Mandibular Trauma 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.

OMS Chief Resident Experience as a Predictor of Future Scope of Practice and Confidence

Residency training requires gradual transfer of entrustable professional activities (EPAs) to residents over time to ensure professional development and competence in a given discipline. To date, surgical literature has addressed neither measurements of resident autonomy and level of responsibility nor the effects these factors may have on resident confidence and future practice plans. Our preliminary study sought to: 1) characterize perceived autonomy in different types of surgeries during the final year of training, 2) characterize actual resident experience in the same areas, and 3) correlate these with resident confidence to meet the standard of care and anticipated scope of practice following completion of training. An online survey was made available to residents in their final year of OMS training in all US programs. The survey addressed resident case exposure and level of participation in care in several domains within OMS: mandibular trauma, midface trauma, TMJ surgery, orthognathics, pathology, reconstruction, craniofacial, cosmetics, implants, and other dentoalveolar surgery. The questionnaire also measured the perceived ability to meet the standard of care and anticipated frequency of practice in each of these domains. Some basic respondent demographics were also recorded. Data collection was from May 2010 to September 2010. Statistical analysis was performed using JMP 8.0 software. Differences were assessed using one-way ANOVA and Student t test as well as Pearson correlations. Trends were identified using Mantel-Haenszel test and an ROC curve was utilized to identify values at which frequencies changed. Statistical significance was defined at P values or rho values less than 0.05. A total of 84 surveys (45%) were completed. Mean age was 33 years. Respondents were 89% male. 13% of respondents had plans for fellowship training and 58% planned to practice in an area population of over 500,000. Over the course of residency, practice plans narrowed in 23%, broadened in 29%, and remained the same in 49%. Increases in autonomy from junior to senior level were noted in all domains. As primary surgeon, mean cases during chief year were 24.6 (midface trauma), 40.7 (mandibular trauma), 9.9 (TMJ), 32 (orthognathic), 11.3 (cosmetics), 33.5 (pathology), 23.7 (reconstruction), 4.5 (craniofacial), 61.4 (implants), and 174.7 (dentoalveolar). Confidence to meet the standard of care among the respondents in each of the domains was: 89% (midface trauma), 100% (mandibular trauma), 45% (TMJ), 80% (orthognathic), 29% (cosmetics), 78% (pathology), 73% (reconstruction), 30% (craniofacial), 94% (implants), and 100% (dentoalveolar). The number of cases as primary surgeon to determine the frequency of future practice in a particular domain was found to be: 12 (midface trauma), 10 (TMJ), 11 (cosmetics), 35 (pathology), 13 (reconstruction), and 8 (craniofacial). In general, resident autonomy showed a statistical correlation with the confidence to meet the standard of care. In addition, the number of cases as primary surgeon during the chief year was associated with the anticipated frequency of practice in a given domain. Consistent measures of autonomy are involvement in treatment planning, involvement in performing the case, and overall sense or autonomy and not the presence or absence of the attending faculty during the procedure. These preliminary findings could help guide residency programs in the training of competent residents in the future. Plans are in place to repeat this survey for consecutive years with a broader, more expansive inquiry in order to quantify year-to-year variations in experience and attitudes.

Ripple Effect - The Financial Burden of Mandibular Trauma

Ripple Effect - The Financial Burden of Mandibular Trauma

Refractory epilepsy is highly associated with severe dentoalveolar and maxillofacial injuries

Dental intrusion and avulsion, crown fracture and mandibular fractures are important dentofacial complications in patients with epilepsy-related traumas. The objective of the present study was to describe the occurrence of orofacial injuries in patients with epilepsy. One hundred and nine consecutive patients (60 women; mean age 38.81 ± 14 years), treated for refractory epilepsy (45 with extratemporal epilepsy and 64 with temporal epilepsy) at the outpatient clinic of our University Hospital, were included in the present study. Orofacial injury occurring as a direct result of a seizure was determined by clinical examination and interview. In addition, seizure frequency, use of medication, and the occurrence and type of injury to other parts of the body, were documented. We employed regression analyses to investigate the association between teeth fractures and frequency of seizures. The majority of injuries were crown fractures (42 subjects), followed by mandibular fractures (eight subjects) and tooth avulsion (eight subjects). Sixteen patients had more than two fractured teeth. Patients with mandibular trauma also suffered concomitant injuries (teeth fracture, avulsion and dislocation). The number of fractured teeth was associated with seizure frequency (r(2) = 0.59, p < 0.001). The data suggest that there is an increased rate of dentoalveolar and maxillofacial injuries in patients with poorly controlled epileptic seizures.

A questionnaire survey on postoperative intermaxillary fixation in mandibular trauma: Is its use based on evidence?

Context:This questionnaire survey was conducted to ascertain if the practice of the routine use of postoperative intermaxillary fixation (IMF) in mandibular trauma (of the dentate segments only) was based on evidence available in the literature.Settings and Design:This study was designed as a questionnaire survey that would be conducted among surgeons operating on mandibular fractures in the state of Gujarat.Materials and Methods:A typed questionnaire was sent to oral maxillofacial surgeons and plastic surgeons of Gujarat state for their feedback by post. Approval of the ethical committee of the university was obtained. All the feedback forms received back were included for this survey which included 25 oral and maxillofacial surgeons and 25 plastic surgeons.Results:Although majority of the surgeons use open reduction and internal fixation (ORIF), 25% of the surgeons still prefer using only IMF as the sole modality of treatment for the said group of mandibular fractures. According to our survey, the majority of surgeons use IMF routinely in the postoperative setting even after using ORIF. Occlusion seems to be the critical factor among 72% of surgeons in deciding on the use of IMF as an adjunct after ORIF. Seventy-eight percent of surgeons vary their period of IMF based on the site of fracture.Conclusion:The routine use of postoperative IMF in cases of mandibular fractures seems to find favor among surgeons despite lack of sound scientific evidence supporting its use. There is also no evidence to suggest that if IMF is not used, it would have deleterious effects on occlusion or otherwise.

Pearls of Mandibular Trauma Management

Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management.

Effect of Isolated Mandible Fracture on the Preoperative Lemon Airway Evaluation and Interincial Opening Used in Prediction of Difficult Direct Laryngoscopy and Intubation Difficulty

Statement of the Problem: The presence of mandibular fracture may be considered a predictor of both difficult direct laryngoscopy (DL) and endotracheal intubation (EI). The use of preoperative predictors and bedside tests has been shown to improve identification of difficult DL. Components of the preoperative airway assessment can be altered by the presence of mandibular fracture and the attendant pain and inflammation. The incidence of difficult DL in maxillofacial surgery patients has been identified as being as high as 15%; however, the incidence in mandibular trauma patients has not been reported.

P113 Mandibular trauma – are post operative radiographs always required?

P113 Mandibular trauma – are post operative radiographs always required?

Tympanic plate fracture following mandibular trauma with emphasis on 3D imaging

The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education

Treatment of caudal mandibular fracture and temporomandibular joint fracture-luxation using a bi-gnathic encircling and retaining device

Fractures of the caudal portion of the mandible and temporomandibular joint (TMJ) fracture-luxation can be challenging to treat with direct fixation methods. This paper describes a simple technique for the indirect treatment of caudal mandibular fracture and TMJ fracture-luxation using a subcutaneous loop of nylon leader line tunnelled around the maxilla, incisive and nasal bones, and under the mandible, placed just caudal to the canine teeth, and crimped ventral to the mandibular skin: a bignathic encircling and retaining device (BEARD). A BEARD was used to treat two immature dogs with simple, unilateral caudal mandibular fractures, six cats with unilateral injury (two with TMJ luxation, three with TMJ fracture-luxation, one with caudal mandibular fracture), and two cats with bilateral injury (comminuted caudal mandibular fracture with contralateral TMJ luxation; bilateral condylar neck fracture). The BEARD treatment failed short-term due to poor tolerance in one cat, and concurrent injuries and poor initial reduction in another cat. One cat was lost to long-term follow-up. Rostral dental occlusion was normal in six out of seven cases, and reported jaw function was normal in seven out of seven cases. The case with poor occlusion had imperfect initial reduction. Complications included dorsal nasal skin swelling or discharge, oesophagostomy tube dislodgement or blockage, BEARD loosening, and regurgitation. Treatment of uni- or bilateral caudal mandibular trauma using a BEARD can lead to clinical union, and normal rostral occlusion, provided that case selection is appropriate and immediate-post-surgical occlusion has been corrected.

S236: Mandibular Trauma: From the Simple to the Complex and Everything in Between

Mandibular trauma is a common injury often evaluated and treated by oral and maxillofacial surgeons. It does have a broad range of presentations and indicated treatments. This clinic will be a comprehensive review of current treatment modalities. Topics covered will include clinical and radiographic evaluation (including cross sectional and three dimensional imaging), treatment planning (open versus closed), surgical access, endoscopic techniques, complication prevention and management. Specific mandibular injuries will be discussed including subcondylar fractures, gunshot injuries and pan facial trauma. We will discuss perioperative antibiotic regimens, pain control and nutritional support. Complication management will address infection, wound breakdown, osteomyelitis and malocclusion.

Effect of Isolated Mandible Fracture on Direct Laryngoscopy and Intubation Difficulty

Statement of the Problem: The presence of mandibular fracture may be considered a predictor of both difficult laryngoscopy and endotracheal intubation. The use of preoperative predictors has been shown to improve identification of difficult direct laryngoscopy. Components of the preoperative airway assessment can be altered by the presence of mandibular fracture and the attendant pain and inflammation. The incidence of difficult direct laryngoscopy in maxillofacial surgery patients has been identified as being as high as 15%, though the incidence in mandibular trauma patients has not been reported.

Bilateral TMJ Dislocation in a 23-month-old Infant: A Case Report

Dislocation of the temporomandibular joint (TMJ) is rare in children. We present the second youngest case reported. Diagnosis was delayed owing to failure to recognize important clinical signs. We outline how this problem can be recognized and treated, and propose radiographic confirmation of the clinical diagnosis which is not necessary if there is no history of direct mandibular trauma. Two new clinical signs are demonstrated. TMJ dislocation is of relevance to all dental professionals because it can occur in the dental chair and because dental professionals are often called upon to manage this condition.

Temporal Artery Scanning Falls Short as a Secondary, Noninvasive Thermometry Method for Trauma Patients

Oral and mandibular trauma pose barriers to oral thermometry. We sought to determine whether temporal artery (TA) scanning thermometry could be an accurate, noninvasive back up method of thermometry in patients with these types of traumatic injury. We compared 3 techniques of TA scanning, axillary thermometry, and oral thermometry in critical care patients. Our results indicate that TA scanning methods were, at best, comparable with axillary measurements. In addition, the performance of the TA scanners varied with body mass index, whereas axillary readings did not.

Herniation of the temporomandibular joint into the external auditory meatus secondary to benign necrotising otitis externa

The temporomandibular joint (TMJ) is intimately related to the external auditory meatus (EAM). Herniation of the joint into the EAM occurs secondary to neoplasia, trauma, inflammation and developmental problems [Conover GL, Crammond RJ. Tympanic plate fracture from mandibular trauma. J Oral Maxillofac Surg 1985; 43:292–4; Ali TS, Rubinstein JT. Rheumatoid arthritis of the temporomandibular joint with herniation into the external auditory canal. Ann Otol Rhinol Laryngol 2000; 109:177–9]. Benign necrotising otitis externa (BNOE) is an uncommon condition characterized by avascular necrosis of the tympanic plate that has been described as a sequela of simple otitis externa. [Wormald PJ. Surgical management of benign necrotizing otitis externa. J Laryngol Otol 1994; 108:101–5.] We present a case of BNOE that resulted in a posterior herniation of the TMJ capsule into the EAM.

Incidence and pattern of mandibular fractures in rural population: a review of 324 patients at a tertiary hospital in Loni, Maharashtra, India

The aim of this study was to document the pattern and incidence of mandibular fractures occurring in rural population, at Rural Dental College and Hospital, Maharashtra, India. A retrospective analysis of patient records and radiographs for the 5-year period from January 2003 to December 2007 was conducted. Data were identified and analyzed based on age group, gender distribution, anatomic location, and cause of injury. A total of 324 patients with 486 injuries were reviewed, males formed 80.9% and females 19.1% of the studied population, with peak incidence occurring in the 21-30 years age group. The most common fractures site was parasymphysis (39.3%). The etiology of mandibular fractures was road traffic accidents (42.9%), followed by falls (25.9%), assaults and interpersonal violence (20.7%), and animal injuries (10.5%). Our results exhibit that road traffic accidents remain the major cause of mandibular trauma and animal injuries being found exclusively in rural population. There is a variation of incidence and pattern of maxillofacial trauma from region to region.

Identification of Mandibular Fracture Epidemiology in Canada: Enhancing Injury Prevention and Patient Evaluation

Mandibular fractures can lead to significant functional and aesthetic sequelae if treated improperly. They may act as an indicator of concomitant trauma and are very demanding on the public health care system. Thus, knowledge of mandibular fracture epidemiology is critical to effective prevention, as well the establishment of accurate trauma evaluation protocols. To identify the epidemiology of mandibular fractures treated at a level 1 Canadian trauma centre, clarify the pathogenesis of these epidemiological patterns and suggest potential targets for preventive efforts. A retrospective review of all mandibular fracture patients presenting to the Montreal General Hospital between 1998 and 2003 was performed. Medical records and digitized radiographic imaging were used to collect patient demographics and injury data. The chart review identified 181 patients with 307 mandibular fractures. Fifty-two per cent of the fractures occurred in individuals 21 to 40 years of age, 78% of patients were male, and there was wide ethnic diversity. Sixty percent of patients had multiple mandibular fractures; 29% were symphyseal/parasymphyseal fractures, 25% were condylar fractures and 23% were angle fractures. Assault was the most common mechanism of injury, with 29% of fractures involving alcohol or illegal drug use. Thirty percent of patients had an associated facial fracture, and more than one-third had another major injury. The present epidemiological review reveals several potential prevention targets as well as significant trends. Further research into the impact of these preventive measures could more objectively identify their impact on mandibular trauma.

Three-dimensional stability of angle fractures using Hayton William's wiring

Mandibular trauma takes about 40% of the major share in the injuries of maxillofacial region. Mandibular angle is more vulnerable to its prominent exposure and also presence of third molars weakens this structure. Displaced angle fractures are usually treated with intraosseous boneplate alone or boneplate with intermaxillary fixation. Using miniplates and screws which most often monocortical in nature and insufficient to retain the approximation till the period of healing. Due to these reasons, we have taken up Hayton William's lower border wiring which gives dynamic compression and rigid approximation at the angle of mandible which allows primary healing within a short period of time.

MANDIBULAR FRACTURES IN FAR NORTH QUEENSLAND: AN ETHNIC COMPARISON

No previous published Australian study on the epidemiology of mandibular fractures has comprehensively shown the differences existing between indigenous and nonindigenous populations. Cairns Base Hospital, which services both the metropolitan city of Cairns and remote regions of Far North Queensland, provides the perfect environment for investigating such differences. A retrospective study of all patients presenting to Cairns Base Hospital with mandibular fractures over the 3-year period between January 1999 and January 2002 was undertaken. A total of 444 mandibular fractures occurred in 276 patients. The indigenous population of 7.6% in Cairns (17.9% in Far North Queensland) represented 49% of all patients. Assaults (74%) were the principal cause. The second most common mechanism was sporting injuries (17%), followed by motor vehicle accidents (5%) and falls (4%). In the indigenous female population, 93% arose from assaults, of which 57% were documented as domestic violence. The nonindigenous population had a defined peak in the third decade of life, with fractures in 47% of men and 38% of women occurring then. However, the indigenous group had a sustained peak between 11 and 40 years of age, with 94% of fractures occurring within this period. The male to female ratio was 6:1 in nonindigenous (3:1 indigenous). The side of predilection was L:R = 1:1 in nonindigenous (L:R = 3:1 indigenous). Recurrent mandibular trauma was documented in 4% of nonindigenous (18% of indigenous). Within the nonindigenous, all women and 90% men sought medical attention within 2 days of injury. In contrast, 38% indigenous men and 20% indigenous women delayed their initial presentation for 3 days or more (P < 0.001). Clinically and statistically significant differences exist between the two ethnic groups. It is proposed that these differences are possible indicators that high rates of interpersonal violence exist in a community.

Use of Three-Dimensional Computerized Tomography Reconstruction in Complex Facial Trauma

Technological advances in computerized tomography (CT) have reduced data acquisition and reconstruction times so that three-dimensional (3D) CT images of maxillofacial injuries may be economically and quickly generated. 3DCT was judged superior to multiplanar two-dimensional CT in demonstrating the spatial relationships of fracture fragments in complex mandibular and midfacial trauma. Although 3DCT failed to demonstrate soft-tissue injuries well, the surgeon's improved appreciation of the disrupted bony architecture facilitated preoperative planning. 3DCT facilitates the evaluation of complex mandibular and midfacial fractures.