Atrophic Mandible Fractures Research Articles

Current Evidence for the Management of Edentulous Atrophic Mandible Fractures: A PRISMA-SWiM Guided Review.

PRISMA-SWiM guided systematic review. 1. Provide consistent evidence regarding the management of atrophic mandible fractures; 2. To search, evaluate and validate existing guidelines if any for the management; 3. Provide evidence regarding specific management of condylar fractures in the atrophic mandible; 4. To address the clinical applicability of bone grafts. A systematic review was conducted using the PRISMA-SWiM protocol. PROSPERO ID: CRD42021235111. Studies with adequate data on outcome, treatment methods were selected. Isolated case reports, case series, and non-human studies were excluded. Quality assessment was done using Newcastle -Ottawa scale. The level of evidence was assessed using Oxford Level of Evidence. Mandibular body was the most common type of fracture. Self falls and RTA were the most common etiologies. Condylar fracture was most commonly managed conservatively with ORIF employed in few studies. For the mandible compression and non-compression osteosynthesis were used. Bone grafts were used in cases with segmental defects or cases requiring augmentation. There is lack of proper evidence to definitely conclude any single treatment modality. However, the consensus is towards ORIF. Reconstruction plates are preferred by many authors. However, unilateral fractures may be managed by miniplates. Bilateral fractures require more rigid fixations. Open reduction and internal fixation of condylar fracture is indicated in cases with displacement or low-level fractures.

Finite element analysis of different internal fixation methods for the treatment of atrophic mandible fractures

The aim of this study is to evaluate different plate systems and contribute to revealing the most appropriate treatment option for severe atrophic edentulous mandible fractures. A total of 8 different types of rigid internal fixation methods, which were a 4-hole miniplate on the crest, a 4-hole miniplate on the basis, a 6-hole miniplate on the crest, a 6-hole miniplate on the basis, two 4-hole mini plates on both the crest and basis, two 6-hole mini plates on both crest and basis, a 6-hole reconstruction plate on the crest and a 6-hole reconstruction plate on the basis, were simulated. Stress analysis on plates and screws and the displacement between fragments were evaluated using finite element analysis. The lowest von Mises stress was observed on the basis plate in Group 6. The highest von Mises stresses were measured on the screws closes to the fracture line. Values exceeding the boundary conditions were observed only in Groups 3 and 4 under molar loading. The highest compressive stresses were measured in Group 1, and the lowest compressive stresses were measured in Group 6. Under molar loading, the highest displacement was observed in Group 3, and the lowest displacement was observed in Group 6. When all groups are evaluated in terms of stress distributions and stability, a 1.5 mm thick six-hole reconstruction plate can be a reliable method in the treatment of severe atrophic edentulous mandible fractures.

Eficacia del sistema portante en el tratamiento de la fractura atrófica mandibular bilateral - Reporte de caso

Atrophic mandible fractures represent a clinical challenge due to both the peculiarities of the population involved and the management of a limited bone remnant. The choice of the type of osteosynthesis is guided by some criteria, including the degree of fracture comminution and the height of the bone remnant, where residual mandibular bone height <10 mm represents an important clinical challenge and is related to major postoperative complications. The aim of this study is to report the efficacy of the load-bearing osteosynthesis in a bilateral atrophic mandible fracture. An 86-year-old male patient, victim of a fall from his own height, evolving with a bilateral body fracture in the atrophic lower jaw. This fracture occurred adjacent to the endof a reconstruction locking plate installed 18 months ago to treat a fracture in the mandibular parasymphysis, requiring a surgical approach to removal the previous fixation and installation of two locking reconstruction plates in each fractured segment. Inthe six months of follow-up, no complication was observed. The uniqueness of this case reinforces the therapy with load-bearing plates and its clinical efficiency.

Management for the rehabilitation of atrophic mandible fracture: case using a conservative approach and short implants

The treatment of atrophic jaw fracture is a challenge in maxillofacial surgery, due to both local and systemic factors of the affected patients. This article aims to report a case of bilateral atrophic fracture of the mandible treated with an intraoral approach through a thinner and locked 2.0 mm system mandibular plate and subsequent rehabilitation with an implant- supported prosthesis. This technique provided the patient with excellent masticatory, aesthetic, and functional recovery with less morbidity and faster recuperation.

Atrophic mandible fracture due to dental implants: Case report

Atrophic mandible fracture due to dental implants: Case report

Management of Atrophic Mandibular Fractures in Pakistan – Changing Trends with Preference to Extra-Oral Approach

Background: With the ever-increasing incidence of facial trauma in geriatric population, it is very important to improve the care given to these patients. This study has been focused on determining a better approach for management of atrophic mandibular fractures.  Objective: To compare the frequency of complications of extra-oral versus intra-oral approach for the management of atrophic mandible fractures. Study Design: Randomized control trial. Settings: Outdoor patient of department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore Pakistan. Duration: One year, 20th January, 2018 till 20th January, 2019. Methodology: Seventy consecutive patients were included in this study from the OPD of Oral and Maxillofacial Surgery. All the patients were randomly assorted in the both groups, group A being the intra-oral approach and group B being the extra-oral approach. The outcome was determined on the basis of presence or absence of mal-union or non-union after the fractures were treated. Results: The mean age of cases in extra and intra oral group was 76.54±8.13 years and 73.66± 8.04 years. In extra-oral group, there were 21(60%) male and 14(40%) females and in intra-oral group, there were 25(71/4%) male and 10(28.6%) female cases. In extra –oral group 3(8.6%) cases had complication and in intra-oral group 2(5.7%) cases had complications, the frequency of complication in both groups, p-value >0.05. Among complications in extra-oral group 2(5.7%) cases had non-union and 1(2.9%) had malunion and in intra-oral group 1(2.9%) cases had non-union and malunion each. The frequency of type of complication was statistically same in both group, p-value >0.05.  Conclusion: The incidence of complications is statistically same in both groups. Hence, we encourage the use of extra-oral approach for management of atrophic fractures of mandible.

Atrophic mandibular fracture treatment: prototyping as a tool in surgical planning

Introduction: Atrophic mandibular fractures are injuries found in old age due to facial trauma. Its treatment is a challenge, even for experienced surgeons, due to the different approaches that can be taken from clinical decisions. Taking into consideration the limitations that the age presented by most of the affected patients brigs, there are devices that stand out by seeking benefits in terms of predictability and time gain in the intraoperative period. The additive manufacturing is a valuable resource in the surgical planning and rehabilitation of these patients. Objective: To expose a clinical case that demonstrates the success in the use of surgical planning through a prototype printed in 3D technology. Clinical case: Elderly woman, 75 years old, victim of a fall from her own height who had a bilateral atrophic mandible fracture due to facial trauma. The surgical procedure was planned using a prototype printed in 3D technology providing predictability and reduced surgical time. The patient evolved in the postoperative period without complaints, with function immediately restores and without signs of infection or plate exposure. Conclusions: Atrophic mandible fractures are still related to a challenging treatment, therefore, adequate surgical planning and the use of auxiliary strategies such as 3D prototyping provide greater predictability of results, as well as time gain during the intraoperative.

Atrophic jaw fracture and predictability in oral rehabilitation: case report

Introduction: The treatment of atrophic jaw fractures requires extensive knowledge by the maxillofacial surgeon. The correct diagnosis and planning optimize the possibility of oral rehabilitation towards many possible alternatives. The difficulty in repairing these fractures makes the treatment complex, in which normally invasive techniques are used. However; which give us satisfactory and predictable aesthetic-functional results. Objective: The objective of this work is to report an atrophic jaw fracture and posterior dental implants rehabilitation. Case report: A 53 years old female patient, victim of in face aggression referred to the emergency care. At the clinical examination, the patient had laceration in the upper lip region and the left side of the mandibular area, with bilateral mobility and paresis. In the oral examination, total lower and partial upper edentulism. After tomographic evaluation, a bilateral fracture of the mandibular body was confirmed, with significant bone fragments uneven. Surgery was performed with total transcervical access and use of reconstruction plate. After 90 days of follow-up, the oral rehabilitation with osseointegrated implants was performed. Conclusion: Complex atrophic mandible fractures in total edentulous patients can be treated with open reduction and stable fixation, allowing a faster return to normal function, improve of quality of life and assists in increasing safety for implant installation.KeywordsEdentulous jaw; Jaw fixation techniques; Dental implants.

Virtual surgical planning using free softwares in the treatment of bilateral severe atrophic mandible fracture: case report

Virtual surgical planning using free softwares in the treatment of bilateral severe atrophic mandible fracture: case report

Use of fibular graft for the treatment of atrophic mandible fracture

Background: Mandibles that present 5 mm or less at their most atrophic point are at high risk for spontaneous fractures. This change in bone volume after tooth loss results in decreased vascular supply from the endosteal and periosteum, as well as decreased potential for osteogenesis, which may compromise bone healing in this population group. The current treatment for atrophic mandible is commonly separated into closed reduction, external fixation and rigid internal fixation. Many surgeons have proposed the use of bone graft at the time of fracture treatment as a way to increase the probability of bone fusion.

The Edentulous Atrophic Mandible Fracture: A Case Report Supporting Use of Large Bone Plating Systems and Discussion of the Value of Identifying Patient Treatment Goals

The Edentulous Atrophic Mandible Fracture: A Case Report Supporting Use of Large Bone Plating Systems and Discussion of the Value of Identifying Patient Treatment Goals

Management of atrophic mandibular fractures: An Italian multicentric retrospective study

PurposeThe aim of this multicentric study was to retrospectively evaluate the surgical outcome of atrophic mandible fractures treated with open reduction and rigid fixation (ORIF), using load-bearing plates. Materials and methods55 patients from three trauma centers were retrieved for the study. Inclusion criteria were: edentulous patients with mandibular body fractures; mandibular body thickness <20 mm. Collected data included: cause of fracture; degree of atrophy (according to Luhr's classification); characteristics of the fracture; adequacy of reduction; postoperative complications. All patients were treated with ORIF, using 2.0 mm, large-profile, locking bone plates and 2.4 mm locking bone plates. No bone graft was used in any case. Results12 patients were classified as class I atrophy, 18 patients as class II, and 25 patients as class III. Mean mandibular height at the site of fracture was 12.8 mm (ranging from 5.4 mm to 20 mm). 22 were unilateral fractures and 23 were bilateral. Mild displacement was observed in 11 fractures, moderate in 34, severe in 16, and comminution was present in seven fractures. Adequacy of reduction was judged good in 62 fractures and poor in six fractures. Transient weakness of the marginal branch of the facial nerve was recorded in 11 patients and permanent weakness in two patients. All patients achieved a complete fracture healing. ConclusionExternal open reduction and rigid fixation (ORIF) with locking, load-bearing plates is a reliable and predictable treatment for atrophic edentulous mandible fracture. Immediate bone grafting should not be considered mandatory unless there is consistent bone loss.

Management of atrophic mandible fractures: an updated comprehensive review

AbstractObjectivesWith advances in healthcare leading to longer life expectancy, the edentulous geriatric population is increasing. Expectantly, head and neck trauma surgeons will encounter atrophic (edentulous) mandible fractures in their practice. The objectives of this paper are to review the prevalence, etiology, and diagnosis of atrophic mandible fractures with a descriptive discussion on the different methods of treatment.Materials and MethodsThe review included a search using PubMed (National Library of Medicine, NCBI) and Medline from 1950–2016 with keywords such as “atrophic mandible” with the addition of the words fracture and computerised guided technology and Virtual Surgical Planning (VSP).ResultsThis search produced 499 articles. Of those 499 articles, 18 were included in this critical review. Management discussion identified papers to provide the most powerful evidence in the decreasing order of strength by cohort studies, case‐control studies, surveys, and case‐series. The update provides new information on virtual surgical planning that will assist in time under general anaesthesia for complex case management.ConclusionsA comprehensive update reviewed all forms of treatment from soft diet to open reduction with computerised technology to provide head and neck trauma surgeons a better basis for clinical management of these fractures.

Atrophic Mandible Fractures: Are Bone Grafts Necessary? An Update

The management of atrophic mandibular fractures poses a challenge because of anatomic variations and medical comorbidities associated with elderly patients. The purpose of this article is to review and update the literature regarding the management of atrophic mandible fractures using load-bearing reconstruction plates placed without bone grafts. We performed a review of the English-language literature looking for atrophic mandibular fractures with or without continuity defects and reconstruction without bone grafts. Included are 2 new patients from our institution who presented with fractures of their atrophic mandibles and had continuity defects and infections. Both patients underwent reconstruction with a combination of a reconstruction plate, recombinant human bone morphogenetic protein 2, and tricalcium phosphate. This study was approved as an "exempt study" by the Institutional Review Board at the University of Kentucky. This investigation observed the Declaration of Helsinki on medical protocol and ethics. Currently, the standard of care to manage atrophic mandibular fractures with or without a continuity defect is a combination of a reconstruction plate plus autogenous bone graft. However, there is a need for an alternative option for patients with substantial comorbidities.Bone morphogenetic proteins, with or without additional substances, appear to be a choice. In our experience, successful healing occurred in patients with a combination of a reconstruction plate, recombinant human bone morphogenetic protein 2, and tricalcium phosphate. Whereas primary reconstruction of atrophic mandibular fractures with reconstruction plates supplemented with autogenous bone graft is the standard of care, in selected cases in which multiple comorbidities may influence local and/or systemic outcomes, bone morphogenetic proteins and tricalcium phosphate can be used as a predictable alternative to autogenous grafts.

Open Reduction and Internal Fixation of Bilateral Atrophic Mandible Fractures Utilizing Virtual Surgical Planning, Custom Cutting Guides and Reconstruction Plate. a Case Report

Open Reduction and Internal Fixation of Bilateral Atrophic Mandible Fractures Utilizing Virtual Surgical Planning, Custom Cutting Guides and Reconstruction Plate. a Case Report

Management of fractures of the atrophic mandible: a case series

This study aims to report the outcome of patients with atrophic mandible fractures. Atrophic mandible fractures in 11 patients (7 females and 4 males) were approached with a transcervical incision, and bone segments were stabilized with 2.7-mm reconstruction titanium plates and locking screws placed at the lateral border of the mandible. In 6 of the 11 cases, autogenous cancellous bone was used to repair a continuity defect or to augment the vertical height of the bone in the region of the fracture(s). No major intraoperative or postoperative complications were encountered in any patient. Two patients presented with postoperative infections that resolved with incision-drainage and antibiotics, and removal or replacement of the reconstruction plates or the bone grafts was not required. Treatment of atrophic mandible fractures can be performed safely and effectively with reconstruction plates, with or without bone grafting. The most conservative and predictable treatment in the long term is the definitive reconstructive surgical procedure to restore form and immediate function.

Surgical Management of Edentulous Atrophic Mandible Fractures in the Elderly

Fractures of the mandible occur with a greater frequency in the elderly. This study reports three cases of edentulous atrophic mandible fracture in elderly patients treated with open reduction technique. Three patients who presented with edentulous atrophic mandible fractures underwent surgical management using open reduction and internal fixation. After treatment, clinical evaluations and postoperative complications were examined with postoperative x-ray. Patients were followed with clinical and radiographic examinations. In the postoperative clinical evaluation, two male patients healed well, but one female patient complained of pain and swelling. In radiographic examinations, no union delay or lack of fusion was observed in the edentulous area. Open reduction technique is a viable treatment option for the edentulous atrophic mandible fractures in geriatric patients.

An unusual case of atrophic mandible fracture in a patient with osteogenesis imperfecta and on oral bisphosphonate therapy: Case report.

Fractures of severely atrophic (height<10mm) edentulous mandibles are infrequent and challenging to manage. Factors such as sclerotic bone and decreased vascularity combined with systemic diseases complicate the management of such fractures. Osteogenesis imperfecta (OI) is a heterogeneous group of inherited disorders of type I collagen metabolism. Patients with OI characteristically present with histories of long bone fractures, deformities, blue sclerae, and opalescent dentin. However, fractures of the facial skeleton are rare. Bisphosphonate therapy has been proven to effectively reduce the fracture risk in patients with OI. The purpose of this clinical report is to present an unusual case of spontaneous fracture of the atrophic mandible in a patient with OI. Despite open reduction and internal fixation (ORIF) with miniplate osteosynthesis, the patient developed a second fracture at a screw placement site distal to the first fracture. The patient was successfully treated with ORIF using locking reconstruction plates fixed in the symphyseal and angle regions. Bone healing following ORIF was normal, and no clinical sign of osteonecrosis as a result of bisphosphonate therapy was observed. Patients with OI can present with spontaneous fractures of already weakened mandibles. Although such fractures can be managed with care using established protocols, further research is required to examine the effects of concomitant medication, such as bisphosphonates.

The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures

The role of the titanium functionally dynamic bridging plate (TFDBP) in the fracture treatment of the severely atrophic mandible was assessed retrospectively. In 28 consecutive patients with fractures of a severely atrophic mandible fixation was carried out with TFDBPs. Twenty-one patients with 27 fractures were included in the study and then followed up for complications and the progress of fracture healing for 17 months postoperatively on average. There was only one case that required plate removal. All patients showed bone healing 3 months after surgery. The mental nerve sensation improved in 12 out of 23 fractures that had presented with nerve function disturbance. Every patient who had dentures prior to sustaining the fracture was able to return to denture wearing 3 weeks after surgery. No major complications occurred. A high proportion of bone healing with a low complication rate was observed with the use of TFDBPs in the treatment of severely atrophic mandible fractures. The TFDBP is an excellent alternative to conventional plating of the severely atrophic mandible.

Effect of the number of screws on the stability of locking mandibular reconstruction plates

Atrophic mandible fractures are frequently a challenge to stabilize. This study evaluated, through mechanical testing in vitro, the number of locking screws that is sufficient to withstand loading when applied with a locking reconstruction plate in the fixation of atrophic mandible fractures. Polyurethane mandibles with a simulated linear fracture at the midline were used as substratum. Results show that resistance of the fixation is poor when one and two screws are used on each side of the fracture. Three screws on each side of the fracture significantly increases the resistance to displacement. However, no additional strength is added to the construct when more than three screws per side are used.