-
Chinese Journal of Traumatology =... Apr 2020Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar... (Review)
Review
Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage. Opinions about the management of mandibular condylar fractures differ among surgeons. With the implementation of new technology, an increased understanding of fracture management, and better functional and morphological outcomes reported in the literature, open reduction and internal fixation is becoming many surgeons' preferred choice for the treatment of condylar fractures. Because surgical treatment of such fractures is complex, certain factors must be considered to achieve satisfactory outcomes. In this article, we summarise six key points in the management of mandibular condylar fractures: virtual evaluation of condylar fracture, a suitable surgical approach, good reduction, stable internal fixation, repair of the articular disc, and restoration of the mandibular arch width. We believe that these points will help to improve the prognosis of mandibular condyle fractures.
Topics: Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Open Fracture Reduction; Prognosis; Temporomandibular Joint Disc
PubMed: 31744656
DOI: 10.1016/j.cjtee.2019.08.006 -
Ear, Nose, & Throat Journal Feb 2022To study anterior nasal spine fractures, including the incidence, missed diagnosis rates, and relationship with shapes using computed tomography (CT).
OBJECTIVE
To study anterior nasal spine fractures, including the incidence, missed diagnosis rates, and relationship with shapes using computed tomography (CT).
METHODS
Two hundred cases of axial CT images performed for maxillofacial trauma were reviewed. The incidence, correct, and missed diagnosis rates of anterior nasal spine fractures were studied. The relationship between the fracture and the shape of the anterior nasal spine was also analyzed.
RESULTS
The rate of anterior nasal spine fractures was 22.00% (44 of 200). The diagnostic accuracy was 4.55% (2 of 44) and the missed diagnosis rate was 95.45% (42 of 44). The fracture rates of the double rod, single rod, triangle, and irregular anterior nasal spine were 33.85% (22 of 65), 32.26% (10 of 31), 12.24% (12 of 98), and 0.00% (0 of 6), respectively. The double and single rod types of anterior nasal spine were most likely to be fractured than the type of triangle (χ = 11.05, 6.67, < .0167). No fracture was found in the irregular type of anterior nasal spine.
CONCLUSION
Anterior nasal spine fractures are not rare and the high missed diagnostic rate results from unfamiliarity with the structure. Double and single rod types of anterior nasal spines are easy to fracture. Bony reconstruction and thin thickness of CT images are necessary for diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Image Processing, Computer-Assisted; Incidence; Male; Maxilla; Maxillary Fractures; Middle Aged; Missed Diagnosis; Nose; Tomography, X-Ray Computed; Young Adult
PubMed: 32757996
DOI: 10.1177/0145561320942679 -
Stomatologija 2022To clarify antibiotic use by oral and maxillofacial surgeons in mandibular fracture patients and evaluate practices based on scientific evidence. (Review)
Review
OBJECTIVE
To clarify antibiotic use by oral and maxillofacial surgeons in mandibular fracture patients and evaluate practices based on scientific evidence.
MATERIAL AND METHODS
We assessed antibiotic use in simple symphysis and angle mandibular fractures among oral and maxillofacial surgeons in the Nordic countries through an e-survey. In addition, we performed a literature review of antibiotic administration in mandibular fracture surgery.
RESULTS
A total of 41 oral and maxillofacial surgeons who treat mandibular fractures responded to the questionnaire. Timing and duration of antibiotic use varied. The duration of postoperative antibiotic treatment ranged from 1 to 7 days (mean 5.6 days). Respondents' practices were not in concordance with scientific evidence. According to previous studies, restricting antibiotic exposure to a maximum of 24 hours postoperatively was not related to a higher risk of surgical site infections. No articles described a benefit of prolonged postoperative antibiotic therapy.
CONCLUSIONS
Antibiotic use in connection with mandibular fracture treatment varied in the Nordic countries and antibiotic practices are not in concordance with the current literature. Restricting antibiotic exposure to a maximum of 24 hours postoperatively should be considered. Clear guidelines for antibiotic prophylaxis as part of the surgical management of mandibular fractures are required.
Topics: Humans; Anti-Bacterial Agents; Mandibular Fractures; Antibiotic Prophylaxis; Surgical Wound Infection; Surveys and Questionnaires
PubMed: 37140236
DOI: No ID Found -
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 -
The Chinese Journal of Dental Research 2012Trauma is the predominant causal factor for temporomandibular joint (TMJ) ankylosis. However, the relationship between condylar fracture and TMJ ankylosis is... (Review)
Review
Trauma is the predominant causal factor for temporomandibular joint (TMJ) ankylosis. However, the relationship between condylar fracture and TMJ ankylosis is complicated. It is believed that post-traumatic TMJ ankylosis arises from TMJ intracapsular changes, including damaged cartilage, displaced or disrupted discs, haematoma formation and subsequent fibrosis and calcification in the joint. In this review, the relationship between TMJ ankylosis and condylar fracture is discussed based on clinical characteristics and animal studies. The management of TMJ ankylosis is also reviewed and discussed.
Topics: Animals; Ankylosis; Disease Models, Animal; Humans; Mandibular Condyle; Mandibular Fractures; Temporomandibular Joint Disorders
PubMed: 22866277
DOI: No ID Found -
Medicina Oral, Patologia Oral Y Cirugia... May 2009The treatment of comminuted fractures of the mandible is challenging due both to the severity of the injuries generally associated with this type of fracture, and the... (Review)
Review
The treatment of comminuted fractures of the mandible is challenging due both to the severity of the injuries generally associated with this type of fracture, and the lack of consensus as to the most appropriate treatment method.There are two distinct approaches for treating comminuted fractures of the mandible: closed reduction with maxillomandibular fixation (MMF) - the oldest and classical treatment - and open operation and internal fixation. The morbidity rate of closed reduction is lower but, with the advent of modern anaesthesia and antibiotics, open surgery has become more frequent. Stable internal fixation (SIF) is acheived using plates, miniplates and/or screws. The advantage of this approach is that there is a more precise reduction of the fragments, with the possibility of early function by eliminating or reducing the time of MMF. This paper reviews the main advantages, disadvantages and differences between the two techniques.
Topics: Fracture Fixation; Fractures, Comminuted; Humans; Mandibular Fractures
PubMed: 19218899
DOI: No ID Found -
BMJ Case Reports Dec 2021Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of...
Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of suspicion and detailed history taking from the caregiver are mandatory to pick up these cases.There are a plethora of management options that have been reported in dealing with such fractures. They range from conservative management to internal fixation by absorbable plates. While conservative management does not interfere with mandibular growth and teeth development, any surgical intervention can carry this risk. Nevertheless, a severely displaced fracture may need anatomical reduction and fixation to allow early nutrition.This study reports a 3-month-old male infant with a fracture in the mandibular symphysis who underwent reduction of the fracture and circummandibular fixation using immobilisation by an acrylic splint for 4 weeks. His long-term follow-up after 20 months showed adequate dentition with proper healing of the fracture site.
Topics: Fracture Fixation, Internal; Humans; Infant; Joints; Male; Mandible; Mandibular Fractures; Splints
PubMed: 34853047
DOI: 10.1136/bcr-2021-245661 -
BMC Oral Health May 2023The aim of this study was to determine the epidemiological pattern of maxillofacial fractures in northwestern China by retrospectively analysing the demographics,...
BACKGROUND
The aim of this study was to determine the epidemiological pattern of maxillofacial fractures in northwestern China by retrospectively analysing the demographics, aetiologies, concomitant injuries, fracture sites, and management.
METHODS
A 10-year retrospective analysis of 2240 patients with maxillofacial fractures admitted to the General Hospital of Ningxia Medical University was conducted. The extracted data included sex, age, aetiology, fracture site, concomitant injuries, time of treatment, therapeutic approaches and complications. Statistical analyses were performed, including descriptive analysis and the chi-square test. Logistic regression was used to determine the impact factors of maxillofacial fractures and concomitant injuries. P values < 0.05 were considered statistically significant.
RESULTS
The age of the included patients ranged from 1 to 85 years, and the mean age was 35.88 ± 15.69 years. The male-to-female ratio was 3.9:1. The most frequent aetiology of maxillofacial fractures was road traffic accidents (RTAs) (56.3%), and the most common fracture sites were the anterior wall of the maxillary sinus, arcus zygomaticus and mandibular body. A total of 1147 patients (51.2%) were affected by concomitant injuries, with craniocerebral injury being the most common. Logistic regression analyses revealed increased risks of mid-facial fractures in elderly individuals (odds ratio (OR) = 1.029, P < 0.001) and females (OR = 0.719, P = 0.005). Younger patients had a higher risk of mandibular fractures (OR = 0.973, P < 0.001). RTAs increased the risk for mid-facial fractures and high falls increased the risk for mandibular fractures.
CONCLUSIONS
The maxillofacial fracture pattern is correlated with sex, age and aetiology. Patients were mainly young and middle-aged males, and the main cause of injury was RTAs, mostly causing compound fractures. Medical staff must be systematically educated to comprehensively examine patients with injuries resulting from RTAs. The management of patients with fractures requires thorough consideration of the patient's age, aetiology, fracture site, and concomitant injuries.
Topics: Aged; Middle Aged; Humans; Female; Male; Young Adult; Adult; Infant; Child, Preschool; Child; Adolescent; Aged, 80 and over; Retrospective Studies; Mandibular Fractures; China; Hospitalization; Hospitals, General
PubMed: 37221520
DOI: 10.1186/s12903-023-03006-x -
Craniomaxillofacial Trauma &... Mar 2022Retrospective descriptive observational study.
STUDY DESIGN
Retrospective descriptive observational study.
PURPOSE
Skiing and snowboarding offers valuable opportunities for outdoor physical activity throughout the cold winter months, but these activities can result in substantial personally injury. This study aimed to analyze trends in skiing and snowboarding-related facial trauma epidemiology.
METHODS
The National Electronic Injury Surveillance System (NEISS) was queried for facial trauma related to skiing and snowboarding treated in United States (US) emergency departments between 2010 and 2019. These data and weighted estimates were used to analyze patient demographics, injury location, and etiology.
RESULTS
A total of 361 skiing or snowboarding-related facial injuries were recorded. Lacerations were most common injury (165/361; 45.7%), and facial fractures occurred in 21.6% (78/261) of patients. The most common facial fracture locations are the nose (38/78; 48.7%), orbit (17/78; 21.8%), and mandible (15/78; 19.2%). Pediatric patients accounted for 52% (187/361) of these injuries and had higher rates of lacerations (51.9% vs 39.1%, P < 0.05) and hospital admission (4.8% vs 1.15%, P < 0.05) than adults. Adults had a higher rate of facial fracture (30% vs 13.9%, P < 0.001) than children.
CONCLUSIONS
Skiing and snowboarding-related facial trauma is relatively uncommon in the US. In general, these injuries are largely decreasing, but facial fractures still occur not infrequently during these activities. Based on our data, we strongly urge helmet manufacturers to increase the availability of recreational snowsport helmets that include nose, orbit, and mandible protections, which could help to prevent many of these injuries.
PubMed: 35265274
DOI: 10.1177/1943387521997237 -
Journal of Cranio-maxillo-facial... Feb 2022The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A...
The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.
Topics: Ear Canal; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 34810109
DOI: 10.1016/j.jcms.2021.11.004