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Journal of Feline Medicine and Surgery May 2024A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed....
CASE SERIES SUMMARY
A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively.
RELEVANCE AND NOVEL INFORMATION
In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.
Topics: Cats; Animals; Bone Plates; Fracture Fixation, Internal; Mandibular Fractures; Male; Female; Treatment Outcome; Postoperative Complications; Tomography, X-Ray Computed; Cat Diseases
PubMed: 38717791
DOI: 10.1177/1098612X241243134 -
F1000Research 2023Maxillofacial Injury (MFI) is a major public health concern that is multifactorial in etiology-road traffic accidents (RTAs), falls and violence. RTAs are the major...
BACKGROUND
Maxillofacial Injury (MFI) is a major public health concern that is multifactorial in etiology-road traffic accidents (RTAs), falls and violence. RTAs are the major cause of maxillofacial injuries (MFIs) in countries like India. Recent studies have shown that maxillofacial fractures (MFF) constitute a significant proportion of facial injuries seen in hospitals (56.5%). The incidence of maxillofacial fractures can vary depending on several factors, including age, gender, and environmental factors. Of particular concern is the impact of seasonal variations, such as the monsoon season, which lead to high incidence of maxillofacial fractures due to hazardous conditions.
METHODS
A retrospective review of medical records was done in a tertiary-care dental teaching hospital was done.
RESULTS
Data of 200 subjects including 154 males (77%) and 46 females (23%) with a mean age of 35.38 ± 16.541 years; age range: 1 - 80 years was analyzed. A total of 200 MFI's were recorded between 2021 and 2022. Soft tissue injuries were reported in 37.5% of the cases in non-monsoon season and 42.3% of the cases during the monsoon season. Dentoalveolar fractures were reported in 6.2% of the cases during the non-monsoon seasons and 7.7% during the monsoon season. In this study, mandible was the most fractured bone (n=104,52%) followed by zygomatic complex (n=50, 25%). The frequently observed pattern among mandibular fracture was condyle 8.3% during the non-monsoon season and 2.9% during the monsoon season).
CONCLUSIONS
The results of the study indicate that mandibular fractures are most commonly seen in maxillofacial fractures, followed by fractures of the zygomatic complex. The study also reveals a higher incidence of soft tissue injuries and dentoalveolar fractures during the monsoon season. Further research is warranted to explore the factors that contribute to the seasonal variation in maxillofacial fractures for effective interventions to reduce their occurrence.
Topics: Male; Female; Humans; Adolescent; Young Adult; Adult; Middle Aged; Infant; Child, Preschool; Child; Aged; Aged, 80 and over; Retrospective Studies; Skull Fractures; Seasons; Tertiary Healthcare; Accidents, Traffic; Maxillofacial Injuries; Mandibular Fractures; Soft Tissue Injuries; Hospitals, Teaching
PubMed: 38585231
DOI: 10.12688/f1000research.134532.2 -
Journal of Cranio-maxillo-facial... May 2024Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the...
Fractures of the mandibular condyle account for a significant proportion of mandibular fractures. The specific functional loads require particular specifications for the implant design used for open reduction and internal fixation of such fractures. The clinical and radiographic outcomes in patients treated using a single rhombic 3D condylar fracture plate for open reduction and internal fixation at a single institution, and who fulfilled the inclusion and exclusion criteria, are presented. The primary outcome variables were: occlusion, maximum interincisal distance and mandibular excursion at 1, 3, and 6 months postoperatively, and radiographic measurements for mandibular height and gonion angle. In total, 263 patients were included, of whom 173 (65.8%) were male and 90 (34.2%) female. The mean age was 40.4 ± 18.9 years. There was satisfactory occlusion in 98.9% of patients at the 6-month follow-up, and a significant improvement in all parameters for mandibular excursion (p < 0.001), with a reduced ramus height and an increase in the gonion angle on the fractured side. Excellent clinical and radiographic results were achieved using the rhombic-shaped implant, deeming it appropriate for the osteosynthesis of mandibular condyle fractures.
Topics: Humans; Mandibular Fractures; Female; Fracture Fixation, Internal; Mandibular Condyle; Male; Bone Plates; Adult; Retrospective Studies; Middle Aged; Open Fracture Reduction; Treatment Outcome; Young Adult; Adolescent; Aged
PubMed: 38582680
DOI: 10.1016/j.jcms.2024.03.001 -
Cureus Feb 2024Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to...
Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to craniofacial injuries because they have a larger cerebral mass-to-body ratio than adults. The fracture pattern in children does not resemble that of adults, due to which the treatment of pediatric fractures differs from that of adults and can pose substantial difficulties to the pediatric dentist due to many factors, including the complex anatomy of the developing jaw. In this case report, a 5-year-old male patient presented with an injury to the upper and lower jaw. A case was managed with a conservative approach by using a modified open cap splint. A radiographic investigation, including CT brain and face, was done, which revealed the mandibular symphyseal fracture, bilateral condyle, and right Lefort II fracture. A modified open cap splint was fabricated and fixed with circummandibular and circumzygomatic wiring under general anesthesia. After two months, the fractured site showed good healing on orthopantomography (OPG), and satisfactory occlusion was achieved. The patient was kept on monthly follow-ups for up to five months. Treatment guidelines for pediatric maxillary and mandibular fractures are different from those for adults in that most pediatric cases are managed by a conservative approach. Cap splints are a versatile treatment option for juvenile mandibular fractures because they can be used to restore function and aesthetics with minimal morbidity, do not impede jaw growth or the development of dentition, and can be applied to patients of a wider range of ages.
PubMed: 38558710
DOI: 10.7759/cureus.55191 -
Journal of Stomatology, Oral and... Jun 2024This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation... (Comparative Study)
Comparative Study
OBJECTIVE
This study aims to quantify the facial symmetry of surgically treated zygomaticomaxillary complex (ZMC) fractures through a new reliable three-dimensional evaluation method, which is crucial for improving post-operative aesthetic and functional outcomes.
MATERIAL AND METHODS
Healthy patients and patients with surgically treated ZMC fractures were retrospectively reviewed. Using Brainlab Elements® the zygomatic bone and the orbit of each patient was segmented and mirrored. Subsequently, the mirrored side was matched with the other side via volume-based registration, using the segmented orbit as reference. Volumetric asymmetry was measured using 3-matic software, and a surface-based matching technique was used to calculate the mean absolute differences (MAD) between the surfaces of the two sides of the ZMC. The reliability of this novel method using volume-based registration was tested, and the intra-class correlation coefficient was assessed.
RESULTS
The MAD between the surfaces of the left and right sides in the control group was 0.51 mm (±0.09). As for the ZMC fracture group, MAD was 0.78 mm (±0.20) and 0.72 mm (±0.15) pre- and post-operatively, respectively. The MAD showed statistically significant differences between pre- and post-operative groups (p = 0.005) and between control and post-operative groups (p < 0.001). The intra-class correlation coefficient was high (≥0.99).
CONCLUSIONS
This evaluation method using mirroring and volume-based registration to determine the symmetrical position of the ZMC is reliable. The surface-based measurements revealed an improved symmetry after surgery. However, the symmetry of the treated patients remained lower than the control group.
Topics: Humans; Zygomatic Fractures; Female; Male; Imaging, Three-Dimensional; Retrospective Studies; Adult; Maxillary Fractures; Middle Aged; Facial Asymmetry; Reproducibility of Results; Young Adult
PubMed: 38556166
DOI: 10.1016/j.jormas.2024.101857 -
Journal of Stomatology, Oral and... Jun 2024Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally...
INTRODUCTION
Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient's quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40 Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed.
MATERIAL AND METHODS
Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analysed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model.
RESULTS
Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8% of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7 Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40 Gy and the occurrence of dental fractures (p = 0.0002) were demonstrated.
CONCLUSIONS
Our predictive model seems to be 82% accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient's oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40 Gy was observed.
Topics: Humans; Retrospective Studies; Osteoradionecrosis; Head and Neck Neoplasms; Male; Female; Middle Aged; Aged; Radiotherapy Dosage; Tooth Extraction; Adult; Squamous Cell Carcinoma of Head and Neck; Aged, 80 and over
PubMed: 38556165
DOI: 10.1016/j.jormas.2024.101858 -
Chinese Journal of Traumatology =... Mar 2024This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and...
PURPOSE
This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.
METHODS
Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct three-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean and standard deviation and compared using independent sample t-tests.
RESULTS
In 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%). The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment.
CONCLUSION
Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.
PubMed: 38514297
DOI: 10.1016/j.cjtee.2024.03.004 -
Acta Biomaterialia Apr 2024Failure-resistant designs are particularly crucial for bones subjected to rapid loading, as is the case for the ambush-hunting northern pike (Esox lucius). These fish...
Failure-resistant designs are particularly crucial for bones subjected to rapid loading, as is the case for the ambush-hunting northern pike (Esox lucius). These fish have slim and low-density osteocyte-lacking bones. As part of the swallowing mechanism, the cleithrum bone opens and closes the jaw. The cleithrum needs sufficient strength and damage tolerance, to withstand years of repetitive rapid gape-and-suck cycles of feeding. The thin wing-shaped bone comprises anisotropic layers of mineralized collagen fibers that exhibit periodic variations in mineral density on the mm and micrometer length scales. Wavy collagen fibrils interconnect these layers yielding a highly anisotropic structure. Hydrated cleithra exhibit Young's moduli spanning 3-9 GPa where the yield stress of ∼40 MPa increases markedly to exceed ∼180 MPa upon drying. This 5x observation of increased strength corresponds to a change to brittle fracture patterns. It matches the emergence of compressive residual strains of ∼0.15% within the mineral crystals due to forces from shrinking collagen layers. Compressive stresses on the nanoscale, combined with the layered anisotropic microstructure on the mm length scale, jointly confer structural stability in the slender and lightweight bones. By employing a range of X-ray, electron and optical imaging and mechanical characterization techniques, we reveal the structure and properties that make the cleithra impressively damage resistant composites. STATEMENT OF SIGNIFICANCE: By combining structural and mechanical characterization techniques spanning the mm to the sub-nanometer length scales, this work provides insights into the structural organization and properties of a resilient bone found in pike fish. Our observations show how the anosteocytic bone within the pectoral gridle of these fish, lacking any biological (remodeling) repair mechanisms, is adapted to sustain natural repeated loading cycles of abrupt jaw-gaping and swallowing. We find residual strains within the mineral apatite nanocrystals that contribute to forming a remarkably resilient composite material. Such information gleaned from bony structures that are different from the usual bones of mammals showcases how nature incorporates smart features that induce damage tolerance in bone material, an adaptation acquired through natural evolutionary processes.
Topics: Animals; Esocidae; Bone and Bones; Stress, Mechanical; Nanoparticles; Compressive Strength; Biological Evolution; Elastic Modulus; Collagen
PubMed: 38513725
DOI: 10.1016/j.actbio.2024.03.017