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Zhou T, Wang H, Du Y, Liu F, Guo Y, Lu H. M 3YOLOv5: Feature enhanced YOLOv5 model for mandibular fracture detection. Comput Biol Med 2024; 173:108291. [PMID: 38522254 DOI: 10.1016/j.compbiomed.2024.108291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND It is very important to detect mandibular fracture region. However, the size of mandibular fracture region is different due to different anatomical positions, different sites and different degrees of force. It is difficult to locate and recognize fracture region accurately. METHODS To solve these problems, M3YOLOv5 model is proposed in this paper. Three feature enhancement strategies are designed, which improve the ability of model to locate and recognize mandibular fracture region. Firstly, Global-Local Feature Extraction Module (GLFEM) is designed. By effectively combining Convolutional Neural Network (CNN) and Transformer, the problem of insufficient global information extraction ability of CNN is complemented, and the positioning ability of the model to the fracture region is improved. Secondly, in order to improve the interaction ability of context information, Deep-Shallow Feature Interaction Module (DSFIM) is designed. In this module, the spatial information in the shallow feature layer is embedded to the deep feature layer by the spatial attention mechanism, and the semantic information in the deep feature layer is embedded to the shallow feature layer by the channel attention mechanism. The fracture region recognition ability of the model is improved. Finally, Multi-scale Multi receptive-field Feature Mixing Module (MMFMM) is designed. Deep separate convolution chains are used in this modal, which is composed by multiple layers of different scales and different dilation coefficients. This method provides richer receptive field for the model, and the ability to detect fracture region of different scales is improved. RESULTS The precision rate, mAP value, recall rate and F1 value of M3YOLOv5 model on mandibular fracture CT data set are 97.18%, 96.86%, 94.42% and 95.58% respectively. The experimental results show that there is better performance about M3YOLOv5 model than the mainstream detection models. CONCLUSION The M3YOLOv5 model can effectively recognize and locate the mandibular fracture region, which is of great significance for doctors' clinical diagnosis.
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Affiliation(s)
- Tao Zhou
- School of Computer Science and Engineering, North Minzu University, Yinchuan, 750021, China; Key Laboratory of Image and Graphics Intelligent Processing of State Ethnic Affairs Commission, North Minzu University, Yinchuan, 750021, China
| | - Hongwei Wang
- School of Computer Science and Engineering, North Minzu University, Yinchuan, 750021, China; Key Laboratory of Image and Graphics Intelligent Processing of State Ethnic Affairs Commission, North Minzu University, Yinchuan, 750021, China.
| | - Yuhu Du
- School of Computer Science and Engineering, North Minzu University, Yinchuan, 750021, China; Key Laboratory of Image and Graphics Intelligent Processing of State Ethnic Affairs Commission, North Minzu University, Yinchuan, 750021, China
| | - Fengzhen Liu
- School of Computer Science and Engineering, North Minzu University, Yinchuan, 750021, China; Key Laboratory of Image and Graphics Intelligent Processing of State Ethnic Affairs Commission, North Minzu University, Yinchuan, 750021, China
| | - Yujie Guo
- School of Computer Science and Engineering, North Minzu University, Yinchuan, 750021, China; Key Laboratory of Image and Graphics Intelligent Processing of State Ethnic Affairs Commission, North Minzu University, Yinchuan, 750021, China
| | - Huiling Lu
- School of Medical Information and Engineering, Ningxia Medical University, Yinchuan, 750004, China.
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Ramos EAA, Munhoz L, Milani BA, Arita ES. Bone quality assessment in patients with healing mandibular fracture sites: a computed tomography investigation. Gen Dent 2024; 72:50-55. [PMID: 38640006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
The objective of this retrospective study was to assess the bone quality of healing mandibular fracture sites by measuring the Hounsfield units (HU) on computed tomographic (CT) images obtained presurgery and postsurgery in patients treated with rigid internal fixation (RIF). The HU values of healing fracture sites were compared to those of corresponding nonfractured (control) sites on the opposing side and cervical vertebrae sites in the same patients. In total, 31 patients with 45 mandibular fractures treated with RIF underwent presurgical and postsurgical CT examinations. The scans performed after surgery (1, 3, 6, 12, or 18 months) were taken only when there was a need for radiographic evaluation due to a complaint of discomfort from the patient or when the surgeon needed to verify the postsurgical outcome, and each patient underwent only a single postsurgical CT. At the presurgical CT examination, the HU values were lower in the fracture sites than in the control sites. At 3 months postsurgery, the HU values in the fracture sites had increased as the mandibular bone healed. At 6 months postsurgery, the HU values in the fracture sites were higher than those of the control sites. At 12 and 18 months postsurgery, the HU values of both sites were similar. The HU values of the cervical vertebrae remained constant with time. These results suggest that, in patients who have been treated with RIF for mandibular bone fracture, HU values measured by CT vary across time, expressing the physiologic bone healing process.
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Zhuang H, Zhu B, Zhu L, You Y, Zhang J, Bu S. Streamlining complex mandibular fracture treatment: Integration of virtual surgical planning and short-segment drilling guides. J Craniomaxillofac Surg 2024; 52:397-405. [PMID: 38458893 DOI: 10.1016/j.jcms.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 03/10/2024] Open
Abstract
This study aimed to evaluate the feasibility and accuracy of a combined virtual surgical planning (VPS) and short-segment drilling guides (SSDGs) workflow for the treatment of complex mandibular fractures. Consecutive patients with complex mandibular fractures underwent treatment using the VPS and SSDGs workflow from August 2020 to April 2022. Various mandibular landmarks were compared between the preoperative virtual surgical plan and postoperative data, including condylar distance (CoD), mandibular angle width (GoL-GoR), GoMeGo angle (∠GoL-Me-GoR), the difference in mandibular angles between the left and right sides (Δ∠Co-Go-Me), and the difference in length between the left and right mandibular body (ΔGo-Me). Additionally, preoperative preparation time and surgical duration were retrospectively analyzed and compared to conventional surgery. All 14 consecutive patients with complex mandibular fractures achieved successful reduction using the VPS and SSDGs workflow. Three-dimensional comparison revealed a mean deviation distance of 0.91 ± 0.50 mm and a root-mean-square deviation of 1.75 ± 0.47 mm between the preoperative designed mandible model and the postoperative mandible model. The percentage of points with deviation distances less than 2 mm, 1 mm, and 0.5 mm between preoperative and postoperative models were 78.47 ± 8.87 %, 60.02 ± 14.28 %, and 38.64 ± 15.48 %, respectively. There were no significant differences observed in CoD, GoL-GoR, ∠GoL-Me-GoR, Δ∠Co-Go-Me, and ΔGo-Me between preoperative virtual surgical planning and postoperative measurements. Furthermore, no significant differences were found in the injury-to-surgery interval, admission-to-surgery interval, and surgical duration between the workflow and conventional surgery. The combined VPS and SSDGs workflow proved to be an accurate and feasible method for treating complex mandibular fractures. It offers advantages such as minimal preoperative preparation time and the ability to precise transfer screw positions of the pre-bent reconstruction plate during surgery. This approach is particularly suitable for managing complex mandibular fractures.
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Affiliation(s)
- Hai Zhuang
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Bowen Zhu
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Liuning Zhu
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Ying You
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Jisheng Zhang
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
| | - Shoushan Bu
- Department of Stomatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China.
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Sohail A, Chishti FUDA, Manzar S, Zahid N, Ahmad F, Rafiq T. Can dynamic elastic therapy be established as the standard protocol of closed reduction for moderately displaced extracapsular condylar fractures? Oral Maxillofac Surg 2024; 28:385-391. [PMID: 37185928 DOI: 10.1007/s10006-023-01154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study was conducted with the aim to establish standard technique of closed reduction (CR) and compare functional outcomes in patients of moderately displaced unilateral extracapsular condylar fractures. MATERIAL AND METHODS This study is a retrospective randomized controlled trial, conducted at a tertiary care hospital setting from August, 2013 to November, 2018. Patients of unilateral extracapsular condylar fractures with ramus shortening < 7mm and deviation < 35° were divided in two groups by drawing lots and were treated by dynamic elastic therapy and maxillomandibular fixation (MMF). Mean and standard deviation were calculated for quantitative variables, and one way analysis of variance (ANOVA) and Pearson's Chi-square test were used to determine significance of outcomes between two modalities of CR. P value < 0.05 was taken as significant. RESULTS The numbers of patients treated by dynamic elastic therapy and MMF were 76 (38 in each group). Out of which 48 (63.15%) were male and 28 (36.84%) were female. The ratio of male to female was 1.7:1. The mean ± standard deviation (SD) of age was 32 ± 9.57 years. In patients treated by dynamic elastic therapy, the mean ± SD (at 6-month follow-up) of loss of ramus height (LRH), maximum incisal opening (MIO) and opening deviation were 4.6mm ± 1.08mm, 40.4mm ± 1.57mm and 1.1mm ± 0.87mm respectively. Whereas, LRH, MIO and opening deviation were 4.6mm ± 0.85mm, 40.4mm ± 2.37mm and 0.8mm ± 0.63mm respectively by MMF therapy. One-way ANOVA was statistically insignificant (P value > 0.05) for above mentioned outcomes. Pre-traumatic occlusion was achieved in 89.47% of patients by MMF and in 86.84% patients by dynamic elastic therapy. Pearson's Chi-square test was statistically insignificant (p value < 0.05) for occlusion. CONCLUSION Parallel results were obtained for both modalities; thus, the technique as dynamic elastic therapy, which promotes early mobilization and functional rehabilitation, can be favored as standard technique of closed reduction for moderately displaced extracapsular condylar fractures. This technique eases patients' stress associated with MMF and prevents ankylosis.
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Affiliation(s)
- Aqib Sohail
- Dental College, Lahore Medical & Dental College, Lahore, Pakistan
| | | | - Saadia Manzar
- Department of Oral & Maxillofacial Surgery, Rashid Latif Dental College/Rashid Latif Medical Complex, Lahore, Pakistan.
| | - Nighat Zahid
- Department of Oral & Maxillofacial Surgery, Lahore Medical & Dental College, Lahore, Pakistan
| | - Fareed Ahmad
- Department of Oral Medicine, CMH Lahore Medical College & Institute of Dentistry, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Tayyaba Rafiq
- Department of Oral & Maxillofacial Surgery, Lahore Medical & Dental College, Lahore, Pakistan
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Zhang C, Song C, Wang D, Gao T, Li J, Yang D, Liu C, Du Y, Zhang K. Digitally driven surgical guide planning. J Clin Pediatr Dent 2024; 48:128-137. [PMID: 38239165 DOI: 10.22514/jocpd.2024.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/15/2023] [Indexed: 01/23/2024] Open
Abstract
To investigate the role of a fully digital process in the surgical treatment of mandibular fractures in children. We analyzed a complete dataset from 22 children with mandibular fractures treated with digital surgical assistance. The patient's treatment process included preoperative thin layer CT (Computed Tomography) scanning, computer-aided design (3D reconstruction, virtual reduction, and internal fixation device determination and shaping), and 3D printing (jaw model, bite plate). We used occlusal and shaping plates during surgery to assist in fracture reduction and fixation. During the follow-up, we observed the occurrence of fracture healing, occlusal relationships, opening degrees, and complications in pediatric patients after surgery. Next, we used the 3D overlay function of MIMICS software to compare the preoperative surgical design with postoperative jaw imaging data to evaluate the overall surgical effect. The postoperative imaging data showed good fracture healing, normal occlusion during follow-up, and significant improvement in opening degrees. The mean preoperative opening degree was 23.59 ± 2.89 mm, and the mean postoperative opening degree was 29.82 ± 1.79 mm; there was a significant difference between these two parameters (p < 0.05). There were no complications such as tooth germ injury, nerve injury or fracture block displacement. The postoperative mandibular imaging data was imported into MIMICS software for 3D overlay visualization, and the postoperative mandibular morphology recovery was well-matched with the preoperative design. We measured the average upper deviation (0.65 ± 0.09) mm and the average lower deviation (-0.57 ± 0.14) mm. The fully digital process has a precise, minimally invasive, and safe effect in the surgical treatment of mandibular fractures in children, and the clinical effect is satisfactory.
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Affiliation(s)
- Chenchen Zhang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Chi Song
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Dong Wang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Tingyi Gao
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Jie Li
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Dongkun Yang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Chang Liu
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Yue Du
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
| | - Kai Zhang
- Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College, 233004 Bengbu, Anhui, China
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Sfondrini D, Marelli S. The "low preauricular" transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures. J Craniomaxillofac Surg 2024; 52:108-116. [PMID: 38129188 DOI: 10.1016/j.jcms.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures. Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications. Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment. The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland. The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.
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Affiliation(s)
- Domenico Sfondrini
- Division of Maxillo-facial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Stefano Marelli
- Division of Maxillo-facial Surgery, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
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Leow J, Exley R, Holmes S, Bhatti N. How good is good enough? Lessons learned from review of outcomes of 50 patients following extraoral open reduction and internal fixation of condylar neck and base fractures at a regional major trauma centre. Br J Oral Maxillofac Surg 2024; 62:83-88. [PMID: 38101970 DOI: 10.1016/j.bjoms.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
The management of mandibular fractures is routine owing to their frequency, particularly those of the mandibular condyle, which are invariably common. Notwithstanding disparities in the literature, the international consensus towards which fractures of the mandibular condyle benefit from open surgical intervention is almost universally accepted. Closed reduction or non-operative management may be utilised in certain circumstances. Whilst outcome research has addressed complications with respect to operative side effects, outcomes related to the quality of bone repair and the setting in which this is delivered have not been universally addressed. The aim of this study was to determine the predictability of translating an indicated operative treatment plan into an acceptable functional result. We evaluated the outcomes of 59 extracapsular condylar fractures in 50 patients who were treated by extraoral open reduction and internal fixation (ORIF) between March 2021 and August 2022. We reviewed demographic data, surgical approach, and plating strategy, and critically evaluated the clinical and radiological outcomes. Whilst we found that the quality of reduction was not universally perfect, the majority were within tolerance, which we set according to the Strasbourg Osteosynthesis Research Group (SORG) definition for minimal displacement (<2 mm overlap and 10° angulation). The cohort had good functional occlusion and minimal long-term postoperative complications. Two patients required re-operation for non-union, and we discuss causality in these cases. In conclusion, we found that ORIF of condylar neck and base fractures is predictable in real-time surgical practice with respect to functional outcome. However, if imperfectly reduced, there is a small risk of non-union.
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Affiliation(s)
- Julian Leow
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom.
| | - Rebecca Exley
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom
| | - Simon Holmes
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom
| | - Nabeel Bhatti
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London E1 1BB, United Kingdom
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Jinka SKA, Davidson EH, Wang HD. Cervical Necrotizing Fasciitis: A Severe Sequela of Open Mandibular Fracture and Delay in Treatment. J Craniofac Surg 2024; 35:e92-e94. [PMID: 37972984 DOI: 10.1097/scs.0000000000009892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
Cervical necrotizing fasciitis (CNF) is a rare condition in the United States, with very few cases reported as a sequela of mandibular fracture. The authors describe the case of a 40-year-old man with poor oral health and no significant past medical history who developed CNF following delayed treatment of an open mandibular fracture, leading to life-threatening septic shock, thrombophlebitis of the internal jugular vein, and septic emboli to the lungs. Successful management of this patient was accomplished by serial surgical debridement, the administration of broad-spectrum antibiotics, and hemodynamic support. Eventual reconstruction was performed with external fixation of the mandible fracture and split-thickness skin grafting for the left neck and chest wound. The authors recommend early treatment of open mandibular fractures for immunocompromised patients or patients with poor oral hygiene to avoid the rare but potentially fatal complication of CNF and highlight external fixation as a useful technique in select cases of complex mandibular fractures.
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Affiliation(s)
- Sanjay K A Jinka
- Case Western Reserve University School of Medicine
- Division of Pediatric Plastic and Reconstructive Surgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Edward H Davidson
- Case Western Reserve University School of Medicine
- Division of Pediatric Plastic and Reconstructive Surgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Howard D Wang
- Case Western Reserve University School of Medicine
- Division of Pediatric Plastic and Reconstructive Surgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
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Zhao L, Long Y, Xu G, Long J. Assessment of relationships between condylar fracture pattern and mandibular third molar position by panoramic radiography and computed tomography: A retrospective comparative study. Dent Traumatol 2023; 39:575-585. [PMID: 37529916 DOI: 10.1111/edt.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND/AIM Although previous studies have revealed the influence of the mandibular third molar (M3) on mandibular condylar fracture risk and that the presence of M3 could result in different incidences of condylar and angle fractures, there have been no analyses of the influence of M3 on fracture patterns. Moreover, evaluations of M3 position using panoramic radiography have shown insufficient accuracy. This study investigated the relationship between condylar fracture patterns and M3 position using panoramic radiography and computed tomography. MATERIALS AND METHODS This retrospective study included 280 patients with unilateral mandibular condylar fractures and ipsilateral M3 admitted to West China Hospital of Stomatology between January 2016 and June 2022. Patient medical records, panoramic radiographs, and computed tomography images were collected. The vertical and horizontal positions of M3 were classified using the Pell and Gregory system. M3 angulation was defined as the angle between the long axis of M3 and the mandibular occlusal plane. Condylar fracture patterns were classified as intracapsular (Types A-C) or extracapsular (neck and base). Data were analyzed using McNemar-Bowker test, Pearson chi-squared test, and Fisher's exact test. RESULTS Classification of M3 position differed significantly between panoramic radiography and computed tomography images (p < .05). There was a significant association between the mandibular condylar fracture pattern and M3 horizontal position on computed tomography (p < .05). Class I M3 position on computed tomography was associated with a higher incidence of intracapsular than extracapsular fractures, along with a higher incidence of Type B than base fractures; the opposite relationships were observed for Class II. No such association was identified on panoramic radiography. CONCLUSIONS Mandibular condylar fracture patterns were presumably influenced by M3 horizontal position on computed tomography. The imaging modality affected the classification of M3 position and subsequent analyses. Computed tomography is recommended for future studies to improve accuracy and reliability.
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Affiliation(s)
- Luyang Zhao
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Yifei Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Guikun Xu
- Department of Oral and Maxillofacial Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Jie Long
- The State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, China
- National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
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Maurer M, Klaes T, Meier JK, Gottsauner JM, Taxis J, Schuderer J, Reichert TE, Ettl T. Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases. Dent Traumatol 2023; 39:586-596. [PMID: 37485754 DOI: 10.1111/edt.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND/AIM Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. METHODS A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. RESULTS The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). CONCLUSION Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.
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Affiliation(s)
- Michael Maurer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tabea Klaes
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Johannes K Meier
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Jürgen Taxis
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Johannes Schuderer
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany
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Dekker P, Callahan NF, Miloro M, Han MD. Which Factors Affect the Reduction Quality of Open Reduction Internal Fixation of Mandibular Subcondylar Fractures? J Oral Maxillofac Surg 2023; 81:1485-1494. [PMID: 37741628 DOI: 10.1016/j.joms.2023.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/26/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Open reduction internal fixation (ORIF) of mandibular subcondylar fractures (MSF) involves several variables that could affect decision making. There is insufficient data regarding factors influencing the outcomes of MSF ORIF. PURPOSE The purpose of this study was to investigate factors associated with quality of bony reduction of MSF and occlusion, after ORIF. STUDY DESIGN, SETTING, AND SAMPLE We designed a retrospective cohort study of consecutively treated subjects for MSF ORIF, ages 18 to 64 years, by University of Illinois' Department of Oral and Maxillofacial Surgery, between January 1, 2013, and January 26, 2021. PREDICTOR VARIABLE The primary predictor variable was the vertical level of MSF from the gonial angle. Secondary predictor variables included surgeon, fixation scheme (number and configuration of miniplate), surgical approach, time to surgery, mechanism of injury, vertical fragment overlap, overlying soft tissue thickness, presence of other mandibular fractures, and severity and direction of displacement. MAIN OUTCOME VARIABLES The primary outcome variable was the mean radiographic reduction score (RRS), rated by 2 blinded observers on a 1 to 5 scale. The secondary outcome variable was presence of postoperative malocclusion as documented in the medical records. COVARIATES Covariates were age and sex. ANALYSES Descriptive statistics were computed. To investigate the influence of the predictor variables on reduction quality, multifactorial analysis of variance with post hoc Tukey test was performed. For malocclusion, χ2 test was performed. The level of significance was set at P < .05. RESULTS Thirty-eight MSF in 37 subjects were included. Mean age was 32.7 years (range 18 to 64), and 83.8% were male. Mean RRS was 4.38 (standard deviation 0.77). Fixation scheme was the only variable that showed significant impact on RRS: single-straight miniplate had lower scores than double-straight (-1.50, P = .011), rhomboid (-1.29, P = .036), and ladder miniplates (-1.38, P = .048). There was 1 incidence of malocclusion (2.7%) which resolved without intervention. CONCLUSIONS AND RELEVANCE Favorable reduction (anatomic reduction to mild discrepancies) can be achieved without malocclusion using double-straight, or rhomboid-shaped or ladder-shaped miniplates, without influences from patient or injury-related factors. In contrast, single-straight miniplate fixation resulted in moderate discrepancies in reduction, although it did not lead to malocclusion.
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Affiliation(s)
| | - Nicholas F Callahan
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Michael Miloro
- Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Michael D Han
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL.
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Cole-Healy Z, Sainuddin S. Distraction test for simple mandibular angle fractures - a useful test to aid clinical decision making. Br J Oral Maxillofac Surg 2023; 61:638-639. [PMID: 37806939 DOI: 10.1016/j.bjoms.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Zachary Cole-Healy
- Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, United Kingdom.
| | - Sajid Sainuddin
- Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, United Kingdom
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13
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Buitenhuis MB, Weinberg FM, Bielevelt F, Gilijamse M, Forouzanfar T, Speksnijder CM, Rosenberg AJWP. Anatomical position of the mandibular condyle after open versus closed treatment of unilateral fractures: A three-dimensional analysis. J Craniomaxillofac Surg 2023; 51:682-691. [PMID: 37852888 DOI: 10.1016/j.jcms.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/24/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023] Open
Abstract
This study aimed to compare open and closed treatment for unilateral mandibular condyle neck and base fractures by final three-dimensional (3D) condylar position at 6 months follow-up. 3D position was associated with mandibular functioning and pain. A total of 21 patients received open (n = 11) or closed (n = 10) treatment. 3D positions were assessed on cone-beam computed tomography scans. Volume differences, root mean square, translations, and rotations were obtained related to the pursued anatomical position and compared between treatment groups by the Mann-Whitney U test. The 3D position parameters were associated with the maximum interincisal opening (MIO), mixing ability test (MAT), Mandibular Function Impairment Questionnaire (MFIQ), and pain based on Spearman correlation coefficients (rs). Translation in the medial-lateral direction was smaller after open treatment (P = 0.014). 3D position was not associated with the MAT; however, worse position was associated with a smaller MIO. A larger pitch rotation was associated with a worse MFIQ (rs = 0.499, P = 0.025). Volume reduction of the affected condyle was associated with more pain (rs = -0.503, P = 0.020). In conclusion, after unilateral condylar fractures, worse 3D position is associated with a smaller mouth opening and worse patient-reported outcomes. This is independent of the chosen treatment, despite a better anatomical reduction after open treatment.
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Affiliation(s)
- Margje B Buitenhuis
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Florine M Weinberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Freek Bielevelt
- 3D Lab Radboudumc, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | | | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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14
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Abdou Ata MAER, Marzook HAEM, Tawfik MAM, Elmissiry ZMA. Z-shaped Miniplates vs Conventional Miniplates for Fixation of Mandibular Parasymphyseal Fractures. J Contemp Dent Pract 2023; 24:761-770. [PMID: 38152909 DOI: 10.5005/jp-journals-10024-3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM The aim of this study was to evaluate a clinically and radiographically Z-shaped miniplate for the fixation of the parasymphyseal fractures. PATIENTS AND METHODS Twenty patients (10 patients in each group) who had parasymphseal mandibular fractures were randomly selected for this study. In this study, open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using two miniplates as group I, and open reduction and internal fixation were performed for mandibular parasymphyseal region fractures using a newly designed Z-shaped miniplate as group II. Clinical and radiographic evaluations were made. Each patient was evaluated: (1) clinically evaluated preoperatively and postoperatively for operating time, ease of placement of the miniplate, and occlusion and (2) radiological: postoperative reduction of fracture was evaluated radiologically at 5-day, 1-month, 2-month, and 3-month intervals with orthopantomogram, and lingual splaying was evaluated by cone-beam computed tomography (CBCT) immediately postoperatively and at an interval of 3 months. The collected data were subjected to statistical analysis. Data analysis was performed by SPSS software, version 25 (SPSS Inc., PASW statistics for Windows version 25). Chicago: SPSS Inc. RESULTS There was a statistically significant difference (p < 0.001) between the mean intraoperative time. This indicates that group I had a longer time for fracture fixation than group II. Group I had a longer time elapsed for plate adaptation and definitive fixation than group II. Occlusion and reduction stability in both groups were similar. There was a statistically significant difference in postoperative lingual display control after 5 days and 3 months between the studied groups. This indicates that lingual display control in group II is better than in group I. CONCLUSION The Z-shaped miniplate is effective and provides three-dimensional stability for the fixation of parasymphyseal fractures, ease of use, easily adapted in cases of fractures near the mental nerve reduced operative time, and better control of lingual splaying than conventional miniplates. CLINICAL SIGNIFICANCE The newly designed Z-shaped miniplate is a valuable option for fixation parasymphysis fractures that need open reduction and internal fixation instead of using conventional miniplates, which are less successful in controlling lingual splaying.
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Affiliation(s)
- Mohamed Abd El-Rahman Abdou Ata
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt, Phone: +201001706755, e-mail: , https://orcid.org/0009-0009-0298-8335
| | | | - Mohamed Abdel-Monem Tawfik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Ziad Mohamed Amr Elmissiry
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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15
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El Sayed AGA, Ghanem AA, Al Mansi YA, Elhadidi YN, El Wahab El Kassaby MA. The Use of Combined Microplate And Miniplate in the Fixation of the Mandibular Fractures (A Randomized Clinical Trial). J Craniofac Surg 2023; 34:e684-e686. [PMID: 37497791 DOI: 10.1097/scs.0000000000009527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/19/2023] [Indexed: 07/28/2023] Open
Abstract
The study group patients have been treated with 1.6 microplates at the superior border and 2.0 miniplate at the inferior border to evaluate its efficacy in the fixation of symphyseal and parasymphyseal fractures using this technique. The control patients were treated with two 2.0 plates. The stability was assessed using computed tomography immediately performed postoperatively and after 6 months. Assessment of the change in the intercanine distance using the Student T test was statistically Non Significant ( P value 0.34). The change of intercanine distance in the study was 0.04 ± 0.05 mm, compared with that of the control, which was 0.01 ± 0.03 mm. Assessment of change in intermental foramina distance was statistically NS ( P value = 0.06). The average difference in intermental foramina distance in the study was 0.04 ± 0.05 mm, compared with the control, which was 0.002 ± 0.004 mm. Based on the findings of the current study, the authors recommend the use of microplates combined with miniplates in the correction of both symphyseal and parasymphyseal fractures successfully.
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Affiliation(s)
| | - Amr Amin Ghanem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The British University
| | - Youssef Ahmed Al Mansi
- Department of Oral and Maxillofacial Surgery in The Military Hospital
- Military Medical Academy, Cairo, Egypt
| | - Yasser Nabil Elhadidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University
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Keskin Yalcin B. Biomechanical Comparison of Titanium and Poly- L -Lactic Acid Trapezoidal Plates Applied in a Subcondylar Fracture Model. J Craniofac Surg 2023; 34:1737-1740. [PMID: 36856431 PMCID: PMC10445633 DOI: 10.1097/scs.0000000000009238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/05/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND/AIM Different types of plates are used in clinical practice for the management of subcondylar fractures. This study aimed to compare the performance of poly- L -lactic acid (PLLA) and titanium trapezoidal plates in the fixation of subcondylar mandibular fractures using finite element analysis. METHODS Titanium and PLLA trapezoidal plates and screws were placed on the virtual model obtained from computed tomography images of a patient with a subcondylar fracture to perform finite element analysis. The analysis included maximum tension distribution, maximum principal strain, displacement, and deformation of the bone, plates, and screws. RESULTS The maximum tension distribution and maximum principal stress were found to be significantly higher on the titanium plate than on the PLLA plate and screws. Almost no difference was found between the trapezoidal and PLLA plates regarding the displacement of the fracture fragments at the fracture line. No difference was recorded regarding the displacement of the PLLA and titanium screws. The values of maximal principal strain between the PLLA and titanium materials showed no significant difference. CONCLUSIONS The trapezoidal PLLA plates can be an alternative to trapezoidal titanium plates due to their functional stability and rigidity.
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Sundaram DS, Lal B, Kumar RD, Bhutia O. A rare case of bilateral pseudoaneurysm secondary to mandibular condyle fracture-a case report with review of literature. Oral Maxillofac Surg 2023; 27:527-532. [PMID: 35654988 DOI: 10.1007/s10006-022-01069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
This paper aims to present a rare case report of bilateral pseudoaneurysm secondary to condylar fracture and its management with a brief review of literature. A patient of age 19 years with alleged history of road traffic accident presented 6 weeks lately to our department with slow growing swelling in right preauricular area. History revealed bilateral condylar fracture with right parasymphysis fracture of mandible for which patient underwent maxillomandibular fixation for 4 weeks. The diffuse swelling in preauricular region showed positive signs of pulsation and audible bruit. Ultrasonography and contrast-enhanced computed tomography suggested the bilateral presence of vascular anamoly from the terminal branches of external carotid artery. Diagnostic angiography confirmed presence of pseudoaneurysm at the bifurcation of the internal maxillary artery and superficial temporal artery (STA) on right side whereas on the left side it was at proximal STA. Bilateral endovascular coil and gel foam embolization was done and thrombosis was confirmed with high frequency ultrasound on fourth postintervention day. The swelling completely resolved in a period of 1 month with no evidence of recurrence in the following 2-year follow-up period. Routine investigation revealed presence of pseudoaneurysm on left side which was completely without any clinical signs as repoterd by many cases of condylar fracture in the literature review. Pseudoaneurysm may remain silent and are exposed intraoperatively with massive bleeding which causes significant morbidity. Hence, prompt diagnosis and management is essential to avoid unexpected complication perioperatively.
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Affiliation(s)
- D Shanmuga Sundaram
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India
| | - Babu Lal
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India
| | - Rudra Deo Kumar
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India
| | - Ongkila Bhutia
- Department of Oral and Maxillofacial Surgery, All India Institue of Medical Sciences, New Delhi-110029, India.
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18
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Wu B, Lv K. Control of Mandibular Width With 3D Printed Occlusal Splint in Children With Multiple Mandibular Fractures. J Craniofac Surg 2023; 34:e582-e584. [PMID: 37236625 DOI: 10.1097/scs.0000000000009418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The fracture of mandibular symphysis combined with bilateral condylar fractures often leads to changes in the width of the mandible, which significantly widens the face of the child. Therefore, it is necessary to reposition the mandible through accurate adduction. METHODS To ensure that the mandible can be accurately repositioned, a 3D printed occlusal splint was used. Bilateral maxillomandibular fixation screws were implanted. The 3D printed occlusal splint was located on the maxillary dentition and fixed to the maxillomandibular fixation screws with wire loops. The reference basis for adduction is to make the mandibular dentition located in the occlusal splint. The absorbable plate was contoured according to the restored model and fixed at the fracture site. The 3D printed occlusal splint was retained in the maxillary dentition for two months. RESULTS AND DISCUSSION Postoperative computed tomography showed that the mandible had been adducted according to the preoperative design. Two months of follow-up showed that the child's facial development, mouth opening type, occlusion, and range of motion were good. It is especially suitable for children with mandibular symphyseal fractures accompanied by bilateral condylar fractures.
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Affiliation(s)
- Benxing Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, People's Republic of China
| | - Kun Lv
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, Wuhan, People's Republic of China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
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19
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McLeod NM, Saeed NR, Gerber B. Remodelling of mandibular condylar head after fixation of fractures with ultrasound activated resorbable pins: A retrospective case series. J Craniomaxillofac Surg 2023; 51:460-466. [PMID: 37553264 DOI: 10.1016/j.jcms.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/22/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
The aim of this study was to assess whether the resorption of poly-lactic acid pins, used for condylar head fracture fixation, adversely affect remodelling of the condylar head. A retrospective review of patients was performed that underwent ORIF of CHF with ultrasound activated resorbable poly-lactic acid pins and had CT/CBCT scans of the condyle at least 18 months after surgery, at which point the fixation material was expected to be resorbed. We reviewed the size, shape and position of the condylar head and compared this to the normal side and compared this to the results of conservative management and ORIF with titanium screws in the literature. Most patients had condylar heads normally positioned and shaped, with minimal bone changes. The position of the condyle in the fossa, its shape and bone changes compare favourably with previous studies on CHF managed conservatively or with titanium screw fixation. There was no radiographic evidence of the pins after 18 months. In conclusion, ultrasound activated resorbable pins can provide suitable fixation for ORIF of condylar head fractures, avoiding the need for screw removal, and there was no evidence that the resorption process adversely affected the remodelling of the condylar head.
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Affiliation(s)
- Niall Mh McLeod
- University Hospitals Coventry and Warwickshire NHS Trust, Department of Oral & Maxillofacial Surgery, University Hospital, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Nadeem R Saeed
- Oxford University Hospitals NHS Trust, Department of Oral & Maxillofacial Surgery, The John Radcliffe, Headley Way, Oxford, OX3 9DU, UK
| | - Barbara Gerber
- Oxford University Hospitals NHS Trust, Department of Oral & Maxillofacial Surgery, The John Radcliffe, Headley Way, Oxford, OX3 9DU, UK
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20
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BlessmannWeber JB, Alves NDM, Coelho EMRDB, Fritscher GG, Dos Santos GFK, Kramer PF. Biodegradable Plates for Mandibular Fracture Fixation in Young Children. J Dent Child (Chic) 2023; 90:102-106. [PMID: 37621042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Mandibular fractures are rare in children and normally result from high-impact trauma. Clinical protocols have evolved in recent years, especially after the introduction of rigid internal fixation methods and the development of novel resorbable materials. The purpose of this report is to present the case of a three-year-old toddler who fell from a bunk bed at home, resulting in a unilateral fracture of the mandibular parasymphysis and a joint fracture on the left side. The patient was treated under general anesthesia with rigid internal fixation with biodegradable plates and screws. Pediatric patients can benefit from resorbable materials, especially their faster mobilization and avoidance of secondary removal operations. Self-reinforced fixation devices are safe and efficient for the treatment of pediatric mandible fractures. However, further clinical investigations are needed to evaluate long-term reliability.
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Affiliation(s)
| | - Nilton de Moura Alves
- Department of Pediatric Dentistry, School of Dentistry, Universidade Luterana do Brasil, Canoas, Brazil
| | | | - Guilherme Gehner Fritscher
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica, Porto Alegre, Brazil
| | | | - Paulo Floriani Kramer
- Department of Pediatric Dentistry, School of Dentistry, Pontifícia Universidade Católica and Universidade Luterana do Brasil, Porto Alegre, Brazil
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Lakshmi Rathan AC, D P Somani S, Ramakrishnan K, Narayanan V, Chandran S, Gurram P. Classification of unusual fracture patterns of the mandible: A retrospective study. J Craniomaxillofac Surg 2023; 51:151-156. [PMID: 37032223 DOI: 10.1016/j.jcms.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023] Open
Abstract
The aim of this study is to devise and summarize a classification of fracture patterns involving multiple anatomical sites of the mandible. A retrospective study was conducted by reviewing clinical case records, imaging records, and the surgical management of patients presenting with mandibular fracture. Demographic data were collected and causes of the fractures were studied. Following radiological evaluations based on the courses of fracture lines, these fractures were categorized into three components: horizontal (H), vertical (V), and sagittal (S). In case of horizontal components, the mandibular canal was used as a reference. For vertical components, the fracture lines were classified according to where they terminated. With sagittal components, the direction of the bicortical split at the base of mandible was used as a reference. Out of a total of 893 mandibular trauma patients, 30 unusual fractures were identified (21 in males and nine in females), which do not fit into existing classifications. These were mainly due to road traffic accidents. Horizontal components of fractures were classified as H-I, H-II, and H-III, and vertical components as V-I, V-II, and V-III. For sagittal components, two types were identified - S-I and S-II - resulting in a bicortical split of the mandible. This classification is proposed to help understanding the complex fractures and to allow standardized communication among clinicians. Moreover, it is designed in such a way that aids in the choice of fixation technique. Further studies are needed to establish standardized treatment algorithms for efficient management of these unusual fractures.
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Affiliation(s)
- A C Lakshmi Rathan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Sapna D P Somani
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Karthik Ramakrishnan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Vivek Narayanan
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Saravanan Chandran
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
| | - Prashanthi Gurram
- Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Tamil Nadu, India.
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Abdelazeem MH, Aboelela S, Erdogan O. Transoral Endoscopic-Assisted Reduction and Internal Fixation of Mandibular Condylar Fractures in Children. J Oral Maxillofac Surg 2023; 81:566-574. [PMID: 36809851 DOI: 10.1016/j.joms.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE Extraoral approaches for open reduction and fixation of condylar fractures in children are associated with serious risks of complications, including facial nerve injury, facial scarring, parotid fistula, and auriculotemporal nerve injury. The purpose of this study was to retrospectively evaluate the outcomes of transoral endoscopic-assisted open reduction and internal fixation of condylar fractures and hardware removal in pediatric patients. MATERIAL AND METHODS This study was designed as a retrospective case series. The study included pediatric patients admitted with condylar fractures that were indicated for treatment with open reduction and internal fixation. The patients were clinically and radiographically evaluated with regard to occlusion, mouth opening, lateral and protrusive movement of the mandible, pain, chewing and speech difficulties, and bone healing at the fracture site. Computed tomography images were used to assess the reduction of the fractured segment, the stability of fixation and progress of healing of the condylar fracture at follow-up visits. The same surgical treatment approach was applied to all patients. The data from the study were analyzed for a single group without any comparison to other groups. RESULTS The technique was used for the treatment of 14 condylar fractures in 12 patients between the ages of 3 to 11 years. A total of 28 transoral endoscopic-assisted approaches to the condylar region either for reduction and internal fixation or hardware removal were applied. The mean operating time was 53.1 (±11.3) minutes for the fracture repair and 20 (±2.6) minutes for hardware removal, respectively. The mean follow-up time of the patients was 17.8 (±2.7) months (median: 18) months. All patients regained stable occlusion, satisfactory mandibular motion, stable fixation, and complete bone healing at the fracture site at the end of their follow-up period. There was no transient of permanent facial nerve or trigeminal nerve injury in any of the patients. CONCLUSIONS Endoscopically assisted transoral approach is a reliable technique for reduction and internal fixation of condylar fracture and hardware removal in pediatric patients. The serious risks of extraoral approaches including facial nerve injury, facial scar, and parotid fistula can be eliminated by using this technique.
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Affiliation(s)
- Mohamed Hazem Abdelazeem
- Associate Professor, Department of General Surgery, Plastic Surgery Division, Cairo University, Cairo, Egypt
| | - Salma Aboelela
- Research Assistant, Electron Microscopy Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ozgur Erdogan
- Professor, Department of Oral and Maxillofacial Surgery, Istanbul Okan University, Faculty of Dentistry, Istanbul, Turkey.
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Weinberg FM, Rosenberg AJWP, Muller BS, Speksnijder CM. Long-term masticatory performance and ability following closed treatment for unilateral mandibular condylar neck or base fractures: a cross-sectional study. Oral Maxillofac Surg 2023; 27:141-149. [PMID: 35066649 PMCID: PMC9938014 DOI: 10.1007/s10006-021-01027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to find explanatory variables for objective and patient-reported long-term masticatory functioning in patients treated with maxillomandibular fixation for unilateral condylar neck or base fractures. These outcomes were compared to healthy control subjects. METHODS Patients treated between 1996 and 2013 were enrolled in the study. Objective measurements included the mixing ability test (MAT) for masticatory performance, and range of motion of the mandible. Patient-reported measurements included the mandibular function impairment questionnaire (MFIQ) for masticatory ability, and the visual analogue scale for pain. Healthy subjects were recruited between October 2018 and January 2019, and performed the MAT and MFIQ. RESULTS Twenty-one patients and 30 healthy subjects were included. The average follow-up period was 11.67 years. In adjusted regression analysis, the amount of occlusal units (OU) was associated with the MAT (P = 0.020; R2 = 0.253) and MFIQ (P = 0.001, R2 = 0.454). The MAT outcome was similar in both groups when correcting for OU (P = 0.001; R2 = 0.201). The MFIQ was inferior in the patient group (P = 0.001). CONCLUSION Long-term masticatory performance was similar in patients with a history of condylar neck or base fracture and healthy subjects; however, masticatory ability was inferior in patients compared to healthy subjects.
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Affiliation(s)
- Florine M Weinberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, The Netherlands.
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, The Netherlands
| | - Barbara S Muller
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, The Netherlands
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Lentge F, Jehn P, Zeller AN, Moysich HC, Gellrich NC, Tavassol F. Quantitative ultrasonographic diagnostics for midface and mandible fractures. J Stomatol Oral Maxillofac Surg 2022; 123:e588-e592. [PMID: 35192967 DOI: 10.1016/j.jormas.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/22/2021] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
The aim of this study was to examine whether ultrasonography and three-dimensional radiological procedures produce significantly different measurement results with respect to fracture dislocation. This was a retrospective study of patients who were admitted to the department for oral and maxillofacial surgery of the Medical Highschool Hannover with facial skull fracture and underwent high-resolution computed tomography and ultrasonography imaging during a period from 1 January 2019 to 31 August 2019. A 10 mHz transducer was used for fracture imaging, and the largest dislocation of each fracture was measured. A paired t-test for dependent samples was used for statistical evaluation of the measured differences, and the p-value was set at 0.05. A total of 16 patients with 29 fractures were included. The fractures were characterized as follows: zygomatic arch (n = 7), lateroorbital region (n = 4), maxilla/zygomatic bone (n = 15), mandible (n = 2), and frontal sinus (n = 1). Regardless of the fracture location, we found no statistical difference in fracture measurements between the ultrasonography and the computed tomography (p = 0.17 (fractures of the zygomatic arch) to p = 0.85 (all fractures)). The study findings suggest that ultrasonography not only allows basic detection but also a quantification of the dislocation in facial skull fractures. The ultrasonography results are not significantly different from those of the computed tomography. In everyday clinical practice, ultrasonography of facial fractures can be considered an adequate imaging procedure. If used correctly, additional radiation exposure to the patient can be avoided, thus representing a diagnostic alternative to computed tomography.
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Affiliation(s)
- Fritjof Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Carl-Neuberg-Straße 1, Hannover 30625, Germany.
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Alexander-Nikolai Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Holger Christian Moysich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Frank Tavassol
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Carl-Neuberg-Straße 1, Hannover 30625, Germany
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Haque IB, Joshi S, Bhandari K, Karna G, Khanal B. Association between Mandibular Angle Fracture with Third Molar Positioning and Residual Bone Height. J Nepal Health Res Counc 2022; 20:207-212. [PMID: 35945877 DOI: 10.33314/jnhrc.v20i01.4187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Mandibular angle fracture are frequently associated with presence of third molar. This study aimed at assessing the role of third molar with angle fracture in relation to its positioning and the remaining bone between the apex of third molar and inferior border of mandible. METHODS A retrospective study of all patients who reported for treatment of mandibular fracture between January 2019 to January 2021 were undertaken. Patient's data and orthopantamogram radiographs were obtained from there medical records. The collected data included presence/absence of mandibular angle fracture, presence/absence of mandibular third molar, angulation and positioning of third molar along with residual bone height. Statistical analysis was done in SPSS version 20 with p-value set at p<0.05 Results: Total of 86 mandibular fracture reported in the study period, of which 34 (39.53%) had angle fracture. Third molar was present in 31 (45.6%) cases and was associated with angle fracture with statistical significance of p<0.026. Mesioangular impaction (86.4%) with class II (57%) ramus relation and position B (72.7%) in occlusal relation were associated with angle fracture in comparison to non-angle fracture group where angulation and occlusal position were statistically significant p<0.001 and p=0.002, respectively. Residual bone height was also found to be less in angle fracture group in comparison to other mandibular fracture group showing statistical significance (p<0.023). CONCLUSIONS Patient with partially erupted mandibular third molar are more frequently associated with angle fracture and the residual bone height could also be a good predictor for risk of angle fracture.
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Affiliation(s)
| | | | - Kishor Bhandari
- Department of oral and maxillofacial surgery Bir hospital, NAMS
| | | | - Bandana Khanal
- Department of oral and maxillofacial surgery Bir hospital, NAMS
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Shakya S, Li KD, Huang D, Liu ZQ, Zhang X, Liu L. Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures. Chin J Traumatol 2022; 25:151-155. [PMID: 35034763 PMCID: PMC9125724 DOI: 10.1016/j.cjtee.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference. METHODS This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures. The inclusion criteria were patients (1) diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment; (2) have given consent for the surgical treatment; and (3) had no contraindications to the surgery. Patients were excluded from this study if: (1) they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture; (2) the comminuted condylar fracture was too severe to be treated with internal reduction and fixation; or (3) patients could not complete follow-up for 3 months. There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included. The 50 patients were randomly (random number) divided into control group (25 patients with 35 sides of condylar fractures) and experimental group (25 patients with 32 sides of condylar fractures). Virtual surgical planning was used in the experimental group, but only clinical experience was used in the control group. The patients were followed up for 1, 3, 6 and 12 months after operation. Variables including the rate of perfect reduction by radiological analysis, the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations (e.g., mouth opening, occlusion) were investigated for outcome measurement. SPSS 19 was adopted for data analysis. RESULTS The average operation time was 180.60 min in the experimental group and 223.2 min in the control group. One week postoperatively, CT images showed that the anatomic reduction rate was 90.63% (29/32) in the experimental group and 68.57% (24/35) in the control group, revealing significant difference (X2 = 4.919, p = 0.027). Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group (0.639 mm vs. 0.995 mm; t = 3.824, p < 0.001). CONCLUSION These findings suggest that virtual surgical planning can assist surgeons in surgical procedures, reduce operative time, and improve the anatomic reduction rate & accuracy, and thus of value in the diagnosis and treatment of condylar fractures.
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Affiliation(s)
- Shubhechha Shakya
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Kai-De Li
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Dou Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Zuo-Qiang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xiao Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Shakya S, Li KD, Huang D, Liu ZQ, Liu ZR, Liu L. Mini suture anchor: An effective device for reduction and fixation of displaced temporomandibular joint disc with intracapsular condylar fracture. Chin J Traumatol 2022; 25:49-53. [PMID: 34518064 PMCID: PMC8787230 DOI: 10.1016/j.cjtee.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture. METHODS From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0. RESULTS All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement. CONCLUSION Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.
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Affiliation(s)
- Shubhechha Shakya
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Kai-De Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Dou Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Zuo-Qiang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Zhi-Ru Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Lei Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Kocaaslan ND, Ünal BK, Özkan MÇ, Karadede B, Çelebiler Ö. Comparison of different treatment techniques in the mandibular condyle fracture. ULUS TRAVMA ACIL CER 2022; 28:99-106. [PMID: 34967439 PMCID: PMC10443169 DOI: 10.14744/tjtes.2020.94992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures. METHODS Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment. RESULTS The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion. CONCLUSION The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.
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Affiliation(s)
- Nihal Durmus Kocaaslan
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Turkey
| | - Beyza Karadede Ünal
- Department of Orthodontics, İzmir Katip Çelebi University Faculty of Dentistry, İzmir-Turkey
| | - Melekber Çavuş Özkan
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Turkey
| | - Berşan Karadede
- Department of Orthodontics, İzmir Katip Çelebi University Faculty of Dentistry, İzmir-Turkey
| | - Özhan Çelebiler
- Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University Faculty of Medicine, İstanbul-Turkey
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Labib A, Elbarbary AS. Symphyseal fracture in a three-month-old infant. BMJ Case Rep 2021; 14:e245661. [PMID: 34853047 PMCID: PMC8638128 DOI: 10.1136/bcr-2021-245661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of suspicion and detailed history taking from the caregiver are mandatory to pick up these cases.There are a plethora of management options that have been reported in dealing with such fractures. They range from conservative management to internal fixation by absorbable plates. While conservative management does not interfere with mandibular growth and teeth development, any surgical intervention can carry this risk. Nevertheless, a severely displaced fracture may need anatomical reduction and fixation to allow early nutrition.This study reports a 3-month-old male infant with a fracture in the mandibular symphysis who underwent reduction of the fracture and circummandibular fixation using immobilisation by an acrylic splint for 4 weeks. His long-term follow-up after 20 months showed adequate dentition with proper healing of the fracture site.
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Affiliation(s)
- Amir Labib
- Plastic Surgery Department, Faculty of Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Amir Samir Elbarbary
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Mooney S, Gulati RD, Yusupov S, Butts SC. Mandibular Condylar Fractures. Facial Plast Surg Clin North Am 2021; 30:85-98. [PMID: 34809889 DOI: 10.1016/j.fsc.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mandibular condyle fractures can result in short-term and long-term morbidity. As a weak area of the mandible, the condyle is vulnerable to injury by a direct impact or an indirect force. Current treatment recommendations aim to better match the severity of the fracture with the choice of closed or open approach. Long-term follow-up of patients provides the best opportunity to monitor the degree of functional restoration after treatment. There is a growing consensus regarding the use of standardized fracture classification methods and outcomes measures that will allow better assessment of treatment results and strengthen the quality of outcomes research.
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Affiliation(s)
- Sean Mooney
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA
| | - Steve Yusupov
- Staten Island University Hospital/Northwell Health, 256-C Mason Avenue, Staten Island, NY 10305, USA
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, SUNY Downstate Health Sciences University, Kings County Hospital Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY 11203, USA.
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周 伟, 安 金, 荣 起, 张 益. [Three-dimensional finite element analysis of traumatic mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures]. Beijing Da Xue Xue Bao Yi Xue Ban 2021; 53:983-989. [PMID: 34650306 PMCID: PMC8517683 DOI: 10.19723/j.issn.1671-167x.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyze the biomechanical mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures using finite element analysis (FEA). METHODS Maxillofacial CT scans and temporomandibular joint (TMJ) MRI were performed on a young male with normal mandible, no wisdom teeth and no history of TMJ diseases. The three-dimensional finite element model of mandible was established by Mimics and ANSYS based on the CT and MRI data. The stress distributions of mandible with different angles of traumatic loads applied on the symphyseal region were analyzed. Besides, two models with or without disc, two working conditions in occlusal or non-occlusal status were established, respectively, and the differences of stress distribution between them were compared. RESULTS A three-dimensional finite element model of mandible including TMJ was established successfully with the geometry and mechanical properties to reproduce a normal mandibular structure. Following a blow to the mandibular symphysis with different angles, stress concentration areas were mainly located at condyle, anterior border of ramus and symphyseal region under all conditions. The maximum equivalent stress always appeared on condylar articular surface. As the angle between the external force and the horizontal plane gradually increased from 0° to 60°, the stress on the mandible gradually concentrated to symphysis and bilateral condyle. However, when the angle between the external force and the horizontal plane exceeded 60°, the stress tended to disperse to other parts of the mandible. Compared with the condition without simulating the disc, the stress distribution of articular surface and condylar neck decreased significantly when the disc was present. Compared with non-occlusal status, the stress on the mandible in occlusal status mainly distributed on the occlusal surface, and no stress concentration was found in other parts of the mandible. CONCLUSION When the direction of external force is 60° from the horizontal plane, the stress distribution mainly concentrates on symphyseal region and bilateral condylar surface, which explains the occurrence of symphyseal fracture and intracapsular condylar fracture. The stress distribution of condyle (including articular surface and condylar neck) decreases significantly in the presence of arti-cular disc and in stable occlusal status when mandibular symphysis is under traumatic force.
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Affiliation(s)
- 伟 周
- 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - 金刚 安
- 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
| | - 起国 荣
- 北京大学工学院力学与工程科学系,北京 100871Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing 100871, China
| | - 益 张
- 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔医学中心 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室,北京 100081Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing 100081, China
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Yamamoto M, Hiruma T, Ueda Y, Doi K. Bilateral mandibular head fractures associated with convulsion. BMJ Case Rep 2021; 14:e245713. [PMID: 34544723 PMCID: PMC8454431 DOI: 10.1136/bcr-2021-245713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Miyuki Yamamoto
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Hiruma
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Ueda
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
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Yao ZT, An W, Maimaitituxun T. [Effect of conservative treatment on jaw symmetry of children with unilateral condylar fracture]. Shanghai Kou Qiang Yi Xue 2021; 30:77-80. [PMID: 33907784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate the effect of conservative treatment of unilateral condylar fractures on jaw symmetry in children. METHODS Twenty-four children with unilateral condylar fractures were divided into control group and experimental group according to the treatment methods, with 12 cases in each group. The control group received surgery, and the experimental group received conservative treatment with intermaxillary traction combined with occlusal pads. The treatment effects of the two groups were compared, and the imaging improvement, three-dimensional structure of the jaw, mandibular motor and occlusal relationship, and facial nerve injury were compared after treatment. SPSS 17.0 software package was used for statistical analysis. RESULTS There was no significant difference in the total effective rate, total effective rate of imaging, disturbance of occlusal relationship, and incidence of facial nerve injury between the two groups (P>0.05). The transverse diameter of the condyles was significantly longer in the experimental group than in the control group, and the width of the condyles and bony condylar deflection in the experimental group were significantly smaller than those in the control group (P<0.05). The degree of mouth opening after treatment in both groups was increased, which was more remarkably in the experimental group after treatment than in the control group (P<0.05). CONCLUSIONS Children with unilateral condylar fractures can obtain similar treatment effects with surgical treatment with conservative treatment. After treatment, the children's mandibular motor function and jaw symmetry are well restored.
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Affiliation(s)
- Zhi-Tao Yao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital and Stomatological Hospital of Xinjiang Medical University. Urumqi 830054, Xinjiang Uyghur Autonomous Region, China. E-mail:
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Skrypa OL. EVALUATION OF THE EFFECTIVENESS OF TREATMENT OF PATIENTS WITH TEMPOROMANDIBULAR JOINT DYSFUNCTION AFTER MANDIBULAR FRACTURES ACCORDING TO X-RAY EXAMINATION. Wiad Lek 2021; 74:2082-2086. [PMID: 34725280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim: On the basis of radiological data to evaluate the effectiveness of our developed treatment complex of patients with temporomandibular joint dysfunction after mandibular fractures. PATIENTS AND METHODS Materials and methods: To achieve this goal, 92 patients hospitalized in the department of surgical dentistry of the Chernivtsi Regional Clinical Hospital were examined for traumatic fractures of the mandible with functional disorders of the TMJ. 46 patients (main group) were treated according to the treatment method developed by us, and 46 patients (control group) were treated with the traditional method. Patients underwent orthopanthography and radiography of the temporomandibular joint according to Schuller. Statistical processing of research results was carried out using commonly used methods of variation statistics. RESULTS Results: After 12 months of studies in patients of the main group, unilateral narrowing of the joint space was determined in 6,52 ± 1,83% of persons p, p1 0.05.The number of persons with unilateral expansion of the joint space according to Rtg, in the main group decreased by 2,3 times relative to the data before treatment. CONCLUSION Conclusions: Timely treatment of musculoskeletal disorders with the help of pharmacological and physiotherapeutic methods proposed by us, allowed, to a large extent, to eliminate clinical, radiological and ultrasound symptoms of temporomandibular joint dysfunction in patients with post-traumatic lesions of mandibule. This was confirmed by the improvement of the data of the conducted functional researches.
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Affiliation(s)
- Olga L Skrypa
- BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
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Scott C, Ramakrishnan K, Vivek N, Saravanan C, Prashanthi G. Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study. J Oral Maxillofac Surg 2020; 79:1330.e1-1330.e12. [PMID: 33524326 DOI: 10.1016/j.joms.2020.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures. MATERIALS AND METHODS A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ2 test and student's t test with P value less than 0.05 indicating statistical significance. RESULTS Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6 ± 0.9 minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively. CONCLUSIONS Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.
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Affiliation(s)
- Cynthia Scott
- Assistant Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India.
| | - Karthik Ramakrishnan
- Associate Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Narayanan Vivek
- Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Chandran Saravanan
- Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
| | - Gurram Prashanthi
- Associate Professor, Department of Oral and Maxillofacial Surgery, SRM Kattankulathur Dental College and Hospital, SRM Institute of Science and Technology, Potheri, Kattankulathur, Chengalpattu District, Tamil Nadu, India
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Staderini E, Patini R, Tepedino M, Gasparini G, Zimbalatti MA, Marradi F, Gallenzi P. Radiographic Assessment of Pediatric Condylar Fractures after Conservative Treatment with Functional Appliances-A Systematic Review. Int J Environ Res Public Health 2020; 17:ijerph17249204. [PMID: 33317118 PMCID: PMC7763300 DOI: 10.3390/ijerph17249204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 12/28/2022]
Abstract
Background: To evaluate the effectiveness of conservative treatment with functional appliances for condylar fractures in pediatric age. Methods: Four electronic databases (PubMed, EBSCO, Scopus, and Web of Science) were consulted with no restriction of publication status or year, up to 31 August 2020. Selection criteria: based on the PICOS criteria, the selection criteria were set for observational human studies, with at least 10 patients and six months of follow-up. The study population included pediatric patients (aged 5–16 years), with unilateral or bilateral condylar fracture, treated with functional appliances. Condylar remodeling and mandibular growth were analyzed through sequential radiographic examinations. Data collection and analysis: Two independent reviewers carried out title-abstract screening, and a senior investigator was involved to solve any disagreement. The quality of the evidence was assessed through the Canada Institute of Health Economics (IHE) quality appraisal checklist, and the National Institutes of Health (NIH) quality assessment tool. Results: A total of 971 articles were retrieved from the electronic search; among them, three studies met the eligibility criteria. A moderate risk of bias was detected in all the studies, due to common limitations (absence of multicenter studies, prospective design, blindness of the investigators, patients’ drop-out). At follow-up examinations (between 6 months and 4.9 years), the difference of condylar neck length between the “injured” and “healthy” side was approximately 2 mm, while the anteroposterior condylar width discrepancy was recorded up to 1 mm. Conclusions: Short- and long-term data revealed that conservative treatment with functional appliances led to partial or full radiological recovery of the joint morphology, along with good to excellent functional results. Patients’ age has a crucial role on the treatment choice, and the type of fracture (presence of condylar displacement, or dislocation) is also a major prognostic indicator of the radiologic outcome. Limitation: To confirm the effectiveness of functional appliances, more prospective clinical long-term follow-up studies with homogeneous samples of condylar fractures are deemed necessary. Registration: The study protocol was registered on PROSPERO (CRD42020205650).
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Affiliation(s)
- Edoardo Staderini
- Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (E.S.); (M.A.Z.); (F.M.); (P.G.)
| | - Romeo Patini
- Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (E.S.); (M.A.Z.); (F.M.); (P.G.)
- Correspondence: (R.P.); (M.T.); Tel.: +39-06-3015-4286 (R.P.)
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Viale S.Salvatore, Edificio Delta 6, 67100 L’Aquila, Italy
- Correspondence: (R.P.); (M.T.); Tel.: +39-06-3015-4286 (R.P.)
| | - Giulio Gasparini
- Maxillofacial Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Maria Antonietta Zimbalatti
- Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (E.S.); (M.A.Z.); (F.M.); (P.G.)
| | - Francesca Marradi
- Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (E.S.); (M.A.Z.); (F.M.); (P.G.)
| | - Patrizia Gallenzi
- Postgraduate School of Orthodontics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; (E.S.); (M.A.Z.); (F.M.); (P.G.)
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Elsayed SAH, Elsayed EH, Altaweel AA. Stabilization of anterior mandibular fracture using different osteosynthesis devices: perioperative clinical notes. Oral Maxillofac Surg 2020; 25:303-311. [PMID: 33111232 DOI: 10.1007/s10006-020-00917-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE There is still no definitive consensus about the ideal technique in the treatment of anterior mandibular fractures. Therefore, this study aimed to determine clinical and radiographic outcomes of four different internal fixation devices used for this type of fractures. METHODS This was a cohort study that included 64 fracture cases. Fractures were fixed using four types of open reduction internal fixation devices: single 2.0-mm mini-locking plates, double 2.0-mm miniplates, double lag screw and double microplates. Investigated variables were surgical duration, wound dehiscence, infection, occlusion, mouth opening, patient compliance, nerve damage and postoperative oedema. RESULTS Male patients constituted 90.6% of the study sample. A proportion of 33% of the fractures were single symphysis and 67% were parasymphysis fractures. The most time-saving technique was the lag screw followed by microplate with mean/SD of 50.65 ± 4.152 min. Wound dehiscence occurred in 4.7% and 3.1% of the miniplate and the mini-locking groups respectively. Miniplate and microplate groups had small interfragmentary space at 1-month postoperative radiographs, while mini-locking and lag screw groups had no extra-callus formation. CONCLUSION The double lag screw and the single mini-locking plate are the most effective devices for primary bone healing of displaced mandibular symphysis/parasymphysis fractures which is attributed to their enhanced stability. Miniplates and microplates gave functionally well-balanced fixation and were also associated with higher patient convenience due to improved adaptability and relatively lower cost than locking plates. Cost-effectiveness of lag screws in comparison to bone plates is particularly beneficial in low-income countries.
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Affiliation(s)
- Shadia Abdel-Hameed Elsayed
- Oral and Maxillofacial Surgery, Faculty of Dental Medicine, for Girls, Al-Azhar University, Cairo, 11727, Egypt
- Oral and Maxillofacial Surgery, Taibah University Dental College & Hospital, Al-Madinah Al-Munawwrah, 42353, Saudi Arabia
| | - Emad Hussein Elsayed
- Plastic Surgery, Faculty of Medicine (Girls Branch), Al Azhar University, Cairo, Egypt
| | - Alaa Abdelqader Altaweel
- Oral and Maxillofacial Surgery, Faculty of Dental Medicine for Boys, Al-Azhar University, Cairo, 11727, Egypt.
- Oral and Maxillofacial Surgery, Alfarabi Private College for Dentistry and Nursing, Jeddah, Saudi Arabia.
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Segura-Pallerès I, Roccia F, Cocis S, Atin CB, Ganasouli D, Bakardjiev A, Jelovac D, Goetzinger M. Surgical Management of Bilateral Mandibular Angle Fractures With a Third Molar in Line of Fracture: A European Multicenter Survey. J Oral Maxillofac Surg 2020; 79:201.e1-201.e5. [PMID: 33011164 DOI: 10.1016/j.joms.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/20/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this survey was to investigate the surgical management of bilateral mandibular angle fracture (BMAF) in Europe. METHODS Data were collected from 2008 to 2018 on patients ≥ 16 years of age who underwent open reduction internal fixation (ORIF) for BMAF with a third molar in the fracture line. The study was conducted at 6 European trauma centers. The following data were recorded: sex, age, cause of the fracture, type of fracture (nondisplaced, displaced, comminuted), type of approach (intraoral, transbuccal, or extraoral), thickness of the plate (≤1.4 mm or ≥1.5 mm), number of plates, cause of plate removal, and third molar extraction status. RESULTS 25 patients with BMAF (24 males, 1 female, 17 to 83 years old [mean: 28.2 years]) were collected. The main cause of BMAF was assault, and the main surgical approach was intraoral. The most common types of BMAF were displaced + undisplaced (11 patients), displaced + displaced (7 patients), undisplaced + undisplaced (6 patients), and comminuted + comminuted (1 patient). Osteosynthesis was performed with 2 ≤1.4 mm plates on 1 angular fracture and 1 ≤1.4 mm plate on the other fracture in 11 patients, 1 ≤1.4 mm plate on both angular fractures in 6 patients, 1 ≥1.5 mm plate on both fractures in 5 patients, and 2 ≤1.4 mm plates on both fractures in the remaining 3 patients. Out of 25 patients with BMAF, 7 third molars were extracted during ORIF. Among these patients, angular fracture fixation was performed in 3 cases with 1 ≥1.5 mm plate and in 4 patients with 2 ≤1.4 mm plates. CONCLUSIONS This retrospective multicenter survey indicates a trend of treating with open reduction and rigid internal fixation at least 1 angular fracture of BMAF and those cases requiring extraction of the third molar in the line of fracture.
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Affiliation(s)
- Ignasi Segura-Pallerès
- Resident of Dpt. Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy.
| | - Fabio Roccia
- Assistant Professor of the Dpt. Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Stefan Cocis
- Resident of Dpt. Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Coro Bescos Atin
- Department Head of the Dpt. of Oral and Maxillofacial Surgery, University Hospital of Vall D'Hebron, Barcelona, Spain
| | - Dimitra Ganasouli
- Assistant Professor of Dpt. of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greek
| | - Angel Bakardjiev
- Professor of the Department Maxillofacial Surgery, Faculty of Dental Medicine, Medical University, Plovdiv, Bulgaria
| | - Drago Jelovac
- Assistant Professor of Clinic of Maxillofacial Surgery, School of dentistry, University of Belgrade, Serbia
| | - Maximilian Goetzinger
- Assistant Professor Dpt. of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
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Schlund M, Raoul G, Marti-Flich L, Nicot R. Re: Use of an endotracheal tube in the biphasic fixation of a mandibular fracture. Br J Oral Maxillofac Surg 2020; 58:e135-e136. [PMID: 32622614 DOI: 10.1016/j.bjoms.2020.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- M Schlund
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
| | - G Raoul
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - L Marti-Flich
- Univ. Lille, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, F-59000 Lille, France
| | - R Nicot
- Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
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Lee DB, Watson KD, Wilson S, Arzi B. Diagnostic Imaging in Veterinary Dental Practice. J Am Vet Med Assoc 2020; 256:51-55. [PMID: 31841085 DOI: 10.2460/javma.256.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chen W, Fang R. [Internal fixation of mandibular comminuted fracture with mini-titanium plate: a retrospective study of 21 cases]. Shanghai Kou Qiang Yi Xue 2020; 29:333-336. [PMID: 33043356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To investigate the value of internal fixation in management of mandibular comminuted fracture with mini-titanium plate. METHODS Twenty-one patients with mandibular comminuted fracture treated in Stomatology Hospital of Shenyang from March 2017 to February 2018 were enrolled, the patients received internal fixation with mini-titanium plate. The lower mandibular margin, upper mandibular margin and middle outer cortex were fixed respectively. The postoperative fracture healing and adverse reactions were recorded and analyzed. RESULTS All patients achieved bone healing within 3 months after surgery, with an average duration of (1.53±0.36) months. Among 21 patients, six patients (28.57%) had minimal occlusion, and 1 patient (4.76%) had local infection. No microtitanium plate fracture, persistent pain, limited mouth opening, tooth injury, facial nerve injury or nonunion were found. CONCLUSIONS Internal fixation with mini-titanium for comminuted mandibular fracture patients without bone defects has the advantages of good postoperative fracture healing, short healing time and few adverse reactions.
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Affiliation(s)
- Wei Chen
- Department of Oral and Maxillofacial Surgery, Stomatology Hospital of Shenyang. Shenyang 110001,Liaoning Province, China. E-mail:
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Alzubaidi MA, Otoom M. A comprehensive study on feature types for osteoporosis classification in dental panoramic radiographs. Comput Methods Programs Biomed 2020; 188:105301. [PMID: 31911333 DOI: 10.1016/j.cmpb.2019.105301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/16/2019] [Accepted: 12/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Osteoporosis is a disease characterized by a decrease in bone density. It is often associated with fractures and severe pain. Previous studies have shown a high correlation between the density of the bone in the hip and in the mandibular bone in the jaw. This suggests that dental radiographs might be useful for detecting osteoporosis. Use of dental radiographs for this purpose would simplify early detection of osteoporosis. However, dental radiographs are not normally examined by radiologists. This paper explores the use of 13 different feature extractors for detection of reduced bone density in dental radiographs. METHODS The computed feature vectors are then processed with a Self-Organizing Map and Learning Vector Quantization as well as Support Vector Machines to produce a set of 26 predictive models. RESULTS The results show that the models based on Self-Organizing Map and Learning Vector Quantization using Gabor Filter, Edge Orientation Histogram, Haar Wavelet, and Steerable Filter feature extractors outperform the rest of the 22 models in detecting osteoporosis. The proposed Gabor-based algorithm achieved an accuracy of 92.6%, a sensitivity of 97.1%, and a specificity of 86.4%. CONCLUSIONS The oriented edges and textures in the upper and lower jaw regions are useful for distinguishing normal patients from patients with osteoporosis.
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Affiliation(s)
| | - Mwaffaq Otoom
- Department of Computer Engineering, Yarmouk University, Irbid 21163, Jordan
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Leonhardt H, Ziegler A, Lauer G, Franke A. Osteosynthesis of the Mandibular Condyle With Magnesium-Based Biodegradable Headless Compression Screws Show Good Clinical Results During a 1-Year Follow-Up Period. J Oral Maxillofac Surg 2020; 79:637-643. [PMID: 32224081 DOI: 10.1016/j.joms.2020.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The use of titanium-based implants in mandibular condyle fractures can require implant removal because of screw penetration through the condylar surface. The use of biodegradable implants can avoid a second operation for implant removal and the associated possible complications. We investigated the clinical and radiologic outcomes of osteosynthesis of mandibular condyle fractures (MCFs) with biodegradable magnesium-based compression screws. MATERIALS AND METHODS We performed a retrospective observational study of 6 patients who had been treated at our department. We recorded the changes in jaw movements over time, occlusion, and possible complications at defined intervals of 1, 3, 6, and 12 months postoperatively. We also compared the preoperative computed tomography (CT) scans with the postoperative cone-beam CT (CBCT) scans at 6 and 12 months postoperatively to evaluate mandibular condyle healing and screw degradation. RESULTS Of the 6 patients, 4 were men and 2 were women, with a mean age of 43.2 years (range, 30 to 66 years). All 6 patients had unilateral MCFs. All the patients showed well-restored function of the temporomandibular joint with significant improvement in mouth opening (46.17 ± 6.49 mm), right (10.67 ± 1.03 mm) and left (10.67 ± 1.97 mm) laterotrusion, and protrusion (10.17 ± 1.33 mm) distances to physiologic values. The CBCT scans showed the remodeling processes of the mandibular condyle and a few radiolucencies indicating the magnesium-based screws. Although penetration of 1 screw tip through the condylar surface had occurred, no implant removal was necessary owing to biodegradation of the implant. CONCLUSIONS The results of the present study have shown that biodegradable magnesium-based compression screws provide good clinical results and avoid implant removal.
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Affiliation(s)
- Henry Leonhardt
- Consultant, Department of Oral Maxillofacial Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Andreas Ziegler
- Scientific Consultant, StatSol, Lübeck, Germany; and School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Guenter Lauer
- Professor and Head, Department of Oral Maxillofacial Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Adrian Franke
- Resident, Department of Oral Maxillofacial Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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WĄdoŁowski P, KrzesiŃski G, Gutowski P. Finite element analysis of mini-plate stabilization of human mandible angle fracture - a comparative study. Acta Bioeng Biomech 2020; 22:105-116. [PMID: 33518721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to analyze three patterns of mandible angle fracture treatment by means of the finite element analysis. METHODS Investigation has been based on the mandible geometry reconstructed with use of hospitalized patient CT data. The KLS Martin mini-plates with corresponding screws were used to establish proper fracture stabilization. Models were run assuming isotropic and elasto-plastic material properties of connecting devices and cortical bone. The main masticatory muscles and artificial temporomandibular joint have been incorporated to assure mandible physiological movement. The gage loading has been applied in three different locations to cover wider range of possible mastication loading cases during daily routine. A different contact conditions have been applied to the fracture plane to simulate both load bearing and sharing behaviors. Prepared FEM models reflect the most frequently used surgery's approaches to mandible angle fracture treatment. A specific nomenclature has been introduced to describe particular model. The tension plate, with one connecting mini-plate, two-point fixation and combined fixation, both using two mini-plates respectively. RESULTS Performed analysis allowed for a detailed estimation of the mini-plate connection response under the applied gauge loading. The equivalent stress within the mini-plates and surrounding cortical bone have been compared between all models. Regarding the fracture plane, the contact status and pressure have been considered. CONCLUSIONS The combined fixation model, acting as a biplanar fastener system, presents the highest flexibility and connection efficiency.
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Affiliation(s)
- Piotr WĄdoŁowski
- Warsaw University of Technology, Faculty of Power and Aeronautical Engineering, Division of Strength of Materials and Structures, Warsaw, Poland
| | - Grzegorz KrzesiŃski
- Warsaw University of Technology, Faculty of Power and Aeronautical Engineering, Division of Strength of Materials and Structures, Warsaw, Poland
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Andrei TP, Raluca-Iulia J, Arghir IA, Arghir OC, Mihai J. A retrospective evaluation of the treatment of viscerocranial fractures in Romania. A study of 1007 patients. Ann Ital Chir 2020; 91:568-574. [PMID: 33554947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The treatment of viscerocranial fractures is complex and involves orthopedic, surgical methods, or combinations of both. The aim of this study is to evaluate the treatment methods applied and the type of materials used in the case of viscerocranial fractures in our geographical area, as well as to assess postoperative complications depending on each type of treatment, the location and the characteristics of the fracture lines. MATERIAL AND METHODS A 10-year retrospective statistical analysis of 1007 patients treated in a Romanian university hospital was performed, the data being collected from patients' medical records. RESULTS The most frequent maxillofacial fractures were located in the mandible (62.16%). The zygomatic bone was the most fractured bone of the midface (44.91%). In the majority of the fractures, displacement of the fractured fragments occurred (84.40%). Most of the patients had a favorable evolution (97.8%) Orthopedic/closed treatment was the most frequent treatment applied (78.15%). This was followed by the greatest number of postoperative complications, while ORIF surgical treatment registered the smallest number of complications (p=0.209). The most frequent postoperative complication was osteitis (74.19%). The highest incidence of postoperative complications was found in the case of fractures in multiple locations and displacement of the fractured fragments (p=0.000). CONCLUSIONS The most effective treatment method in the case of maxillofacial fractures is ORIF surgery. The rate of postoperative complications is directly proportional to the number of fracture lines and the degree of bone displacement. KEY WORDS Maxillofacial, Trauma, Treatment.
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Affiliation(s)
- Micah G Katz
- University of Utah Health Care, Salt Lake City, UT
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Reiter MJ, Schwope RB, Theler JM. Postoperative CT of the Mandible Following Trauma: Review of Normal Appearances and Common Complications. Acad Radiol 2019; 26:686-698. [PMID: 30072290 DOI: 10.1016/j.acra.2018.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Surgeons aim to restore occlusion and jaw function to baseline status for patients with mandibular fractures using either closed treatment or reduction and fixation. MATERIALS AND METHODS Occlusion is defined as the relationship between the maxillary and mandibular teeth as they approach each other. RESULTS Radiologists should be familiar with the goals of repair to help identify which treatment is adequate as well as to diagnose potential complications. Some of the more common complications encountered are infection, nonunion or malunion, and malocclusion. CONCLUSION We provide a comprehensive review of both the desired and untoward CT findings after surgical repair of traumatic mandibular injuries.
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Affiliation(s)
- Michael J Reiter
- Department of Radiology, Stony Brook University Medical Center, Stony Brook, New York.
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas; Uniformed Services University of the Health Sciences, Bethesda, Madison
| | - Jared M Theler
- Department of Otolaryngology, Brooke Army Medical Center, San Antonio, Texas
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Abstract
CASE DESCRIPTION A 2-year-old male bearded dragon (Pogona vitticeps) was evaluated because of a traumatic mandibular fracture. CLINICAL FINDINGS An open comminuted fracture of the rostral aspect of the right mandible was evident, with a fragment of bone exposed and dorsally displaced. Whole-body radiography revealed no evidence of additional injury. Other findings were unremarkable, except for moderate anemia (PCV, 19%). TREATMENT AND OUTCOME The fracture fragments were stabilized with 2 crossed 36-gauge interfragmentary wire loops. An external fixator device was fashioned from four 25-gauge needles inserted at alternating angles through the fracture fragments; plastic IV fluid line tubing filled with dental acrylic was used as a connecting bar. One day after surgery, the lizard had regained its typical activity level and appetite. Body weight was measured and the external fixator was inspected 1 week after surgery and monthly thereafter. Three months after initial injury, the fracture was stable, radiography revealed bony callus formation at the fracture site, and the external fixator was removed. Recheck radiography performed 5.5 months after initial injury revealed complete osseous union of the fracture fragments, and the interfragmentary wires were removed. CLINICAL RELEVANCE Surgical management of the traumatic comminuted mandibular fracture in this bearded dragon by means of a combination of internal and external fixation resulted in complete healing of the mandible and restoration of function. Management of this complicated fracture was achieved with the aid of readily available and inexpensive supplies in a clinical setting, which may be useful to other clinicians in the management of similar cases.
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Satpute AS, Mohiuddin SA, Doiphode AM, Kulkarni SS, Qureshi AA, Jadhav SB. Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures. Oral Maxillofac Surg 2018; 22:419-428. [PMID: 30302602 DOI: 10.1007/s10006-018-0723-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Intermaxillary fixation (IMF) is a fundamental principle in the management of mandibular fractures but with recent advent of open reduction and internal fixation (ORIF), use of IMF is almost limited intraoperatively. Therefore, we compared the efficacy of Erich arch bar versus embrasure wires for intraoperative IMF in mandibular fractures. METHOD This prospective study was comprised of 50 patients with mandibular fractures who required ORIF with intraoperative IMF. Patients were categorized into two groups of 25 patients each: Erich arch bar technique was used for group A and embrasure wire technique for group B. Parameters were time taken for IMF, needle stick injury, occlusal stability, iatrogenic complications, and periodontal status of patients. STATISTICAL ANALYSIS Chi-squared test and unpaired t test analyses was run on IBM SPSS 21.0 version (2015) software. RESULT Mean time for placing embrasure wire (3.48 min) was significantly less than that for Erich arch bar (48.08 min). Needle stick injury rates to the operator as well as the assistants were significantly less when using the embrasure wire than the Erich arch bar. The Erich arch bar had significantly superior postoperative occlusion stability. Iatrogenic injury was more common when placing the Erich arch bar than the embrasure wire. Postoperative oral hygiene status was good in patients that received the embrasure wire. CONCLUSION Embrasure wire technique is a quick, easy, and reliable technique for minimally or moderately displaced fractured mandible and had better clinical outcomes than did patients that underwent the Erich arch bar technique.
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Affiliation(s)
- Ashish Shrikant Satpute
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India.
| | - Syed Ahmed Mohiuddin
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Amol Madhukar Doiphode
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Sujay Sanjay Kulkarni
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Ahtesham Ahmad Qureshi
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Swapnil Bharat Jadhav
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
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Sinha P, Skolnick G, Patel KB, Branham GH, Chi JJ. A 3-Dimensional-Printed Short-Segment Template Prototype for Mandibular Fracture Repair. JAMA FACIAL PLAST SU 2018; 20:373-380. [PMID: 29710318 PMCID: PMC6233625 DOI: 10.1001/jamafacial.2018.0238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 11/14/2022]
Abstract
IMPORTANCE After reduction of complex mandibular fractures, contouring of the fracture plates to fixate the reduced mandibular segments can be time-consuming. OBJECTIVE To explore the potential application of a 3-dimensional (3-D)-printed short-segment mandibular template in the management of complex mandibular fractures. DESIGN, SETTING, AND PARTICIPANTS A feasibility study was performed at a tertiary academic center using maxillofacial computed tomography data of 3 patients with comminuted mandibular fractures who required preoperative planning with a perfected complete mandible model. INTERVENTIONS Thresholding, segmentation, and realignment of the fractured mandible were performed based on computed tomography data. Each reduced mandible design was divided to create 3-D templates for 6 fracture sites: right and left angle, body, and symphyseal/parasymphyseal. Sessions were conducted with junior otolaryngology and plastic surgery residents, during which mandibular fracture plates were contoured in a "preoperative" setting against the 3-D-printed short-segment templates, and an "intraoperative" setting against the previously manufactured, complete mandible model. The previously manufactured, complete model served as a surrogate for the intraoperative mandible with the fracture site reduced. MAIN OUTCOMES AND MEASURES The time for 3-D template printing, the "preoperative" (measure of the time consumed preoperatively), and "intraoperative" (measure of the time saved intraoperatively) times were recorded. Comparisons were made for cost estimates between a complete model and the 3-D-printed short-segment template. The operating room charge equivalent of the intraoperative time was also calculated. RESULTS Of the 3 patients whose data were used, 1 was a teenager and 2 were young adults. The total time for 3-D modeling and printing per short-segment template was less than 3 hours. The median (range) intraoperative time saved by precontouring the fracture plates was 7 (1-14), 5 (1-30), and 7 (2-15) minutes, and the operating room charge equivalents were $350.35 ($50.05-$700.70), $250 ($50.05-$1501.50), and $350.35 ($100.10-$750.75) for the angle, body, and symphyseal/parasymphyseal segments, respectively. The total cost for a single 3-D-printed template was less than $20, while that for a perfected complete model was approximately $2200. CONCLUSIONS AND RELEVANCE We demonstrate that patient- and site-specific 3-D-printed short-segment templates can be created within the timeframe required for mandibular fracture repair. These novel 3-D-printed templates also demonstrate cost efficiency in the preoperative planning for complex mandibular fracture management compared with perfected models and facilitate plate contouring in a similar fashion. Estimation of reduced operative room cost and time with the application of these short-segment templates warrants studies in actual patient care. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Gary Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Kamlesh B. Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Gregory H. Branham
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - John J. Chi
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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