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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 -
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 -
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 -
European Journal of Trauma and... Aug 2022To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with...
A clinical decision aid to discern patients without and with midfacial and mandibular fractures that require treatment (the REDUCTION-II study): a prospective multicentre cohort study.
PURPOSE
To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment.
METHODS
A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment.
RESULTS
A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7-99.3), a specificity of 38.6 (35.0-42.3), and a negative predictive value of 99.3 (97.3-99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6-100.0), a specificity of 39.1 (33.2-45.4), and a negative predictive value of 100.0 (96.1-100.0).
CONCLUSION
The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future.
TRIAL REGISTRATION
The study was registered at ClinicalTrials.gov with the identifier NCT03314480.
Topics: Cohort Studies; Decision Support Techniques; Humans; Malocclusion; Mandibular Fractures; Prospective Studies; Tooth Mobility
PubMed: 35211773
DOI: 10.1007/s00068-022-01892-4 -
Acta Otorhinolaryngologica Italica :... Aug 2016Mandibular fracture is usually the clinical end of bisphosphonate-related osteonecrosis of the jaw. This is a painful complication and patients cannot feed as usual,...
Mandibular fracture is usually the clinical end of bisphosphonate-related osteonecrosis of the jaw. This is a painful complication and patients cannot feed as usual, with a worsening of their quality of life. The goal of treatment in bisphosphonate related osteonecrosis of jaw (BRONJ) patients is to slow progression of bone necrosis. We present a novel technique for treatment of severe mandibular BRONJ in stage 3 patients that present with a high risk to develop fracture, since they have a residual unaffected mandibular bone height less than 6 mm. We treated 10 patients in this clinical situation with an extra-oral application of a reconstructive plate superficial to the platysma, to keep the plate separated from the infected site to avoid contamination and consequent need of removal, followed by an intraoral approach for active curettage of mandibular necrosis. The preservation of blood supply to the mandible and avoidance of direct contact of the infected site with the reconstructive plate are some advantages of this technique. This plate allows enhancement of mandibular strength, allowing proper treatment of the BRONJ site on the oral side without fear of causing a mandibular fracture when the residual mandible is thin. This technical solution guarantees these patients an extended disease-free period since it is effective in preventing mandibular fractures in patients with low mandibular residual height left after the BRONJ onset.
Topics: Aged; Aged, 80 and over; Bisphosphonate-Associated Osteonecrosis of the Jaw; Female; Humans; Male; Mandibular Fractures; Middle Aged
PubMed: 27734985
DOI: 10.14639/0392-100X-823 -
Injury Sep 2021To assess the diagnostic accuracy of physical examination findings used to identify patients at risk for midfacial or mandibular fractures.
OBJECTIVES
To assess the diagnostic accuracy of physical examination findings used to identify patients at risk for midfacial or mandibular fractures.
MATERIALS AND METHODS
A five-year retrospective cohort was constructed from all emergency department patients with a midfacial or mandibular trauma. The sensitivity, specificity, pre-test probability, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio data was calculated for 19 and 14 physical examination findings for midfacial and mandibular fractures respectively. Computed Tomography and panoramic radiography were used as index tests.
RESULTS
A total of 1484 patients were identified among whom 40.4% midfacial and 33.4% mandibular fractures were diagnosed. Overall, specificity was found to be higher than sensitivity. Regarding midfacial fractures, high specificity was found for raccoon eyes, malar eminence flattening and all the findings that are related to palpation, the nasal, ocular and intra-oral assessment. Malar eminence flattening, external nasal deformity, nasal septum hematoma, change of globe position and palpable step-off had ad high positive predictive value and positive likelihood ratio. Regarding mandibular fractures high specificity was found for mouth opening restriction, auditory canal bleeding, intra-oral assessment related findings, palpable step-off, inferior alveolar nerve paresthesia, the angular compression test and chin axial pressure test.
CONCLUSIONS
The diagnostic accuracy of relevant physical examination findings were identified for the prediction of midfacial and mandibular fractures.
Topics: Humans; Mandibular Fractures; Physical Examination; Predictive Value of Tests; Radiography, Panoramic; Retrospective Studies
PubMed: 34103150
DOI: 10.1016/j.injury.2021.05.037 -
Cirugia Y Cirujanos 2023Fractures of the atrophic mandible have been historically treated in various ways, from intermaxillary fixation to internal fixation, some cases require bone grafts....
BACKGROUND
Fractures of the atrophic mandible have been historically treated in various ways, from intermaxillary fixation to internal fixation, some cases require bone grafts. Besides, the Luhr classification serves as a guide to select the type of treatment.
OBJECTIVE
To show the treatment of fractures in atrophic mandible with plates and screws, and the potential indications of bone graft in this type of fractures.
METHOD
We presented a serie of 17 patients with atrophic mandible treated with plates and screws, some of them no blocked system and other with locked screws. For patients in luhr classes II and III cancellous bone grafts were used, looking for best osteogenic response, harvesting for the proximal third of the tibia.
RESULTS
Postoperative progress was generally uneventful. Oral intake with purees was resumed 24 hours after surgery, as well as ambulation. Fracture healing at 6 months was seen in 17 patients. One patient died before the 6-month time point as the result of a stroke. Delayed union was diagnosed 3 months after surgery in another patient, who refused secondary treatment.
CONCLUSIONS
Treatment of fractures in atrophic mandibles with plates and screws is a reliable procedure. Luhr classification provide useful guidance regarding the use of bone grafts for best osteogenic response in the fracture. This treatment allows a quick restart of the feeding by mouth and movilization of the patients.
Topics: Humans; Mandibular Fractures; Jaw, Edentulous; Bone Plates; Mandible; Fracture Fixation, Internal
PubMed: 37084311
DOI: 10.24875/CIRU.21000281 -
Experimental Biology and Medicine... Nov 2021After high fractures of the mandibular condyle, the insufficient blood supply to the condyle often leads to poor bone and cartilage repair ability and poor clinical...
After high fractures of the mandibular condyle, the insufficient blood supply to the condyle often leads to poor bone and cartilage repair ability and poor clinical outcome. Parathyroid hormone (PTH) can promote the bone formation and mineralization of mandibular fracture, but its effects on cartilage healing after the free reduction and internal fixation of high fractures of the mandibular condyle are unknown. In this study, a rabbit model of free reduction and internal fixation of high fractures of the mandibular condyle was established, and the effects and mechanisms of PTH on condylar cartilage healing were explored. Forty-eight specific-pathogen-free (SPF) grade rabbits were randomly divided into two groups. In the experimental group, PTH was injected subcutaneously at 20 µg/kg (PTH (1-34)) every other day, and in the control group, PTH was replaced with 1 ml saline. The healing cartilages were assessed at postoperative days 7, 14, 21, and 28. Observation of gross specimens, hematoxylin eosin staining and Safranin O/fast green staining found that every-other-day subcutaneous injection of PTH at 20 µg/kg promoted healing of condylar cartilage and subchondral osteogenesis in the fracture site. Immunohistochemistry and polymerase chain reaction showed that PTH significantly upregulated the chondrogenic genes Sox9 and Col2a1 in the cartilage fracture site within 7-21 postoperative days in the experimental group than those in the control group, while it downregulated the cartilage inflammation gene matrix metalloproteinase-13 and chondrocyte terminal differentiation gene ColX. In summary, exogenous PTH can stimulate the formation of cartilage matrix by triggering Sox9 expression at the early stage of cartilage healing, and it provides a potential therapeutic protocol for high fractures of the mandibular condyle.
Topics: Animals; Cartilage; Collagen Type II; Female; Fracture Fixation, Internal; Male; Mandibular Condyle; Mandibular Fractures; Matrix Metalloproteinase 13; Osteogenesis; Parathyroid Hormone; Rabbits; SOX9 Transcription Factor; Up-Regulation; Wound Healing
PubMed: 34233524
DOI: 10.1177/15353702211027114 -
The Journal of International Medical... Jul 2020To analyse the epidemiology of mandibular fractures and the correlation between combined fractures during a 10-year period in central Taiwan.
OBJECTIVE
To analyse the epidemiology of mandibular fractures and the correlation between combined fractures during a 10-year period in central Taiwan.
METHODS
This retrospective study analysed data collected from the medical records of patients that had mandibular fractures between January 2007 and October 2017. Data on age, sex, cause of injury, anatomical site of fracture, treatment and complications were obtained and analysed.
RESULTS
A total of 265 patients who received treatment were included in the study. The mean ± SD age was 30.08 ± 13.47 years (range, 6-70 years) and the 21-30 years age group showed the highest incidence of mandibular fractures. The male-to-female ratio was 1.25:1. Road traffic accidents were the most common cause of fracture (206 of 265; 77.74%). The symphysis and parasymphysis area was the most common fracture site (169 of 420; 39.29%). Single-site fracture represented slightly more than 50% of the total 420 fractures. The most frequent combination of two fractures was an angle fracture combined with a symphysis and parasymphysis fracture (29 of 106 double fracture patients [27.36%]). There was a weak positive association between several combinations of fractures.
CONCLUSIONS
A better understanding of the influence of age and sex on the mechanism of injury is of great clinical importance in the assessment and diagnosis of fractures.
Topics: Adolescent; Adult; Aged; Child; Female; Humans; Incidence; Male; Mandibular Fractures; Middle Aged; Retrospective Studies; Taiwan; Young Adult
PubMed: 32705932
DOI: 10.1177/0300060520915059