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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 -
The American Journal of Case Reports Oct 2023BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related...
BACKGROUND Bisphosphonates inhibit bone resorption in patients with postmenopausal osteoporosis and reduce osteoporotic fracture incidence. Medication-related osteonecrosis of the jaws (MRONJ) and atypical femoral fractures (AFF) are both rare but serious adverse effects of anti-resorptive drugs (ARD) such as bisphosphonates. The most advanced form of MRONJ is termed stage 3 and can lead to severe local sequelae like pathologic mandibular fractures (PMF). This study reports a case of MRONJ-related PMF and AFF with osteomyelitis secondary to bisphosphonate treatment for osteoporosis. CASE REPORT A 63-year-old white woman was diagnosed with PMF related to MRONJ stage 3 during treatment of an AFF with osteomyelitis. She had been treated for postmenopausal osteoporosis with 70 mg of alendronate weekly for 2 years. The PMF was treated by stable internal fixation combined with debridement and sequestrectomy, but further debridement was required and 2 mandibular implants were then removed. Postoperative recovery was uneventful and the mandibular infection was controlled after the second surgery. Three weeks later, she was discharged from the hospital, instructed to discontinue the use of alendronate, and referred for 30 sessions of hyperbaric oxygen therapy. At the 3-year follow-up, the PMF was completely healed without signs of mandibular infection or bone exposure. CONCLUSIONS This report raises awareness of both MRONJ and AFF as possible adverse effects of short-term bisphosphonate therapy for postmenopausal osteoporosis, and highlights the importance of dental and orthopedic follow-ups. It is crucial to emphasize the need for early diagnosis and treatment to prevent MRONJ progression to PMF.
Topics: Female; Humans; Middle Aged; Diphosphonates; Alendronate; Osteoporosis, Postmenopausal; Bone Density Conservation Agents; Mandibular Fractures; Osteoporosis; Fractures, Spontaneous; Femoral Fractures; Osteomyelitis
PubMed: 37867315
DOI: 10.12659/AJCR.941144 -
Plastic and Reconstructive Surgery Apr 2021Cell-based treatments have demonstrated the capacity to enhance reconstructive outcomes in recent decades but are hindered in clinical utility by regulatory hurdles...
BACKGROUND
Cell-based treatments have demonstrated the capacity to enhance reconstructive outcomes in recent decades but are hindered in clinical utility by regulatory hurdles surrounding cell culture. This investigation examines the ability of a noncultured stromal vascular fraction derived from lipoaspirate to enhance bone healing during fracture repair to further the development of translatable cell therapies that may improve outcomes in irradiated reconstruction.
METHODS
Isogenic male Lewis rats were divided into three groups: fracture, irradiated fracture, and irradiated fracture with stromal vascular fraction treatment. Irradiated groups received a fractioned dose of 35 Gy before mandibular osteotomy. Stromal vascular fraction was harvested from the inguinal fat of isogenic donors, centrifuged, and placed intraoperatively into the osteotomy site. All mandibles were evaluated for bony union and vascularity using micro-computed tomography before histologic analysis.
RESULTS
Union rates were significantly improved in the irradiated fracture with stromal vascular fraction treatment group (82 percent) compared to the irradiated fracture group (25 percent) and were not statistically different from the fracture group (100 percent). Stromal vascular fraction therapy significantly improved all metrics of bone vascularization compared to the irradiated fracture group and was not statistically different from fracture. Osteocyte proliferation and mature bone formation were significantly reduced in the irradiated fracture group. Bone cellularity and maturity were restored to nonirradiated levels in the irradiated fracture with stromal vascular fraction treatment group despite preoperative irradiation.
CONCLUSIONS
Vascular and cellular depletion represent principal obstacles in the reconstruction of irradiated bone. This study demonstrates the efficacy of stromal vascular fraction therapy in remediating these damaging effects and provides a promising foundation for future studies aimed at developing noncultured, cell-based therapies for clinical implementation.
Topics: Adipose Tissue; Animals; Cell Extracts; Combined Modality Therapy; Fracture Healing; Intraoperative Care; Male; Mandible; Mandibular Fractures; Rats; Rats, Inbred Lew; Treatment Outcome
PubMed: 33760575
DOI: 10.1097/PRS.0000000000007781 -
Stomatologija 2014PURPOSE. Aim of this study was to analyze relation of occlusal correction and alterations of temporomandibular joint function during treatment of unilateral mandibular... (Comparative Study)
Comparative Study
PURPOSE. Aim of this study was to analyze relation of occlusal correction and alterations of temporomandibular joint function during treatment of unilateral mandibular fractures. MATERIALS AND METHODS. We compared 49 patients treated for unilateral mandibular fracture without occlusal correction with 21 patient treated for unilateral mandibular fracture along with early and consequent occlusal analysis and correction and with 49 control subjects. Patients' complaints, mandibular movements and occlusal parameters were evaluated during the period of healing. ZEBRIS ultrasound system (Jaw Motion Analyzer, Zebris Medical GmbH, Isny, Germany) was used for analysis of mandibular movements and T-Scan analyzer (Tekscan, Inc., Boston, MA, USA) was used for occlusal analysis. RESULTS. Findings of our study showed statistically significant (p<0.05) diminution of patients complaints, mandibular movement alterations and occlusal disturbances in patients who received occlusal correction during MF treatment if compared to patients treated without occlusal correction, except noises from the joint in the injured side and mandibular lateral track to the injured side in the final stage of investigation. Despite applied treatment recovery of the TMJ function was not complete and the investigated parameters remained worse if compared to the control group. CONCLUSIONS. Results of this study confirmed positive influence of early and subsequent occlusal analysis and correction during stages of MF treatment on diminution of functional alterations of the temporomandibular joint function. Timely occlusal correction improves and hastens process of rehabilitation therefore it is indispensable part of MF treatment.
Topics: Adult; Bite Force; Bone Wires; Dental Occlusion, Balanced; Female; Follow-Up Studies; Fracture Fixation, Internal; Fracture Healing; Humans; Jaw Fixation Techniques; Joint Dislocations; Male; Malocclusion; Mandibular Fractures; Patient Satisfaction; Range of Motion, Articular; Temporomandibular Joint; Ultrasonography
PubMed: 25471992
DOI: No ID Found -
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 -
Scientific Reports Apr 2021This study aimed to analyze the relationship of the occlusal support together with the lower third molars to the mandibular fractures of the angle and condyle among...
This study aimed to analyze the relationship of the occlusal support together with the lower third molars to the mandibular fractures of the angle and condyle among patients in our medical institutions. This was a retrospective study that reviewed the medical records and radiographs of all patients treated for mandibular fractures from 2015 to 2019. The data collected by using picture archiving and communicating system. Only records with mandibular angle or condyle fractures were included. The dependent variable was the presence of the fractures of the mandibular angle or condyle. The independent variables were epidemiological data, third molar characteristics, existence or absence of occlusal support. The data was analyzed through Univariate logistic regression and multivariate logistic regression. From a total of 187 mandibular fractures, 44 presented mandibular angle fracture and 29 shown condyle fractures. The average age was 40.34 ± 13.47 years. The absence of occlusal support increased the chance of condyle fractures by 5.1 times (95% CI 1.61-17.29). The lack of occlusal support is more associated with condyle fractures than the presence of occlusal support, regardless of third molar presence and characteristics and other variables evaluated.
Topics: Adult; Cross-Sectional Studies; Dental Occlusion; Female; Humans; Logistic Models; Male; Mandibular Condyle; Mandibular Fractures; Medical Records; Middle Aged; Molar, Third; Retrospective Studies; Tooth, Impacted
PubMed: 33863971
DOI: 10.1038/s41598-021-87820-9 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2009Many studies have shown that the greatest risk of fracture of the mandibular angle is related to the presence of an unerupted lower third molar, based on the hypothesis...
UNLABELLED
Many studies have shown that the greatest risk of fracture of the mandibular angle is related to the presence of an unerupted lower third molar, based on the hypothesis that there is a decrease in the area of bone and absorption of the impact in this area, leading some surgeons to indicate its prophylactic removal in patients most exposed to the risk factors of facial trauma. On the other hand, other authors have observed a greater frequency of condylar fractures in patients without an impacted lower third molar.
PURPOSE
The aim of this study was to relate the condylar and angle fracture with an unerupted lower third molar, taking into account the position of the tooth.
MATERIAL AND METHODS
Panoramic radiographs were used to determine if the presence or absence of the third molar is related to the occurrence of mandibular fractures, such as angle and condylar fractures.
RESULTS
In a total of 43 patients with angle fractures, the greatest percentage had erupted teeth, and 41.9% had impacted teeth; however there was no significant difference between the fractured side and the tooth condition (p=0.350). There were 91 condylar fractures and in 42.9% the third molar was absent and in 40.7% the tooth was erupted . There was no significant difference between the fractured side and the tooth condition (p=0.852).
CONCLUSIONS
The absence of an impacted third molar may increase the risk of condylar fractures and decrease the prevalence of mandibular angle fractures.
Topics: Adolescent; Adult; Female; Humans; Male; Mandibular Fractures; Middle Aged; Molar, Third; Retrospective Studies; Tooth, Impacted; Young Adult
PubMed: 19300366
DOI: No ID Found -
Comparison of functional outcome after open and closed reduction of mandibular subcondylar fracture.JPMA. the Journal of the Pakistan... Dec 2020To compare open reduction with internal fixation of mandibular subcondylar fracture with closed reduction in terms of adequate mouth opening. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare open reduction with internal fixation of mandibular subcondylar fracture with closed reduction in terms of adequate mouth opening.
METHODOLOGY
The randomised clinical trial was conducted from March 2014 to February 2015 at the Oral and Maxillofacial Surgery Department, King Edward Medical University and Allied Hospitals, Lahore, Pakistan, and comprised patients who presented with unilateral subcondylar fractures. The patients were randomly divided into 2 groups. Group-A patients were treated with closed reduction and immobilisation and were discharged the same day, while Group-B patients were treated by open reduction with internal fixation and retained in ward for 1 day. Both were recalled for periodic follow-ups, and were compared in terms of achieving adequate mouth opening. Data was analysed using SPSS 20.
RESULTS
Of the 70 patients, 35(50%) were in each of the two groups. The mean age in Group-A was 28.88±11.86 years compared to 28.22±10.80 years in Group-B (p>0.05). Mean mouth opening in the two groups were consistently positive, and significant at the last two follow ups(p<0.001).
CONCLUSIONS
The difference in results of both treatment modalities was significant, indicating that open reduction and internal fixation should be the preferred treatment.
Topics: Adolescent; Adult; Fracture Fixation, Internal; Humans; Mandibular Condyle; Mandibular Fractures; Pakistan; Treatment Outcome; Young Adult
PubMed: 33475580
DOI: 10.47391/JPMA.1263 -
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 -
BMC Oral Health Oct 2021Alveolar bone plays a vital role in mastication and supporting the teeth. The alveolar process is one of the most challenging regions of facial bone to reconstruct due...
BACKGROUND
Alveolar bone plays a vital role in mastication and supporting the teeth. The alveolar process is one of the most challenging regions of facial bone to reconstruct due to the deformity involves both hard and soft tissues. However, the etiology, gender, and age distribution vary between different regions, cultures, and countries. This study aims to investigate the prevalence of alveolar trauma in Shahid Rajaee Hospital, Shiraz, Iran, for three years.
METHODS
In a retrospective cross-sectional study, patients with alveolar fractures referred to Shahid Rajaei Hospital in Shiraz were included in the study. Age, sex, site of alveolar fractures, and etiology factors of trauma explored. The collected data was analyzed by SPSS software. Mean [Formula: see text] SD calculated for the inferential statistics, and the data compared using Chi-square and Exact Fisher. A p-value of < 0.05 was considered statistically significant with a 95% reliability.
RESULTS
A total of 165 patients had alveolar fractures in this study. We found that the most common cause of alveolar fracture was road accidents (32.3%) and the lowest reason was violence (9%). Most people with alveolar trauma were male and in the 21-30 years. The prevalence of mandibular and maxillary alveolar fractures was 17.61 and 17.01%, respectively, with the most anterior area of injury.
CONCLUSION
Alveolar trauma is one of the most common injuries among trauma patients. Early diagnosis and treatment plans are necessary to reduce the complications of facial trauma. Early training for a young adult is essential to prevent the severity of trauma.
Topics: Cross-Sectional Studies; Facial Bones; Humans; Iran; Male; Mandibular Fractures; Reproducibility of Results; Retrospective Studies; Young Adult
PubMed: 34615508
DOI: 10.1186/s12903-021-01863-y