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Oral Surgery, Oral Medicine, Oral... Apr 2020The aim of this study was to evaluate the mandibular and articular dynamics and the presence of complications associated with surgical or nonsurgical treatments of... (Meta-Analysis)
Meta-Analysis Review
Changes in mandibular and articular dynamics associated with surgical versus nonsurgical treatment of mandibular condylar fractures: a systematic review with meta-analysis.
OBJECTIVE
The aim of this study was to evaluate the mandibular and articular dynamics and the presence of complications associated with surgical or nonsurgical treatments of condylar fractures.
STUDY DESIGN
Clinical trials that compared open reduction internal fixation and maxillomandibular fixation in patients with condylar fractures were included. We performed an electronic search of PubMed, Scopus, Cochrane Library, Web of Science, and LILACS (Latin American and Caribbean Health Sciences) databases starting from February 2017 and updated in January 2019 and found 467 articles. We evaluated methodologic quality by using the criteria from Cochrane's Collaboration Tool.
RESULTS
After independent screening of abstracts, we assessed the full texts of 88 articles; 9 studies were included for qualitative synthesis; but only 8 were included for the meta-analysis. Four studies were considered to have high risk of bias, and 5 were considered to have low risk. The risk ratio (RR = 0.20; 95% confidence interval [CI] 0.13-0.32) was observed for complications. The quality of evidence, using GRADE software, was considered low for maximum mouth opening and protrusive movement and moderate for lateral excursion movement and complications.
CONCLUSIONS
This review suggested that open reduction internal fixation and maxillomandibular fixation are effective. However, surgical treatment presented higher objective parameters. Nonsurgical treatment presented a high index of complications, such as malocclusion, pain and deviation.
Topics: Fracture Fixation, Internal; Humans; Jaw Fixation Techniques; Mandibular Condyle; Mandibular Fractures; Treatment Outcome
PubMed: 32102762
DOI: 10.1016/j.oooo.2019.10.010 -
International Journal of Oral and... May 2016The objective of this study was to assess the anatomical changes to the condyle and articular disc following mandibular advancement surgery, the adaptation of the... (Review)
Review
The objective of this study was to assess the anatomical changes to the condyle and articular disc following mandibular advancement surgery, the adaptation of the masticatory muscles, and the improvement or worsening of temporomandibular disorders (TMD) in patients with pre-existing disorders and those who developed them following surgery. Four databases were searched systematically: PubMed, Scopus, Embase, and Cochrane Library. Of the 544 articles initially selected, 219 were duplicates and a further 165 were excluded on the basis of their titles and abstracts. On reading the full text, 89 were excluded because they were of no interest and 43 because they did not meet the inclusion criteria. Of the remaining 28 articles, six were excluded because they were considered of low quality and 22 articles were reviewed. Mandibular advancement surgery with condyle repositioning is associated with less TMD. Condylar resorption is a physiological process with a multifactorial aetiology. It is accelerated following mandibular advancement surgery but is not a contraindication to this procedure. Despite the large number of studies on the effects of mandibular advancement surgery on the temporomandibular joint (TMJ), this surgery can neither be said to improve nor to worsen TMJ health.
Topics: Adaptation, Physiological; Bone Resorption; Humans; Mandibular Advancement; Mandibular Condyle; Masticatory Muscles; Temporomandibular Joint Disc; Temporomandibular Joint Disorders
PubMed: 26644217
DOI: 10.1016/j.ijom.2015.10.016 -
Clinical Oral Investigations May 2021Evaluate the relation of rheumatoid arthritis (RA) and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography (CBCT). (Meta-Analysis)
Meta-Analysis Review
Is there an association between rheumatoid arthritis and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography? A systematic review and meta-analysis.
OBJECTIVES
Evaluate the relation of rheumatoid arthritis (RA) and bone changes in the temporomandibular joint diagnosed by cone-beam computed tomography (CBCT).
MATERIALS AND METHODS
This systematic review and meta-analysis were recorded in the PROSPERO database, using the CRD42020153246 protocol. The electronic searches were performed in the following databases: Pubmed, Scopus, Web of Science, Lilacs, Cochrane, and Open Grey. Cross-sectional studies that evaluated patients with RA with bone changes in the temporomandibular joint diagnosed by CBCT, without language restriction or publication date, were included. Meta-analysis was performed in Stata Software (StataCorp, TX, USA, version 12.0), using the metan, and a random effects model, and the risk of different bone alterations occurring in adults with and without arthritis was estimated using odds ratios (ORs) as a pooled measure of effect. Forest plots were used to present the isolated and the pooled effects (ORs and 95% CI).
RESULTS
Six studies were used for qualitative synthesis and 2 studies for quantitative synthesis. All studies diagnosed higher prevalence changes in the bone structures of the TMJ of RA patients, described as erosion, flattening, sclerosis, and osteophytes. Meta-analysis showed that the chance of bone changes occurring in components of the TMJ is greater in individuals who have RA.
CONCLUSION
There is an association between RA and bone changes in TMJ structures diagnosed through CBCT, as RA patients were more likely to have osteoarthritic changes in this joint.
CLINICAL RELEVANCE
Understanding the existence of an association between bone alterations in TMJ and RA can assist in the management of patients.
Topics: Adult; Arthritis, Rheumatoid; Cone-Beam Computed Tomography; Cross-Sectional Studies; Humans; Mandibular Condyle; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 33547580
DOI: 10.1007/s00784-021-03817-8 -
The Journal of Craniofacial Surgery 2019Fractures of the mandibular condyle represent more than 30% of all mandible fractures. If required, reduction has been performed using either a closed or an open...
INTRODUCTION
Fractures of the mandibular condyle represent more than 30% of all mandible fractures. If required, reduction has been performed using either a closed or an open technique with similar outcomes. Endoscopic fracture repair is a minimally invasive approach for open reduction, but there is limited data regarding indications and outcomes. This study aims to systematically review the demographics, features, and outcomes following endoscopic repair of mandibular fractures in adult patients.
METHODS
The following databases were searched from their inception to December 31, 2016: PubMed, Cochrane, Web of Science, and the WHO Global Health Library, using terms related to endoscopy and mandibular fractures. Articles were screened and data were extracted by 2 independent reviewers. Disagreements arbitrated by discussion or a 3rd reviewer.
RESULTS
Twenty-two manuscripts were included, representing 509 adult patients who had endoscopic repair of a mandibular fracture over 18 years. All endoscopic repairs were of the mandibular condyle, including both subcondylar and condylar neck fractures. The sample-sized weighted mean age was 33.5 years with 74.5% males in the study population. Permanent facial nerve injury was reported once (0.24%) and occlusive complications reported in 31 patients (6.5%).
CONCLUSION
This systematic review identifies a large cohort of patients who underwent endoscopic repair of their mandibular fractures. Complications were rare and usually temporary, with permanent complications occurring at a respectable rate. The demographics and outcomes identified in this study can be used as an epidemiologic baseline for future research on endoscopic repair of mandibular fractures.
Topics: Adult; Endoscopy; Fracture Fixation, Internal; Humans; Mandibular Fractures; Treatment Outcome
PubMed: 31137451
DOI: 10.1097/SCS.0000000000005262 -
Journal of Oral Rehabilitation Jun 2022Botulinum toxin type A (BoNTA) injection into the masticatory muscles has been widely used to treat a number of painful and nonpainful conditions; however, no systematic... (Review)
Review
BACKGROUND
Botulinum toxin type A (BoNTA) injection into the masticatory muscles has been widely used to treat a number of painful and nonpainful conditions; however, no systematic reviews have been performed on the long-term effect to the mandibular bone.
OBJECTIVE
Our systematic review aimed to evaluate the impact of botulinum toxin injection into the masticatory muscles on mandibular bone based.
METHODS
PubMed, Embase, Ovid, CINAHL and Web of Science were searched for human studies assessing mandibular bone after injection of BoNTA using computed tomography (CT) and cone beam CT (CBCT).
RESULTS
Seven studies were eligible for review; five reported significant bony changes to one or more areas of the mandible. Most frequently affected were the condylar head, coronoid process and ramus. The most frequent changes were decreased bone volume, cortical thickness and cortical and trabecular density.
CONCLUSIONS
This is the first systematic review to examine an association between BoNTA injection into the masticatory muscles and mandibular bone quality. Data were analysed from a limited number of studies with a small sample size, and the quality of the included studies was very low. While the majority of available evidence suggests BoNTA injection results in bony change, further study is required to confirm a dose-dependence effect and the impact of gender and age. High-quality trials should utilise a combination of software analysis and radiologist review, with longer-term follow-up to monitor for persistence of bony effect and clinical significance.
Topics: Botulinum Toxins, Type A; Cone-Beam Computed Tomography; Humans; Mandible; Mandibular Condyle; Masticatory Muscles; Tomography, X-Ray Computed
PubMed: 35348239
DOI: 10.1111/joor.13326 -
The British Journal of Oral &... Feb 2024This study aims to review surgical treatment in paediatric condylar fractures and describe different types of techniques performed, along with the results obtained from... (Review)
Review
This study aims to review surgical treatment in paediatric condylar fractures and describe different types of techniques performed, along with the results obtained from them. A retrospective review was conducted from records of paediatric patients (from one to 17 years old) who sustained fractures of the mandibular condyle and underwent surgical treatment from 2003 to 2023. The number of patients, age, location, and type of fracture, clinical and imaging examinations, treatment methods, intraoperative/postoperative complications, removal of osteosynthesis material, follow up and outcomes were recorded and analysed. A total of 68 patients with 79 fractures were identified. The most common fracture pattern was condylar neck fracture (61.1%). Of the 68 patients who underwent surgical treatment, one had a complication of minimal temporal paraesthesia and another patient had near-complete resorption of the condyle. A total of 55 patients (81%) reported normal dental occlusion, mouth opening (>35 mm), lateral excursions (7-8 mm), TMJ function, no pain, no deviation of the midline or the jaw, and no ankylosis. Thirteen patients (19%) developed an unsatisfactory result, nine patients (13%) had a jaw deviation on mouth opening, four patients (6%) had mandibular retrusion, and seven patients (10%) had signs of TMJ dysfunction. A total of 59 patients (87%) reported bone completely healed with no signs of bone abnormality; seven patients (10%) had shortening of the condylar neck and/or ramus. Surgical treatment can lead to good or excellent results for severely dislocated and displaced condylar fractures in children and can reduce the unsatisfactory results resulting from closed treatment.
Topics: Humans; Child; Infant; Child, Preschool; Adolescent; Mandibular Condyle; Tooth Ankylosis; Fractures, Bone; Intraoperative Complications; Postoperative Complications
PubMed: 38155068
DOI: 10.1016/j.bjoms.2023.10.015 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2016Although many orthodontists have no doubts about the effectiveness of functional appliances for mandibular advancement, the impact on the temporomandibular joint (TMJ)... (Review)
Review
BACKGROUND
Although many orthodontists have no doubts about the effectiveness of functional appliances for mandibular advancement, the impact on the temporomandibular joint (TMJ) is still in dispute. The objective of this systematic review is to examine the main effects on the TMJ of using functional appliances, both in healthy patients and in patients with a pre-existing disorder.
MATERIAL AND METHODS
A systematic review of the literature was conducted in accordance with the PRISMA guidelines. Only systematic reviews, meta-analyses, randomized clinical trials (RCTs), case-control studies and cohort studies were included. A detailed language-independent electronic search was conducted in the Pubmed, Scopus, Cochrane Library and Embase databases. All studies published between 2000 and 2015 were included.
RESULTS
A total of 401 articles were identified. Of these, 159 were duplicates and were excluded. On reading the title and abstract, 213 articles were excluded because they did not answer the research question, leaving a total of 29 articles. These articles were read and assessed. Following critical reading of the full text, eight articles were excluded: seven because they were considered of low quality and one because it published redundant data. As a result, 21 articles were included.
CONCLUSIONS
After treatment with functional appliances, the condyle was found to be in a more advanced position, with remodelling of the condyle and adaptation of the morphology of the glenoid fossa. No significant adverse effects on the TMJ were observed in healthy patients and the appliances could improve joints that initially presented forward dislocation of the disk.
Topics: Humans; Mandibular Advancement; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 27475694
DOI: 10.4317/medoral.21180 -
Journal of Stomatology, Oral and... Oct 2022Maxillary impactions are seen as an orthognathic surgical movement that increases the number of complications. The aim of this paper is to research literature on this... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Maxillary impactions are seen as an orthognathic surgical movement that increases the number of complications. The aim of this paper is to research literature on this topic, with special attention to avoiding of complications.
METHODS
A systematic review was carried out according to the PRISMA guidelines. The PROSPERO registration has been performed. A risk of bias assessment was carried out with RevMan and graphics were created. A total of 20 articles were included in this systematic review.
RESULTS
Some interesting and conclusive facts about maxillary impactions. Relapses are not common due to the higher bone contact. Bleeding is a common complication due to the location of palatal artery. Aesthetic and functional complications can arise, especially in the nasal region. Bimaxillary orthognathic surgeries has a higher incidence of complications.
CONCLUSIONS
Today it is not possible to confirm that maxillary impactions alone are responsible for a higher incidence of complications due to the complexity of the three-dimensional movements. Some surgical steps could be safer and cause fewer complications.
Topics: Humans; Maxilla; Nose; Orthognathic Surgery; Orthognathic Surgical Procedures; Tooth, Impacted
PubMed: 34755611
DOI: 10.1016/j.jormas.2021.10.014 -
Oral Surgery, Oral Medicine, Oral... Sep 2022To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To address the factors that affect the quality of life (QoL) of individuals undergoing treatment for mandibular fractures.
STUDY DESIGN
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the search strategy was constructed according to the Populations, Interventions, Comparison, Outcomes, and Study Design principle in the following databases: PubMed, Web of Science, Scopus, and EMBASE. Risk of bias assessment was performed with Risk Of Bias In Non-randomized Studies of Interventions and Cochrane Risk of Bias tool for randomized trials 2.
RESULTS
Nineteen studies were included: 15 observational and 4 clinical trials. Mean age ranged from 28 to 39 years, with a higher proportion of males. The condyle was the main fracture location and traffic accident was the fracture cause. Treatment approaches were mostly open reduction (89.4%) and maxillomandibular fixation (63%). QoL measurements varied considerably with the General Oral Health Assessment Index (31.5%) and Oral Health Impact Profile-14 (21%) as the main instruments. Meta-analysis showed that open reduction and maxillomandibular fixation did not present significant differences to QoL (P = .39), but significant differences were observed with time (P < .00001). Other factors affected QoL, such as mental health, pain, socializing, appearance, and eating difficulties.
CONCLUSIONS
Several factors, apart from the treatment approach, mentioned in this review seemed to affect the QoL of patients with mandibular trauma. Treatment choice should be based on well-stablished clinical criteria and on all other factors mentioned here.
Topics: Adult; Humans; Jaw Fixation Techniques; Male; Mandibular Fractures; Quality of Life
PubMed: 35440426
DOI: 10.1016/j.oooo.2022.01.012 -
National Journal of Maxillofacial... Aug 2022To review the literature on the effect of different surgical approaches on facial nerve injuries. The present systematic review addresses the following focus question:... (Review)
Review
To review the literature on the effect of different surgical approaches on facial nerve injuries. The present systematic review addresses the following focus question: Is the facial nerve at risk following surgical correction of mandibular condylar fracture? Electronic and manual literature searches were conducted on databases:PubMed, ScienceDirect and Google scholar,Cochrane and clinicaltrials.gov for studies published until July 2020 to collect information about the effect of different surgical approaches on facial nerve injuries. Systematic literature review was performed following the prisma guidelines to identify studies. Quantitative retrospective and prospective studies,controlled trials,controlled clinical trials were included;case reports and review articles were excluded from this systematic review. 1500 articles published till July 2020 was identified. 116 articles met inclusion criteria. After applying exclusion criteria seven articles were shortlisted. The level of heterogeneity was observed to be less than 50%, between all parameters for all studies making publication bias to be minimum. On comparing various studies statistically using Z-test for all parameters,it was observed that level of significance was significant for various findings like Displacement/Dislocation of fracture and transient facial nerve weakness was found to be statistically significant between all studies (p-value <0.05). Odd ratio, relative ratio and 95% CI was derived for all parameters recorded for various studies. Due to less number of subjective studies, and variability in study designs and lack of reporting on confounding factors,definitive conclusions on effect of various surgical approaches on facial nerve injury cannot be drawn Future well-designed long-term randomized controlled trials are necessary to reveal the necessary correlation between both the parameters.
PubMed: 36393942
DOI: 10.4103/njms.njms_481_21