Atrophic Mandible Fractures Research Articles

The comparison of angular and curvilinear marginal mandibulectomy on force distribution with three dimensional finite element analysis

AimThe purpose of this study was to analyse and compare right angled and curved osteotomy design on stress distribution and to determine an osteotomy design which decreases the risk of pathologic fracture. Patients and methodsSolid mathematical model of the mandible was created by three dimensional finite element analysis and two different osteotomy, right angled and curvilinear osteotomy was performed on model. 150 N incisal force vertically and 250 N molar force to the angulus area oblically were applied. The effects of osteotomy types to the stress formation and risk of fracture between models were evaluated. ResultsRight angled osteotomy causes much more stress in the posteroinferior quadrant and mainly localized on the horizontal and vertical osteotomy intersection area. On the other hand, the distribution of the stress on curvilinear formed osteotomy shows posteroinferior localization and stress spreads wider area. Furthermore the amount of stress was less than right-angled one. ConclusionIn this study, curved osteotomy denominated less stress distribution. The shape of osteotomy might be a factor to decrease the risk of postoperative atrophic mandible fracture.

Fracture of the Atrophic Mandible: Case Series and Critical Review

Atrophic mandible fracture is common among elderly patients. Such fractures present management difficulties related to anatomic and physiologic alterations in this population. The purpose of this study was to evaluate the results of this type of fracture treatment and to realize a critical review of literature on the subject. The sample was obtained from records of patients of Restauração Hospital (Recife, Brazil) who underwent surgical treatment of atrophic mandible fracture between 2006 and 2009. Data, such as etiology, location, and degree of displacement of the fractures, as well as access, type of fixation used, and the presence of postoperative complications, were analyzed. Successful bone union was achieved in 100% of cases. Complications were related to those patients treated with reconstruction plates (2.4 mm). Open reduction and internal fixation with miniplates seem a feasible option for primary treatment of atrophic mandible fractures without comminution or loss of substance. The level of scientific evidence for the treatment of atrophic mandible fractures is low.

Management of Atrophic Mandible Fractures: Are Bone Grafts Necessary?

Management of Atrophic Mandible Fractures: Are Bone Grafts Necessary?

Macroplate fixation of fractures of the edentulous atrophic mandible: immediate function and masticatory rehabilitation

The present study aimed at evaluating the treatment outcome of fractures of the edentulous atrophic mandible by means of an extraoral approach using open reduction and internal fixation with macroplates. Eighteen patients with 21 fractures of the atrophic mandible, who had been treated between 1997 and 2006, were retrospectively analysed. Mandible height was categorised according to the Luhr classification and the patients' general health (The American Society of Anesthesiologists (ASA) classification). Three types of titanium macroplates were used. Demographic data, treatment outcomes and the pre- and postoperative ability to wear mandible dentures were evaluated. The study population consisted of five men and 13 women with a median age of 78 years. The mean follow-up duration was 28 months. The most common cause of fractures was accidental falls (50%); the mandible was affected in 77.8%. Three fractures occurred in class I (bone height 15-20 mm), seven in class II (10-15 mm), and 11 in class III atrophy (<10 mm). According to the ASA classification, the collective showed a mean value of 3. An overall complication rate of 16.7% was noted, consisting of two minor and one major complication that required a second intervention. Five patients needed removal of the osteosynthesis material for prosthetic reasons. Only 50% of the patients were able to wear their dentures before surgery, and all but one were able to wear their prosthesis postoperatively. Treatment of atrophic mandible fractures with macroplates by means of an extraoral approach showed good results and a low complication rate. This procedure allows elderly patients to instantly load the mandible in the means of prosthetic and masticatory rehabilitation, preventing the necessity for second interventions.

Treatment of Atrophic Mandibular Fractures Based on the Degree of Atrophy—Experience With Different Plating Systems: A Retrospective Study

The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems. Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach. In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively. Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height.

Resorbable mesh as a containment system in reconstruction of the atrophic mandible fracture

Purpose The purpose of this article is to introduce the use of a resorbable material ( l-lactide, Co dl-lactide) to help contain the bone graft used during the reconstruction of the edentulous atrophic mandibular fracture. Technique After the mandibular fracture was reduced and fixated with a large reconstruction plate, the resorbable mesh was contoured with scissors and a hot water bath. The mesh was secured into position with 1.5-mm tacks to the inferior border or buccal cortical plate of the mandible. The material was then filled with particulate bone graft harvested from the medial aspect of the anterior iliac crest. Results Two patients had augmentation of the superior aspect of the mandible and one patient had augmentation of the inferior aspect of the mandible. All patients were augmented at least 10 to 12 millimeters. The mean follow-up was 25 months. All went on to heal to complete bony union. Conclusion This material can be used as a containment system when bone grafting the edentulous atrophic mandible fracture.

Fibula microvascular free tissue reconstruction of the severely comminuted atrophic mandible fracture—case report

Severely atrophic comminuted fractures of the mandible often have inadequate bone stock available to allow for adequate rigid fixation and subsequent progression to union. Grafting with rib, iliac crest or a variety of allograft materials is required in order to increase the success rate of the repair in this patient population. In this article, we report our favourable experience in using a fibula microvascular free tissue transfer for the treatment of a particularly challenging patient with a fractured atrophic mandible. Secondary implant rehabilitation completed the reconstruction. This method may represent an alternative in the treatment of fractures of the severely atrophic mandible in select individuals.