Mandibular Body Fractures Research Articles

Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury.

Iatrogenic Arteriovenous Fistula of the Superficial Temporal Artery After Manual Reduction of Temporomandibular Joint Dislocation

A 33-year-old man fell from a height and was referred to our hospital. Physical examination showed a swelling in the left preauricular region without laceration. No thrill or bruit was detected at this time. A face x-ray and a computed tomographic scan showed a left temporomandibular joint (TMJ) dislocation, Le Fort I fractures, and a mandibular body fracture. Left TMJ dislocation was treated by manual reduction. Two days after admission, a swelling in the left preauricular region progressed, with thrill and bruit. Left external carotid artery angiograms showed an arteriovenous fistula with a dilated pouch near the left TMJ. The fistula was fed by the left superficial temporal artery and drained into the left superficial temporal vein. The fistula was successfully embolized using Tornado coils. This is the first case of an arteriovenous fistula of the superficial temporal artery after manual reduction of TMJ dislocation.

A mandibular body fracture related to mouth-opening training in a dialysis patient

A mandibular body fracture related to mouth-opening training in a dialysis patient is reported. A 61-year-old male patient had noticed pain in the right mandibular body and difficulty in mouth opening a week previously. The patient had been performing mouth-opening training for a couple of weeks. The right lower face was slightly swollen with tenderness at the right lower border of the mandible. Hypoesthesia of the right lower lip was also observed. A bone step was palpable on the alveolar ridge of the right mandible, but mobility was not marked. The mandible was atrophic in the body region with only four anterior teeth left. Panoramic X-ray examination revealed a moderately displaced fracture in the right molar region of the mandible. The patient had no severe pain or difficulty in eating using a partial denture. The patient had received dialysis for 17 years and had also been treated by warfarin and aspirin. The patient was followed up under restricted mouth opening. Osteosynthesis with bone remodeling was confirmed after 6 months by X-ray examination. No complication requiring further treatment occurred during the follow-up period. In this patient, a medically compromised condition under long-term dialysis is considered a predisposing factor, which made the atrophic mandible more susceptible to the stress related to mouth-opening training.

Lingual Arch Bar Application for Treatment of Rostral Mandibular Body Fractures in Cats

To describe a lingual arch bar technique for fixation of rostral mandibular body fractures and report outcome in 16 cats. Original study. Cats (n=16) with rostral mandibular body fracture (10 bilateral, 6 unilateral) just caudal to the canine teeth. Orthodontic wire (Dentaurum® ; 0.9 mm) was used as a lingual arch bar by contouring it to the shape of the lingual side of the alveolar margin, and secured by circum-mandibular wires passed interproximal to teeth. Stability of fixation, occlusion, tolerance to the lingual arch bar, degree of secondary gingivitis/periodontitis, and ability to eat were evaluated clinically, and fracture union was assessed radiographically. The lingual arch bar was well tolerated. Eleven cats without a feeding tube were able to eat within 24 hours. Time to fracture union and appliance removal ranged from 28 to 64 days (mean, 42.5 days). Malocclusion of the rostral part of the fracture occurred in 5 cats; however only 1 required correction. Intraoral stabilization of rostral mandibular fractures using a lingual arch bar is a simple and effective method for the treatment of rostral mandibular fractures just caudal to the canine teeth.

Use of Rectangular Grid Miniplates for Fracture Fixation at the Mandibular Angle

The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws. This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated. The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months. The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentary contact.

Superolateral Dislocation of the Mandibular Condyle Not Associated With Fracture: A Case Report

Superolateral dislocation is rarely encountered in clinical practice. It is usually associated with fracture of the contralateral mandibular body or zygoma. The occurance of type II superolateral dislocation of the condyle without associated fracture is very rare and only a few cases are reported in literature. We present a case report in which the patient had a type II superolateral dislocation of the mandibular condyle which is not associated with any fracture. The condyle was hooked laterally above the zygomatic arch. The fracture was reduced surgically and good results were obtained. We thereby would like to ascertain the fact that a type II superolateral dislocation of the mandibular condyle can occur without any associated fractures.

Management of mandibular body fractures in pediatric patients: A case report with review of literature

Mandibular fractures are relatively less frequent in children when compared to adults, which may be due to the child's protected anatomic features and infrequent exposure of children to alcohol related traffic accidents. Treatment principles of mandibular fractures differ from that of adults due to concerns regarding mandibular growth and development of dentition. A case of a 4.5-year-old boy with fractured body of mandible managed by closed reduction using open occlusal acrylic splint and circum mandibular wiring is presented. This article also provides a review of literature regarding the management of mandibular body fracture in young children.

The management of mandibular body fractures in young children

This article reviews the management of mandibular body fractures in young children. Treatment principles of this fracture type differ from that of adults due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as non-invasively as possible and with minimal residual esthetic and functional impairment. The management of mandibular body fractures in children depends on the fracture type and the stage of skeletal and dental development; treatment modalities range from conservative non-invasive, through closed reduction and immobilization methods to open reduction with internal fixation. Disruption of the periosteal envelope of the mandibular body may have an unpredictable effect on growth. Thus, if intervention is required closed reduction is favored.

Microsurgical Repair of Peripheral Trigeminal Nerve Injuries From Maxillofacial Trauma

Injuries to the peripheral branches of the trigeminal nerve from maxillofacial trauma can have distressing sensory or functional sequelae. The present study reports the results of trigeminal microneurosurgical repair in a series of patients with maxillofacial trauma. A retrospective chart review was completed of all patients who had undergone microneurosurgical repair of peripheral trigeminal nerve injuries caused by maxillofacial trauma and who had been treated by one of us (R.A.M.) from March 1986 through December 2005. A physical examination, including standardized neurosensory testing, was completed on each patient preoperatively. All patients were followed up periodically after surgery for at least 1 year with neurosensory testing repeated at each visit. Sensory recovery was evaluated using the guidelines established by the Medical Research Council. The following data were collected and analyzed: patient age, gender, nerve injured, etiology (location of fracture), chief sensory complaint (ie, numbness or pain, or both), interval from injury to surgical intervention, intraoperative findings, surgical procedure, and neurosensory status at the final evaluation. A total of 42 patients (25 males and 17 females) with average age of 37.1 years (range 11 to 61) and a follow-up of at least 12 months were included in the study. The most commonly injured/repaired nerve was the inferior alveolar nerve caused by mandibular angle fracture (n = 21), followed by the mental nerve due to mandibular parasymphysis fracture (n = 12), the infraorbital nerve from zygomaticomaxillary complex fracture (n = 7), and lingual nerve and long buccal nerve from mandibular body fracture (n = 1 each). In 17 patients, the chief sensory complaint was numbness, and 25 patients complained of pain with or without mention of numbness. The average interval from nerve injury to repair was 12.5 months (range 2 to 24). The most common intraoperative finding was a compression injury (n = 19), followed by partial nerve severance (n = 9). The most frequent surgical procedure was external decompression/internal neurolysis (n = 20). Ten injured nerves required reconstruction of a discontinuity defect with an autogenous nerve graft (donor sural or great auricular nerve), all of which were associated with mandibular angle or parasymphysis fractures. After a minimum of 1 year of follow-up, neurosensory testing demonstrated that 6 nerves (14%) showed no sign of recovery, 23 nerves (55%) had regained "useful sensory function," and 13 nerves (31%) showed full recovery as described by the Medical Research Council scale. Microsurgical repair of peripheral branches of the trigeminal nerve injured by maxillofacial trauma produced significant improvement or complete recovery in 36 (86%) of 42 patients. These results compare favorably with the microsurgical repair of peripheral trigeminal nerve injuries resulting from other causes.

Fracture of the anterior iliac crest following monocortical bone graft harvest in bisphosphonate-related mandibular pathological fracture: a case report

The anterior iliac crest is the most common donor site for autologous nonvascularized bone because of the great amount of bone available and easy access. Documented donor-site complications include arterial, nerve, or urethral injury; herniation; chronic donor-site pain; sacroiliac joint instability; pelvic fractures; gait disturbances; hematoma; infection; peritoneal perforation; cosmetic defects; and hip subluxation. We present the case of a pathologic fracture of the right anterior iliac crest during the immediate postoperative period in a patient with a bisphosphonate-related osteochemonecrosis with pathological fracture of mandibular body. The patient was managed with nonoperative treatment.

Effects of Titanium Plate Fixation on Mandibular Growth in a Rabbit Model

The purpose of this study was to evaluate the effect of metallic rigid fixation of mandibular corpus fracture on mandibular growth in growing rabbits. Thirteen 90-day-old white New Zealand rabbits weighing 2 to 2.6 kg were included in this study. Unilateral mandibular fractures were created in all of the animals and fixed with microplates and screws. Microplates that had been adapted for fixation of the left (experimental) side were also used as a template for the drilling procedure on the right (control) side of the mandible. The plate was then removed, and screws were inserted. Digital submentovertex radiographs of each animal were taken before the operation and 6 months after surgery. Cephalometric values were analyzed. The distance between the centers of the 2 screws on the right side of the mandible was measured with a caliper in all samples, and values were compared with measurements taken from the left (experimental) side of the mandible upon which the plates had been placed. The mean amount of mandibular growth was 4.38+/-2.43 mm on the right (control) side and 4.64+/-2.27 mm on the left (experimental) side. This difference was not statistically significant (P> .05). The distance between the 2 screws was 13.89+/-0.23 mm on the experimental side and 13.44+/-0.46 mm on the control side. This difference was statistically significant (P< .05). Metallic fixation of a mandibular body fracture did not cause mandibular asymmetry or restricted mandibular growth in growing rabbits in this relatively small sample.

顔面多発骨折に伴う出血に対して外頸動脈分枝の動脈塞栓術が有効であった1例

We report a case of hemorrhage due to a panfacial fracture that was successfully treated by embolization of the branches of the external carotid artery. A 39-year-old man had a traffic accident while intoxicated and was admitted to the emergency department. The clinical diagnosis included a panfacial fracture（Le Fort Ⅰ, Ⅱ, Ⅲ, and right mandibular body and symphysis fractures）with associated fractures of the limbs and other bones. The patient had a massive hemorrhage from the oral and nasal cavities. The hemorrhage was controlled temporarily by application of pressure. Dental impressions were taken to prepare for surgical fracture fixation. Immediately after impression taking, hemorrhage from both the nasal cavities and the posterior portion of the maxilla recurred. We attempted to induce hemostasis by gauze packing and Bellock tamponade repeatedly, but complete hemostasis was difficult to achieve. Therefore, embolization of the branches of external caroid artery was performed bilaterally, using the Seldinger technique. Complete hemostasis was achieved after embolization, and the operation was performed at a later date.

Effect of low intensity ultrasound on healing of mandibular body fractures

Fracture healing is the result of complex interactions of mechanical, molecular and biological factors. A number of methods are employed to ensure or accelerate fracture healing. Ultrasound, a form of mechanical energy, is used widely in medicine as a therapeutic, operative and diagnostic tool. The aim of our study was to determine if the application of low intensity ultrasound stimulus accelerate the healing of mandibular body fractures after treatment with closed reduction. Patients of the age group 20–40 years, who reported with mandibular body fractures that could be satisfactorily reduced after closed reduction and immobilisation by maxillomandibular fixation, were included in this study.

Dentoalveolar and Mandibular Body Fractures Caused by a Horse Kick: Report of a Case

A rare case of multiple mandibular fractures and severe facial laceration is presented. The cause was a horse hoof kick to an unmounted equestrian. The pertinent literature is reviewed and the maxillofacial injuries associated with animal interaction are discussed.

Treatment of Mandibular Fractures in Infants

This report describes 2 infants with mandibular fractures. Reduction of the fracture and fixation using a thermoforming splint with circummandibular wiring under general anaesthesia is thought to be an adequate surgical method to treat displaced mandibular body fractures in infants.

２人乗り自転車前転事故による小児顎関節突起完全骨折の２例

We report on two children with infantile condylar fractures, caused by falling from front child seats of bicycles.Patient 1 was a 5-year-old boy, and patient 2 was a 2-year-old boy. Both patients had fractures of the mandible with complete condylar fractures. The first patient had a complete left fracture, and the second patient had complete right and incomplete left fractures.Circumferential wiring with an occlusal plate was performed for fixation of the mandibular body fractures, and mouth opening exercises were started several days after wiring. The occlusal plate was extremely useful, but many potential problems, such as caries or tooth luxation, were considered in patient 1.These patients show that a child riding in a front child seat of a bicycle can sustain a hard blow to the face, head, or both in the event of an accident. Increased external force due to the mother's weight can increase the severity of fractures.

Efeitos da fratura de corpo da mandíbula no crescimento da maxila e da mandíbula: estudo experimental em ratos jovens

Objetivo: Observar os efeitos da fratura experimental de corpo de mandíbula no crescimento da maxila e mandíbula. Métodos: Utilizando ratos com um mês de idade. Estes foram distribuídos em dois grupos: experimental, onde foi efetuada a fratura de corpo de mandíbula à direita, e controle-operado, no qual foi realizado apenas o acesso cirúrgico. Aos três meses de idade foi realizada a eutanásia e após a maceração, a mandíbula foi desarticulada. O crânio foi submetido à incidência radiográfica axial e as hemi-mandibulas à incidência radiográfica lateral. Com base nestas, foram feitas mensurações cefalométricas por meio de um sistema de computador e os valores submetidos a análises estatísticas. Resultados: O comprimento da maxila, bem como a altura e o comprimento da mandíbula apresentaram diferença significante a menor para o lado direito, no grupo experimental. No grupo controle-operado houve diferença significante a menor para o comprimento da porção posterior da maxila e para a altura e comprimento da mandíbula para o lado direito. O grupo experimental quando comparado ao grupo controle-operado mostrou ser significativamente menor em todas as mensurações da maxila e mandíbula para ambos os lados, com exceção do comprimento da mandíbula. Conclusão: A fratura de corpo da mandíbula, bem como a abordagem cirúrgica, tiveram efeitos negativos no crescimento da maxila e da mandíbula.

Simultaneous treatment of pseudoarthrosis of mandibular body fractures and inferior alveolar nerve defects

The purpose of this paper is to present the experience with two patients with pseudoarthrosis of mandibular body fractures and unacceptable anesthesia of the lower lip and chin on the affected side. This was corrected by establishing stable fixation with locking screw mandibular plate, microsurgical repair of the inferior alveolar nerve, and filling the fracture gap with an autogeneous bone graft. The combination of these therapies resulted in satisfactory sensory improvement without complications in both patients.

Eosinophilic granulomaA case report with pathologic fracture

Approximately 10% to 20% of all cases of eosinophilic granuloma occur in the jaws. A palpable mass with or without pain is the most frequent presenting clinical feature. Less common clinical signs include gingivitis, loose teeth, and oral ulceration with poor healing. We report a case of monostotic mandibular eosinophilic granuloma in a 38-year-old woman that initially manifested mandibular body fracture, an unusual and poorly documented clinical sign for this disease. The clinical and radiographic features, differential diagnosis, and treatment plan of the case are presented. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:756-9)

両側性下顎関節突起骨折の臨床的検討 臨床病態ならびに非観血的治療成績

We investigated clinical characteristics and treatment outcome in 38 patients with bilateral condylar fractures, which accounted for 17.5% of mandibular condylar fractures. Mandibular body fractures were concurrently present in 24 (63.2%) of 38 cases. Condylar fractures occurred most frequently in the upper neck and head of the cundyle; fractures of the condylar head often showed a longitudinal pattern. When bilateral condylar fractures were conservatively treated, the treatment outcome of bilateral condylar fractures combined with mandibular body fractures was slightly better than that of bilateral condylar fractures alone. These results suggest that mandibular body fractures combined with bilateral condylar fractures might play a role in reducing soft tissue injuries due to external force in temporomandibular joint region.