Treatment of extensive comminuted mandibular fracture between both mandibular angles with bilateral condylar fractures using a reconstruction plate: a case report

A Cone Bean Computer Tomography Investigation of the Newly Formed Mandibular Anterior Ridge following the Treatment of an Extended Comminuted Fracture: A 12-Year Follow-Up

Introduction

Extensive comminuted fractures are associated with tooth loss that ultimately leads to dimensional changes in the hard and soft tissues of the alveolar ridge. Reconstruction of the lost mandibular anterior ridge is very complex due to the natural curvature of the region. Case Presentation. In this case report, the combination of the modified shell technique with autologous bone plates and the guided bone regeneration (GBR) technique was performed on an 18-year-old patient after a comminuted fracture, to ensure new bone formation in the anterior ridge with a natural curvature. After the treatment progressed without complications, three dental implants were placed. Annual cone beam computed tomography (CBCT) images were obtained and evaluated using the GNU Image Manipulation Program (GIMP© 2.10). This allowed measurements of the buccal and lingual bone around the implants, showing the annual bone loss in a twelve-year observation period. Discussion. The treatment of the comminuted fracture and the combination of the modified shell technique with autologous bone plates, the GBR technique, and implant placement can be considered successful. The three dental implants were osseointegrated in 2010, with the buccal bone level averaging 1.31 mm below the implant shoulder and the lingual bone level 1.57 mm above the implant shoulder. In 2021, the measurements showed a bone loss of 0.99 mm at the buccal implant shoulder and 0.69 mm at the lingual implant shoulder.

Conclusion

The combination of the modified shell technique with autologous bone plates and the GBR technique is a reliable method to ensure new bone formation in the anterior ridge. The use of CBCT is an excellent method to evaluate bone resorption around dental implants, but due to minimal bone resorption in the observation period, an annual CBCT examination is exaggerated.

Treatment of pediatric bilateral condylar fractures: A comprehensive analysis

Pediatric bilateral condylar fractures (PBCF) is a rare clinical pathology, where the management is carried out with both conservative and surgical approaches. The purpose of this study was to analyze and compare these two treatment approaches and their associated long term complications in PBCF. An extensive literature review- through the search of online databases- was conducted to survey, collect, analyze and compare the reported outcomes of different treatment modalities for PBCF. The number of studies presenting PBCF case reports was 16, while the number of such retrospective studies included here was 19. Analyses of these studies revealed that the conservative treatment is preferred in PBCF patients younger than 12 years of age. Moreover, a composite approach where the open reduction and internal fixation (ORIF) is carried out for one side while the intermaxillary fixation (IMF) for the contralateral side is frequently reported for the management of PBCF cases; this approach appears effective in improving daily functioning of temporomandibular joint and reducing long term complications. Performing ORIF for one side while IMF for the contralateral side seems the most common treatment approach in PBCF. This study may help in rapid decision making for treatment selection of PBCF patients while minimizing the risk for late complications.

Treatment of extended comminuted mandibular fractures with infected cutaneous fistule Post-ORIF using a reconstruction plate: A case report

Introduction

Case report

Discussion

Conclusion

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Extensively comminuted mandibular fractures are known to be difficult to manage and have high rates of complications such as cutaneous fistules.

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Infection of jaw fractures represents the most commonly encountered postoperative complication and mandibular fractures are reported to be associated with the highest rate of infections among other maxillofacial fractures.

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Open reduction allows the patient to have faster results with less complications in the future.

Open Reduction and Internal Fixation Strategy For Treatment of Comminuted Mandibular Fracture

PURPOSE

The aim of this study was to evaluate the treatment strategy of open reduction and internal fixation (ORIF) for comminuted mandibular fracture (CMF).

METHODS

Clinical studies about CMF were collected. Detailed information was extracted, and data were analyzed and merged from included articles.

RESULTS

Twelve studies, including 338 patients with CMF, were reported. A total of 256 patients receive ORIF among these 338 patients, and exhibited followed characteristics: ORIF usually were performed several days after injury; the extraoral approach for ORIF was used for 103 patients among 205 patients who received ORIF with definite information about surgical approach; titanium mesh, or reconstruction plate, combined with mini-plates was used in 17 and 194 patients, respectively; intermaxillary fixation (IMF) usually persisted about 1 to 3 weeks after ORIF; most patients exhibited satisfactory effect without serious complications, and the complication rate varied from 0 to 42%.

CONCLUSIONS

ORIF strategy for treatment of CMF including: ORIF was a priority choice for CMF. ORIF usually was performed at several days after injury. Reconstruction plate, or titanium mesh, combined with mini-plates was recommended for ORIF surgery. After ORIF, IMF usually was recommended for about 1 to 3 weeks.

Efficacy of open reduction and internal fixation in achieving bony union of comminuted mandibular fractures caused by civilian gunshot injuries

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.

Treatment of Extensively Comminuted Mandibular Fracture with the Aid of a Condylar Positioning Device

We describe a case of extensively comminuted mandibular fracture that extends bilaterally to the angle of mandible successfully treated with the use of condylar positioning device (CPD). This simple, yet effective, technique that almost exclusively described in orthognathic surgery is useful when advance surgical techniques such as pre- or intraoperative landmark identification may not be readily available. CPD technique optimizes the manual manipulations of the comminuted distal segments during fracture reduction and internal fixation. At the same time, it allows greater control of the proximal segments to avoid further surgical complication.

Rehabilitation of the Work Accident-Related Traumatic Mandible With Iliac Free Flap, Distraction Osteogenesis, and Dental Implants

Mandibular bone defects due to extensive trauma impair occlusion and affect the aesthetics of facial contouring, making it difficult to obtain a satisfactory outcome. Distraction osteogenesis and free flap is an effective and aesthetic treatment option for rehabilating these defects. In this clinical report, the authors present rehabilitation of a wide mandibular traumatic defect due to a work-related accident with iliac free flap, distraction osteogenesis, and dental implants.