Reduction Of Mandibular Fractures Research Articles

Single versus Double Plate Fixation in Condylar Neck Fractures: Clinical Results and Biomechanics Simulation.

The open reduction of mandibular condyle neck fractures is difficult due to the limited surgical field and complex facial nerve structures. The most effective fixation method for narrow fractured segments is debated as standard double four-hole plate fixation is often not feasible. This research compared bone stability and force resistance between single-long-plate and double-short-plate fixations using clinical outcomes, a Sawbones mandible model, and finite element analysis. In patients with condyle neck fractures, nine were fixed with single-long-plate and twelve with double-short-plate fixations, with no significant differences in malocclusion and facial palsy rates. In compression tests with a Sawbones model, displacements in the posterior part were similar in both fixation groups. In contrast, the anterior part had significantly higher displacements in the single-long-plate group. Finite element analysis showed higher displacements in both anterior and posterior parts in the single-plate group compared to the double-short-plate group. Maximum stresses were at the second screw hole in single-long-plate fixation and the turning point of the upper plate at the condyle neck in double-short-plate fixation. Double-short-plate fixations demonstrated better stability and force resistance than single-long-plate fixations.

Management of Limited Mouth Opening After Open Reduction and Fixation of Mandibular Coronoid Fractures.

Mandibular coronoid process fractures are relatively rare and generally treated conservatively. This paper reports a case of limited mouth opening and pain after open reduction and fixation of the mandibular coronoid fracture. After the loose titanium screws, plates, and absorbed coronoid fracture fragments were removed, the patient's mouth opening was restored immediately. The authors believe that open reduction and fixation for coronoid process fractures can cause postoperative limited mouth opening and pain. Conservative treatment of coronoid process fractures is more beneficial for patients.

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

Transoral endoscopic assisted reduction and internal fixation of mandibular condylar neck fractures with short condylar segment

This study aimed to assess the reliability and safety of transoral endoscopic-assisted reduction internal fixation (TERIF) for treating short-segment condylar neck fractures (CNF), including hardware removal.Patients with displaced CNF and short condylar segments treated using TERIF were included in the study. Clinical evaluation covered dental occlusion, range of mouth opening, deviation during mouth opening, protrusion, laterotrusion, pain, and chewing. Radiological evaluation was used to assess fracture displacement, angulation, head dislocation, postoperative reduction, fixation stability, and bone healing. The same technique was used to treat 15 patients with 18 CNF and short condylar segments. Hardware removal was performed for nine fractures in eight patients after fracture healing using the same approach.All patients regained satisfactory, pain-free mouth opening with no deviation and complete bone healing. Computed tomographic images displayed adequate reduction and stable fixation during the follow-up period for all patients. No temporary or permanent facial nerve impairment occurred in any of the patients.TERIF is a reliable and safe treatment for CNF with short condylar segments, even in the presence of head dislocation, medial override, and malunited fractures; hardware can be safely removed after healing using the same approach.

Electromyographic Study of Facial Nerve Function Using Two Different Surgical Approaches in Low Condylar Fractures of the Mandible: A Randomized Controlled Clinical Trial

Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures. The purpose of this study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram. A randomized controlled clinical trial was designed. The study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery. The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP. The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1week (T1), 1month (T2), and 3months (T3). The secondary outcomes studied were operating time and any other complications recorded. Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata etal.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the study participants were homogenous in all aspects. Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P<.05. The study sample was composed of 22 patients with a mean age of 32.82±11.21years in TMAP and 27.82±8.54years in the TP group respectively (P=.26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P=.53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P=.31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03±9.7 vs 89.56±10; 95% confidence interval -24.28 to -6.65 with P value=.002). TP approach was faster with a mean exposure time of 9.9minutes. The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.

Accidental finding of an accessory mental nerve during mandibular fracture reduction

Accidental finding of an accessory mental nerve during mandibular fracture reduction

Complications of Open Reduction and Internal Fixation of Mandibular Condyle Fractures in Oman

Objectives: The management of mandibular condyle fractures by Open Reduction and Internal Fixation (ORIF) is gaining popularity worldwide. The aim of this study is to report the complication rate associated with ORIF of mandibular condyle fractures in Oman. Methods: A retrospective cohort study was conducted among all patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and Sultan Qaboos University Hospital, Muscat, Oman, from January 2008 to December 2020. Data collected included; patient demographics, fracture aetiology, fracture side and type, surgical approach, and recorded complications and outcome. Results: A total of 68 patients (59 males and 9 females, mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fracture was the commonest type accounting for 62.7% and bilateral fractures occurred in 21 (30.8%) patients. The most common surgical approach was retromandibular accounting for 42.2%. The overall rate of recorded complications was 42.6% and the commonest reported complications were transient facial nerve palsy (18.1%), followed by malocclusion and restricted mouth opening accounting for 14.7% and 10.3%, respectively. Subsequent surgical intervention to correct malocclusion was performed in six cases. There was no statistically significant difference in overall complications and the patient’s clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures offers a favourable outcome, it carries a small risk of developing a few complications.&#x0D; Keywords: Mandibular Fracture; Mandibular Condyle; Open Fracture Reduction; Complications; Facial Nerve Injuries; Oman.

Liposomal Bupivacaine Suspension Can Reduce the Length of Stay of Patients Undergoing Open Reduction and Internal Fixation of Mandibular Fracture

Poorly controlled postoperative pain results in prolonged length of stay (LOS). The use of liposome bupivacaine injectable suspension (LB) for postoperative pain control is a relatively recent practice. The purpose of this study was to investigate the following. In patients undergoing open reduction and internal fixation of mandibular fracture(s), does the use of LB reduce LOS compared with regular bupivacaine? We implemented a retrospective cohort study of consecutive patients with mandibular fracture(s) presented to Grady Memorial Hospital in Atlanta, GA, from January 2021 to January 2022. Adult patients diagnosed with 1 or more isolated mandibular fracture(s) and treated by open reduction and internal fixation were included. We excluded patients with non-isolated mandibular fracture(s), isolated condyle, infected, previously treated fractures, and documented allergy to amide local anesthetics and/or its preservatives. Primary predictor variable was the use of local anesthetic. Primary outcome variable was LOS, defined as the number of days from surgical procedure until discharge. Secondary outcome variables were number of opioid prescription refill(s) and postoperative pain at discharge, determined with visual analogue score. Demographics, American Society of Anesthesiologists classification, smoking, alcohol exposure, illicit drug use, etiology, location, laterality, number of fracture(s), surgical approach, and method of maxillomandibular fixation. Univariate and bivariate analyses were calculated. Statistical significance was P<.05. Sixty-two subjects met the inclusion criteria (31 subjects in each group). The mean ages in LB/regular bupivacaine and regular bupivacaine alone groups were 33.3 (±12) and 35.1 (±15.6), respectively (P=.94), the mean LOS in days was 0.23 (±0.44) in LB/regular bupivacaine and 1.48 (±1.77) in regular bupivacaine alone (P=<.001), and the mean VAS pain scores for LB/regular bupivacaine and regular bupivacaine alone groups were 0.53 (±1.07) and 1.87 (±2.66), respectively (P=.02). Mean number of opioid prescription refill(s) was 0 in LB/regular bupivacaine and 1 in regular bupivacaine alone group, respectively (P=.01). The study findings suggest that the use of LB/regular bupivacaine for mandibular fracture(s) results in decrease in LOS and number of opioid refills compared to regular bupivacaine alone.

Comparison of Neurosensory Recovery of the Inferior Alveolar Nerve After Open and Closed Reduction for Mandibular Fractures: A Prospective Study.

Traumatic mandibular fractures are the most common fractures of the facial region and are associated with loss of neurosensation in the inferior alveolar nerve (IAN). The present study aimed to compare IAN recovery after traumatic mandibular fractures between the open and closed reduction methods. The study included 90 patients with traumatic mandibular fractures of the body, angle, and symphysis, divided into two groups of 45 patients: group 1 was treated with closed reduction and fixation with rich arch-bar fixation under local anesthesia, and group 2 was treated with open reductionand rigid internal fixation with 2-mm titanium mini plates and monocortical screws (6 mm), and the plate was fixed to the fractured bony fragments. All patients underwent neurosensory testing using the Zuniga and Essick algorithm at baseline (preoperative), one week after surgery (postoperative), at three months, and at six months of follow-up. No statistically significant differences were observed in IAN recovery between the groups. The most common site of fracture was the body (44% in group 1 and 56% in group 2). The maximum recovery was observed in the younger age group (25-30 years). At baseline, functional nerve recovery was observed in 40 cases (88%) in group 1 and 38 cases (84%) in group 2, and the difference was not statistically significant. Levels A and B tests were affected by surgical management and improved after three months.The total recovery in group 1 ranged from 60% to 80%, and that in group 2 ranged from 56% to 72%. Based on the findings of the current study, both methods are recommended for surgical management of traumatic mandibular fractures with IAN recovery in 60-80% of cases six months postoperatively.

Evaluation of Efficacy of Herbert Bone Screw and Lag Screw in Management of Oblique Mandibular Fractures: A Prospective Randomized Comparative Study.

To assess the efficacy of Herbert cannulated bone screw versus Lag screw in fixation of oblique mandibular fractures. Study composed of two groups of 20 patients each and descriptive statistics were performed with p value set at 0.05 with confidence interval of 95%. Group A was treated by Titanium Lag screws; while, Group B was treated by Titanium Herbert Cannulated Bone Screws for the management of oblique mandibular fractures. Postoperatively, all the patients were evaluated clinically and radiographically by recording the incidence of complications (if any) which included trismus, neurosensory deficit, swelling, infection. Parameters such as occlusal discrepancy, rigid fixation (interfragmentary gap) and duration of surgery were also recorded for all the patients. All the patients were followed for a period of three months. Difference in mouth opening was found to be statistically significant during 1st month follow-up (p-Value-0.002). Postoperatively, the mean interfragmentary gap in Group A was significantly more than Group B (p-Value-0.000). Other parameters like neurosensory deficits, occlusal discrepancies, chewing efficiency, stability of fractured fragments and post-operative complications in terms of swelling, hardware exposure, radiolucency surrounding screw and wound dehiscence did not show any statistically significant difference. The obtained results showed that both lag screws and Herbert cannulated bone screws fulfill the treatment goals of adequate reduction, fixation and stabilization of oblique mandibular fractures. Herbert screws have shown to have better results in terms of interfragmentary gapreduction as compared to lag screws.

Neurosensory Recovery Following Skeletonization of Mental Nerve During Open Reduction &amp; Internal Fixation for Mandibular Fractures

Background: Intraoral open reduction and internal fixation (ORIF) procedures used to treat mandibular fractures can result in neurosensory abnormalities due to soft tissue and nerve manipulation. While treating fractures located in the parasymphysis and anterior body regions, where the inferior alveolar and mental nerves are located, there is limited access which can impede correct reduction and hinder the use of optimal fixation. To counter these problems, better access can be gained through skeletonization of the mental nerve, which is known to result in neurosensory disturbances. However, the extent of neurosensory deficits that may result from these procedures and the degree of their recovery remain unknown in current literature. Objective: The primary purpose of our study was to evaluate and correlate the objective and subjective neurosensory recovery of the mental nerve following skeletonization during Open Reduction and Internal Fixation of mandibular fractures. Study Design: This was a prospective observational study. Settings: The adult subjects having mandibular fractures treated at Jinnah Hospital, Lahore Pakistan, a level III tertiary care hospital. Duration: The study duration was from July 1, 2022 and December 31, 2022. Methods: Demographic details were taken and preoperative objective and subjective neurosensory assessment was performed. Following surgery, postoperative objective and subjective neurosensory assessment was performed on post op day 1, after 1 and 6 weeks. Collected data was analysed with significance level of &lt;0.05. Results: Twenty four subjects who completed regular follow-up visits for 6 weeks were included in this study. All subjects had objective or subjective neurosensory deficit preoperatively. Following surgery, all the subjects had FSR grade S0 and subjective loss of sensation at immediate postoperative assessment after surgery. 87.5% of the subjects had complete objective and subjective neurosensory recovery at the end of 6 weeks. There was a significant negative correlation between objective and subjective neurosensory recovery during the initial stages of the study, which became non-significant by the end of 6 weeks. Conclusion: Following mental nerve skeletonization during ORIF of subjects with mandibular fractures having some degree of preoperative paraesthesia, a majority of subjects achieved complete neurosensory recovery 6 weeks postoperatively. Therefore, it is expected for a skeletonized mental nerve to return to normal function within 2 months after ORIF for mandibular fractures.

Prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures: a systematic review and meta-analysis.

Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.

The necessity of removal of third molars involved in mandibular fractures: A retrospective study

This retrospective analysis aimed to investigate the necessity of removing the wisdom tooth in cases of angle fractures of the mandible. The study retrieved 595 mandible fractures from January 2006 to December 2021 through the Hospital Inpatient Enquiry System, of which 303 involved a fracture through the angle of the mandible, including the wisdom tooth socket. Of these, 203 (66.9%) underwent open reduction and internal fixation with retention of the third molar. The authors found that only four (2%) patients returned for the removal of plates and the retained third molar during the follow-up period. Therefore, the authors concluded that wisdom teeth removal should remain an exception during open reduction and internal fixation of mandibular angle fractures unless they hinder fracture reduction, pose a potential infection risk, or interfere with occlusal stability.

Precise minimally invasive treatment of mandibular fracture in children assisted by digital surgery technology

Objective: To explore the role of digital three-dimensional printing technology and multifunctional board in the treatment of mandibular fracture in children. Methods: From January 2006 to January 2022, 42 children with mandibular fracture were treated by Department of Stomatology, in The First Affiliated Hospital of Bengbu Medical College, including 25 males and 17 females. The patients, aged from 4 to 12 years, with the median age was 10 years old, were divided into observation group (22 cases) and routine group (20 cases) according to the treatment methods. In the observation group, the multifunctional board was made before operation, and the CT data of the children were imported into Mimics software in".dicom"format, and the displaced mandible was virtually reset. The jaw reduction model was made by three-dimensional printing, and the surgical operation was simulated on the reduction model to determine the model and position of the internal fixation device and shape it. During the operation, the fracture was reduced and fixed according to the preoperative design; The conventional group was treated with open reduction and internal fixation of mandibular fracture by traditional methods, and the clinical application value was compared and analyzed through the intraoperative situation, occlusal relationship, and follow-up of the two groups. Results: The total intraoperative bleeding volume [(30.25±4.02) ml] and surgical time [(64.3±9.2) min] in the observation group were significantly lower than those in the conventional group [(35.13±5.69) ml and (84.6±13.9) min, respectively] (F=6.18, P=0.003; F=1.32, P=0.001). The excellent and good rate of occlusal relationship in the observation group [96% (21/22)] was significantly higher than that in the conventional group [85% (17/20)] (F=4.27, P=0.039). The incidence of complications, the observation group, 1 case of poor occlusion, 1 case of postoperative infection; In the routine group, there were 3 cases with poor occlusion, 1 case with nerve injury, 1 case with root injury and 1 case with tooth germ injury. Conclusions: The application of digitization three-dimensional printing technology combined with multifunctional occlusal plate in children's mandibular fracture is minimally invasive, safe, efficient and accurate, and the clinical effect is good.

Non-Surgical Site-Related Complications in Mandibular Fracture Surgery – A Problem of Elderly Patients?

Scientific evidence of nonsurgical site-related complications in mandibular fracture patients is limited. The purpose was to measure the frequency of nonsurgical site complications in patients with mandible fractures, describe the types of complications, and identify the risk factors associated with these complications. A retrospective cohort study was conducted at the Helsinki University hospital between 2018 and 2021. Patients undergoing surgery with open reduction and internal fixation of mandibular fracture(s) were evaluated. Patients under 16years of age were excluded. Primary predictor variable was age. Patient-related predictor variables were sex, long-term disease(s), smoking, and alcohol and/or drug abuse. Injury and fracture-related variables were injury mechanism, type and site of facture, combined craniofacial fracture(s), and associated injury(s). The primary outcome variable was nonsurgical site-related postoperative complication. The secondary outcome variable was type of complication. Not applicable. The main outcome variable was cross tabulated for pairwise comparisons with predictor variables. Multivariate logistic regression was performed for statistically significant (P<.05) variables. The data included 314 patients (age range: 16 to 89years; mean age: 38years old; median age: 33years old); most (78.3%) were men. Nonsurgical site-related postoperative complications occurred in 6.7% of patients. The most common complication type was pulmonary complication (36.0%), followed by urinary complication (20.0%) and general infection (16.0%). Nonsurgical site-related postoperative complications were most likely to occur in patients who were elderly (adjusted odds ratio [aOR] 5.55; 95% CI 1.92 to 16.21; P=.002), had combined craniofacial fractures (aOR 2.92; 95% CI 1.06 to 8.03; P=.038), and abused alcohol or drugs (aOR 4.51; 95% CI 1.70 to 11.96; P=.003). Pulmonary complications occurred more often in elderly patients, whereas urinary complications were more common in younger patients. The types of nonsurgical site complications in mandibular fracture patients increase and vary according to the patient's age. Awareness of possible complications related to different age groups helps anticipate and identify these in clinical work, and to consider the overall treatment of the patient beyond the fracture.

Prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures: a systematic review and meta-analysis

Our study aims to estimate the prevalence of Frey syndrome following open reduction and internal fixation (ORIF) for mandibular fractures. Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed. In total, fifteen eligible studies were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of Frey syndrome following extraoral surgical treatment for mandibular fractures was estimated as 0.01% (95%CI 0%-0.7%) with moderate heterogeneity observed between studies. In the meta-regression analysis with continuous variables, no statistically significant association was observed. Despite the relatively low prevalence, the impact of Frey syndrome on affected individuals should not be underestimated. Additional research will provide a more comprehensive understanding of the underlying factors contributing to Frey syndrome, leading to improved preventive measures and treatment strategies. A better grasp of the prevalence and associated risk factors will aid in the development of guidelines to minimize the occurrence of this syndrome.

Liposomal Bupivacaine Suspension Can Reduce Length of Stay of Patients Undergoing Open Reduction and Internal Fixation of Mandibular Fracture

Liposomal Bupivacaine Suspension Can Reduce Length of Stay of Patients Undergoing Open Reduction and Internal Fixation of Mandibular Fracture

Erich arch bars vs intermaxillary fixation screws for mandibular fracture reduction during ORIF: a randomized clinical trial.

This randomized clinical trial aimed to compare the efficacy of Erich arch bars (EAB) and intermaxillary fixation (IMF) screws in reducing mandibular fractures during open reduction and internal fixation (ORIF). A total of 28 patients with mandibular fractures were randomly allocated to either the EAB group or the IMF screws group. The study evaluated various parameters including occlusal stability, complications, duration of application, oral hygiene status, quality of life, and patient characteristics. The study found no significant differences in occlusal stability between the EAB and IMF screw groups. However, the application and removal times were longer for EAB compared to IMF screws. The EAB group showed a higher presence of biofilm on teeth, indicating poorer oral hygiene status compared to the IMF screws group. In terms of quality of life, patients in the EAB group reported worse results in the "handicap" domain at the 15th postoperative day. No significant differences were observed in other quality-of-life parameters. Patient characteristics were well distributed between the two groups, enhancing the reliability of the results. Both EAB and IMF screws demonstrated comparable occlusal stability for minimally displaced mandibular fractures. However, IMF screws offered advantages such as shorter application and removal times, better oral hygiene maintenance, and potentially improved quality of life in the "handicap" domain. Further studies with larger sample sizes are necessary to validate these findings and explore the stability of IMF methods in cases requiring postoperative malocclusion correction or prolonged IMF.

Frequency of Inferior Alveolar Nerve Damage After Open Reduction and Internal Fixation in Mandibular Fractures

One of the most frequent injuries to the maxillofacial region is mandibular fracture. Numerous places experience fractures. The inferior alveolar nerve is often injured as a result of mandibular fractures. Objective: To ascertain how frequently patients in the oral and maxillofacial department of the Ayub Teaching Hospital in Abbottabad experienced inferior alveolar nerve injury following open reduction and fixation of a mandibular fracture. Methods: This was a Descriptive case series carried out at Oral and Maxillofacial Department, Ayub Teaching Hospital, Abbottabad after approval from the IRB of the institution and CPSP vide number (CPSP/REU/DSG-2018-010-2532). Using the formula to evaluate proportion with absolute precision and the following premises, the sample size was determined to be 96 using the WHO software for sample size computation in health studies: The expected percentage of inferior alveolar nerve injury following fixation in mandibular fracture is 45%, the confidence level is 95%, and the absolute precision is 10%. Results: The mean age of participants was 35.81±5.63 years with range from 26 to 45 years. Most common age group was 36-40 years and 41-45 years (n=26, 27.08%) followed by 26-30 years (n=23, 23.96%). There were 70 (72.92%) males and 26 (27.08%) females in the study. Majority (n=88; 91.67%) of the patients were given general anesthesia while the remaining (n=8; 8.33%) received local anesthesia. Perioperative inferior alveolar nerve injury was observed in 56 (58.33%) patients while permanent inferior alveolar nerve injury was diagnosed in 39 (40.63%) patients. Conclusions: Damage to inferior alveolar nerve is a frequent problem of open reduction and fixation of mandibular fracture. However, utmost care should be exercised to reduce its occurrence in patients with mandibular fracture.

Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases.

Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.