January 2013 to December 2019, were retrieved from our database, and necessary information was collected. The data collected were analyzed statistically using IBM SPSS ver. 21.

Results

Totals of 146 patients and 211 fractures were analyzed. There were 127 males and 19 females with an age range of 3-70 years (mean age, 26 years). Road traffic accident (RTA) was the most common cause of fracture (64.4%), followed by fall (19.9%), assault (15.1%), and sports injury (0.7%). Of all patients, 42.5% had bilateral fractures, 31.5% had left side fracture, 21.2% had right side fracture, 3.4% sustained midline symphyseal fracture, and 1.4% had symphyseal fracture along one side of the mandible. Site distribution was as follows parasymphysis (34.6%), angle (23.7%), condyle (20.4%), body (12.8%), symphysis (4.3%), ramus 2.4%, and dentoalveolar 1.9%. The most common facture combination was angle with parasymphysis (17.8%). Occlusion was disrupted in 69.2% patients. Closed reduction was the predominant treatment modality.

Conclusion

The data obtained from retrospective analyses of maxillofacial trauma increase the understanding of variables and their outcomes among populations. The results of the present study are comparable to those of the literature in some aspects and different in others.

A new classification of mandibular fractures

There is no accepted method of reporting mandibular fracture that reflects incidence, treatment and outcome for individual cases. As most series include anatomical site only for all fractures, the aim was to establish a new method to report fractures based on a systematic review of the literature and an internal audit. The classification proposed is: Class I; condyle, II; angle, IIc; II+condyle, III; body/symphysis, IIIc; III+condyle, IV; multiple fractures not including condyle, IVc; IV+condyle, V; bilateral condyle±other fracture(s). A total of 10,971 adult and 914 paediatric cases were analyzed through systematic review, and 833 from the regional audit. Only 32% (14/44) of reported series could be reclassified which, when added to the audit data, showed Class IV was most common (29%), with similar proportions of Class III, Class IIIc and Class II (18-23%). External validation (literature review) in terms of treatment and outcome was non-informative, but the internal validation (audit) demonstrated an increasing requirement for adding maxillomandibular fixation (MMF) to open reduction and internal fixation (ORIF) as class increased. The heterogeneity of data reporting found in the systematic review confirms the need for a classification such as this, likely to enhance comparison of varying management protocols.