Assessment of temporomandibular joint following maxillomandibular fixation in mandibular fracture patients: A case series

The maxillofacial zone is a common site of traumatic injury, which has a direct impact on the aesthetics and function of the patient's face. The mandible is the main structural skeletal bone associated with the face, and the maxillofacial area is a common site of injury. Mandibular fractures have a significant impact on masticatory function. The main cause could also be the patient's ability to chew vigorously until the strength is below normal. This is related to dental comfort and mental attitude. Treatment consisting of surgery along the length of the mandibular fracture, focuses on restoring the structural shape of the mandible, with the hope of restoring normal form and function. Writing purpose systematic review (SR ) for studied further regarding the improvement of masticatory muscle function in mandibular fracture patients after open reduction internal fixation (ORIF). SR writing is done with search and analyze journal from PMC, Pubmed and Science Direct portals with criteria inclusion and exclusion that have been determined. Nine articles journal Which identified four (4) prospective articles, one (1) retrospective, one (1) cross sectional, one (1) systematic review, one (1) case report, and one (1) case control. Of the ten journal articles that have been reviewed, there are articles, all of which measure masticatory muscle function as an indicator of the success of open reduction procedures. fixation (ORIF). It's just that there are various research specifications that vary, both in terms of the age of the research subjects, part of the injury, method, type of action, data analysis and other indicators that need to be considered in each study. There is an increase in masticatory muscle function in mandibular fracture patients after open reduction internal fixation (ORIF).

Aim: To find the effectiveness of Occupational therapy intervention in post operative mandibular fracture patients. Objective: To improve mouth opening and reduce jaw deviations (temporomandibular joint mobility). Study design: A Retrospective study. Study setting: OPD of Occupational Therapy Department In Seth G. S. Medical College, KEM Hospital, Parel, Mumbai -400012, India. Methodology: Data was retrieved from Occupational therapy department records for the last one and half years i.e from july 2019 to jan 2021. In the said period around 33 operated mandibular fractures patients had been referred to Occupational therapy dept for therapy. Out of which only 20 patients followed up. Data of these 20 mandibular fractures patients were analysed. Inclusion criteria, Both males and females, Age group 20-60 years, Operated for mandibular fractures in period July 2019 – January 2021 who were referred to occupational therapy department for therapeutic intervention. Exclusion criteria: Incomplete data, Patients who have not followed up for second visit also. Outcome measures – Mouth opening with a tape measure at 1^st, 3^rd and 5^th week respectively. All these data was already available in Occupationa therapy department records and there was no patient contact at all. Hence waiver of consent was asked for. Results: Statistical analysis (paired t-test) was used to assess the significance of difference. The calculated t value for mouth opening measurements was 17.1850 which was much much higher than the tabular t value at P=0.001, which means the increase in post treatment mouth opening measurements is just not by chance but it’s extremely significant at p= 0.001. The pre and post photograph of the patients showed a difference in jaw deviation angle too while opening mouth. The above results showed the treatment proved to be effective. Conclusion: The Occupation therapy intervention in post-operative mandibular fracture patients proved to be effective in improving mouth opening measurements and jaw deviations.

Risk Factors for Cervical Spine Injury in Patients With Mandibular Fractures

Risk Factors for Cervical Spine Injury in Patients With Mandibular Fractures

It is important to evaluate the level of bone-specific alkaline phosphatase as it relates to the quantity of callus formed in mandibular fracture healing. The objective of the present study was to assess Serum Bone-Specific Alkaline Phosphatase (BsALP) as an indicator of callus formation in patients with mandibular fracture and determine the relationship between BsALP and callus formation using two treatment methods. Fifty-five patients with isolated mandibular fractures were enrolled. BsALP was measured at presentation, 3rd and 6th week. The patients were recruited into two treatment groups: Closed Reduction with Mandibulomaxillary Fixation (MMF) and Open Reduction and Internal Fixation (ORIF). The Callus Index was measured at 3rd and 6th week after treatment using digital postero-anterior view of the jaws on DICOM viewer software. The mean value of BsALP was 26.2±9.5 ng/mL. BsALP concentration in patients with double site fractures was higher than those with a single fracture, p=0.102. Peak serum BsALP observed in the 3rd week post-intervention was (28.1±8.2 ng/mL). Statistically significant differences were observed between the BsALP concentration in the 3rd and 6th week, and between BsALP concentration at presentation and 6th week, p<0.001, respectively. There was no significant correlation between the Callus Index and mean serum BsALP at 6 weeks (r=-0.08, p=0.580). MMF treatment group had higher levels of serum BsALP compared with ORIF group in the 3rd week (p=0.14) and in the 6th week (p=0.18). BsALP is an indicator of the amount of callus formed in patients treated for mandibular fractures. Hence, it could be used as an adjunct to monitor the healing of mandibular fractures.

TMJ assessment before anaesthesia

Background/objectives: Mandibular fractures account for almost half of all the fractures occurring in the maxillofacial region. Among mandibular fractures, angle fracture has a highest rate of post-operative complications (0-32%). This study compared the fixation of mandibular angle fracture with intra-oral external oblique ridge fixation versus transbuccal lateral cortical plate fixation using a single miniplate. Post-operative complications especially infection was noted and compared. Methods: A randomized controlled trial was done to compare the outcome of the two procedures. A total of 120 mandibular angle fracture patients were randomly allocated into Group A and Group B, 60 in each group. Group A underwent ORIF with intraoral approach and Group B underwent open reduction Internal fixation (ORIF) with transbuccal lateral cortical plate fixation for mandibular angle fractures. Patients of both groups were reviewed on 1st week, 1st month and third month for clinical signs of infection. Results: In group A, 10 (16.66%) patients suffered from infection and in group B, 4 (6.66%) of patients reported with infection at the last follow up visit that is at the end 3 months. No statistically significant p value after application of ‘Chi square test’ was noted for infection at the end of the third month review. Conclusion: Mandibular angle fractures can be effectively treated with transbuccal lateral cortical plate fixation as ease of plate adaptation, placement of plate in mid neutral area and less chance of infection.

The authors' aim was to evaluate the effect of perioperative systemic dexamethasone (DXM) administration on postoperative pain, edema, and trismus in mandibular fracture patients. The authors conducted a prospective randomized study of 45 patients with one or 2 noncomminuted fractures of the dentate part of the mandible. All patients underwent surgery for intraoral miniplate fixation. Patients in the study group were given a total of 30 mg DXM, while patients in the control group received neither DXM nor placebo. Only paracetamol and opioids were served as analgesics. Pain severity was assessed using the visual analog scale. The effect in facial swelling was measured in centimeters and analyzed as percentage change. Trismus was evaluated as the difference in maximal mouth opening by measuring interincisal distance in millimeters. The Mann-Whitney U test was applied to determine the statistical significance of differences between the groups. Thirty-four patients were included in the statistical analysis. The visual analog scale score was significantly lower in the study group than in the control group at 18 hours postoperatively (P = 0.033). Significant differences in edema or trismus were not found postoperatively between the DXM and control groups. In conclusion, perioperative DXM decreases postoperative pain in mandibular fracture patients when nonsteroidal anti-inflammatory drugs are not used, but it does not seem to be effective in reducing edema or trismus.

Maxillofacial injuries, frequently caused by accidents or violence, often result in mandibular fractures. Treatment options include open and closed reduction, the latter utilising maxillomandibular fixation. Although maxillomandibular fixation is a cost-effective method, it may restrict normal dietary intake, leading to weight loss and potential malnutrition that can negatively impact recovery. Objective: To assess weight changes in mandibular fracture patients following maxillomandibular fixation. Methods: A comparative cross-sectional study was conducted at the Pakistan Institute of Medical Sciences from November 2023 to April 2024, enrolling 75 adult patients (ages 18-50) undergoing maxillomandibular fixation for mandibular fractures. Weight measurements were recorded preoperatively and at one and four weeks postoperatively. Statistical analysis was performed using SPSS Version 27.0. Results: The mean age of participants was 26.4 years, with 92% being male. The average preoperative weight was 63.08 kg, decreasing significantly to 58.57 kg after one week and 57.57 kg after four weeks (p<0.001). This weight loss was attributed to dietary restrictions and discomfort from jaw immobilisation. Conclusions: It was concluded that this study reveals significant weight loss post-maxillomandibular fixation, indicating a need for targeted nutritional support during recovery. These findings emphasize the importance of developing effective intraoperative and postoperative care protocols to meet nutritional needs, potentially enhancing recovery outcomes and quality of life for patients. Future research should explore the long-term effects of weight changes and interventions to mitigate weight loss during recovery.

Mandibular fractures in Northern Finland in the 1980s — A 10-year study

Background: Mandibular fractures are among the most common facial bone injuries, often leading to complications such as inferior alveolar nerve (IAN) injuries. These injuries can significantly impact a patient’s quality of life due to altered sensory function. Limited data exist regarding the prevalence of IAN injury in tertiary care centers in Karachi, Pakistan. Aim: To determine the prevalence of inferior alveolar nerve injury in mandibular fracture patients presenting at Abbasi Shaheed Hospital and identify factors associated with its occurrence. Methods: This cross-sectional study was conducted over six months in the emergency department of Abbasi Shaheed Hospital. A total of 90 patients aged 18–50 years with mandibular fractures were included. Data were collected through detailed clinical examinations and neurosensory evaluations using standardized protocols. Variables such as age, gender, fracture type, and etiology were recorded. SPSS version 23 was used for data analysis. Results: The mean age of patients was 29.8 ± 6.3 years, with a male-to-female ratio of 2:1. Road traffic accidents (53.3%) were the leading cause of injury, followed by interpersonal violence (25.6%). The prevalence of IAN injury was 38.9%, with a significant association noted with displaced fractures (p < 0.05). Neurosensory dysfunction was more common in fractures involving the mandibular angle and body. Conclusion: IAN injury is a frequent complication of mandibular fractures, particularly in displaced fractures. Early assessment and management can minimize long-term morbidity. Future studies should focus on long-term outcomes and potential preventive measures.

Objective: To compare the quality of life after surgical management with closed reduction and internal fixation (CRIF) versus open reduction and internal fixation (ORIF) for mandibular condylar fractures. Methodology: This analytical observational study was carried out between January 2024 to June 2024, at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, focusing on patients with mandibular condylar fractures. The study assessed their quality of life using the General Oral Health Assessment Index (GOHAI) Questionnaire, with scores ranging from 1 to 3, where 1 denoted "Always," 2 indicated "Sometimes," and 3 represented "Never." Quality of life scores were categorized as high (34-36), medium (31-33), or low (<30) based on the GOHAI results. Results: In this study there were 66.7% neglected patients had high quality of life, 15.4% had moderate, and 27.3% had low GOHAI, (p=0.084). Further, there were only 16.7% patient close reduction management had high quality of life, 5 (38.5%) had moderate, and 545.5% had low GOHAI. According to open reduction management, there were 83.3% patients had high quality of life, 61.5% had moderate, and 45.5% had low GOHAI, (p=0.157). Conclusion: Factors such as age, gender, neglected type, and treatment modality did not significantly affect the post-operative quality of life. However, mandibular fracture patients who underwent surgical treatment with open reduction technique, as assessed by the GOHAI parameter, experienced a high quality of life.

Is a Tooth Extraction Required If Dentition Lies Within a Mandible Fracture?

Internal Fixation of Mandibular Angle Fractures: A Comparison of 2 Techniques

Scientific evidence of nonsurgical site-related complications in mandibular fracture patients is limited. The purpose was to measure the frequency of nonsurgical site complications in patients with mandible fractures, describe the types of complications, and identify the risk factors associated with these complications. A retrospective cohort study was conducted at the Helsinki University hospital between 2018 and 2021. Patients undergoing surgery with open reduction and internal fixation of mandibular fracture(s) were evaluated. Patients under 16years of age were excluded. Primary predictor variable was age. Patient-related predictor variables were sex, long-term disease(s), smoking, and alcohol and/or drug abuse. Injury and fracture-related variables were injury mechanism, type and site of facture, combined craniofacial fracture(s), and associated injury(s). The primary outcome variable was nonsurgical site-related postoperative complication. The secondary outcome variable was type of complication. Not applicable. The main outcome variable was cross tabulated for pairwise comparisons with predictor variables. Multivariate logistic regression was performed for statistically significant (P<.05) variables. The data included 314 patients (age range: 16 to 89years; mean age: 38years old; median age: 33years old); most (78.3%) were men. Nonsurgical site-related postoperative complications occurred in 6.7% of patients. The most common complication type was pulmonary complication (36.0%), followed by urinary complication (20.0%) and general infection (16.0%). Nonsurgical site-related postoperative complications were most likely to occur in patients who were elderly (adjusted odds ratio [aOR] 5.55; 95% CI 1.92 to 16.21; P=.002), had combined craniofacial fractures (aOR 2.92; 95% CI 1.06 to 8.03; P=.038), and abused alcohol or drugs (aOR 4.51; 95% CI 1.70 to 11.96; P=.003). Pulmonary complications occurred more often in elderly patients, whereas urinary complications were more common in younger patients. The types of nonsurgical site complications in mandibular fracture patients increase and vary according to the patient's age. Awareness of possible complications related to different age groups helps anticipate and identify these in clinical work, and to consider the overall treatment of the patient beyond the fracture.