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Dental Traumatology : Official... Dec 2022Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features...
BACKGROUND/AIMS
Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses.
MATERIAL AND METHODS
Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury.
RESULTS
Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury.
CONCLUSIONS
There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.
Topics: Humans; Middle Aged; Aged; Mandibular Fractures; Mandible; Skull Fractures; Memory Disorders; Retrospective Studies
PubMed: 35950946
DOI: 10.1111/edt.12778 -
Journal of Feline Medicine and Surgery Feb 2023Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular... (Review)
Review
PRACTICAL RELEVANCE
Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice.
CLINICAL CHALLENGES
Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity.
AIMS
This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants.
EVIDENCE BASE
Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.
Topics: Animals; Cats; Humans; Craniocerebral Trauma; Dentists; Mandibular Fractures
PubMed: 36744847
DOI: 10.1177/1098612X231152521 -
BMJ Case Reports Dec 2020A 33-year-old male patient reported to us with the history of assault. The patient was cooperative and oriented, with no sign of head injury. He was assaulted with an...
A 33-year-old male patient reported to us with the history of assault. The patient was cooperative and oriented, with no sign of head injury. He was assaulted with an axe over the mandible. The patient is having posteroanterior view radiographs of the mandible suggesting isolated horizontal fracture of the anterior mandible. Under general anaesthesia, this unusual fracture was treated by open reduction and internal fixation with a three-dimensional plate and miniplates. The case was managed successfully without any postoperative complications.
Topics: Adult; Bone Plates; Fracture Fixation, Internal; Humans; Male; Mandible; Mandibular Fractures; Open Fracture Reduction; Postoperative Complications; Radiography; Treatment Outcome
PubMed: 33370934
DOI: 10.1136/bcr-2020-240452 -
Oral and Maxillofacial Surgery Jun 2019It is presumed that adequate reduction of a fracture of the mandible favors bone healing and diminishes the risk of complications. In this retrospective study, we...
PURPOSE
It is presumed that adequate reduction of a fracture of the mandible favors bone healing and diminishes the risk of complications. In this retrospective study, we compared the accuracy of fracture alignment and complication rate of mandibular fractures reduced without or with aid of a repositioning forceps.
METHODS
Retrospective analysis of consecutive 252 patients with mandibular fractures treated between January 2010 and December 2016. Eligible for this study were patients with isolated mandibular fractures needing open reduction and internal fixation in whom pre- and postoperative radiographs and patient records were available. In total, 131 (252 fractures) patients fulfilled the inclusion criteria.
RESULTS
Seventy-one (54%) patients were men. Mean age of the patients was 33 ± 16.5 years, and the median and interquartile range of age was 25 (20;41). In 54 patients, mandibular fractures were reduced without the aid of repositioning forceps, and in the remaining 77 patients, the fractures were reduced with the aid of the repositioning forceps. Anatomical alignment of the fractures was poor in the non-forceps-aided group (48%) compared to the forceps-aided group (58%) (P = .067). Overall complication rate was higher in the group of fractures reduced without the aid of forceps (17%) than in the forceps-aided group (7%) (P = .045; OR, 2.7; 95% CI, 1.0-7.4).
CONCLUSIONS
Mandibular fractures reduced with the aid of repositioning forceps are accompanied by a lower complication rate and better alignment. This is an important observation as better alignment of the fracture fragments favors bone healing and reduces complications.
Topics: Adolescent; Adult; Bone Plates; Fracture Fixation, Internal; Humans; Male; Mandible; Mandibular Fractures; Middle Aged; Postoperative Complications; Retrospective Studies; Surgical Instruments; Treatment Outcome; Young Adult
PubMed: 31055659
DOI: 10.1007/s10006-019-00759-0 -
Anesthesiology Oct 2016
Topics: Adult; Humans; Intubation, Gastrointestinal; Male; Mandibular Fractures; Occipital Bone; Skull Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 27148919
DOI: 10.1097/ALN.0000000000001145 -
Schweizer Archiv Fur Tierheilkunde Sep 2022Mandibular fractures are among the most common fractures in cattle. The medical records of 108 cattle with a mandibular fracture, that were referred to the University of... (Review)
Review
Mandibular fractures are among the most common fractures in cattle. The medical records of 108 cattle with a mandibular fracture, that were referred to the University of Zurich Veterinary Hospital from 2005 to 2019, were analysed to document the types of treatment, complications and long-term outcomes. Cattle, still alive at the time of retrospective analysis, underwent clinical and radiographic examinations. A fall was the single most common cause of a mandibular fracture (48,1 %), and a third of all cattle had a concomitant disease at the time of referral. Seventy-five cattle (69,4 %) had a single fracture, 26 (24,1 %) had two fractures and seven (6,5 %) had three fractures of the mandible. The molar part of the mandibular body was most commonly (40,7 %) fractured followed by the diastema (23,6 %), the pars incisiva (13,4 %), the ramus (12,1 %) and the symphysis (10,2 %) of the mandible. The majority of cattle (84/108, 77,8 %) had open fractures. Treatment was instituted in 63/108 animals (58,3 %) with 77/148 fractures. Of these fractures, 28 were treated with plate osteosynthesis, 25 with an external fixator, 8 with cerclage wire, 7 using mixed techniques, 4 with fragment excision, 4 underwent conservative treatment and one a mucosal suture. In total, 45/108 animals (41,7 %) were culled because of multiple fractures, concomitant diseases and because of economic reasons. Complications occurred in 34 (54,0 %) treated cattle; 22 had abnormal wound healing of which 18 developed osteomyelitis complicated by a sequestrum (14). Of the treated 63 cattle, 56 (88,9 %) were discharged. The mean postoperative productive life was 46 ± 29,2 months for animals that were deceased at the time of the study. Thirteen of the cattle with a sequestrum remained in the herd for 15 to 92 months (mean, 47 months) and one for 2 months. The life expectancy after treatment did not differ significantly from that of the Brown Swiss and Swiss Holstein dairy cattle populations, where the cattle of this study mainly came from. Eleven cattle were available for long-term follow-up; all had a good general health status but nine had dental abnormalities including missing teeth, steps or enamel points, which did not noticeably affect the body condition of the animals. Surgical treatment of selected mandibular fractures had a favourable prognosis (52/63 healed, 82,5 %) in cattle.
Topics: Animals; Bone Plates; Cattle; Cattle Diseases; Fracture Fixation, Internal; Mandibular Fractures; Retrospective Studies; Treatment Outcome
PubMed: 36047817
DOI: 10.17236/sat00364 -
Australian Dental Journal Dec 1997Although the mandibular condyle is one of the most common sites of injury of the facial skeleton, it is also the most overlooked and least diagnosed site of trauma in... (Review)
Review
Although the mandibular condyle is one of the most common sites of injury of the facial skeleton, it is also the most overlooked and least diagnosed site of trauma in the head and neck region. The condyle forms the very cornerstone of mandibular form and function and therefore injuries to the mandibular condyle in growing children may adversely affect growth and development of the jaws and the occlusion. The aim of this article is to present an overview of condylar injuries in growing patients for the purpose of increasing the awareness of all dental practitioners involved in the treatment of children with acute oro-facial injuries.
Topics: Child; Child, Preschool; Dental Care for Children; Humans; Infant; Malocclusion; Mandibular Condyle; Mandibular Fractures; Temporomandibular Joint Disorders
PubMed: 9470277
DOI: 10.1111/j.1834-7819.1997.tb06079.x -
International Journal of Environmental... Dec 2022Maxillofacial trauma is associated with facial deformation, loss of function, emotional and social impacts, and high financial costs. This study investigated cases of...
Maxillofacial trauma is associated with facial deformation, loss of function, emotional and social impacts, and high financial costs. This study investigated cases of maxillofacial trauma in a large Brazilian city through a cross-sectional study conducted at two public and two private hospitals. Primary data of 400 patients were collected through a questionnaire, clinical examination, and tomography. Statistical analysis at the 5% significance level was performed. Motorcycle accident was the major cause of trauma (41%); the most frequent trauma and treatment were mandibular fracture (24.3%) and surgery (71%), respectively. The female sex was more affected only regarding domestic accidents ( = 0.041) and falls ( < 0.001). Motorcycle accidents were more prevalent among 20 to 29 year-olds ( < 0.001), followed by physical aggression ( < 0.001) and sports accidents ( = 0.004). Falls were more frequent among 40 to 59 year-olds ( < 0.001). Mandibular fracture affected males and 20 to 29 year-olds more and was mainly associated with motorcycle accidents (48.2%) and physical aggression (22.7%) ( = 0.008). Nose fracture was more frequent in falls (29.6%), physical aggression (22.5%), and sports accidents (21.1%) ( < 0.001). Compound fracture was associated with motorcycle accidents (84.2%; = 0.028). Maxillofacial trauma (mandibular, nasal, and zygomatic fractures) was associated with motorcycle accidents, physical aggression, and falls. Surgical treatment, hospital care, and public services were the most frequent.
Topics: Male; Humans; Female; Cross-Sectional Studies; Brazil; Mandibular Fractures; Retrospective Studies; Maxillofacial Injuries; Hospitals; Accidents, Traffic
PubMed: 36554879
DOI: 10.3390/ijerph192416999 -
JAMA Facial Plastic Surgery May 2018Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates.
IMPORTANCE
Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates.
OBJECTIVES
To analyze patient, injury, and surgical factors, including approach to the angle and plating technique, associated with postoperative complications, as well as the rate of reoperation with regard to mandible angle fractures.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective cohort study analyzing the surgical outcomes of patients with mandible angle fractures between January 1, 2000, and December 31, 2015, who underwent open reduction and internal fixation. Patients were eligible if they were aged 18 years or older, had 3 or less mandible fractures with 1 involving the mandibular angle, and had adequate follow-up data. Patients with comminuted angle fractures, bilateral angle fractures, and multiple surgical approaches were excluded. A total of 135 patients were included in the study. All procedures were conducted at a single, large academic hospital located in an urban setting.
MAIN OUTCOMES AND MEASURES
Major complications and reoperation rates. Major complications included in this study were nonunion, malunion, severe malocclusion, severe infection, and exposed hardware.
RESULTS
Of 135 patients 113 (83.7%) were men; median age was 29 years (range, 18-82 years). Eighty-seven patients (64.4%) underwent the transcervical approach and 48 patients (35.6%) received the transoral approach. Fifteen (17.2%) patients in the transcervical group and 9 (18.8%) patients in the transoral group experienced major complications (difference, 1%; 95% CI, -8% to 10%). Thirteen (14.9%) patients in the transcervical group and 8 (16.7%) patients in the transoral group underwent reoperations (difference, 2%; 95% CI, -13% to 17%). Active smoking had a significant effect on the rate of major complications (odds ratio, 4.04; 95% CI, 1.07 to 15.34; P = .04).
CONCLUSIONS AND RELEVANCE
During repair of noncomminuted mandibular angle fractures, both of the commonly used approaches-transcervical and transoral-can be used during treatment with equal rates of complication and risk of reoperation. For a patient undergoing surgery for mandibular angle fracture, smoking status is more likely to predict surgical outcomes rather than how the surgeon chooses to approach and fixate the fracture.
LEVEL OF EVIDENCE
3.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Fracture Fixation, Internal; Humans; Male; Mandibular Fractures; Middle Aged; Postoperative Complications; Reoperation; Treatment Outcome
PubMed: 29302682
DOI: 10.1001/jamafacial.2017.2227 -
A Novel Method for Quantitative Three-Dimensional Analysis of Zygomatico-Maxillary Complex Symmetry.The Journal of Craniofacial SurgeryTo develop a reliable and accurate method to quantify the symmetry of the zygomaticomaxillary complex (ZMC).
OBJECTIVE
To develop a reliable and accurate method to quantify the symmetry of the zygomaticomaxillary complex (ZMC).
METHODS
Virtual three-dimensional models were created from 53 computed-tomography scans: 15 healthy cases without maxillofacial disorders and 38 patients with ZMC fractures requiring surgical treatment.Asymmetry of the ZMC was measured using a mirroring and surface-based matching technique that uses the anterior cranial fossa as reference to determine the symmetrical position of the ZMC. The measure for ZMC asymmetry was defined as mean surface distance (MSD) between the ZMC-surface and the symmetrical position.Reliability of the method was tested in the 15 healthy cases. Inter-and intra-observer correlation coefficients (Ce) and variabilities were assessed. Accuracy was assessed by comparing ZMC asymmetry between healthy and ZMC fracture cases, and by assessing correlation of ZMC fracture severity with ZMC asymmetry.
RESULTS
The average MSD of the 15 healthy cases was 1.40 ± 0.54 mm and the average MSD of the 38 ZMC fracture cases was 2.69 ± 0.95 mm ( P < 0.01). Zygomaticomaxillary complex asymmetry correlated with fracture severity ( P = 0.01). Intra-rater CC was 0.97 with an intra-rater variability of 0.09 ± 0.11 mm. Inter-rater Ce was 0.95 with an inter-rater variability of 0.12 ± 0.13 mm.
CONCLUSIONS
Our method is reliable and accurate for quantitative three-dimensional analysis of ZMC-symmetry. It takes into account asymmetry caused by the shape of the ZMC as well as asymmetry caused by the position of the ZMC.
CLINICAL RELEVANCE
This method is useful for the evaluation of ZMC asymmetry associated with congenital and acquired disorders of craniofacial skeleton, for surgical planning and for evaluation of postoperative results.
Topics: Humans; Maxilla; Maxillary Fractures; Reproducibility of Results; Research Design; Tomography, X-Ray Computed; Zygomatic Fractures
PubMed: 34864750
DOI: 10.1097/SCS.0000000000008382