Postoperative malocclusion after maxillofacial fracture management: a retrospective case study

Young-Kyun Kim,Sang-Yun Kim,Yong-Hoon Choi

doi:10.1186/s40902-018-0167-z

Abstract

PurposeVarious complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture.Materials and methodsIn this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors’ department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery.ResultsOne patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration.ConclusionsConsidering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

Highlights

Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain
The incidence of complications such as temporomandibular joint disorder can be minimized by avoiding the movement of the fractured segments by performing only the intermaxillary fixation and removing the inflammatory product and preventing fibrous adhesion through arthrocentesis surgery in the case of mandibular condyle fracture [1]
Materials and methods In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed with the initial operation from other units and were referred to the authors’ department had been included

Summary

Introduction

Materials and methods In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed with the initial operation from other units and were referred to the authors’ department had been included. Treatment of maxillofacial fractures can be classified into surgical and nonsurgical methods. Maxillofacial fractures and mandibular condylar fractures without occlusion and functional problems can be treated well with nonsurgical methods. In this case, the incidence of complications such as temporomandibular joint disorder can be minimized by avoiding the movement of the fractured segments by performing only the intermaxillary fixation and removing the inflammatory product and preventing fibrous adhesion through arthrocentesis surgery in the case of mandibular condyle fracture [1]. The purpose of this study was to evaluate the dental treatment of malunioned maxillofacial fractures

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Discussion

Conclusion