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Journal of Oral and Maxillofacial... Apr 2024Detection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint.
BACKGROUND
Detection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint.
PURPOSE
The purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age.
STUDY DESIGN, SETTING, SAMPLE
A single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE
Age (in months) at the time of presentation, measured as a continuous variable.
MAIN OUTCOME VARIABLE(S)
The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant's mouth and applies slight pressure to encourage MMO. In older infants with erupted central incisors, MMO was measured from the gingival margins.
COVARIATES
The covariates were sex, race, and gestational age.
ANALYSES
Findings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age.
RESULTS
The sample was composed of 151 infants with a mean age of 5.2 months (95% confidence interval [CI] 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, P < .001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4 to 23.6), compared to a mean of 36.7 mm (95% CI 34.8 to 38.6) in infants 11 months of age.
CONCLUSIONS AND RELEVANCE
The results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.
Topics: Infant; Infant, Newborn; Humans; Female; Aged; Male; Prospective Studies; Mouth; Temporomandibular Joint; Trismus; Range of Motion, Articular; Malocclusion
PubMed: 38336351
DOI: 10.1016/j.joms.2024.01.013 -
Journal of Imaging Informatics in... Jun 2024Previous research on computer-assisted jawbone reduction for mandibular fracture surgery has only focused on the relationship between fractured sections disregarding...
Previous research on computer-assisted jawbone reduction for mandibular fracture surgery has only focused on the relationship between fractured sections disregarding proper dental occlusion with the maxilla. To overcome malocclusion caused by overlooking dental articulation, this study aims to provide a model for jawbone reduction based on dental occlusion. After dental landmarks and fracture sectional features are extracted, the maxilla and two mandible segments are aligned first using the extracted dental landmarks. A swarm-based optimization is subsequently performed by simultaneously observing the fracture section fitting and the dental occlusion condition. The proposed method was evaluated using jawbone data of 12 subjects with simulated and real mandibular fractures. Results showed that the optimized model achieved both accurate jawbone reduction and desired dental occlusion, which may not be possible by existing methods.
Topics: Humans; Mandibular Fractures; Surgery, Computer-Assisted; Male; Female; Proof of Concept Study; Dental Occlusion; Adult; Mandible
PubMed: 38332406
DOI: 10.1007/s10278-024-01014-z -
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 -
Journal of Cranio-maxillo-facial... Mar 2024This retrospective analysis aimed to investigate the necessity of removing the wisdom tooth in cases of angle fractures of the mandible. The study retrieved 595 mandible...
This retrospective analysis aimed to investigate the necessity of removing the wisdom tooth in cases of angle fractures of the mandible. The study retrieved 595 mandible fractures from January 2006 to December 2021 through the Hospital Inpatient Enquiry System, of which 303 involved a fracture through the angle of the mandible, including the wisdom tooth socket. Of these, 203 (66.9%) underwent open reduction and internal fixation with retention of the third molar. The authors found that only four (2%) patients returned for the removal of plates and the retained third molar during the follow-up period. Therefore, the authors concluded that wisdom teeth removal should remain an exception during open reduction and internal fixation of mandibular angle fractures unless they hinder fracture reduction, pose a potential infection risk, or interfere with occlusal stability.
Topics: Humans; Mandibular Fractures; Molar, Third; Retrospective Studies; Mandible; Fracture Fixation; Tooth Extraction; Tooth, Impacted
PubMed: 38320919
DOI: 10.1016/j.jcms.2023.11.012 -
The Journal of Contemporary Dental... Dec 2023This study aimed to compare the clinical outcomes of a conventional Erich's arch bar vs a modified screw-retained arch bar in maxillomandibular fixation of mandibular... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
This study aimed to compare the clinical outcomes of a conventional Erich's arch bar vs a modified screw-retained arch bar in maxillomandibular fixation of mandibular fracture.
MATERIALS AND METHODS
This parallel-arm randomized control trial included patients from the outpatient clinic with single favorable mandibular fractures that are indicated for closed reduction. They were subjected to maxillomandibular fixation using conventional Erich's arch bars in the control group and modified screw-retained arch bars in the study group. The outcome measures included operating time, glove perforations, postoperative pain, oral hygiene, fixation stability, occlusion, and mucosal coverage.
RESULTS
A total of 20 patients (12 males and 8 females) with a 1:1 allocation ratio were included. There was a significant statistical difference regarding operation time and number of glove perforations in favor of group B as < 0.001, = 0.007, respectively. There was a significant statistical difference regarding pain after 1 day ( < 0.001), 1 week ( < 0.001) in favor of group B, and at 4 weeks ( = 0.015), and 6 weeks ( = 0.002) in favor of group A. Regarding oral hygiene at 1 week ( = 0.021) and at 6 weeks ( < 0.001), there was a significant statistical difference in favor of group B. Regarding mucosal coverage at 6 weeks, there was a significant statistical difference in favor of group A ( = 0.005).
CONCLUSION
The modified screw-retained arch bar can be considered an alternative to conventional arch bar as it provided less application time and better operator safety. It also showed better patient satisfaction regarding pain and oral hygiene.
CLINICAL SIGNIFICANCE
Maxillomandibular fixation with the conventional technique was modified to screw-retained arch bar which is less time-consuming and provides better patient and operator satisfaction. How to cite this article: Elhadidi MH, Awad S, Elsheikh HAE, . Comparison of Clinical Efficacy of Screw-retained Arch Bar vs Conventional Erich's Arch Bar in Maxillomandibular Fixation: A Randomized Clinical Trial. J Contemp Dent Pract 2023;24(12):928-935.
Topics: Male; Female; Humans; Jaw Fixation Techniques; Fracture Fixation, Internal; Bone Screws; Treatment Outcome; Pain, Postoperative; Mandibular Fractures
PubMed: 38317388
DOI: 10.5005/jp-journals-10024-3613 -
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 -
Quintessence International (Berlin,... Feb 2024Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the...
Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathological fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCC. Adverse impact on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCC exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathological fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC and had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with our growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dentist may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management.
PubMed: 38299599
DOI: 10.3290/j.qi.b4925761 -
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 -
The Journal of Oral Implantology Dec 2023This clinical report describes the oral rehabilitation of a 25-year-old male patient who lost the lower incisors, right canine, and a significant amount of anterior...
This clinical report describes the oral rehabilitation of a 25-year-old male patient who lost the lower incisors, right canine, and a significant amount of anterior mandibular bony and soft tissue following severe dentoalveolar trauma due to a car accident. The patient's young age, anterior esthetic zone in the lower jaw, previous mandibular fracture, and extended bony and soft-tissue defect hindering ideal 3-dimensional implant placement oriented the therapeutic plan toward a staged approach, with several reconstructive surgical procedures before implant rehabilitation. The treatment involved deepening the labiobuccal vestibule and lingual sulcus to correct cicatricial shrinkage due to previous surgical fixation of the mandibular fracture, vertical guided bony augmentation to regenerate adequate volumes of bone, free gingival graft to achieve sufficient height and thickness of peri-implant soft tissues, and a prosthetic-driven surgical procedure to place the implants in a good functional and esthetic position. This therapeutic approach restored function and esthetics and achieved outcome stability at 3-year follow-up.
Topics: Male; Humans; Adult; Dental Implantation, Endosseous; Dental Implants; Follow-Up Studies; Mandibular Fractures; Esthetics, Dental; Plastic Surgery Procedures; Treatment Outcome
PubMed: 38279654
DOI: 10.1563/aaid-joi-D-23-00143