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The Journal of Craniofacial Surgery Jun 2024An improved method of treating inwardly dislocated mandibular extracapsular condylar fracture-three times titanium plate gradual fixation method was introduced, and the...
OBJECTIVE
An improved method of treating inwardly dislocated mandibular extracapsular condylar fracture-three times titanium plate gradual fixation method was introduced, and the clinical efficacy of this method was evaluated.
METHODS
Twenty patients with extracapsular condylar fractures who underwent surgical treatment using the three times titanium plate gradual restoration and fixation method in the Department of Oral Craniomaxillofacial Surgery of the Ninth People's Hospital of Shanghai from November 2020 to June 2023 were selected as the study subjects.
RESULTS
After condylar restoration 22 sides reached healing and 1 side was basically healed; in 3 months after the operation, the degree of opening the mouth and the type of the opening of the mouth reached normal, and 1 case had mildly poor occlusion, which required to be further adjusted through orthodontics, and there was no temporomandibular function disorder or facial nerve function damage.
CONCLUSION
Three times of gradual fixation with a titanium plate can make the condylar process achieve precise and stable repositioning, and make the surgical process orderly, and it is a kind of reliable fixation method for extracapsular condylar fractures.
Topics: Humans; Mandibular Fractures; Bone Plates; Titanium; Mandibular Condyle; Male; Fracture Fixation, Internal; Female; Adult; Middle Aged; Treatment Outcome; Young Adult; Adolescent
PubMed: 38483294
DOI: 10.1097/SCS.0000000000010005 -
Journal of Cranio-maxillo-facial... May 2024Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures. The...
Our study aimed to evaluate modified patient-specific surgical-guide-assisted precise treatment of unilateral comminuted zygomaticomaxillary complex (ZMC) fractures. The retrospective non-randomized study was conducted in a single hospital in China. All patients diagnosed with unilateral comminuted ZMC fractures between January 1, 2018 and December 31, 2022 were retrospectively reviewed. All patients underwent preoperative spiral computed tomography (CT). CT data were processed using software to DICOM format and transferred to Proplan CMF3.0 for preoperative virtual surgical planning and postoperative evaluation. All data were extracted from standardized electronic medical records. All statistical analyses were performed using SPSS version 20.0. The chi-square test and t-test were used for statistical analyses. The 54 included patients were divided into two comparable, equal cohorts of 27 patients, and followed up for at least 6 months. Fracture reduction was assisted using the modified patient-specific surgical guides in the guide group (23 males, four females; mean age 37.74 ± 12.07 years) and without the modified patient-specific surgical guides in the control group (20 males, seven females; mean age 37.44 ± 13.58 years). In the guide group, the mean eminence deviation between the affected and unaffected sides was 1.01 ± 0.92 mm, and the mean width deviation between the affected and unaffected sides was 1.29 ± 1.32 mm. In the control group, the mean eminence deviation between the affected and unaffected sides was 1.99 ± 1.69 mm, and the mean width deviation between the affected and unaffected sides was 2.68 ± 2.01 mm. The differences in facial protrusion (p = 0.001) and width (p = 0.003) symmetry between the affected and healthy sides of the two groups were statistically significant (p < 0.05). In conclusion, applying the modified patient-specific surgical guides to unilateral comminuted zygomaticomaxillary complex fracture reduction has the advantages of greater predictability and effectiveness, and improved bilateral ZMC symmetry. It should be noted that this approach would be especially beneficial for less-experienced surgeons.
Topics: Humans; Retrospective Studies; Male; Female; Zygomatic Fractures; Adult; Fractures, Comminuted; Maxillary Fractures; Middle Aged; Surgery, Computer-Assisted; Tomography, Spiral Computed; Imaging, Three-Dimensional; Fracture Fixation, Internal
PubMed: 38448338
DOI: 10.1016/j.jcms.2024.02.021 -
The Journal of Craniofacial Surgery Jun 2024The decision to retain or extract teeth in the line of mandibular fractures has been a subject of debate in much of the scientific literature, and there is a need for...
OBJECTIVE
The decision to retain or extract teeth in the line of mandibular fractures has been a subject of debate in much of the scientific literature, and there is a need for further evidence to clear this issue. Thus, the aim of this study was to investigate both the positive and negative effects of teeth in the line of mandibular fractures provide more evidence in this field, as well as take into consideration patients' quality of life after the surgery.
METHODS
Patients after trauma with teeth in the line of mandibular fractures were included in this study. Open reduction and rigid internal fixation, elastic intermaxillary reduction were expected to achieve a satisfactory occlusion and/or anatomical reduction in the fragments as assessed by orthopantomogram, computed tomography scans, and clinical examination. The remaining cases had maxillomandibular fixation (MMF) with an arch bar and bridle wire. All the patients included in this study will take the Visual Analog Scale score evaluation before and after surgery subjectively to further verify the impact on their life qualify, as well as the further treatment needed.
RESULTS
A total of 78 patients with teeth in the line of mandibular fractures were included in this study. Open reduction and rigid internal fixation was used in 37 patients, whereas another 35 patients accepted elastic intermaxillary reduction. Six cases underwent MMF. The number of involved teeth was 83. Three of the 83 teeth involved in the fracture lines healed with complications. In the cases where the teeth had been removed before fracture treatment, or in cases of delayed extractions, no complications were noted. The majority of the patients felt good about the whole treatment, however, 4 in the MMF group complained about worry about their oral health due to MMF leading to mouth open limitation.
CONCLUSION
The factors that should be considered for removal include the condition of the teeth and alveolar bone, the timing and the type of treatment, as well as the patients' desire, if possible. This is an individual-based decision that needs to consider more objective and subjective potential risks to avoid complications.
Topics: Humans; Mandibular Fractures; Male; Quality of Life; Female; Fracture Fixation, Internal; Adult; Radiography, Panoramic; Tomography, X-Ray Computed; Jaw Fixation Techniques; Tooth Extraction; Middle Aged; Treatment Outcome; Tooth Injuries; Open Fracture Reduction
PubMed: 38421202
DOI: 10.1097/SCS.0000000000009992 -
Annals of Maxillofacial Surgery 2023Apart from the usual presentation of herpes zoster (HZ) infection (HZI), reports of spontaneous teeth exfoliation and osteonecrosis are infrequent and sporadic.
RATIONALE
Apart from the usual presentation of herpes zoster (HZ) infection (HZI), reports of spontaneous teeth exfoliation and osteonecrosis are infrequent and sporadic.
PATIENT CONCERNS
A 51-year-old male patient presented with spontaneous exfoliation of multiple teeth and subsequent pathological fracture on the right side of the lower jaw after three months of HZI.
DIAGNOSIS
Biopsy was taken from the alveolar bone of the oedematous region, which revealed the presence of trabeculae of dead bone with empty lacunae.
INTERVENTION
Necrosed part of the alveolar bone was excised under local anaesthesia and antibiotic coverage, which was followed by open reduction and internal fixation of the pathological fracture under general anaesthesia.
OUTCOMES
The patient was followed up for one year without any evidence of recurrences.
TAKE-AWAY LESSONS
Presentation of osteonecrosis following HZI is unique but rare and should be diagnosed at the earliest.
PubMed: 38405553
DOI: 10.4103/ams.ams_42_23 -
Clinical Oral Investigations Feb 2024To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.
OBJECTIVES
To explore predictive factors for the development and maintenance of jaw pain over a 2-year period.
METHODS
One hundred nineteen cases (73 women) and 104 controls (59 women), mean age 34.9 years (SD 13.9), attended baseline and 2-year follow-up examinations. The whiplash cases visited the emergency department at Umeå University Hospital, Sweden, with neck pain within 72 h following a car accident, and baseline questionnaires were answered within a month after trauma. Controls were recruited via advertising. Inclusion criteria were age 18-70 years, living in Umeå municipality and Swedish speaking. The exclusion criterion was neck fracture for cases and a previous neck trauma for controls. Validated questionnaires recommended in the standardized Research Diagnostic Criteria for temporomandibular disorders were used. Jaw pain was assessed by two validated screening questions answered with "yes" or "no." A logistic regression analysis was used to predict the outcome variable jaw pain (yes/no) after 2 years.
RESULTS
Whiplash trauma did not increase the odds of development of jaw pain over a 2-year period (OR 1.97, 95% CI 0.53-7.38). However, non-specific physical symptoms (OR 8.56, 95% CI 1.08-67.67) and female gender (OR 4.89, 95% CI 1.09-22.02) did increase the odds for jaw pain after 2 years.
CONCLUSION
The development and maintenance of jaw pain after whiplash trauma are primarily not related to the trauma itself, but more associated with physical symptoms.
CLINICAL RELEVANCE
The development of jaw pain in connection with a whiplash trauma needs to be seen in a biopsychosocial perspective, and early assessment is recommended.
Topics: Humans; Female; Adult; Adolescent; Young Adult; Middle Aged; Aged; Whiplash Injuries; Neck Pain; Sweden
PubMed: 38383824
DOI: 10.1007/s00784-024-05555-z -
Proceedings (Baylor University. Medical... 2024Approximately 70% of multiple myeloma patients develop pathologic fractures. Osteoclast inhibitors can provide reduction in vertebral fractures with an increased risk of...
BACKGROUND
Approximately 70% of multiple myeloma patients develop pathologic fractures. Osteoclast inhibitors can provide reduction in vertebral fractures with an increased risk of osteonecrosis of the jaw (ONJ). ONJ associated with currently used osteoclast inhibitors causes significant morbidity, often from delayed diagnosis and ineffective treatment.
METHODS
The TriNetX Diamond Network was used to create patient cohorts for each medication: alendronate, pamidronate, zoledronic acid, and denosumab. All patients had a diagnosis of multiple myeloma as identified by International Classification of Disease-10 (ICD-10) code C90.0. Pamidronate, zoledronic acid, and denosumab were each compared to alendronate for 5-year incidence of pathologic vertebral fracture (ICD-10 M48.50XA) and development of ONJ.
RESULTS
The 5-year risk of pathologic vertebral fracture was not statistically different between alendronate versus pamidronate, zoledronic acid, and denosumab. However, the 5-year risk of ONJ was significantly higher for both zoledronic acid and denosumab (relative risk 4.85 and 2.9, respectively).
CONCLUSION
This study shows that fracture reduction risk is comparable for all four treatments in multiple myeloma patients, but ONJ risk is lowest for alendronate and pamidronate. Overall, these data support the continued use of pamidronate and alendronate in multiple myeloma patients.
PubMed: 38343457
DOI: 10.1080/08998280.2023.2298667 -
Journal of Oral Biology and... 2024There is no cause -based treatment for Medication-Related Osteonecrosis of the Jaw (MRONJ). MRONJ is a morbid condition including exposed, infected bone and mandibular...
INTRODUCTION
There is no cause -based treatment for Medication-Related Osteonecrosis of the Jaw (MRONJ). MRONJ is a morbid condition including exposed, infected bone and mandibular fractures in osteoporotic individuals and metastatic cancers patients treated with nitrogen containing bisphosphonates (NBP). NBPs inhibit farnesyl diphosphate synthase (FDPS) in the mevalonate pathway, depriving osteoclasts and other bone cells of small GTPases necessary for their function and survival. We test the hypothesis that geranylgeraniol (GGOH),a metabolite downstream of FDPS, when incorporated into a bone cement pellet, enhances osteoclast function and promotes local bone healing in and in a proven animal model of MRONJ.
METHODS
H labelled GGOH (2 mM) was incorporated into a Hydroset bone cement pellet and release from the cement was assessed over time. To assess the effect on bone cell function, the GGOH-loaded cement was placed in a porous filter above cultured osteoclasts treated with bisphosphonate and the effect on osteoclast survival and function were measured. In a pilot study the effect of GGOH on osteotomy microstructure was measured in a rat model of MRONJ using a split mouth design.
RESULTS
The release of GGOH from bone cement increased osteoclast survival/metabolic activity, and promoted resorption of the calcified substrate. In vivo released GGOH limited the effects of the bisphosphonate and promoted healing. In an animal pilot study, GGOH from the infused cement carrier stabilizes bone structure and restores the ability of osteoclasts to remodel.
CONCLUSION
These initial findings point to GGOH in a bone cement carrier as a useful therapeutic approach to prevent or mitigate the pathogenesis of MRONJ.
PubMed: 38327595
DOI: 10.1016/j.jobcr.2024.01.014 -
Cureus Jan 2024Vagal nerve stimulation (VNS) is a well-tolerated procedure for patients with medication-resistant and non-focal epilepsy. It does, however, have potential complications...
Vagal nerve stimulation (VNS) is a well-tolerated procedure for patients with medication-resistant and non-focal epilepsy. It does, however, have potential complications (e.g., hoarseness and cough) thought to be from vagus nerve irritation. These arise postoperatively and generally improve without intervention. If these symptoms present later or do not improve, it suggests a more insidious etiology. Herein we report the case of a patient in their 50s with medication-resistant epilepsy, who subsequently underwent VNS electrode array and pulse generator implantation to aid seizure management. Three years after the initial implantation, the patient experienced vocal cord paralysis and neck pain following a syncopal fall. The pain radiated to their jaw and chest and was eliminated when their VNS was turned off. The patient was taken to the OR for removal and replacement of their entire VNS system. Their original electrodes were unable to be removed secondary to being scarred in place. The patient's preoperative pain symptoms completely resolved after the removal of their old VNS and implantable pulse generator (IPG) and replacement with a new system 14 days postoperatively. While short-term postoperative sequelae and lead fractures/displacements have been reported in the literature, this is the first case to our knowledge of a patient experiencing a likely symptomatic traction injury without displacement of the VNS coils or obvious vagus nerve injury. Furthermore, the removal and replacement of the entire VNS system led to complete relief of their presenting symptoms.
PubMed: 38304691
DOI: 10.7759/cureus.51489 -
Case Reports in Ophthalmology 2024Osteopetrosis is a rare heritable disorder characterized by increased bone density resulting from osteoclast dysfunction. Major complications include bone fracture,...
INTRODUCTION
Osteopetrosis is a rare heritable disorder characterized by increased bone density resulting from osteoclast dysfunction. Major complications include bone fracture, osteomyelitis, anemia, and cranial nerve compression. Optic atrophy can occur due to compression of the optic nerve. Although osteomyelitis of the jaw is a common complication, it rarely occurs in the maxilla. Here, we report a case of a 74-year-old female with osteopetrosis who developed maxillary osteomyelitis, leading to orbital inflammation.
CASE PRESENTATION
She was referred to our clinic for 2 months of ptosis and swelling of the left eyelid and temporal region. Previous imaging revealed a left intraorbital occupying lesion, but a biopsy of the temporal subcutaneous tissue did not provide a definitive diagnosis. After 7 months, she presented with severe temporal swelling and purulent discharge. Upon examination, maxillary osteomyelitis resulting from caries of the upper jaw was observed. Treatment with oral antibiotics, drainage of the temporal skin fistula, and regular cleaning of the maxillary drainage improved her symptoms.
CONCLUSION
This is a rare case of maxillary osteomyelitis associated with osteopetrosis, causing orbital inflammation.
PubMed: 38288029
DOI: 10.1159/000536140 -
Oral and Maxillofacial Surgery Jun 2024To clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures.
PURPOSE
To clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures.
METHODS
Patients with clinically infected mandibular fracture of the dentate part without preceding surgery were studied retrospectively. Clinical infection was defined to occur if pus, abscess, or a fistula in the fracture area was present. Patient-, fracture-, and surgery-related variables were evaluated, and predictors for postoperative complications were analysed.
RESULTS
Of 908 patients with surgically treated fracture in the dentate part of the mandible, 41 had infected fracture at the time of surgery (4.5%). Of these patients, 46.3% were alcohol or drug abusers. Median delay from injury to surgery was 9 days. Patient-related factors were the most common cause for delayed surgery (n = 30, 73.2%), followed by missed diagnosis by a health care professional (n = 8, 19.5%). Twenty-two fractures were treated via extraoral approach (53.7%) and the remaining 19 intraorally (46.3%). Postoperative surgical site complications were found in 13 patients (31.7%), with recurrent surgical site infections predominating. Notable differences between total complication rates between intraoral and extraoral approaches were not detected. Secondary osteosynthesis for non-union was conducted for one patient treated intraorally.
CONCLUSIONS
Postoperative surgical site complications are common after treatment of infected mandibular fractures, and these occur despite the chosen surgical approach. Infected mandibular fractures heal mainly without bone grafting, and non-union is a rare complication. Due to the high complication rate, careful perioperative and postoperative care is required for these patients.
Topics: Humans; Mandibular Fractures; Adult; Male; Female; Surgical Wound Infection; Middle Aged; Retrospective Studies; Adolescent; Aged; Young Adult; Fracture Fixation, Internal; Postoperative Complications; Time-to-Treatment; Substance-Related Disorders; Delayed Diagnosis
PubMed: 38286958
DOI: 10.1007/s10006-024-01213-6