Bilateral Mandibular Fractures Research Articles

Postoperative Intermaxillary Elastic Traction Contributes to the Stability of Absorbable Plates Fixation for Bilateral Mandibular Fracture.

The use of absorbable plates can be challenging for mandibular fractures involving bilateral dentition. Chewing and mouth opening movements may cause loosening or breakage of absorbable materials, leading to displacement of bone segments and resulting in malocclusion. The use of absorbable materials for bilateral mandibular fracture surgery itself raises concerns for surgeons. Timely intermaxillary elastic traction is essential for these patients after surgery to maintain correct occlusion. The surgical approaches were performed with intraoral mandibular sulcus incisions. During the surgery, intermaxillary fixation screws were implanted and steel wires were used for intermaxillary ligation and fixation to restore the occlusal. After the fractured segments were sequentially reduced, they were fixed with inion 2.0 absorbable plates. The patient underwent intermaxillary elastic traction for 1 week. Elastic mask was used to assist in stabilizing the position of the jawbone and maintaining occlusion. After discharge, the patient continued traction at home for 3 weeks before removing the intermaxillary fixation screws. The patient recovered well after surgery without any complications. The postoperative occlusal relationship is good. Postoperative CT showed good reduction of the fractured segments. For the case reported in this article, elastic traction was promptly implemented after surgery. We emphasize that restoring occlusion is always the treatment goal for jawbone fractures. We believe that keeping the intermaxillary fixation screws for a month is a wise choice to be prepared for unexpected needs.

Partially Edentulous Arches and Bilateral Mandibular Fracture: Application of Condensation-Silicone Bite Block-Splint, Mandibulo-Maxillary Fixation Screws, and Elastics for Intraoral Immobilization

Each mandibular fracture is unique. It requires individual treatment solutions due to different number of fracture sites, fracture terms, level of dislocation, presence/absence of the infection, number, location, and condition of teeth, etc. Management of jaw fractures in partially edentulous arches are even more complicated and typically can involve assistance of a dental technician. Published English language literature lacks information about application of condensation silicone (C-silicone) bite block-splint with mandibulo-maxillary fixation (MMF) screws and elastics for management of bilateral mandibular fracture. This is why we present this novel technique developed by our team based on fracture treatment in a 38-year-old male partially edentulous patient. Also, we introduce a Kyiv’s Modification of the Kennedy Classification System of the partially edentulous arches useful for mandible fracture cases. The Kennedy–Kyiv Classification System considers the non-treated teeth roots as supporting locking points (temporary additional retention points) that increase the stability of the bite block-splint and decrease probability of micromovements. Moreover, it contraindicates extracting such teeth roots immediately before the block-splint fixation as extraction of such roots can provoke the alveolar osteitis upon the fracture site(s) healing and immobilization period what will increase the risk of the block removal for the treatment of osteitis. A review of published MMF techniques and appliances designed for mandible fracture treatment is performed. Multiple appliances for partially and totally edentulous mandibles are considered as well as for the dentulous jaws. The Gunning-type splints and its modifications were considered. An in-chair fabrication of C-silicone bite block-splint and its combined application with MMF screws and elastics is a novel alternative for the Gunning splint. This appliance allows to decrease the time typically required for the Gunning splints fabrication, decreases number of the involved specialists, decreases cost of treatment, and easy for performance.

Two pediatric cases of bilateral mandibular condylar fracture with follow-up of morphological recovery process of the condyles

Two pediatric cases of bilateral mandibular condylar fracture with follow-up of morphological recovery process of the condyles

Rigid versus non-rigid fixation for bilateral mandibular angle fractures: a retrospective multicentre review.

Fractures involving the bilateral mandibular angle are an uncommon occurrence with limited evidence to inform the ideal fixation requirements for adequate treatment. The aim of this study was to evaluate the outcomes of managing bilateral mandibular angle fractures and determine if rigid fixation on one side improves outcomes compared to bilateral non-rigid fixation. Patients with isolated bilateral mandibular angle fractures surgically treated at the Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Gold Coast University Hospital and Townsville University Hospital between January 1, 2010 and December 31, 2022 were retrospectively identified. Data collected included patient demographics, mechanism of injury, fixation scheme, postoperative occlusion and the occurrence of postoperative complications and subsequent management. Eighty-four patients met the inclusion criteria. Fifty-two patients had non-rigid fixation applied to both fractures, and thirty-two had rigid fixation placed on at least one side. All cases proceeded to union. There was no statistically significant difference between the groups for occlusal outcomes, wound dehiscence, infection or plate or screw loosening. Our results suggest that bilateral non-rigid fixation can be used to treat bilateral mandibular angle fractures in the appropriate clinical context.

Bilateral Condylar Fracture: A 10-Year Case Report Follow-Up after a Conservative Myofunctional Approach

Mandibular condylar fractures can be approached with invasive techniques, such as surgical repositioning and fixation of the fractured condyle, or with conservative techniques using myofunctional appliances. Recent publications recommend non-invasive or conservative approaches when treating mandibular condylar fractures, as they may produce more stable results and fewer consequences. However, to the knowledge of the authors, there is no long-term follow up publications of clinical cases treated with a conservative approach. This report presents a ten-year follow-up of a case report published two years ago by the same authors. In the previous report, the authors showed an eleven year-old girl treated with a myofunctional appliance due to a bilateral mandibular condylar fracture. The treatment produced a stable result over the following ten years with the patient not using any appliance after the myofunctional treatment was completed. The benefits of a conservative treatment, as well as the consequences of mandibular condylar fracture, such as a heart shaped mandibular condyle, are discussed here by the authors.

Long-term results of the restoration of the mobility of the mandible after fractures and prolonged immobilization

BACKGROUND: Fractures of the lower jaw accounts for up to 85% of the total number of fractures of the facial bones. Its damage leads to the formation of temporary and persistent functional disorders of the stomatognathic apparatus. Understanding the regularities of the processes of restoring the motor functions of the mandible and chewing apparatus is necessary for planning and improving rehabilitation programs in these patients.
 AIM: To examine the degree and rate of restoration of the amplitude of movements of the mandible in the long-term period of the rehabilitation stage of patients with mandibular fractures.
 MATERIAL AND METHODS: A prospective study was conducted on 40 patients with unilateral and bilateral mandibular fractures, who made up two groups depending on the volume of treatment according to current clinical protocols: group 1 included 22 people who underwent double-jaw splinting during treatment, and group 2 included 18 people who, according to indications, also underwent osteosynthesis of the mandible with subsequent intermaxillary immobilization in the postoperative period. One year after the removal of splinting structures, all mobile patients underwent a clinical assessment of the range of motions of the lower jaw.
 RESULTS: Even 1 year after the successful treatment of patients in the acute period of trauma, despite the implementation of myogymnastics in the rehabilitation period, the range of motions of the lower jaw remains limited. In group 1, after 1 year of observations, the average values correspond to the lower limits of the norms according to literature data: opening, 4.35 cm; with protrusion, 0.78 cm; laterotrusion with unilateral fractures in the damaged side, 0.95 cm; intact, 0.91; bilateral, the damaged side 1 (right), 0.86 cm, damaged side 2 (left), 0.86 cm. In group 2, during the observation period, these indicators remained significantly lower, not reaching the limits of the norm in any case. Moreover, in both groups, their values were significantly lower than those of the healthy volunteers
 CONCLUSIONS: Data obtained on the patterns of restoration of the range of motion of the lower jaw after sustaining a fracture and prolonged immobilization in the long-term justify the need to develop and conduct mandatory early comprehensive rehabilitation measures. Their clinical effectiveness should be confirmed from the standpoint of evidence-based medicine, which enables the comprehensive assessment of the function of the stomatognathic apparatus. This study established indicators that can be considered control criteria when performing relevant studies.

Rigid versus non-rigid fixation for bilateral angle of mandible fractures: A 10 year perspective

BackgroundBilateral mandibular angle fractures are an uncommon occurrence. Optimal management of bilateral angle fractures is controversial and owing to the rarity of the presentation, limited evidence regarding fixation strategies exists. MethodsA retrospective chart review of patients treated at three tertiary hospitals in Western Australia between January 2008 and June 2018 was performed. Patient demographics, injury mechanism, fixation type and the use of intermaxillary fixation were recorded. Rigid fixation (increased plate thickness (>1mm), additional screws/plate length/additional plates) was compared against the complication rates between non-rigid fixation (Champy's load-sharing/mini-plate fixation principles). Primary end-points were complications requiring a return to theatre during the follow-up period. ResultsDuring the study period, 2458 patients were managed with open reduction internal fixation. Fifty-eight bilateral angle of mandible fractures were identified, representing 2.4% overall. Nine patients had a complication during follow-up with 8 requiring a return to theatre for treatment. Statistical analysis demonstrated no increase in complication in either group. ConclusionsThis study represents the largest review of patients with bilateral mandibular angle fractures. Given no increase in complication rates, it is suggested that the surgeons preference, incorporating fracture and patient factors be considered in determining the need for either rigid or non-rigid fixation for this particular fracture pattern.

Predicting Difficult Airway Intubation Based on Maxillofacial Trauma: A Retrospective Study.

PurposeThe purpose of this study was to determine which types of facial injuries in traumatic patients' wounds cause difficult intubation for anesthesiology team. By anticipating potential complications with airway management, the surgeons can be better prepared for emergent cricothyrotomy if needed. This could include prior to the planned procedure in the operating room (OR) as well as in emergent conditions in trauma bay.MethodsTrauma patients with facial injuries in a level II trauma center from January 2007 to September 2017 that required intubation were evaluated for types of facial injury. Anesthesiology intubation documents were reviewed to determine which types of facial injuries were associated with difficult intubation per anesthesiology documentation.ResultsA total of 232 subjects were selected and it was found that patients with LeFort II facial fracture, bilateral mandibular fracture, and facial fracture associated with basilar skull fracture were noted to have difficult intubation by the anesthesiology team.ConclusionOn the basis of CT imaging findings, our study demonstrates that certain types of facial fractures could pose difficult intubation. Surgeons should be aware of these injuries and be ready to intervene with emergent cricothyrotomy if necessary.

Leriche syndrome diagnosed due to polytrauma: a case report

BackgroundLeriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT).Case presentationA 61-year-old Asian male was driving a passenger car and had a head-on collision with a dump truck that required an emergency call. The patient was transported to our hospital in a doctor’s helicopter. Physical examination revealed the following vital signs: respiratory rate, 23 breaths per min; SpO2, 98% under a 10-L administration mask; pulse rate, 133 beats per min; blood pressure, 142/128 mmHg; Focused Assessment with Sonography for Trauma, positive; Glasgow Coma Scale assessment, E3V5M6; and body temperature, 35.9 °C.Trauma pan-scan CT showed bilateral mandibular fractures, bilateral multiple rib fractures, bilateral pneumothorax, sternal fractures, hematoma around thoracic spine, small bowel perforation, mesenteric injury, right clavicle fracture, right ankle debridement injury, and thrombotic occlusion from just above the abdominal aortic bifurcation to the bilateral common iliac arteries. Although thrombotic occlusion needed to be differentiated from traumatic aortic injury, the presence of collateral blood vessels led to the diagnosis of Leriche syndrome, and conservative treatment was performed.Damage control surgery was required for the small bowel injuries. From the second day of admission, the patient was treated with continuous intravenous heparin and prostaglandin preparations. However, impaired blood flow and reperfusion injury in the right lower extremity progressed. On the fifth day of admission, right thigh amputation was performed. The patient required renal replacement therapy for 2 weeks starting from the third day of admission.ConclusionsIn this case, conservative therapy was initially chosen for Leriche syndrome. However, the complex factors in the acute phase of trauma led to development of hemorrhagic necrosis, requiring amputation of the lower extremity. Our findings indicate the need to carefully consider the unique factors affecting Leriche syndrome patients when considering treatment indications and choices for trauma.

Three-dimensional biomodel in the treatment of bilateral mandibular fracture sequelae: a case report

Mandibular fractures lead to changes in occlusion, aesthetic deformities and functional alterations, when untreated, their sequelae may cause permanent problems, leading to a more complex treatment than the acute trauma. The treatment offers challenges that can be minimized with the aid of biomodels, printed by 3D technology. This article aims to report a biomodel-assisted surgical procedure for mandibular reconstruction, arguing how these prototypes may help to achieve better outcomes. The patient was involved in an automobile accident and sought treatment for the sequelae of mandibular fractures two years after the initial trauma. The biomodel printing of her mandible allowed for the execution of surgery on the model, reestablishing correct occlusion and facial aesthetics, and helping shorten the surgical time through the pre-bending of reconstruction plates. The patient improved uneventfully. The use of biomodels must be encouraged, especially in cases where the patient shows sequelae, when the anatomical landmarks are compromised, they offer more predictability for treatment outcomes, as described on this case report.

Could mandibular fractures lead to obstructive sleep apnea?

ABSTRACT Objective To detect and assess obstructive sleep apnea (OSA) before and after repair of different types of mandibular fractures. Methods In patients with traumatic isolated mandibular fractures who were indicated for open reduction and internal fixation (OR/IF), polysomnography (PSG) was done before and 3 months after surgery. Results Of 51 patients (80 mandibular fractures), fractures were unilateral in 29 patients (56.9%) and bilateral in 22 patients (43.1%). PSG was normal in 33 patients (64.7%), and OSA was detected in 18 cases (35.3%); all had bilateral fracture. Mild OSA was reported in 9 cases (17.65%), and moderate OSA was detected in 9 cases (17.65%). Three months after OR/IF of the fractures, successful reduction was obtained, and PSG was within normal limits in all patients. Conclusion Bilateral mandibular fractures often lead to OSA, which could be cured with proper OR/IF of the fractures. OSA is not encountered in unilateral fractures.

Outcomes of functional treatment of condylar mandibular fractures with an articular impact: a retrospective study of 108 children

IntroductionThe treatment of fractures of the mandibular condylar process remains controversial, especially in children. The aim of this study was to assess the long-term clinical and radiographic outcomes of functional treatments for mandibular condylar fractures with an articular impact. Materials and MethodsYoung patients (< 15 years of age) presenting with either a unilateral or a bilateral mandibular fracture of the condylar process were included in this retrospective study. The clinical analysis focused on investigation of joint amplitudes at 1, 2, 6, 12, and 24 months after the beginning of the treatment, and at the end of their physical growth for the long-term study. Other clinical parameters included temporomandibular joint (TMJ) disorders and facial asymmetry. Photographs of patients and panoramic X-rays were assessed to identify any growth disorders at the end of the follow-up. ResultsOne hundred and eight patients were included in this study, and 33 patients who were no longer undergoing mandibular growth at the time of the last follow-up were included in the long-term study. The mean age at the time of the trauma was 9.33 years, and the mean follow-up was 82.2 months. A significant improvement was observed in the maximal mouth opening (MMO), diduction, and propulsion in the first months after the trauma, reaching 44.31 mm (p < 0.0001), 10.50 mm (p = 0.0001), and 6.33 mm (p = 0.01), respectively, at 6 months. Three patients experienced a clinical posterior vertical insufficiency, one of which required a surgical procedure, while four patients exhibited a ramus asymmetry of up to 10 mm, albeit with no clinical consequences. One case of TMJ ankylosis was noted. ConclusionOur study suggests that functional treatment is appropriate for fractures of the mandibular condyle with an articular impact in children, as it promotes mandibular growth and good functional recovery. Children have to be followed up, however, until completion of growth.

Utilization of Platelet-Rich Plasma (PRP) to Reconstruct Bilateral Mandibular Defects

Background: Platelet-rich plasma (PRP) plus bone substitute matrix used to repair defects in the viscerocranium has been demonstrated to be equally as effective at regenerating bone as autografts. The creation of fewer surgical sites, reduced operative and recovery time, and infection prevention are all potential benefits of this novel approach, especially for patients with conditions that complicate surgical management and recovery. Case presentation: A 33-year-old male with schizophrenia presented with trauma-induced bilateral mandibular fractures. Premorbid mental health factors and a complicated clinical trajectory precluded traditional management using bone autografts to repair mandibular defects and restore occlusive alignment. Instead, a composite matrix consisting of cadaver-derived bone chips and PRP was used to span 1 and 1.5 cm mandibular gaps. No complications were identified and occlusion with adequate alignment and function was achieved. Conclusion: We report the first patient to undergo surgical repair for multiple trauma-induced mandibular bone defects using a matrix made only of bone substitute and PRP.

Surgical management of bilateral mandibular fracture in Buffalo

Surgical management of bilateral mandibular fracture in Buffalo

Application of Plate and Circumferential Wiring with Resin to Bilateral Mandibular Fractures in a Calf: Case Report

Application of Plate and Circumferential Wiring with Resin to Bilateral Mandibular Fractures in a Calf: Case Report

Management of bilateral mandibular fracture in a medically compromised patient: A case report

Management of bilateral mandibular fracture in a medically compromised patient: A case report

Open Reduction and Internal Fixation of Double Bilateral Mandibular Fractures: A Multicenter Randomized Controlled Trial

Open Reduction and Internal Fixation of Double Bilateral Mandibular Fractures: A Multicenter Randomized Controlled Trial

Surgical Management of Bilateral Mandibular Angle Fractures With a Third Molar in Line of Fracture: A European Multicenter Survey

The aim of this survey was to investigate the surgical management of bilateral mandibular angle fracture (BMAF) in Europe. Data were collected from 2008 to 2018 on patients ≥ 16years of age who underwent open reduction internal fixation (ORIF) for BMAF with a third molar in the fracture line. The study was conducted at 6 European trauma centers. The following data were recorded: sex, age, cause of the fracture, type of fracture (nondisplaced, displaced, comminuted), type of approach (intraoral, transbuccal, or extraoral), thickness of the plate (≤1.4mm or ≥1.5mm), number of plates, cause of plate removal, and third molar extraction status. 25 patients with BMAF (24 males, 1 female, 17 to 83years old [mean: 28.2years]) were collected. The main cause of BMAF was assault, and the main surgical approach was intraoral. The most common types of BMAF were displaced+undisplaced (11 patients), displaced+displaced (7 patients), undisplaced+undisplaced (6 patients), and comminuted+comminuted (1 patient). Osteosynthesis was performed with 2 ≤1.4mm plates on 1 angular fracture and 1 ≤1.4mm plate on the other fracture in 11 patients, 1 ≤1.4mm plate on both angular fractures in 6 patients, 1 ≥1.5mm plate on both fractures in 5 patients, and 2 ≤1.4mm plates on both fractures in the remaining 3 patients. Out of 25 patients with BMAF, 7 third molars were extracted during ORIF. Among these patients, angular fracture fixation was performed in 3 cases with 1 ≥1.5mm plate and in 4 patients with 2 ≤1.4mm plates. This retrospective multicenter survey indicates a trend of treating with open reduction and rigid internal fixation at least 1 angular fracture of BMAF and those cases requiring extraction of the third molar in the line of fracture.

Use of adrenaline continuous infusion to treat hypotension during general anaesthesia in a cow and a calf

BackgroundHypotension is one of the most common complications observed during inhalation anaesthesia in veterinary patients. Treatment of hypotension in cattle is more challenging than in other species, owing to the limited number of drugs licensed in food producing animals. The use of adrenaline as an infusion to support blood pressure has not been described previously in bovines.Case presentationA cow and a calf presented to University College Dublin Veterinary Hospital for bilateral mandibular fracture repair and bladder rupture repair respectively, developed severe anaesthetic related hypotension unresponsive to conventional treatments. In both cases an adrenaline infusion was started and slowly increased to effect, with infusion rates ranging from 0.01 to 0.25 μg/kg/min. Blood pressure increased as the adrenaline infusion rate increased, but clinically significant improvements in blood pressure were only observed with infusion rates exceeding 0.05 μg/kg/min. The side effect observed with adrenaline infusion was an increase in plasma lactate levels in both cases. Both animals were euthanised due to non-anaesthetic related complications.ConclusionsMaintenance of normotension is important during bovine anaesthesia to prevent the development of post-anaesthetic complications. In the cases described here, adrenaline was effective as an additional treatment of anaesthetic related hypotension. Further research is required to establish the recommended infusion rates, cardiovascular effects and possible side effects of adrenaline infusion administration as a treatment for hypotension in bovines.

Combination of Rigid and Nonrigid Fixation Versus Nonrigid Fixation for Bilateral Mandibular Fractures: A Multicenter Randomized Controlled Trial

We aimed to compare complication rates and functional outcomes in patients with bilateral mandibular fractures treated with different degrees of internal fixation rigidity. This international, multicenter randomized controlled trial included adults with bilateral mandibular fractures located at either the angle and body, angle and symphysis, or body and symphysis. Patients were treated with either a combination of rigid fixation for the anterior fracture and nonrigid fixation for the posterior fracture (mixed fixation) or nonrigid fixation for both fractures. The primary outcome was complications within 6weeks after surgery. Secondary outcomes were complications within 3months, Helkimo dysfunction index, and mandibular mobility at 6weeks and 3months after surgery. Of the 315 patients enrolled, 158 were randomized to the mixed fixation group and 157 to the nonrigid fixation group. The overall complication rate at 6weeks in the intention-to-treat population was 9.6% (95% confidence interval [CI], 5.3% to 15.6%) in the mixed fixation group and 7.8% (95% CI, 4.0% to 13.5%) in the nonrigid fixation group. With an unadjusted odds ratio of 1.25 (95% CI, 0.51 to 3.17), there were no statistically significant differences in complication rates between the 2 groups (P=.591). A multivariable model for complication risk at 6weeks found no significant differences between treatment groups, but patients with moderate or severe displacement had a higher complication rate than those with no or minimal displacement (adjusted odds ratio, 4.58; 95% CI, 1.16 to 18.06; P=.030). There were no significant between-group differences in complication rates at 3months. Moreover, no significant differences in Helkimo dysfunction index and mandibular mobility index at 6weeks and 3months were found between groups according to treatment allocated and treatment received. A combination of rigid and nonrigid fixation in patients with bilateral mandibular fracture has similar complication rates and functional outcomes to nonrigid fixation for both fractures.