-
The Journal of Craniofacial Surgery Jun 2024Case report. Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head and neck irradiation. The progression of ORN can lead to loss of bone,...
Case report. Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head and neck irradiation. The progression of ORN can lead to loss of bone, teeth, soft tissue necrosis, pathologic fracture, and oro-cutaneous fistula. Reconstructive surgery has mostly been reserved for late-stage disease where segmental resections are frequently necessary. Evidence is emerging to support earlier treatment in the form of debridement in combination with soft tissue free flaps for intermediate-stage ORN. The authors present a case of a 76-year-old male with persistent Notani 2 ORN of the mandible, treated with surgical removal of all remaining mandibular teeth, transoral debridement of all necrotic mandibular bone, and bone coverage with a left medial femoral condyle (MFC) periosteal free flap based on the descending genicular artery. Treatment was uneventful both intraoperatively and postoperatively. Since surgery (15 mo) the patient has remained free from clinical and radiologic signs of ORN. The MFP periosteal free flap provided an excellent result with minimal surgical complexity and morbidity in this case. Such treatment at an intermediate stage likely results in a reduction in segmental resections, less donor site morbidity, less operative time, less overall treatment time, and possibly fewer postoperative complications compared with the status quo.
Topics: Humans; Male; Osteoradionecrosis; Aged; Debridement; Free Tissue Flaps; Femur; Mandibular Diseases; Periosteum; Plastic Surgery Procedures; Tooth Extraction
PubMed: 38635500
DOI: 10.1097/SCS.0000000000010059 -
The Journal of Oral Implantology Jun 2024When considering placing dental implants in atrophic edentulous sites, there may be inadequate site width and little or no vertical bone loss. Any of several surgical...
When considering placing dental implants in atrophic edentulous sites, there may be inadequate site width and little or no vertical bone loss. Any of several surgical procedures can augment these sites. Extracortical augmentation is done by applying graft material against the cortical bone. This technique expects progenitor cells to migrate outside the bony ridge's confines and form new bone. Another method entails ridge splitting and expansion to create space for osteogenesis and, when possible, implant placement. This may be a better method for horizontal ridge augmentation. The ridge is split, separating the facial and lingual cortices for a complete bone fracture. The patient's osseous cells can then migrate into the created space from the exposed medullary bone to form bone. The technique can be preferably performed flapless so the intact periosteum maintains a blood supply to ensure appropriate healing.
Topics: Humans; Alveolar Ridge Augmentation; Bone Transplantation; Dental Implantation, Endosseous; Alveolar Process; Jaw, Edentulous
PubMed: 38624042
DOI: 10.1563/aaid-joi-D-23-00186 -
The British Journal of Oral &... May 2024
Comparative Study
Re: 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.
Topics: Bone Plates; Humans; Mandibular Fractures; Fracture Fixation, Internal; Biomechanical Phenomena; Equipment Design; Mandible
PubMed: 38614943
DOI: 10.1016/j.bjoms.2024.02.004 -
Journal of Cranio-maxillo-facial... Jun 2024Posttraumatic and postsurgical sensory disturbance is a known complication of almost all zygomaticomaxillary (ZMC) complex fractures involving the infraorbital nerve,... (Randomized Controlled Trial)
Randomized Controlled Trial
Posttraumatic and postsurgical sensory disturbance is a known complication of almost all zygomaticomaxillary (ZMC) complex fractures involving the infraorbital nerve, for which few treatments are effective. Our study used neurosensory assessments to evaluate the efficacy of melatonin on pain and nerve healing following ZMC surgery. Sixty-four randomly allocated ZMC fracture patients were prophylactically administered either oral melatonin or an identical placebo for 15 consecutive days. Pre- and postsurgical clinical parameters included subjective pain, numbness, and objective neurosensory function. Melatonin significantly reduced subjective pain perception in the early postoperative days, with a significant difference in VAS scores between the groups from postoperative day 3 (p = 0.048) until day 7 (p = 0.002). The VAS assessment of subjective numbness perception showed significantly lower self-perceived neurosensory disturbance for patients in the interventional group from the first month (p = 0.039) until the third month (p = 0.005). Objective neurosensory assessment using the pinprick test and two-point discrimination showed statistically significant improvement to almost normal sensation by the first month (p = 0.014) to fully normal sensation by the third month (p = 0.001). The study findings suggest that the prophylactic administration of melatonin confers significant clinical benefits in terms of reduced postoperative pain and improved sensory recovery.
Topics: Humans; Melatonin; Zygomatic Fractures; Pain, Postoperative; Male; Female; Adult; Maxillary Fractures; Middle Aged; Pain Measurement; Young Adult; Double-Blind Method; Hypesthesia; Recovery of Function
PubMed: 38609755
DOI: 10.1016/j.jcms.2024.03.037 -
The British Journal of Oral &... May 2024This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly...
This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures.
Topics: Humans; Bone Plates; Fracture Fixation, Internal; Mandibular Fractures
PubMed: 38604919
DOI: 10.1016/j.bjoms.2024.02.006 -
Journal of Maxillofacial and Oral... Apr 2024Mandible fractures are the second most common fractures of the facial skeleton because of the prominent position of the lower jaw. The purpose of this study was to...
PURPOSE
Mandible fractures are the second most common fractures of the facial skeleton because of the prominent position of the lower jaw. The purpose of this study was to calculate the prevalence of mandibular fractures based on their causes and locations.
MATERIALS AND METHOD
A systematic search of 3 electronic databases from January 2010 and January 2020 was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. There were 359 articles identified for screening against selection criteria. The search identified 39 articles to be included in our analysis.
RESULTS
A total of 20,135 patients with 31,468 mandible fractures in this review. There was a 76% male predominance. The third decade was the most common age group (21-30). Motor vehicle accidents (39.89%) were the leading cause of mandible fractures, followed by falls (27.72%) and violence (25.35%). Condylar fractures are the most common cause of MVA and fall (33.11%, 50% respectively). Mandible body fractures are the second most common type of MVA injury (17.06%). When it came to violence, the angle of the mandible was the most common site (31.73%).
CONCLUSIONS
The prevalence of mandible fractures was higher in male patients in the current study, particularly in the second and third decades of life. Road traffic accidents were the most common cause, and the condylar process of the mandible was the most frequently affected region. Demographic data such as age, gender, and mechanism of injury can help surgeons predict and identify specific areas of mandibular fracture.
PubMed: 38601229
DOI: 10.1007/s12663-022-01750-1 -
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 -
Shanghai Kou Qiang Yi Xue = Shanghai... Feb 2024To observe the long-term clinical effect of implants retained complete overdentures with Locator attachments.
PURPOSE
To observe the long-term clinical effect of implants retained complete overdentures with Locator attachments.
METHODS
A total of 48 patients with edentulous jaws treated with implants retained complete overdentures with Locator attachments were selected from the Outpatient Department of Peking University School and Hospital of Stomatology from 2016 to 2017. Among them, 21 patients underwent double-maxillary complete overdentures restoration and 27 patients underwent single-maxillary restoration. A total of 230 implants were implanted. The clinical observation indicators included the implant survival rate, peri-implant mucosal bleeding on probing(BOP), the change in the vertical height of alveolar bone absorption around the implants, overdenture base fracture rate, artificial tooth fall off and fracture rate and other complications. The change of the locator attachment retention force of the implant-supported overdentures was evaluated. SPSS 13.0 software package was used for data analysis.
RESULTS
During the five-years clinical observation period, 5 implants fell off, 1 narrow dimeter implant in the anterior zone was broken, and 12 implants were lost to follow-up. The implant survival rate was 97.25%. One year after the restoration therapy finished, peri-implant mucosal bleeding on probing (BOP+) was detected in 48 (21.4%) implants. The average BI was 0.21±0.42, which was higher in the anterior zone than that in the posterior zone. The vertical alveolar bone absorption height around the implants was (0.21±0.35) mm, 2 implants-supported complete overdenture bases were broken. After 5 years of restoration, 163(76.89%) implants had peri-implant mucosal bleeding on probing(BOP+). The average BI was 1.00±0.70, and the vertical alveolar bone absorption height around the implants was (0.58±0.85) mm. There was no significant difference between males and females. There was no significant difference in the peri-implant mucosal bleeding index and the alveolar bone vertical absorption height between the anterior zone and the posterior zone(P>0.05). The mean BI of peri-implant mucosa and the vertical absorption height of peri-implant alveolar bone were significantly different between the 1-year observation period and the 5-year observation period respectively(P<0.01). There were 17(26.15%) cases with overdenture bases fracture, and the fracture rate of artificial teeth was 16.92%. Most of them occurred in the midline area of the anterior zone and the location of the overdenture base on the locator attachments. The average first replacement time of the locator attachment nylon retainer washer was 34.2±10.3 months.
CONCLUSIONS
Implants retained complete overdentures with Locator attachments are effective in long term clinical observation. Complications are mainly found in peri-implant mucosal bleeding on probing and vertical alveolar bone absorption, and tended to increase gradually over time. The fracture of the implant retains complete overdenture bases and the fall off or fracture of the artificial teeth are the second serious complications. Overdenture base with metal frame at the location of the Locator abutment and the midline of the anterior area should be strengthened, and narrow diameter implants should be avoided as far as possible in the anterior zone.
Topics: Male; Female; Humans; Denture, Overlay; Dental Prosthesis, Implant-Supported; Denture Retention; Jaw, Edentulous; Mandible; Dental Implants
PubMed: 38583032
DOI: No ID Found -
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 -
Journal of Cranio-maxillo-facial... May 2024The purpose of this study was to elucidate the effects of mandibular anatomy and osteotomy technique on lingual fracture patterns in SSRO. The predictor variables were:...
The purpose of this study was to elucidate the effects of mandibular anatomy and osteotomy technique on lingual fracture patterns in SSRO. The predictor variables were: length of horizontal medial osteotomy; type of border osteotomy; buccolingual width; and vertical length of the basal cortex. The outcome variable was the type of lingual split pattern. This was categorized into four types according to a lingual split scale (LSS): LSS 1, true Hunsuck; LSS 2, fracture line to posterior border of the ramus; LSS 3, through to mandibular canal; LSS 4, unfavorable fracture pattern. Data were analyzed using analysis of variance and the Pearson χ test. Values of p < 0.05 were considered statistically significant. The study sample comprised 312 lingual split patterns in 156 patients. The most common type of lingual split pattern was LSS 1 (n = 204). There was a significant relationship between inferior border osteotomy type and LSS type (p = 0.001). Whilst LSS 1 was the most common among all border osteotomy types. LSS 4 was most frequently observed in cases where the lower border osteotomy remained in the buccal surface. According to the results of this study, the likelihood of an unfavorable split pattern increases when the lower border osteotomy remains in the buccal surface.
Topics: Humans; Osteotomy, Sagittal Split Ramus; Male; Female; Adult; Mandible; Young Adult; Adolescent; Mandibular Fractures; Middle Aged; Retrospective Studies
PubMed: 38580559
DOI: 10.1016/j.jcms.2024.03.005