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Indian Journal of Dental Research :... Oct 2023Maxillofacial skeleton is the most vulnerable site for trauma due to its prominence. The aim of our study was to analyse the cause and pattern of maxillofacial injuries...
INTRODUCTION
Maxillofacial skeleton is the most vulnerable site for trauma due to its prominence. The aim of our study was to analyse the cause and pattern of maxillofacial injuries & to correlate the aetiology and pattern of facial injury.
MATERIALS AND METHODS
This prospective study includes 304 patients with facial trauma, who reported to our institute within a time span of 2 years. Data were collected on basis of sociodemographic status plus additional data obtained on type of injury, aetiology, location and status of the victim.
RESULT
The most frequent cause of maxillofacial trauma (MFT) was fall (43.3%) followed by RTA (34.2%) and assault (15.1%). In upper 3rd face region frontal bone fracture was prevalent with 1.3%, while in the midface, zygomatic complex (ZMC) fracture (3.9%) and in lower 3rd part of face, mandible fracture (42.8%) and dentoalveolar fracture (30.2%). Mandible was the most prevalent site for trauma. Although fall was the main aetiological factor in our study, midfacial injuries were mainly due to assault and RTA. Combination of mandibular fracture and soft tissue injury were mainly seen in RTA and injury due to fall. Conservative management was mainly employed for treatment with 46.1% followed by ORIF with 36.2%.
CONCLUSION
Changing trend in aetiology of MFT was noted. Furthermore, study should be conducted for better understanding, and to carry out preventive measure for the same.
Topics: Humans; Prospective Studies; Maxillofacial Injuries; Male; Female; India; Adult; Adolescent; Middle Aged; Accidental Falls; Young Adult; Child; Violence; Aged; Accidents, Traffic; Child, Preschool; Mandibular Fractures
PubMed: 38739817
DOI: 10.4103/ijdr.ijdr_731_22 -
The British Journal of Oral &... Jun 2024The aim of this article was to evaluate the efficacy of tranexamic acid (TXA) to reduce blood loss after maxillofacial fracture surgery. Clinical data were collected...
The aim of this article was to evaluate the efficacy of tranexamic acid (TXA) to reduce blood loss after maxillofacial fracture surgery. Clinical data were collected retrospectively on patients with unilateral fractures of the zygomaticomaxillary complex (ZMC) or mandibular condyle. Patients were then further divided into TXA and control groups according to whether or not TXA was used after surgery. The amount of postoperative blood loss was evaluated by negative pressure drainage volume. Data were statistically analysed. In patients with unilateral ZMC fractures, total postoperative blood loss in the TXA group was about 30 ml less than that in the control group (p = 0.006). It was significantly less on the first and second postoperative days. However, in patients with unilateral mandibular condylar fractures, there was no significant difference between the TXA and control groups (p = 0.917). TXA can reduce postoperative bleeding in patients with ZMC fractures, and the optimal usage time is on the first and second postoperative days. For patients with mandibular condylar fractures, TXA may not be used.
Topics: Humans; Tranexamic Acid; Postoperative Hemorrhage; Male; Female; Retrospective Studies; Antifibrinolytic Agents; Adult; Middle Aged; Mandibular Fractures; Zygomatic Fractures; Mandibular Condyle; Maxillary Fractures; Treatment Outcome
PubMed: 38735769
DOI: 10.1016/j.bjoms.2024.04.002 -
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 -
Nederlands Tijdschrift Voor... May 2024A fracture of the mandibular condyle is a common fracture of the mandible. After the diagnosis has been made, there are various treatment options: wait and see,... (Review)
Review
A fracture of the mandibular condyle is a common fracture of the mandible. After the diagnosis has been made, there are various treatment options: wait and see, conservative or surgical. Which of these treatment options is best depends on several different factors and is often the subject of debate. A common complication of a fracture of the mandibular condyle is malocclusion. Malocclusion can cause problems - even in the long term - for which the patient often requires secondary treatment.
Topics: Humans; Mandibular Condyle; Mandibular Fractures; Malocclusion
PubMed: 38715533
DOI: 10.5177/ntvt.2024.05.23107 -
The Journal of Craniofacial Surgery Jun 2024The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current...
PURPOSE
The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF).
MATERIAL AND METHODS
This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded.
RESULTS
Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type.
CONCLUSION
Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.
Topics: Humans; Mandibular Fractures; Prospective Studies; Male; Female; Bone Plates; Fracture Fixation, Internal; Adult; Middle Aged; Europe; Adolescent; Aged; Postoperative Complications; Open Fracture Reduction; Young Adult; Treatment Outcome; Aged, 80 and over
PubMed: 38713082
DOI: 10.1097/SCS.0000000000010128 -
Journal of Clinical Oncology : Official... Jun 2024Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict...
PURPOSE
Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN.
METHODS
Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection).
RESULTS
ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% ( < .001) with an AUC of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, ClinRad, was proposed on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems.
CONCLUSION
We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.
Topics: Humans; Osteoradionecrosis; Male; Head and Neck Neoplasms; Female; Middle Aged; Aged; Radiotherapy, Intensity-Modulated; Risk Factors; Risk Assessment; Severity of Illness Index
PubMed: 38691822
DOI: 10.1200/JCO.23.01951 -
Zhonghua Zhong Liu Za Zhi [Chinese... Apr 2024Bone-modifying agents are a class of drugs that alleviate a series of bone-related events such as pain, pathologic fracture, spinal cord compression, and hypercalcemia...
Bone-modifying agents are a class of drugs that alleviate a series of bone-related events such as pain, pathologic fracture, spinal cord compression, and hypercalcemia caused by bone metastases, and currently include bisphosphonates and RANKL inhibitors. Due to the widespread use of bone-modifying agents, the adverse effects of them are gradually increasing and affecting patients' quality of life. The Breast Cancer Group, Chinese Medical Doctor Association, and the International Medical Society, Chinese Anti-cancer Association have organized relevant experts to focus on the treatment of bone metastases of advanced malignant tumors based on evidence-based medicine, discuss the management of adverse reactions to bone-modifying agents and form the consensus. Based on the first Expert Consensus on Safety Management of Bone-modifying Agents in China, this consensus added the definition of osteonecrosis of the jaw related to bone-modifying agents, the occurrence of adverse reactions of bone-modifying drugs reported in the literature, and summarized the clinical experience of clinicians in the management of adverse reactions in practice in recent years, and ultimately, the expert group members discussed and proposed reasonable suggestions to guide clinicians in the safety management of bone-modifying agents.
PubMed: 38679792
DOI: 10.3760/cma.j.cn112152-20240111-00022 -
General Dentistry 2024The objective of this retrospective study was to assess the bone quality of healing mandibular fracture sites by measuring the Hounsfield units (HU) on computed...
The objective of this retrospective study was to assess the bone quality of healing mandibular fracture sites by measuring the Hounsfield units (HU) on computed tomographic (CT) images obtained presurgery and postsurgery in patients treated with rigid internal fixation (RIF). The HU values of healing fracture sites were compared to those of corresponding nonfractured (control) sites on the opposing side and cervical vertebrae sites in the same patients. In total, 31 patients with 45 mandibular fractures treated with RIF underwent presurgical and postsurgical CT examinations. The scans performed after surgery (1, 3, 6, 12, or 18 months) were taken only when there was a need for radiographic evaluation due to a complaint of discomfort from the patient or when the surgeon needed to verify the postsurgical outcome, and each patient underwent only a single postsurgical CT. At the presurgical CT examination, the HU values were lower in the fracture sites than in the control sites. At 3 months postsurgery, the HU values in the fracture sites had increased as the mandibular bone healed. At 6 months postsurgery, the HU values in the fracture sites were higher than those of the control sites. At 12 and 18 months postsurgery, the HU values of both sites were similar. The HU values of the cervical vertebrae remained constant with time. These results suggest that, in patients who have been treated with RIF for mandibular bone fracture, HU values measured by CT vary across time, expressing the physiologic bone healing process.
Topics: Humans; Retrospective Studies; Bone Density; Mandibular Fractures; Tomography, X-Ray Computed; Tomography
PubMed: 38640006
DOI: No ID Found -
The British Journal of Oral &... Jun 2024The parasymphysis area of the mandible is highly dynamic because it is subjected to both occlusal and muscular forces. As a result, the fractures in this transition zone... (Comparative Study)
Comparative Study
Biomechanical analysis and comparison between 'Zeta' miniplate design and conventional miniplate system for fixation of fracture segments in transition zone of parasymphysis body region of mandible - an in vitro study.
The parasymphysis area of the mandible is highly dynamic because it is subjected to both occlusal and muscular forces. As a result, the fractures in this transition zone have a special pattern, posing a challenge for surgeons whether to use one miniplate versus two miniplates, as per Champy's recommendations. The commonest complication resulting to treat this area is mental nerve paraesthesia due to the dissection and stretching of the nerve. Hence, an in vitro research study of a newly designed 'Zeta' miniplate is performed, to evaluate the biomechanical behaviour using finite element (FE) analysis and biomechanical analysis along with a comparison study with the conventional miniplate configurations. The results showed that the Zeta miniplate produces the lowest stresses 17.511 MPa and the least total structural deformation of 0.0011 mm after applying the maximum occlusal bite force. On application of torsional load, total structural deformation was 0.0004 mm and von Mises (VM) stress value was 0.24 MPa which was lowest when compared with the two miniplate system. Hence, the newly developed Zeta miniplate is superior in terms of stability. Another benefit of its design is that it helps in preventing mental nerve paraesthesia and tooth root damage while fixing and stabilising the fractured bony segments.
Topics: Bone Plates; Mandibular Fractures; Humans; Biomechanical Phenomena; Finite Element Analysis; Fracture Fixation, Internal; Stress, Mechanical; Bite Force; Mandible; Torsion, Mechanical; Equipment Design; Materials Testing; Paresthesia; Mandibular Nerve; Titanium; Miniaturization
PubMed: 38637215
DOI: 10.1016/j.bjoms.2024.01.008