Line Of Mandibular Angle Fractures Research Articles

Should Degree of Third Molar Eruption Influence Operative Management of Mandibular Angle Fractures? A Systematic Review.

Systematic review. There is a growing trend toward evidence-based management of third molars in the fracture line of mandibular angle fractures (MAFs). This study aimed to differentiate MAF fixation complications by degree of third molar eruption and by extraction strategy in patients undergoing Champy fixation. PubMed, EMBASE, OVID, SCOPUS, the Cochrane Library, and clinicaltrials.gov were queried through May 2020 for English-language publications for MAFs with third molar involvement for this systematic review. Bias was assessed using author-defined criteria. Relative risk (RR) of post-operative complications associated with extracted unerupted and retained partially erupted third molars (Group I) was calculated against controls of retained unerupted and extracted partially erupted third molars (Group II). Ten studies reported complications by eruption or extraction; however, only one study stratified complications by both eruption and extraction to meet inclusion criteria. The risk of bias was medium as only cases meeting defined follow-up were included. 73 cases (N) were included: 34 qualified for Group I and 39 for Group II. Quantitative synthesis of individual case data demonstrated significantly higher complication rate in Group I compared to Group II (23.5% vs 5.1%) (RR 4.6, 95% CI 1.04-20.1). No significant differences were observed between groups for infectious complications, mechanical complications, nonunion, or dehiscence. Reoperation was required significantly more often for Group I (P = .043). For MAFs involving the third molar, concomitant extraction of unerupted as well as retention of partially erupted third molars increases risk of complications with Champy fixation technique. For these patients, alternative strategies for fixation should be considered.

Surgical Management of Mandibular Angle Fractures: Does the Extraction of the Third Molar Lead to a Change in the Fixation Pattern? A European Multicenter Survey

The authors conducted a retrospective, multicenter study to investigate the differences in the fixation patterns, in terms of number and thickness of plates, between patients in whom a third molar (3M) was maintained or removed in the line of mandibular angle fractures. The study was conducted in 6 European level I and II maxillofacial trauma centers. Data were collected on patients ≥ 16years of age who underwent open reduction internal fixation (ORIF) for mandibular angle fractures (MAF) from 2008 to 2018, in whom a 3M in the fracture line was present and who had a follow-up duration of 6months. The study population was divided into 2 groups: patients treated with ORIF in whom the 3M was maintained (group 1) and those treated with ORIF in whom the 3M was extracted (group 2) during treatment. The 2 groups were compared for differences in the internal fixation pattern, specifically in terms of the number and thickness of the plates. A total of 749 patients with 774 MAF were collected. A total of 1,050 plates were placed: 849 were ≤ 1.4mm thick (80.9%) and 201 plates≥1.5mm thick (19.1%). 548 patients were treated with ORIF and 3M maintained (group 1), and 201 treated with ORIF and 3M extracted (group 2). Statistically significant differences were seen in the number of ≤1.4mm plates between the 2 groups for single undisplaced/displaced MAF(P value≤0.5) and for undisplaced/displaced angle+parasymphysis/body fractures (P-value≤0.5). Analyses of data collected from 6 European maxillofacial centers indicated that the majority of surgeons of our sample perceived the MAF as being more unstable when removing the 3M during ORIF leading them to perform a rigid fixation in the angular region.

Complication rates in angle fractures with or without retaining third molars: A comparative study

Aim: The aim of this study is to assess whether the third molar in the line of mandibular angle fracture predisposes to post-operative infection, which further may lead to implant retrieval. Materials and Methods: Surgically rehabilitated cases of mandibular angle fracture at our center Sanjay Gandhi institute of trauma and orthopedics from 2016 to 2019 were considered in the study. During this period 49 cases were followed up for over a period of 6 months at 3 moths and 6months interval. All the cases were operated by the same surgeon using universal aseptic precautions using semi- rigid fixation. Results: Out of 49 cases, 20 cases the third molar was removed and in 29 cases the third molar was retained. The mean age group of the population of the study was 33.67 (18 to 60 years), out of which majority of the cases 93.9%(46) were male patients and 6.3%(3) were female patients. The main etiology of the cases were attributed to RTA. 96.3%. At the end of the 6 months follow up it was noted that 4 plates in case of retained group and 2 plates in removed group. In the 3 month follow up in 4 cases of the retained third molar was extracted due to signs of infection. When the tooth in question was removed, infection did not occur. At the 3rd to 6 month follow another 4 retained third molars were extracted along with implant retrieval. Statistically the relationship between the two groups were analyzed using Chi-square test bivariate statistics. A P ? 0.05 was taken as significant. Conclusion: In our study we could not provide any concrete evidence to form a protocol for the management for the third molar in the line of mandibular angle. Retaining the third molar in the line of fracture has an increased chance of post-operative infection. We would like to conclude that partially impacted tooth are best to be removed during the procedure for better outcomes provided the fractured segments stability is maintained. Until an algorithm is set for the management of the third mola

Management of Teeth in the Line of Mandibular Angle Fractures Treated with Open Reduction and Internal Fixation: A Systematic Review and Meta-Analysis.

Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction. PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar. Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent). The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.

Effect of third molars in the line of mandibular angle fractures on postoperative complications: systematic review and meta-analysis

The aim of this systematic review was to verify whether the presence of a lower third molar in the mandibular angle fracture line is associated with postoperative complications. An electronic survey was conducted in five databases. Eligibility criteria included observational and experimental studies that evaluated the association between the presence of the lower third molar in the fracture line of mandibular angle fractures and possible postoperative complications, including infection, paresthesia, necessity of plate removal, temporomandibular joint disorders, malocclusion, dehiscence, and non-union. Thirty-four papers were included in the qualitative analysis and 26 of those in the meta-analysis. The risk of bias of observational studies was assessed by Newcastle–Ottawa scale and of the clinical trials by Cochrane Collaboration risk-of-bias tool. Absence of the third molar was associated with a lower chance of postoperative infection in angle fractures compared to presence of the tooth (odds ratio 0.55, 95% confidence interval 0.34–0.88). No statistically significant difference between the groups was found for the other outcomes evaluated. The findings of this systematic review suggest that the absence of the third molar in the mandibular angle fracture line is associated with a lower postoperative infection rate when compared to angle fractures with a third molar present.

The influence of third molars in the line of mandibular angle fractures on wound and bone healing.

The objective of this study was to evaluate postoperative complications after removal or retention of the third molar in the line of mandibular angle fractures. This retrospective study included the data of 98 patients with a molar in the line of a mandibular angle fracture treated with internal reduction and mini-plate fixation at our department over 9years. Patients were classified into two groups: tooth removal during osteosynthesis (n = 45) and tooth retention (n = 55). The primary target criterion was the incidence of minor (outpatient treatment, local measures) and major (surgical revision, rehospitalisation) complications. Time between trauma and surgery was 1.4days (range 0 to 12), and the average follow-up 291days (range 66 to 863). Regarding the eruption status, 26 of 52 (50.0%) impacted third molars, 11 of 19 (57.9%) incompletely erupted and 8 of 27 (29.6%) completely erupted molars had been removed during open reduction. Overall, 17 (17.3%) patients had postoperative minor (n = 7) or major (n = 10) complications, in detail 10/45 (22.0%) patients after tooth removal and 7/55 (13%) patients after tooth retention (p = 0.286). Complication rates between impacted and incompletely erupted third molars (impacted molars 15.0%, incompletely erupted molars 10.0%) did not differ significantly, but completely erupted molars had a complication rate of 26.0%. Mandibular angle fractures with a completely erupted third molar show the highest complication rate after open reduction and osteosynthesis. Retention of a non-infectious third molar facilitates open reduction and does not increase the complication risk. The study helps with the decision of removing or retention of a third molar during surgical treatment of a mandibular angle fracture.

Fate of third molar in line of mandibular angle fracture - Retrospective study.

The study aimed to answer for the question whether a tooth in line of fracture predispose to complications such as infection and thereby warranting removal of the plates. Surgically rehabilitated patients for unilateral angle of mandible fractures at author's center from 2000 to 2013 were considered in this study. During the study period, about 116 cases fulfilled the inclusion and exclusion criteria, and hence included in this study. All patients were treated by open, rigid fixation. During the fracture reduction and immobilization, 52.6% (n = 61) cases, the third molar was extracted and in 47.4% (n = 55) cases, the tooth was preserved. Only two cases of infection that required the plate removal occurred by 3 months and another one case within the next 6 months. When the tooth in question was removed, infection did not occur. In all, 52.72% (n = 29) of the 55 cases preserved were needs to be extracted for various reasons. The most common being periodontal causes followed by periapical pathology. Statistically the relationship between demographic data and outcome measures were analyzed using Chi-square test bivariate statistics. A P < 0.05 was taken as significant. The present study fails to identify any concrete factors that would predict the failure of the retained third molar that were involved in the line of mandibular fractures. The proof presented here, especially with low complication rates indicate that all impacted third molar along the line of fracture be removed and unless necessary, the partially erupted teeth would also be extracted. In such a situation, the rate of infection and survival of the third molar would have been entirely different.

Lower third molar in the line of mandibular angle fractures treated with stable internal fixation: To remove or retain?

PurposeTo evaluate whether the retention of lower third molars in the line of fracture of mandibular angle fractures adversely affects treatment outcomes. MethodsData were collected on patients treated by intraoral open reduction and stable internal fixation for fractures of the mandibular angle during a 6-year period. 75% of patients had a third molar tooth in the line of fracture. Outcome variables were postoperative infection, delayed healing, nonunion, malunion, osteomyelitis, malocclusion and need for removal of bone plates. Data regarding patient demographics, cause of injury, associated fractures, time of treatment after injury, management of the third molar and postoperative complications were statistically analyzed. ResultsSeventy five patients had sufficient follow-up for inclusion in the study. A tooth was present in the fracture line in 75% of the cases. Teeth in the fracture were removed in 34.6% of the cases. Postoperative complications occurred in 8% of the sample. Fractures not containing teeth at the time of fracture had a 10.5% rate of postoperative complication compared with 7.1% for patients who had teeth in the fracture (p=NS). For angle fractures with a tooth retained in the fracture line, the incidence of postoperative complications was 5.2%. When the tooth was removed, the incidence was 11.1% (p=NS). ConclusionsThere is no statistically significant increase in risk for postoperative complications when a tooth is present in the line of fracture at the mandibular angle. Selective removal of these teeth may not decrease complication rates in angle fractures.

Infection Rate in Mandibular Angle Fractures Treated With a 2.0-mm 8-Hole Curved Strut Plate

The aim of this study was to determine the rate of postoperative infection and the efficacy of removing teeth in the line of mandibular angle fractures treated with 2.0-mm 8-hole titanium curved strut plates. Our understanding is that this method of repair is currently being used only in a few centers in the United States. A retrospective review of mandibular angle fractures treated with a 2.0-mm 8-hole strut plate during a 4-year period. Postoperative antibiotics were given for 1 week. Follow-up appointments were 4 weeks or longer. A nonchewing diet was instructed for 6 weeks. Data for all selected patients include the information such as age, gender, etiology of injuries, medical history, concurrent injuries, nerve deficits, pre- and postoperative antibiotic administration, postop infection, a presence or absence of teeth in the line of fractures, and whether these teeth were removed. Four patients (4 of 49 or 8.2%) developed infections. Two of those patients had a tooth in the line of a fracture that was retained (2 of 14 or 14%). The third had a tooth in the line of a fracture that was extracted (1 of 18 or 5.6%). The fourth patient was 1 of the 17 patients who did not have teeth in the line of fracture and developed infection (1 of 17 or 5.9%). None of the patients developed failed hardware, malunion, nonunion, malocclusion, or iatrogenic nerve injury. The use of a 2.0-mm 8-hole strut plate is associated with a low infection rate (8.2%). The infection rate for those mandibular angle fractures with teeth in the line of fracture retained was 14% compared with 5.6% for those fractures with the teeth in the line of fracture extracted.

The effects of molar tooth involvement in mandibular angle fractures treated with rigid fixation

Objective To determine whether the presence of a tooth in the line of mandibular angle fracture increases the incidence of complications and whether removing these teeth has an effect on complication rates. Design Case series with chart review. Subjects and Methods The analysis was performed on 83 patients who underwent open reduction and internal fixation for mandibular angle fractures. Lower molar teeth involved in the fracture line were extracted if they were loose, fractured, or grossly infected or prevented satisfactory reduction. Data regarding demographics, involvement of a molar tooth, management of the involved tooth, and postoperative outcome were analyzed. Statistical analysis was performed by using likelihood ratio χ 2 and logistic regression. Results The revision surgery in fractures with molar tooth involvement was 28.9 percent, compared to 12.9 percent when no tooth was involved ( P = 0.084). When a tooth was involved in the fracture, the revision surgery rate was 25 percent when it was removed and 30% when it was preserved ( P = 0.734). Conclusion Postoperative complications, especially the revision surgery rates, may not increase by involvement of lower molar teeth in the fracture line and selective removal of these teeth by using commonly accepted guidelines may not decrease complication rates in angle fractures.

P.121 How to manage teeth in the line of mandibular angle fractures treated with stable internal fixation?

P.121 How to manage teeth in the line of mandibular angle fractures treated with stable internal fixation?

Outcomes of patients with teeth in the line of mandibular angle fractures treated with stable internal fixation

Purpose: This study examines the relationship between postoperative infection and/or need for plate removal with the presence and management of teeth in the line of mandibular angle fractures. Methods: Data were collected on patients treated by intraoral open reduction and internal fixation for fractures of the mandibular angle during an 8-year period. Outcome variables were postoperative infection and need for removal of the bone plate(s). The relationships of demographic variables, teeth in the line of fracture, and management of teeth in the line of fracture were analyzed using standard statistical methods. Results: Four hundred two patients had sufficient follow-up for inclusion in the study. A tooth was present in the fracture line 85% of the time. Teeth in the fracture were removed in 75% of the fractures that contained teeth. Postoperative complications occurred in 19% of the sample. Fractures not containing teeth at the time of fracture had a 15.8% rate of postoperative infection compared with 19.1% for patients who had teeth in the fracture (P = NS). For angle fractures associated with a tooth, when the tooth was retained, the incidence of infection was 19.5%. When the tooth was removed, the incidence was 19.0% (P = NS). Conclusions: There is an increased risk for postoperative complications when a tooth is present, but the increase is not statistically significant. The incidence of postoperative infection and/or the need for plate removal is not affected by whether the tooth in the fracture is removed. © 2002 American Assoication of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:863-865, 2002