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Journal of Orthopaedic Case Reports 2018Oral bisphosphonates are commonly prescribed for osteoporosis to arrest bone loss and preserve bone density. Complications such as atypical femoral fractures (AFF) and...
INTRODUCTION
Oral bisphosphonates are commonly prescribed for osteoporosis to arrest bone loss and preserve bone density. Complications such as atypical femoral fractures (AFF) and osteonecrosis of jaw (ONJ) are rare.
CASE REPORT
We describe a case of a 60-year-old patient who was on oral bisphosphonate therapy for osteoporosis and developed ONJ, AFF, recurrent ONJ, and subsequent mandible fracture with delayed AFF union - this is a very unique and extremely rare case. For the same, she underwent multiple surgeries - sequestrectomy in the mandible, proximal femoral nailing for femur fracture and plate fixation for her jaw. The delayed union needed teriparatide administration. At 1 year follow-up, the patient had a complete radiological union for AFF and on recent follow-up the patient is asymptomatic as regards the femur as well as the jaw. This unique sequence of events has not been described previously.
CONCLUSION
This case report shows the possibility of extremely rare adverse effects happening sequentially in the same patient with long-term oral bisphosphonate therapy. Patients need to be informed and monitored regularly for symptoms such as jaw pain and thigh pain and if these occur, the drug must be stopped immediately, and other alternative medical treatment for the osteoporosis should be started.
PubMed: 30584526
DOI: 10.13107/jocr.2250-0685.1124 -
Dental Traumatology : Official... Oct 2022The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible...
BACKGROUND/AIM
The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations.
MATERIAL AND METHODS
Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12-year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed.
RESULTS
Sixty-two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49-4.16, p < .001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non-helmeted groups.
CONCLUSIONS
Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site.
Topics: Accidents, Traffic; Bicycling; Female; Head Protective Devices; Humans; Male; Mandibular Fractures; Retrospective Studies; Trauma Centers
PubMed: 35481880
DOI: 10.1111/edt.12756 -
Facial Plastic Surgery & Aesthetic... 2020The nasal bone is one of the most commonly fractured bones of the midface. However, the frequency of coincident fractures of adjacent bones such as the frontal process...
The nasal bone is one of the most commonly fractured bones of the midface. However, the frequency of coincident fractures of adjacent bones such as the frontal process of the maxillary bone, nasal septum, and medial or inferior orbital walls has not been fully evaluated. The purpose of this study was to investigate the incidence of fractures of adjacent structures in the setting of a nasal bone fracture. Second, we propose a new classification system of nasal bone fractures with involvement of adjacent bony structures. One thousand, one hundred ninety-three patients with midfacial fractures were retrospectively reviewed. The characteristics of fractures of the nasal bone and the incidence of coincident fractures of the frontal process of maxilla, bony nasal septum, medial, or inferior orbital walls were analyzed. All patients included in the study presented with nasal trauma. The coincident fractures of adjacent midfacial structures were assessed, and a new classification of midfacial fractures based on computed tomography (CT) scan images was proposed. Among the 1193 cases, bilateral fractures of the nasal bone were most common (69.24%), and coexistent fracture of the frontal process of the maxilla and bony nasal septum was 66.89% and 42.25%, respectively. Coincident fracture of the orbital walls was observed in 16.51% of cases. The major etiology of fracture for the younger and elderly groups was falls, compared with assault as the most common etiology in the adult group. A classification scheme was generated in which fractures of the nasal bone were divided into five types depending on coexisting fractures of adjacent structures. External force applied to the nasal bone can also lead to coexistent fracture of adjacent bony structures including the frontal process of the maxilla, nasal septum, and orbital walls. The proposed classification of nasal fracture based on CT imaging helps to incorporate coincident disruption of adjacent structures.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; China; Female; Humans; Incidence; Male; Maxillary Fractures; Middle Aged; Multiple Trauma; Nasal Bone; Nasal Septum; Orbital Fractures; Retrospective Studies; Skull Fractures; Tomography, X-Ray Computed; Trauma Severity Indices; Young Adult
PubMed: 32250646
DOI: 10.1089/fpsam.2020.0026 -
The Journal of Craniofacial Surgery Sep 2016Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects...
Mandible fractures have a special place within the injuries of the other bones of the maxillofacial system. In their management, cosmetic issues and functional aspects such as chewing, speaking, and swallowing become very important.In this study, a retrospective analysis of 419 mandible fractures in 283 patients was performed in relation to epidemiologic factors, treatment strategies, and complications. The average age was 32.14 years (4-69 years). The male/female ratio was 4/1. The most frequent etiologic factor was interpersonal violence (104 patients, 36.7%). The parasymphysis region was the mostly affected site (28.4%). A total of 157 patients (55.5%) were presented with single fracture and the rest with 2, 3, or 4 fracture lines on the mandible. The most common fracture combination was angulus-parasymphysis fracture combination (24.6%). Open reduction and fixation with mini plates and screws was the most preferred treatment strategy (48.2%). Transient short arch bars were not used intraoperatively for any of the patients. There was not any difference in terms of complications between the patients treated with plating systems and plating systems plus intermaxillary fixation.In conclusion, proper treatment of mandible fractures is critical. Except certain fracture types, the usage of intermaxillary fixation as an adjunct to fixation with plating systems is not necessary.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Incidence; Male; Mandibular Fractures; Middle Aged; Retrospective Studies; Time Factors; Turkey; Young Adult
PubMed: 27536913
DOI: 10.1097/SCS.0000000000002737 -
Journal of Surgical Technique and Case... Jul 2013Facial fracture is gradually become a public health problem in our community due to the attendant morbidity and mortality. Hence, the aim of this study was to determine...
BACKGROUND
Facial fracture is gradually become a public health problem in our community due to the attendant morbidity and mortality. Hence, the aim of this study was to determine the pattern of facial fracture in Dental and Maxillofacial Surgery Department of Usmanu Danfodiyo University Teaching Hospital. This cross-sectional study was undertaken to provide information regarding gender, age, etiology, and diagnosis of patients with maxillofacial fractures.
MATERIALS AND METHODS
A 1-year review of patients diagnosed and treated for facial fractures in Usmanu Danfodiyo University Teaching Hospital between January 2011 and December 2011. The diagnosis was based on radiographic data and clinical examination. The main analysis outcome measures were etiology, age, gender, site, and treatment. Data were organized and presented by means of descriptive statistics and Pearson's Chi-square test. The level of significance adopted was 5%.
RESULTS
A total of 40 patients were treated in this period. Over 95% were male, 81% were caused by road traffic crash (RTC) and 86.4% were in the 21-30 years group. Most patients (52%) had mandibular fractures, and the most common site was the body. Most patients with midfacial fractures had fractures of the zygomaticomaxillary region (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). The most common treatment for jaw fractures was mandibulomaxillary fixation (MMF). Stable zygomatic complex fractures were reduced (elevated) intraorally, and unstable ones were supported by antral packs.
CONCLUSIONS
This study highlights facial fractures secondary to RTC as a serious public health problem in our environment. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of RTC. It also bring to the fore the necessity to shift to open reduction and internal fixation (ORIF) of fractures.
PubMed: 24741422
DOI: 10.4103/2006-8808.128723 -
Nigerian Journal of Clinical Practice Mar 2022Maxillofacial fractures and craniocerebral injuries are common in patients with head trauma. These are injuries with high mortality and morbidity. Therefore, patients...
BACKGROUND
Maxillofacial fractures and craniocerebral injuries are common in patients with head trauma. These are injuries with high mortality and morbidity. Therefore, patients with head trauma should be evaluated early with a multidisciplinary approach.
AIM
The association between frontal and maxillary bone fractures and concurrent craniocerebral injuries were investigated in patients presenting with head trauma in this study. The data of the patients were analyzed retrospectively.
METHODS AND MATERIAL
Age and gender distributions were evaluated in frontal and maxillary fractures. Concomitant craniocerebral injuries were investigated. Craniocerebral injuries were grouped as pneumocephalus, extra-axial, intra-axial injuries and brain edema. Craniocerebral injuries in frontal and maxillary fractures were compared statistically.
RESULTS
Frontal bone and maxillary bone fractures were detected in 24% and 95% of the patients. Coexistence of pneumocephalus and intra-axial injuries in frontal bone fracture was statistically significant. The association of frontal posterior wall fractures with pneumocephalus and parenchymal contusion was found to be statistically significant. In addition, the association of craniocerebral injuries were evaluated and statistically significant ones were determined.
CONCLUSION
The presence of maxillofacial fractures in patients presenting with head trauma increases mortality and morbidity. Craniocerebral injuries can be life-threatening and delay the treatment of facial fractures. Upper facial bone fractures are significantly more common in craniocerebral injuries.
Topics: Craniocerebral Trauma; Humans; Maxillary Fractures; Retrospective Studies; Skull Fractures
PubMed: 35295058
DOI: 10.4103/njcp.njcp_1582_21 -
The Australasian Medical Journal 2016Previous analysis of jaw fracture hospitalisations in Western Australia (WA) indicated disproportionately high rates of hospitalisations for Aboriginal people. This...
BACKGROUND
Previous analysis of jaw fracture hospitalisations in Western Australia (WA) indicated disproportionately high rates of hospitalisations for Aboriginal people. This study was to follow-up on the earlier analysis to determine if inequalities in terms of jaw fracture hospitalisation rates between Aboriginal and non-Aboriginal people have changed.
AIMS
This study, done over a 10-year period from 1999/2000 to 2008/2009, aimed to determine rates of hospitalisations for jaw fractures in WA, trends over the 10-year period, and direct costs associated with these hospital admissions.
METHODS
Hospitalisation data were obtained from the Western Australian Hospital Morbidity Data System (HMDS). Episodes were selected on the basis of an ICD10-AM code being S02.4 (Fracture of the malar and maxillary bones) and S02.6 (Fracture of the mandible). Self-reported Aboriginality were used to compare Aboriginal to non-Aboriginal populations. Estimated cost of care was determined for each episode using the national standard diagnostic-related group (DRG) average price.
RESULTS
Our findings indicate that inequalities between Aboriginal and non-Aboriginal people in terms of hospital admissions for jaw fractures exist in WA, and continued over a decade-long period. Higher fracture rates occurred amongst males, Aboriginal people, younger adult age-groups, those from low socioeconomic areas, and those from remote and very remote areas. The DRG cost per person for jaw fractures ranged between AUD $842 and $109,002, with a median cost of $4,965.
CONCLUSION
Hospital admission rates for the treatment of maxillary and mandibular fractures is very strongly divided along racial and socioeconomic lines in WA.
PubMed: 26913087
DOI: 10.4066/AMJ.2015.2570 -
Craniomaxillofacial Trauma &... Dec 2012Materials and Methods A 6-year retrospective analysis of 111 patients treated for maxillofacial fractures in Davangere, Karnataka from January 2004 to December 2009... (Review)
Review
Materials and Methods A 6-year retrospective analysis of 111 patients treated for maxillofacial fractures in Davangere, Karnataka from January 2004 to December 2009 was performed. Variables like age, gender, occupation, type of fracture and mechanism of injury, concomitant injury, mode of treatment, and complications were recorded and assessed. Results Men between 21 and 30 years were mostly affected (male-to-female ratio = 10:1; age range = 17.60 years; mean 31.7 ± 9.8 [standard deviation]). Most fractures were caused by road traffic accidents (RTAs; 74.7%), followed by interpersonal violence (IPV; 15.8%), falls (4.2%), industrial hazards and animal attacks (2.1% each), and self-inflicted injury (1.1%). Forty-two cases were isolated zygomaticomaxillary complex (ZMC) fractures. The total number of facial fractures documented was 316, of which 222 were purely related to the ZMC; however, 11 were confined only to the midface. Fifty-three cases had concomitant lower jaw fractures, totaling 83. Ophthalmic injuries occurred in 30.52% of cases. Ninety-two cases were treated with open reduction and internal fixation (ORIF), and three cases were managed conservatively. The complication rate observed was 25.26%. Conclusion RTA continues to be the chief etiological factor in maxillofacial injury with males being affected predominantly. IPV and falls next contribute significantly to the incidence of such injuries. Concomitant injuries, however, require prompt recognition and appropriate management. ORIF still remains the mainstay of treatment; however, fixation devices are constantly being improved upon in an attempt to reduce immobilization time thereby facilitating early return to function with minimal morbidity. Nevertheless, future advances in maxillofacial trauma diagnosis and management are likely to reduce associated morbidity.
PubMed: 24294402
DOI: 10.1055/s-0032-1322536 -
Medicina Oral, Patologia Oral Y Cirugia... Aug 2011The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molar on the mandibular angle stiffness. (Review)
Review
OBJECTIVE
The purpose of this study is to estimate how is the magnitude of the impact of a mandibular third molar on the mandibular angle stiffness.
STUDY DESIGN
It was performed a literature search on whole MEDLINE and LILACS data base to find articles that match the following inclusion criteria: cohort studies presenting data on patients with mandibular fractures and third molars; that had a similar angle fracture definition; and that present data available to be cross-classified in a statistic analysis.
RESULTS
The sample was composed by 4 studies, involving 2533 patients from USA, Nigeria, Germany and Jordan, evaluated between 1976 and 2001. The analysis of the sample shows a relative risk for a mandibula to fracture, comparing patients with and without third molars, ranging from 1,18 to 2,25. The data of the sample was grouped because of the homogeneity of the articles methods. The estimated relative risk across the 4 studies was 1,94 (95% CI 1,6 - 2,35).
CONCLUSIONS
The presence of a third molar may double the risk of an angle fracture of the mandible to occur. Even with this data, the present study cannot support conditions related to the third molar that may affect this impact. Further studies are necessary to discuss the true indication of removal of these teeth as a prophylactic measure in population groups more predisposed to fracture.
Topics: Humans; Mandible; Mandibular Fractures; Molar, Third; Risk Factors
PubMed: 20711126
DOI: 10.4317/medoral.16970 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2022Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have...
BACKGROUND
Mandibular condyle fractures can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation. Although many studies have discussed for the optimal treatment method, the issue remains controversial. In this study, we aimed to compare conservative techniques in the mandibular condyle fractures.
METHODS
Twenty four unilateral condyle fracture patients aged between 18 and 48 years were treated according to one of three different modalities. Bracketing, arch bar or mini screw was applied to all non-surgery patients to obtain IMF. Eight patients were treated with only IMF meanwhile eleven patients were treated with one or double-sided amplifier occlusal splint according to the status of fractured segments, in addition to IMF. Remaining five patients have undergone open reduction and fractured segments immobilized with mini plates. Pre- and post-operative images were recorded with a computerized tomography device. Clinical and radiological examinations were performed by orthodontists and surgeons at baseline and at 6 months of treatment.
RESULTS
The condyle lengths of the patients with unilateral fracture after recovery were compared with the unaffected side. The length between the most protruding point of the condyle and the mandible was measured and the length difference was only 5.94 mm in patients who were treated by IMF. The length difference of patients who used brackets and splints was 3.36 mm (p<0.05). The length difference of patients who were repaired by plate screws was 1.80 mm (p>0.05). However, there was no statistically significant difference (p>0.05) between the groups in the IMF, occlusal splint and IMF and mini plate groups, between the trauma side and the opposite side. None of the patients developed ankylosis, open mouth, limitation of mouth opening, facial asymmetry, laterognathia, and retrognathia. The occlusion of the patients who were not known to have pre-trauma occlusions were directed, repositioned and provided an appropriate occlusion.
CONCLUSION
The use of IMF with an occlusal splint is a more conservative and acceptable treatment modality than open reduction in selected cases.
Topics: Adolescent; Adult; Bone Screws; Follow-Up Studies; Fracture Fixation, Internal; Humans; Jaw Fixation Techniques; Mandibular Condyle; Mandibular Fractures; Middle Aged; Treatment Outcome; Young Adult
PubMed: 34967439
DOI: 10.14744/tjtes.2020.94992