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Journal of Biomechanics Oct 2023After a fracture of the condyle, the head of the condyle is often pulled inwards, which causes the fractured part to angulate medially. This change can cause a...
After a fracture of the condyle, the head of the condyle is often pulled inwards, which causes the fractured part to angulate medially. This change can cause a disbalance in the masticatory system. The disbalance could lead to contact stress differences within the temporomandibular joints (TMJs) which might induce remodelling within the TMJ to restore the balance. The contact stress in the fractured condyle during open and closing movements is expected to decrease, while the contact stress in the non-fractured condyle will increase. In a clinical situation this is hard to investigate. Therefore, a finite element model (FEM) was used. In the FEM a fractured right condyle with an angulation was induced, which was placed at different degrees, varying from 5° to 50° in steps of 5°. This study shows only minor differences in amount of contact stress between the fractured and the non-fractured condyle. The amount of contact stress in the condyles does not increase with a higher degree of angulation. However, with larger angulations, the contact stress within the fractured condyle is more centralized. Clinically, this more centralized area could be associated with complaints, such as pain. In conclusion, due to the more centralized contact stress in the fractured condyle, one would expect some minor remodelling on the fractured side with more angulation.
Topics: Humans; Mandibular Condyle; Mandibular Fractures; Finite Element Analysis; Temporomandibular Joint
PubMed: 37683378
DOI: 10.1016/j.jbiomech.2023.111769 -
BMC Oral Health Aug 2023The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint...
PURPOSE
The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire.
METHODS
A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients.
RESULTS
Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed.
CONCLUSION
The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.
Topics: Humans; Child; Mandibular Fractures; Conservative Treatment; Quartz; Retrospective Studies; Splints
PubMed: 37641075
DOI: 10.1186/s12903-023-03309-z -
Clinical Oral Investigations Oct 2023Since the introduction of miniplate osteosynthesis and the use of prophylactic antibiotics, the complication rate related to the teeth in the fracture gap has...
OBJECTIVES
Since the introduction of miniplate osteosynthesis and the use of prophylactic antibiotics, the complication rate related to the teeth in the fracture gap has significantly decreased. Currently, there are still no established guidelines for the management of such teeth in mandibular fracture lines. However, the long-term viability of these teeth within the fracture gap remains uncertain. Therefore, this study aimed to assess the survival rate of teeth located within the mandibular fracture line and evaluate related follow-up treatments over a minimum period of one year.
MATERIALS AND METHODS
This retrospective study examined 184 patients who underwent surgical treatment for mandibular fractures between January 2018 and December 2021. A total of 189 teeth located in the fracture line were analyzed. Clinical and radiological parameters were collected, including patient age and gender, fracture etiology and location, intraoperative tooth treatment, as well as complications related to both the fracture and the affected teeth in long term.
RESULTS
Most of the examined teeth remained uneventful, with postoperative tooth-related complications seen in 14 (7.4%) teeth. The most common complications were symptomatic apical periodontitis (n = 9, 4.8%) and increased tooth mobility (n = 3, 1.5%). A correlation was found between complications and trauma-related tooth luxation (p = 0.002, OR = 15.2), as well as prior teeth connected to retainers or orthodontic appliances (p = 0.001, OR = 10.32).
CONCLUSION
Tooth-related complications are rare when intact teeth are retained within the fracture gap. Therefore, unless there is a definitive intraoperative indication for extraction, it is recommended to preserve the teeth in the fracture line.
CLINICAL RELEVANCE
Intact teeth in the fracture line of the mandible should not be primarily extracted.
Topics: Humans; Retrospective Studies; Mandibular Fractures; Tooth Extraction; Tooth; Mandible; Postoperative Complications
PubMed: 37610459
DOI: 10.1007/s00784-023-05218-5 -
Frontiers in Endocrinology 2023Diabetes mellitus is associated with higher risks of long bone and jaw fractures. It is also associated with a higher incidence of delayed union or non-union. Our...
INTRODUCTION
Diabetes mellitus is associated with higher risks of long bone and jaw fractures. It is also associated with a higher incidence of delayed union or non-union. Our previous investigations concluded that a dominant mechanism was the premature loss of cartilage during endochondral bone formation associated with increased osteoclastic activities. We tested the hypothesis that FOXO1 plays a key role in diabetes-impaired angiogenesis and chondrocyte apoptosis.
METHODS
Closed fractures of the femur were induced in mice with lineage-specific FOXO1 deletion in chondrocytes. The control group consisted of mice with the FOXO1 gene present. Mice in the diabetic group were rendered diabetic by multiple streptozotocin injections, while mice in the normoglycemic group received vehicle. Specimens were collected 16 days post fracture. The samples were fixed, decalcified, and embedded in paraffin blocks for immunostaining utilizing anti cleaved caspase-3 or CD31 specific antibodies compared with matched control IgG antibody, and apoptosis by the TUNEL assay. Additionally, ATDC5 chondrocytes were examined in vitro by RT-PCR, luciferase reporter and chromatin immunoprecipitation assays.
RESULTS
Diabetic mice had ~ 50% fewer blood vessels compared to normoglycemic mice FOXO1 deletion in diabetic mice partially rescued the low number of blood vessels (p < 0.05). Additionally, diabetes increased caspase-3 positive and apoptotic chondrocytes by 50%. FOXO1 deletion in diabetic animals blocked the increase in both to levels comparable to normoglycemic animals (p < 0.05). High glucose (HG) and high advanced glycation end products (AGE) levels stimulated FOXO1 association with the caspase-3 promoter in vitro, and overexpression of FOXO1 increased caspase-3 promoter activity in luciferase reporter assays. Furthermore, we review previous mechanistic studies demonstrating that tumor necrosis factor (TNF) inhibition reverses impaired angiogenesis and reverses high levels of chondrocyte apoptosis that occur in fracture healing.
DISCUSSION
New results presented here, in combination with recent studies, provide a comprehensive overview of how diabetes, through high glucose levels, AGEs, and increased inflammation, impair the healing process by interfering with angiogenesis and stimulating chondrocyte apoptosis. FOXO1 in diabetic fractures plays a negative role by reducing new blood vessel formation and increasing chondrocyte cell death which is distinct from its role in normal fracture healing.
Topics: Animals; Mice; Apoptosis; Caspase 3; Chondrocytes; Diabetes Mellitus, Experimental; Fracture Healing; Glucose; Forkhead Box Protein O1
PubMed: 37576976
DOI: 10.3389/fendo.2023.1136117 -
PloS One 2023The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this META-analysis was to evaluate the efficacy of photobiomodulation (PBM) therapy in the treatment of inferior alveolar nerve (IAN) injury due to orthognathic surgeries, extraction of impacted third molars and mandibular fractures.
METHODS AND MATERIALS
A electric search was conducted by a combination of manual search and four electric databases including Pubmed, Embase, Cochrane library and Web of Science, with no limitation on language and publication date. Gray literature was searched in ClinicalTrials.gov and googlescholar. All retrieved articles were imported into ENDNOTE software (version X9) and screened by two independent reviewers. All analysis was performed using the REVMAN software (version 5.3).
RESULTS
Finally, 15 randomized controlled trials met the inclusion criteria for qualitative analysis and 14 for META-analysis from 219 articles. The results showed that PBM therapy had no effect on nerve injury in a short period of time (0-48h, 14 days), but had significant effect over 30 days. However, the effect of photobiomodulation therapy on thermal discrimination was still controversial, most authors supported no significant improvement. By calculating the effective rate of PBM, it was found that there was no significant difference in the onset time of treatment, whether within or over 6 months.
CONCLUSIONS
The results of this META-analysis show that PBM therapy is effective in the treatment of IAN injures no matter it begins early or later. However, due to the limited number of well-designed RCTs and small number of patients in each study, it would be necessary to conduct randomized controlled trials with large sample size, long follow-up time and more standardized treatment and evaluation methods in the future to provide more accurate and clinically meaningful results.
Topics: Humans; Low-Level Light Therapy; Tooth Extraction; Mandibular Nerve; Mandibular Fractures
PubMed: 37561792
DOI: 10.1371/journal.pone.0287833 -
Case Reports in Plastic Surgery & Hand... 2023A 3-year-old patient sustained a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and symphyseal...
A 3-year-old patient sustained a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and symphyseal fracture. Staged lower jaw reconstruction with closed reduction of the laterally dislocated condyle, transfacial pinning between the mandibular angles, MMF using circummandibular wiring and intermaxillary fixation screws was performed.
PubMed: 37547270
DOI: 10.1080/23320885.2023.2242498 -
Heliyon Aug 2023There is a great effort from numerous research groups in the development of materials and therapeutic strategies for the functional recovery of patients who have...
There is a great effort from numerous research groups in the development of materials and therapeutic strategies for the functional recovery of patients who have suffered peripheral nerve injuries (PNI). In an article , the formation of a nerve bridge was observed, reconnecting the distal and proximal stumps, in the sciatic nerve of rats, indicating the effective participation of the biomaterial in the recovery of peripheral nerve injuries. For the current pilot study, 15 cases of multiple fractures of the mandible, with involvement of the inferior alveolar nerve (IAN) were selected and studied: JC (control cases) n = 6 with conventional treatment, and JT (treated cases) n = 9, with the use of biomimetic biomaterial. The evaluation of the return to sensitivity was measured through a self-assessment, where the patients assigned scores from 0 to 10, where zero (0) represented the complete absence of sensitivity and ten (10) the normality of the perception of local sensitivity. Patients were evaluated from the preoperative period to the 360th day. The statistical results obtained by the t-Student, Shapiro-Wilk normality and non-parametric One-Way ANOVA tests indicated statistically significant differences ( < 0.005; 0.005 e 0.5 respectively), between the two treatments, which were reflected in the clinical results observed, we also calculate the size of the effect represented by , calculated by Cohen's . The results indicate a great difference between the treatments performed = 1.00. In the 6 cases followed up in the JC group, four remained with a significant deficit until the end of the evaluations and two indicated the remission of the lack of sensitivity in this period. In the JT group, in 28 days, all cases indicated complete remission of the lack of sensitivity with healing concentration. In one of the cases where there was a complete rupture of the mental nerve, the (score-10) was observed in 60 days. The observed results indicate the existence of a statistical significance between the groups and an important relationship when using the biomimetic biomaterial during the recovery of the perception of sensitivity in polytraumatized patients, compatible with the results observed in laboratory animals, which may indicate its clinical feasibility in the reduction of sequelae in PNI.
PubMed: 37520975
DOI: 10.1016/j.heliyon.2023.e18304 -
Scientific Reports Jul 2023The treatment of ulna coronal process fractures in the terrible triad of elbow, especially type I and II Regan-Morrey coronoid fractures, still have been controversial....
The treatment of ulna coronal process fractures in the terrible triad of elbow, especially type I and II Regan-Morrey coronoid fractures, still have been controversial. The purpose of this retrospective study was to evaluate the novel Lasso-plate technique to have a more reliable fixation and a well clinical outcomes for type I and II Regan-Morrey coronoid fractures in a terrible triad of the elbow (TTE). Patients with simple TTE, closed fracture, aged > 18 years, duration of injury < 2 weeks, type I and II Regan-Morrey coronoid process fracture fixed by the Lasso-plate technique or ORIF were enrolled in the study. Total 144 patients with type I and II Regan-Morrey coronoid fracture in TTE were included in the Lasso-plate group or ORIF (open reduction and internal fixation) group in the Xi'an Honghui Hospital from January 2017 to December 2020. Eighty-six patients in Lasso-plate group underwent surgery using a novel Lasso-plate technique. And other 58 patients in ORIF group underwent surgery using ORIF. The data of two groups, including the X-ray films, Computed tomography (CT), the range of elbow motion, Mayo Elbow Performance Score (MEPS) and the surgical complications, were extracted from the hospital's patient records. All patients in both groups were followed up at least 12 months. The mean operation time (88.2 ± 12.3 min) in Lasso-plate group is shorter than that of ORIF group (109.1 ± 13.0 min). There was one patient with injury of deep branch of radial nerve and one patient with superficial surgical incision infection in Lasso-plate group. There were two patients with surgical incision infection in ORIF group. There were three heterotopic ossifications in Lasso-plate group and eight heterotopic ossifications in ORIF group. There were 5 elbow joints stiffness in Lasso-plate group and 12 in ORIF group. At 12 months follow up, the mean range of flexion-extension motion in Lasso-plate group was 122.9° ± 13.4° versus 113.2° ± 18.1° in ORIF group (p < 0.01), the mean 89.7 ± 5.6 MEPS in Lasso-plate group versus mean 83.7 ± 6.1 MEPSin ORIF group. The fixation of coronoid process fracture in TTE by the Lasso-plate technique, especially type I and II Regan-Morrey coronoid fracture, could be easier to master and operate, could provide the sufficient stability of elbow joint to enable early functional exercise, along with a better clinical outcome, a lower surgical complication. For the treatment of TTE, we recommend the fixation of type I and II Regan-Morrey coronoid fracture with the Lasso-plate technique, which would result in a better clinical outcome.
Topics: Humans; Elbow Joint; Elbow; Retrospective Studies; Surgical Wound; Treatment Outcome; Fracture Fixation, Internal; Radius Fractures; Mandibular Fractures; Range of Motion, Articular
PubMed: 37468520
DOI: 10.1038/s41598-023-38885-1 -
Scientific Reports Jul 2023Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to... (Meta-Analysis)
Meta-Analysis
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
Topics: Humans; Mandibular Fractures; Surgical Wound Infection; Prevalence; Prospective Studies; Retrospective Studies
PubMed: 37430033
DOI: 10.1038/s41598-023-37652-6