Mandibular Angle Fractures Research Articles

Photoelastic Analysis of the Use of a Single Plate for the Treatment of Mandibular Angle Fractures

Angle fractures are 1 of the most common trauma. A good fixation with less discomfort is something desirable to achieve. The objective of this study was to evaluate the distribution of tensions around osteosynthesis used in mandibular angle fracture (MAF) treated by the Champy technique through a photoelastic test.

Management of Mandibular angle fractures using three-dimensional strut plate: A comparison between transoral and transbuccal approaches

Aim: To compare between transoral and transbuccal approaches in the management of mandibular angle fractures using 3d-strut plates.Materials and methods: Ten patients with unilateral mandibular angle fracture with an age range 18-56 years were included in our study. The patients were divided into two groups based on the approach for the 3d strut plate placement and fixation. Group A included 5 patients undergoing open reduction and internal fixation (ORIF) via transoral approach and group B included 5 patients undergoing ORIF via transbuccal approach. Patients were followed up clinically at 1 week, 1 month and 3 months postoperatively and radiographically at 1 week and 3 months postoperatively.Results: In the transbuccal group patients, extraoral scar evaluation revealed 3 patients (60%) with invisible scar, 2 patients (40%) with barely visible scar after 3 months postoperatively. The mean time of the surgical procedure starting from the first incision till the last suture was 38.4±6.5 minutes for group A and 41.1±5.2 minutes for group B patients. None of the patients in both groups was introduced with malocclusion, facial nerve affection, segmental mobility, wound dehiscence, infections or parathesia during different follow up periods. Radiographic evaluation didn’t reveal any kind of hardware failures in the terms of plate fracturing or screws loosening and there was no statistically significant difference in the mean bone density along the fracture line between both groups.Conclusion: The use of 3d strut plates in angle fractures through transoral or transbuccal approaches resulted in excellent results with no significant difference clinically or radiographically between both approaches. However, The transbuccal approach was our preferred technique due to ease of use, negligible necessity for plate bending and easy placement of the plate in the neutral mid-point region.

Evaluation of different stable internal fixation in unfavorable mandible fractures under finite element analysis.

The mandibular angle fracture is the most common fracture between this type of injury in jaw bone and also is the type of fracture treatment that presents a larger number of complications, and a series different osteosynthesis types have been studied over the years by the world literature. The finite element method is a form of mathematical analysis, which is based on dividing a structure into a finite number of small areas. It has the ability tomathematically model structures, making it possible to apply forces anywhere. For this study, a three-dimensional mandible with an unfavorable angle fracture was simulated. Five different types of fixations were evaluated: group 1, Champy technique with one 4-holes miniplate, 2.0 system; group 2, technique with two parallel 4-holes conventional miniplates, 2.0 system; group 3, technique with two parallel 4-holes locking miniplates, 2.0 system; group 4, technique with one reconstruction 6-holes plate, 2.8 system in base jaw; and group 5, technique with one reconstruction 6-holes plates, 2.8 system in jaw body + one parallel 4-holes conventional miniplate, 2.0 system. The results showed that strains are better distributed through the locking miniplate and screws system and presented less stress concentration when compared with the conventional ones. The Champy technique had the worst results about of all groups. The use of the locking system shows less stress compared to the non-locking system, and the presence of a reconstruction plate associated with a mini plate does not lead to increased stability compared with an isolated reconstruction plate.

Who Can Treat Mandibular Trauma Better?

Oral and maxillofacial surgery, a specialty responsible for the diagnosis, treatment of trauma, congenital, developmental and iatrogenic lesions in the maxillofacial complex. Despite all the progress that has occurred in the specialty of this fraternity, many people are still unaware of the specialty. Even today, difficulties are experienced owing to the lack of knowledge of the general public and health professionals concerning the scope of oral and maxillofacial surgery. To investigate recognition of the scope of oral and maxillofacial surgery; 50 questionnaires about mandible angle fracture were sent to the oral & maxillofacial surgeons and plastic surgeons, in 2 equal groups. The questionnaire covered 9 questions regarding peri-operative care of mandible angle fracture. Each interviewee had to answer the clinical situation with their own perspective and knowledge. On the basis of questionnaire responses, a good knowledge of treatment plan in terms of function and aesthetics were evaluated, which were instituted by oral and maxillofacial surgeons and plastic surgeons gave little consideration on functional outcome. Results obtained from this questionnaire signified that less number of plastic surgeons operated on mandibular angle fractures as compared to oral surgeons, with not much a discrepancy in the choice of radiographs. The plastic surgeons usually prefer an extraoral approach over an intraoral, with the main aim to re-establish esthetics whereas oral surgeons preferred functional establishment. Both the surgeons treat these fractures with the help of rigid osteosynthesis and intermaxillary fixation. Not many plastic surgeons opt for Champ’s technique of osteosynthesis. Both the surgeons do not prefer to remove plates postoperatively. Moreover, the plastic surgeons do not wish to extract tooth in line of fracture majorly. Thus, we conclude that oral and maxillofacial surgeons are better proficient than plastic surgeons in handling mandibular angle fracture and the specialty needs to broaden its horizons in order to ensure the correct referral of all patients.

Ti-15Mo Alloy Decreases the Stress Concentration in Mandibular Angle Fracture Internal Fixation Hardware.

Comparison of the mechanical stability of 2.0 plates made of commercially pure titanium (cpTi) and a titanium-molybdenum (Ti-15Mo) alloy and two methods of internal fixation employed mandibular angle fractures, using 3D finite element analysis. Four groups were evaluated. For the cpTi: group Eng 1P, one 4-hole plate and 4 screws 6mm long, in the tension zone of the mandible; group Eng 2P, two 4-hole plates, one in the tension zone of the mandible and the other in the compression zone, both were fixed with 8 screws 6mm long. The same groups were created for the Ti-15Mo alloy. A 100N compressive load was applied to the occlusal surface of the mandibular first molar on the plated side. When considering the von Mises equivalent stress (σ vM) values for the comparison between both groups with one plate, a decrease of 10.5% in the plate and a decrease of 29.0% in the screws for the Ti-15Mo group was observed. Comparing the same groups with two plates, a decrease of 28.5% in the screws was shown for the Ti-15Mo alloy group. No significant differences were observed when considering maximum and minimum principal stresses (σ max, σ min), and maximum principal strain (ε max) to the mandibular bone. The Ti-15Mo alloy plates substantially decreased the stress concentration in the screws for both internal fixation techniques and in the plate for the Ti-15Mo 1 plate group. From a clinical standpoint, the use of Ti-Mo alloy with reduced stiffness will decrease the stress shielding between the hardware and bone, influencing the outcome of the treatment.

Comparative Evaluation between Single Noncompression Miniplate and Two Noncompression Miniplates in the Treatment of Mandibular Angle Fractures.

This study was conducted to compare the outcome of single noncompression miniplate versus two noncompression miniplates in the treatment of mandibular angle fracture. A total of 40 patients were divided into two groups: Group I ( n = 20), patients were treated by single miniplate at superior border of mandible by intraoral approach; Group II ( n = 20), patients were treated by one miniplate at superior border of mandible, intraorally, and another at the lateral aspect of angle, transbuccally by trocar and cannula. Comparative evaluation was done at 1, 2, 4, 6, and 12 weeks and 6 months. The findings of this study suggest that there was no significant difference in postoperative complications (malocclusion, pain, swelling, infection, facial nerve injury, wound dehiscence, plate exposure) and bite force between the two groups.

Mandibular angle fracture with presence of third molar included: Muay Thai professional fighter

Background: High impact sports, risk and adrenaline, such as martial arts, cycling, running, among others; expose the athlete to possible injury even when safety equipment is used correctly. The head is a well-targeted area in body fighting, and is also a very affected region in cases of falls, raising the risk of facial fractures depending on region, incidence and strength. In the bones of the face there are pillars of resistance and these resist more to the actions of the intrinsic and extrinsic forces. As well as, there are also zones of bone fragility. The mandibular angle is one of these regions of fragility. Direct forces in the angle region can cause fractures and in this region, the third lower molar may be included, impacted or presenting some type of injury. The presence of the third molar included in the mandible makes the region of the angle more fragile and susceptible to fractures. This susceptibility may increase according to the habits of each individual. Competitive sports and the practice of martial arts combat make critical the presence of the third molar included in jaw after deferred a blow, falls or other external impact in this region.

Photoelastic analysis of the use of a single plate for the treatment of mandibular angle fractures

Background: Angle fractures are one of the most commom trauma. A good fixation with less discomfort is something desirable to achieve.

Transoperative mandibular angle fracture from third molar extraction, case report

Transoperative mandibular angle fracture from third molar extraction, case report

Morphometric features as a predisposing factor to mandibular angle fractures

Morphometric features as a predisposing factor to mandibular angle fractures

The influence of the mandibular gonial angle on the occurrence of mandibular angle fracture

Angle fractures represent the largest percentage of mandibular fractures. They pose as a unique entity because of their codependent morphological dynamic factors, rendering the understanding of the mechanism, and treatment challenging. The aim of this study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture while highlighting its clinical relevance. A retrospective analysis of radiographs of patients treated for mandibular fractures was done. The factors studied were as follows: the presence of a high gonial angle and an impacted third molar. The outcome was mandibular angle fracture. The gonial angle was measured using Planmeca Digital Software 3.7.0.R. Status of the third molar was also noted. Data obtained were analyzed using SPSS 22 (IBM Corp, Armonk, NY). The sample comprised 70 mandibular fractures (32 angle fractures and 38 non-angle fractures). The mean gonial angle in the angle fracture group was 128.5±5.4º which was 10.2° larger than in the non-angle group (mean 118.5±4.4º; P=0.0001). Patients with a high gonial angle were 8.7 times more likely to sustain an angle fracture than those with normal or low gonial angles. A statistically significant relationship between the presence of impacted third molar and patients sustaining mandibular angle fractures was noted (P=0.0001). Subjects with a high gonial angle and an impacted third molar are at an increased risk for mandibular angle fracture due to direct and indirect morphological factors.

APPLICATION STUDY OF CHAMPY’S TECHNIQUE IN SURGICAL TREATMENT OF MANDIBULAR ANGLE FRACTURE

Background: Angle mandibular fractures are among the most common traumatic injuries of the maxillofacial region. The optimal treatment modality for angle fractures remains controversial. The present study was designed to describe the clinical and radiographic features of patients who had suffered mandibular angle fractures and evaluate the postoperative outcome in patients treated for the Champy’s technique. Materials and methods: 32 patients with 32 fractures of the mandibular angle were treated by the Champy’s technique at the department of maxillo facial surgery of Hue University of Medicine and Pharmacy and Hue Central Hospital, from April 2018 to February 2019. Evaluating of results when patients were discharged from hospital, 3 and 6 months after surgery. Results: The majority of the patients were males (84.4%). The majority of angle fractures have unfavorable fractures (96.9%) and displaced fractures (68.7%). The most common symptoms were pain, throbbing pain, mouth limited opening, swelling, malocclusion. Panoramic radiographs plays an important role in diagnosis (96.9). The patients were treated successfully according to Champy’s principle of osteosynthesis. Conclusions: The Michelet – Champy’s technique for surgical treatment of mandibular angle fractures was simple, easy to use, had high success rates and few complications. Key words: mandibular angle fracture, Champy’s technique

Angle Fracture: An Outcome in Bareilly Population

Introduction: Mandibular angle fracture is a very common fracture of the mandible. These account for approximately 30% of all fractures. These fractures are treated by many techniques such as open reduction or maxilla-mandibular fixation. These fractures have high complication rate accounting for 0% to 32% postoperatively. Material and Methods: This study was conducted on 50 patient reported in Institute of dental sciences, Bareilly and Rohilkhand medical college and hospital, Bareilly to evaluate the outcome of mandibular angle fracture in our institute. Result: Out of 50 patients of mandibular angle fracture, 30 were treated surgically, 17 were treated conservatively, and 3 patients were not interested in any kind of treatment. Males are more commonly affected and road traffic accidents was a very common cause of angle fracture.

MANDIBULAR ANGLE FRACTURE;

Objectives: To compare the outcome of treatment of mandibular angle fracture by using intra oral, vs. transbuccal approaches in terms of complications. Setting: Oral & Maxillofacial surgery department, Faculty of dentistry Liaquat University of Medical & Health Sciences, Jamshoro/ Hyderabad. Duration: 1st March 2017 to 31st August 2017. Design: Randomized controlled trail. Subject and Methods: 180 patients consuming bilateral mandible angle fracture were involved in this study. 90 randomly allocated patients were managed with transbuccal approach and 90 managed by intra oral approach. Follow up was continued for each patient after every one week for 8 weeks. Results: The average age of the patients was 35.09±5.96 years. Rate of infection, malocclusion, scar formation, facial nerve injury and non-union was significantly low in transbuccal approach as compare to intra oral approach. Conclusion: In conclusion, transbuccal approach was preferred over the intra oral approach due to easy usage, negligible requirement for plate twisting, and enablement of plate engagement in the neutral mid-point zone.

The effect of the mandibular plane angle on fracture line stability: An ex vivo experimental study.

Mandibular angle fractures fixated with plate osteosynthesis techniques have to withstand the effects of muscle attachments. Individual variations in the craniofacial morphology may alter the biomechanical resistance of the bone-plate construct. The aim of the present study was to determine the influence of variations in the mandibular plane angle (MPa) on the biomechanical stability of sheep mandibular angle fractures (MAFs). Sixty sheep hemi-mandibles were used. The mandibles were positioned on a test jig that simulated low (15°, group L), normal (25°, group N), and high (35°, group H) MPa. Unfavorable MAFs were created with thin diamond cutting disks. One four-hole, 9.0-mm-spacing, standard titanium miniplate of 2.0mm thickness and 5.0-mm-long screws were inserted at the superior border of the alveolar bone in monoplanar orientation. Specimens were then subjected to vertical loads between 10N and 150N in a universal testing machine. The displacement values at each 10N force increment and the load magnitude at which 3.0mm displacement limit was reached were recorded. Starting from 40N, the displacement values at each 10N increment in the H group were significantly higher than those of the L and N groups until 150N (P<0.05). The force magnitude required to reach 3.0mm of displacement in the H group was significantly lower than that for the L and N groups (P<0.05 for each). The one-miniplate monoplanar fixation technique used in sheep MAF with high MPa is more likely to offer lower biomechanical resistance to the vertical forces applied over the molar region than do the normal and low MPa.

Treatment of mandibular angle fracture: Revision of the basic principles

Biodynamics of mandibular angle fractures has been extensively discussed in the literature in search for the best way to fixate and expedite recovery of trauma patients. Pioneers like Michelet and Champy had the greatest impact on evolving of osteosynthesis in maxillofacial traumatology; they introduced their basic principles frequently used to describe the biomechanics of mandibular fixation. Their concept states when a physiologic load is applied on mandibular teeth a negative tension will be created at superior border and a positive pressure will appear at inferior border. These simple definitions are the basis for the advent of fixation modalities in mandibular angle fracture. This article sought to reassess these principals based on load location via finite elements method.

Management of mandibular angle fractures using 3- dimensional or standard miniplates: A systematic review and meta-analysis

PurposeThis study proposed to compare clinical outcomes between three-dimensional (3D) plate and standard miniplate fixation systems for the management of mandibular angle fractures (MAFs). MethodsA systematic review search of several databases, including MEDLINE-Ovid, Embase, Springer Link, and PubMed, for relevant articles in English and without date restrictions was performed in February 2018. The quality of studies was assessed, and the relative risk (RR) with its corresponding 95% confidence interval (CI) was assessed to measure postoperative complications. ResultsEleven publications were enrolled in the analysis. The results showed that there were significant differences in overall complications (RR, 0.453; 95% CI, 0.311–0.660; P = 0.007). The incidence of hardware failure showed a statistically significant difference in the outcome, favoring 3D miniplates (fixed: RR 0.156; 95% CI, 0.042–0.581; P = 0.0006). Subgroup analyses indicated that the 3D miniplate caused a lower incidence rate of malunion and hardware failure than the standard miniplate with 8 or 10 holes (P = 0.006, P = 0.03, respectively). In addition, the use of standard miniplates had a shorter operation time than the use of 3D miniplates (P = 0.002). ConclusionThe present study demonstrates that the three-dimensional miniplate was a better fixation system than the standard miniplate technique in reducing postoperative complications in the management of mandibular angle fracture (P = 0.007).

Association between impacted mandibular third molar and occurrence of mandibular angle fracture: A radiological study

Background: Presence of an impacted mandibular third molar contributes to the weakness of the angle region of the mandible and increases the risk of its fracture. The influence of the presence of impacted mandibular third molars on the occurrence of angle fractures is, however, imprecisely estimated despite boundless research on this subject. Aim: To determine the influence of impacted third molars on the incidence of mandibular angle fractures. Materials and Methods: This was a retrospective study of panoramic radiographs (orthopantomogram [OPG]) that were taken at the Radiology Unit of the Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences, for 2 years. The collected data included presence of fracture of mandibular angle, presence/absence of impacted lower third molar, and classification of impacted tooth. Data were analyzed using Statistical Package for the Social Sciences software Version 22. A significant level of P

Assessment of the Integrity of Adult Human Mandibular Angle

The purpose of this study was to analyze the integrity of the adult human mandibular angle. The left hemimandibles of 24 human cadavers were selected and divided into three groups based upon remaining dental status. The height of the left mandibular body was measured. Hemimandibles were mounted in acrylic bone cement at the mandibular condyle. The left mounted hemimandibles were secured into an Instron 5565 mechanical unit and the occlusal plane was sequentially loaded until fracture of the mandibular bone occurred. Minimum, maximum, mean, and standard deviations for compressive force as well as displacement of the occlusal plane were derived and compared for descriptive statistics. The correlations between the gender, mandibular body height, and maximal load were examined. The mean mandibular heights among males and females were 22.44 mm and 17.53 mm, respectively. Results portrayed a significant correlation between gender and mandibular height. The mean maximal loads among males and females were 1,174.17 and 828.14 N, respectively. Results portrayed a statistically significant difference between males and females regarding maximum load as well as the height of the mandible ( p=0.0103 and p=0.0067, respectively). No statistically significant association between maximum load and dental status (presence/absence of molar teeth) was found ( p &gt; 0.05). The maximal load of human mandibular angle was found to be higher than that of the heavily investigated polyurethane synthetic mandible replica. The average height of the mandibular body in males was found to be greater than that of females. Mandibular body height showed a direct correlation to maximal load of the hemimandibular angle. In maxillofacial research, biomechanical evaluations of mandibular angle fractures and plating techniques with human cadaveric bone should be considered alongside or in place of conventional synthetic polyurethane mandibles.

The “European Mandibular Angle” Research Project: The Epidemiologic Results From a Multicenter European Collaboration

The aim of this study was to analyze the demographic variables and causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery. This study was based on a multicenter systematic database that allowed the recording of data from all patients with mandibular angle fractures between January 1, 2013, and December 31, 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, and osteosynthesis. The study included 1,162 patients (1,045 male and 117 female patients). A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (P<.0000005).Furthermore, assaults were associated with the presence of voluptuary habits (P<.00005), a younger mean age (P<.00000005), male gender (P<.00000005), and left-sided angle fractures (P<.00000005). Assaults and falls actually represent the most frequent causes of angle fractures. The presence of a third molar may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.