Treatment Of Jaw Fractures Research Articles

EFFECT OF INTERMAXILLARY FIXATION ON BIOCHEMICAL AND BLOOD MARKERS IN A SAMPLE OF YEMENI ADULTS

Background: Intermaxillary fixation is a technique that is used in the treatment of jaw fractures, orthognathic surgery, temporomandibular joint disorders, and occasionally morbid obesity. However, it disrupts normal nutrition, leading to weakened immunity, impaired healing, and higher complication risks, negatively impacting treatment outcomes and patient recovery. Thus, the aim of this study was to investigate the physiological changes in a sample of Yemeni patients following four weeks of IMF treatment. Materials and Methods: A study involving ten Yemeni adults underwent intermaxillary fixation for mandibular fractures. Parameters like body weight, lipid profile, liver function tests, kidney function tests, electrolytes, and hemoglobin levels were analyzed before and after treatment at a central blood bank. Results: The majority of patients were male (80.0%) and aged between 25 and 35 years, and the majority had a unilateral mandibular body fracture (50%). Clinical results after 4 weeks of intermaxillary fixation demonstrated significant reductions in body weight (4.2 kg) and BMI (1.0 kg/m2). post-IMF application, lipid profile analysis showed non-significant changes in total cholesterol, high-density lipoprotein levels, low-density lipoprotein, and triglycerides (p>0.05), liver function tests exhibited significant decreases in AST (7.7 µ/l, p=0.044), kidney function tests and electrolyte analysis revealed non-significant changes, and there were significant reductions in T.WBC (2.48 x 10⁹/L) and neutrophils (19.5%) after IMF (p=0.007). Conclusions: Intermaxillary fixation in Yemeni adults leads to weight loss and changes in liver and blood parameters, indicating its systemic effects. These findings highlight the importance of nutritional support and close monitoring during IMF treatment to mitigate malnutrition risks and optimize healing outcomes. Peer Review History: Received 21 May 2024; Reviewed 15 July 2024; Accepted 25 August; Available online 15 September 2024 Academic Editor: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Abdulwahab Ismail Al-kholani, Dean of Faculty of Dentistry at 21 September University, Yemen. prof_khholani@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Comparison of hybrid arch bar versus conventional arch bar for temporary maxillomandibular fixation during treatment of jaw fractures: a prospective comparative study.

This study aimed to compare the effectiveness of a hybrid arch bar (hAB) with the conventional Erich arch bar (EAB) for the management of jaw fractures, focusing on their use for temporary fixation in patients undergoing open reduction and internal fixation (ORIF). Patients presenting with maxillary and mandibular fractures at our institution were included in this prospective, comparative study. Placement time and ease of occlusal reproducibility were recorded intraoperatively for Group A (hAB patients) and Group B (EAB patients). The primary outcome was comparison of the postoperative stability of the two arch bars. Postoperative measurements also included mucosal overgrowth, screw loosening or wire retightening, and replacement rates. The data were tabulated and computed with a P<0.05 considered statistically significant. The study included 41 patients. A statistically significant difference was observed in postoperative stability scores (3) between Group A and Group B (85.0% vs 9.5%, P=0.001). The mean placement time in Group A (23.3 minutes) significantly differed from that in Group B (86.4 minutes) (P<0.001). The ease of intraoperative occlusion was not different between the two groups (P=0.413). Mucosal overgrowth was observed in 75.0% of patients (15 of 20) in Group A. The hAB was superior to EAB in clinical efficiency, maxillomandibular fixation time reduction, stability, versatility, and safety. Despite temporary mucosal overgrowth, the benefits of hAB outweigh the disadvantages. The choice between hAB and EAB should be based on specific clinical requirements.

Evaluation of Biodegradable Fixation Application for Jaw Fracture in Pediatric Patients

Background: The treatment of jaw fractures in pediatric patients need a special concern and different management than adult patients due to their dynamic and structural changes following their growth patterns. Treatment by open reduction and internal fixation (ORIF) using titanium or biodegradable plates as osteosynthesis material is indicated for displaced jaw fracture. Biodegradable fixation could be used as an alternative choice, using plates and screw that will decompose along with bone healing. Case: Two pediatric patients brought to RSUP Dr. Sardjito, Yogyakarta with complaints of jawbone fracture. The first patient was a 7-years-old woman diagnosed with mandibular symphysis fracture and a left mandibular kondilus fracture, while the second patient was a 15-years-old woman diagnosed with malunion of left maxillary fracture. Fracture treatment was performed using biodegradable fixation. The first patient was repositioned according to the anatomical state and the second patient the maxillary refracture was done before repositioning. Patients were evaluated clinically for up to three months postoperatively and radiological imaging was performed. Evaluation results show good jaw bone union, no malocclusion, no tooth mobility and no paresthesia in both patients. Intraoral wound dehiscence with exposed plate was found in the second patient at the vestibule of the left uper canine until premolar region and can be resolved by removal of the plates under local anesthesiaConclusions:. Biodegradable as an ideal osteosynthesis material for jaw fracture in pediatric patients

Battlefield Management of Facial Fractures Using Minnie Ties: An Innovative Technique for Maxillomandibular Fixation.

Application of maxillomandibular fixation (MMF) for the treatment of jaw fractures has a long history stretching back thousands of years. Modern methods of MMF require extensive training for correct application and are often not practical to perform in a forward operating environment. Most MMF methods carry inherent risks of sharps injuries and exposure to bloodborne pathogens. The authors present a method of MMF with Minnie Ties, which are simple, effective, and much safer than traditional methods of MMF.

А case of a lower jaw fracture treatment after lower wisdom tooth extraction

One of the most common dental surgical procedures performed in specialized oral surgery and dental practice is extractions of mandibular third molar. In this report, we look at the case of a 55-year-old patient who is receiving hospital treatment for lower jaw pain and edema. After orthopantomography, a fracture was found in the angle of the lower jaw, accompanied by an inflammatory process. In the intraoral examination, an unhealed completely extraction wound to the left of the mandible was observed in the area of the wisdom tooth, pathological mobility and bone crepitus. Mandibular angle fracture is the most common mandibular fracture, accounting for approximately 40% of all mandibular fractures. Mandibular angle fracture is defined as a fracture line between the anterior border of the mandibular ramus and the jaw body. In the present case, the patient received an additional graphy of the facial skeleton and was treated with intermaxillary fixation with rigid fixation and restraints bilaterally in the area of the upper and lower jaws and molars.

An experimental study using known variants of transport immobilization and comparing them with the original temporary splint for the treatment of jaw fractures

Academician I.P. Pavlov Ryazan state medical University of the Ministry of health of the Russian Federation, 390026, Ryazan, Russian Federation&#x0D; Patients with injuries of the maxillofacial region make up about 30% of all patients treated in the in-patient departments of maxillofacial surgery. Meanwhile, fractures of the lower jaw account for about 70%85% of all fractures of the bones of the face. The need for immobilization is due to the risk of pain and complications (bleeding, microbial contamination, asphyxiation, damage to nerves and blood vessels). The article provides a comparative analysis between temporary immobilization of the jaws using well-known designs and a new universal temporary bus with a channel. We conducted the experiment under simulated conditions using the following splinting structures: a smooth splint bar and a patented temporary splint with a channel for treating jaw fractures (Application No. 2020103350/14 (005106) (22) Application submission date 27.01.2020). From the experimental research complex, it was possible to verify that the methods of temporary splinting of the jaws have their own characteristics of superposition and displacement of structures. It is worth noting that the displacement of jaw fragments occurred in each splinting and this should definitely be taken into account at the stage of first aid. The study also revealed that that the splinting technique for the splint has a number of disadvantages, the most significant of which are the negative impact on periodontal disease, a significant decrease in oral hygiene, and the possibility of secondary infection. Among the obvious advantages of a universal temporary bus with a channel, include the simplicity of applying and fixing fragments, the ability to supply the patient, receive fluids and drugs through the probe, as well as ensuring full breathing in the absence of nasal breathing.

Obwegeser cerclage technique for the treatment of jaw fractures in horses: a retrospective study on 46 cases (1987–2010)

Skull fractures, particularly mandibular fractures, are the second most common fractures in horses after limb fractures. The majority of mandibular fractures involves its most rostral part, i.e. the pars incisiva. Like other head fractures, those of the jaws are commonly caused by a blunt external trauma such as a kick from another horse, a fall or a collision with a solid object. Rostral fractures can also occur when horses get caught between vertical metal bars in the stall: the horse bites the bar with its head tilted towards a slightly horizontal position and then suddenly pulls back its head together with a vertical movement of the head, while the teeth remain lodged between the metal bars. In rare cases jaw fractures occuriatrogenically following dental treatment or due to pathological alteration of the bone in case of neoplasia or chronic osteomyelitis. In the majority of cases jaw fractures are open toward the oral cavity and may be severely contaminated. Unstable, bilateral or dislocated fractures which lead to impaired occlusion need surgical intervention. Intraoral wiring is one of the fixation techniques used, depending on the fracture configuration. The Obwegeser multiple-loop intraoral wiring method is particularly suited for fixation of avulsion fractures of the incisors because teeth can be fixed individually, the tension can be distributed evenly among different teeth and the fixation can be extended across a wide area. This method is very suitable for fixation of rostral jaw fractures. It can also be used in combination with other fixation techniques, e.g. plate osteosynthesis, to provide additional stability on the tension side of a fractured mandible and incisor bone. This retrospective study examined 46 patients with jaw fractures that were fixed using the Obwegeser wiring method alone (n=31) or in conjunction with another fixation method (n=15). Medical records, repeated radiological examinations and telephone interviews with the owners were used to gather information about clinical signs on presentation, type of fracture fixation, the healing process, short and long term complications, time of removal of the wires and owner satisfaction with the surgical outcome. The following clinical signs were found with the initial examination: oral haemorrhage (n=28), dysphagia (n=24) and local swelling (n=21). 23 horses suffered from malocclusion and in 5 of 46 patients crepitation was obvious. In 20 cases (43%) the fracture was older than 24 hours at the time of presentation to the hospital. Forty (87%) of the fractures were open. Cases that were fixed using the Obwegeser wiring method alone had a lower complication rate (11/31, 35%) than cases in which wiring was used in conjunction with another fixation method (12/15, 80%). In most cases the fracture could be repaired in the standing horse using sedation and local anaesthesia. An orthopaedic stainless steel wire with a diameter of 1.25 mm was used for cerclage. Wires used alone were left in place for an average of 10 weeks (mean 10.0 and SD±5.8) and those used in addition to another fixation method for an average of 16 weeks (mean 16.0 and SD±8.9). No further complications associated with the fracture occurred in 31 (93%) of the 33 cases that had long-term follow-up information. The fact that in 20 cases (43%) the fracture was older than 24 hours at the time of presentation to the hospital shows that jaw fractures are commonly not recognized immediately or are underestimated by owners or referring veterinarians. The lower complication rate in the 31 cases treated with the Obwegeser wiring method alone may be explained by the lower complexity of the fractures, the intra- versus the extraoral position of the implants and thereby no possible interference of the implant with fracture healing, and the reduced amount of implant material. This study shows that the inexpensive and relatively simple Obwegeser method is a very suitable method for fixation of rostral jaw fractures in the horse.

Effects of interdental/intermaxillary wiring on teeth and periodontal tissues in the management of dentoalveolar and jaw fractures

Objectives: To evaluate immediate and late probable side effects of interdental/intermaxillary wiring used in treatment of jaw fractures on gingival and other deeper structures. Methods: 30 patients undergoing wiring procedure as an aid for treatment of jaw fractures were selected. The immediate and late effects with a six month follow up were studied using various parameters that were Plaque index, Modified gingival index, Ramfjord’s periodontal disease index, tooth mobility (graded as ‘normal or pathological’), tooth vitality using gutta-percha hot stick and checking for ankylosis or root resorption clinically as well as radiographically. Results: Immediate effects noticed after placement of wiring were increased accumulation of plaque, inflammatory gingival hyperplasia with bleeding on probing, deepening of gingival sulcus and increased tooth mobility. Most of the changes had totally reversed after 6 months follow up. Conclusions: The late deleterious effects on teeth and periodontal tissues from interdental wiring in the treatment of jaw fractures are minimal and hardly of any significance. Key words: Interdental/Intermaxillary Wiring, Jaw Fractures, Modified Gingival Index, Plaque Index, Ramford’s Periodontal Index.

Force relaxation of 3/16 inch heavy orthodontic latex elastics used in maxillofacial trauma in simulated jaw fracture situation

Introduction: Orthodontic elastic has been investigated for tooth movement. Study about their use in treatment of jaw fractures is limited. This study is designed to measure force relaxation of 3/16 inch heavy latex orthodontic elastics in jaw fracture treatment simulated conditions. Materials and Methods: This study is designed to study the force relaxation of 45 heavy 3/16 inch orthodontic elastic (American Orthodontist, AO) (4/8 mm internal diameter) were measured using Zwick testing machine (Zwick GmbH & Ulm Germany) in 0, 1, and 14 days of immersion in simulated oral environment. In each of these three occasions, 15 specimens were placed in jigs with metallic pins that inserted 15 mm and 20 mm apart that is equivalent to the normal inter-arch space in a closed mouth position. The jigs were incubated in 37°C and each 24 hours they received 10 thermal cycles of 55°C and 5°C for 30 seconds in a thermocycle. The distribution of the data was evaluated by Klomogrov-Simirnov test and after confirmation of a normal distribution; data was analyzed using analysis of variance (ANOVA). Results: Mean force decay at 15 mm stretch was significantly differ between 0-1 days and 0-14 days (P < 0.05) but was not significantly differ between 1-14 days. The same relations exist for 20 mm stretch. Conclusions: This study creates scientific basis for use of orthodontic elastics in treatment of fractured jaws.

Infected Mandibular Fractures: Risk Factors and Management

Postoperative infection is one of the most commonly encountered complications after treatment of jaw fractures. Mandibular fractures are reported to be associated with the highest rate of infections among other maxillofacial fractures. Different factors can increase the risk of infection, including, for example, the patient systemic condition, nature of injury, time of medical care, and type of treatment utilized. This article was aimed to review these risk factors and to highlight the management of the infected mandibular fractures.

Genotoxicity of fixation devices analyzed by the frequencies of sister chromatid exchange

Metal alloys utilized in the management of jaw fractures may exert genotoxic effects. Our purpose was to compare the genotoxicity of intermaxillary fixation devices containing nickel and chromium to that of titanium miniplates utilized in treatment of jaw fractures through the analysis of sister chromatid exchange. In this prospective study, in a total of 28 non-smoker patients (10 females, 18 males; mean age 33.43±10.76; range 15 to 60 years) with jaw fractures, 14 were treated with intermaxillary fixation by administration of nickel-chromium wire and arch bar and 14 with titanium miniplates to investigate the genotoxicity of different metal alloys. The outcome variable was the frequency of sister chromatide exchange in peripheral lymphoctyes, determined through the analysis of venous blood samples obtained preoperatively and 4 to 6 weeks postoperatively. The frequency of the average sister chromatid exchange was found to be significantly higher in patients treated with the nickel-chromium intermaxillary fixation devices than those treated by titanium miniplates (1.29±0.29 vs. 0.46±0.39, p<0.001). Although titanium miniplate osteosynthesis is an invasive technique in comparison with the nickel-chromium-containing intermaxillary fixation devices, titanium seems to exert less genotoxic effect than the nickel-chromium alloy. However, this finding should be supported in clinical studies with a larger sampling size.

Evaluation of Composite Resin Materials for Maxillomandibular Fixation in Cats for Treatment of Jaw Fractures and Temporomandibular Joint Luxations

To identify a method of composite application for maxillomandibular fixation (MMF) in cats that ensures the material will remain bonded during convalescence but be easy to remove with a low complication rate. Experimental study. Feline cadavers (n=88). MMF was applied using composite to 4 groups of 22 feline cadaver heads each. The protocols were: group CR: acid etch and composite resin; group CR+: acid etch, bonding agent, and composite resin; group FR50: partial surface acid etch and flowable composite resin; group FR100: complete surface acid etch and flowable composite resin. Removal time and complication rate were noted. Load to failure was determined by tensile loading. Load to failure was similar for groups CR and CR+ and for groups FR50 and FR100; however, load to failure for groups FR50 and FR100 was higher than groups CR and CR+ (P<.01). Time for material removal for group FR100 was longer (P<.01) and the complication rate was higher (P<.01) compared with the groups CR, CR+, and FR50, with no significant differences in removal times and complication rate between the latter groups. The most frequent complication during material removal in group FR100 was crown fracture. Partial coronal surface acid etch before use of flowable composite maintained a strong bond, yet resulted in easy material removal with a low complication rate.

Evaluation of metal release and local tissue response to indigenous stainless steel miniplates used in facial fractures

The issue of metal release from stainless steel bone plates has gained considerable momentum advocating the removal of stainless steel miniplates after healing of fracture. So far no study has been published in the literature regarding metal release with the indigenously manufactured stainless steel miniplates.Objective Aim of the study was to find any pathological changes at cellular and ultracellular levels and metal particles in the soft tissue surrounding the stainless steel miniplates.Method Retrieval of indigenous stainless steel implants, used in treatment of jaw fractures, samples of surrounding soft tissue were histopathologically assessed for tissue response as well as metal release, using light microscope and Transmitted Electron Microscope (TEM).Result Light microscopic examination revealed chronic inflammation in symptomatic cases, but TEM did not show any significant pathological alteration and metal deposits even in cases with clinically observed pigmentation. Short-term (upto 1 year) retention of stainless steel mini plates will not cause any significant local complications.

Application of Biological Principles to Treatment of Jaw Fractures

Abstract No Abstract Available. * Presented at the Twelfth Biennial Meeting of the Edward H. Angle Society of Orthodontia, October 8 to 14, 1939, Chicago.

Interdental wiring in jaw fractures: effects on teeth and surrounding tissues after a one-year follow-up

Several authors have suggested that interdental wiring may have an adverse effect on the teeth and surrounding tissues. In the present study we examined 250 teeth that had been subjected to wiring and 142 adjacent teeth that had not been wired (controls). During the wiring period, and after a minimum of 1 year following treatment of the jaw fracture, the teeth and periodontal tissues were examined by periodontal probing, percussion sound test, mobility test, sensitivity test, and radiography. One tooth showed temporary increased mobility. Periodontal health was clinically and radiologically fully restored after a year in all teeth. Progressive caries was seen in 2 patients and was treated. Loss of sensitivity was seen in 3 teeth adjacent to the fracture site and in one tooth adjacent to a titanium cortical screw. However, these pulpal changes either recovered spontaneously or were treated endodontically. There were few late problems in the teeth and surrounding tissues. In 243 teeth (97%), completely healthy conditions were found in pulp and periodontium. There was no evidence of root resorption or dentoalveolar ankylosis. We conclude that late deleterious effects on the teeth and periodontal tissues from interdental wiring in the treatment of jaw fractures were uncommon 1 year after the removal of the interdental wiring.

チタン骨ネジ埋入後の固定力の経時的変化に関する研究

In the field of oral surgery, titanium bone screws are used for plate fixation in the treatment of jaw fractures and maxillary degeneration, but there have been very few reports on the time course of changes during relatively short fixation. To investigate fixation changes in titanium bone screws with the passage of time, we implanted titanium bone screws with a defined screwing torque in the femoral bone of the rat, and then progressively measured the loosening torque and bone destructing torque in the period from immediately after until 8 weeks after implantation. In addition, new bone formation and calcification around the screw and in its periphery were observed macroscopically and by soft radiography; histological examination was then performed at the time exhibiting the greatest dynamic change.The following results were obtained from this investigation. Fixation strength of titanium bone screws decreased with time, reaching a minimum 2 weeks after implantation. By 8 weeks after implantation, fixation strength was higher than that immediately after implantation. These findings indicated that the fixation strength of titanium bone screws used for anchorage in oral surgery decreases progressively until 2 weeks after implantation. This suggests the need for some form of adjuvant fixation until 3 weeks after implantation; in addition, strong occlusal force and mandibular movement that might loosen the fixed site should be avoided.

Ultrastructural findings in soft tissues adjacent to titanium plates used in jaw fracture treatment

The present study was conducted on biopsies from soft tissues overlying titanium miniplates that were used for the treatment of jaw fractures. The aim was to investigate the morphology of liberated titanium particles and cellular or ultrastructural changes in tissues adjacent to the miniplates. Conventional transmission electron microscope (TEM) images were used for ultrastructural investigation and identification of metal-dense particles. The presence of titanium was proved by an increase in the intensity of element-specific, inelastically scattered electrons from the primary beam. The results showed that 5–8 months after insertion of the plates and screws, there was weak cellular activity within the scar tissue overlying the plates without inflammatory cells. Most of the titanium particles were located extracellularly. The ultrastructural appearance of most of these particles suggested that titanium may be shaved off the plates or screws and may undergo cellular uptake and lysosomal degradation. The partially degraded titanium particles are then left in place after the phagocytic cells have been isolated by collagenous fibers and have finally perished.

Treatment of Jaw Fractures in Small Animals With Parapulpar Pin Composite Bridges

This article describes a 5-year study of 73 cats that were surgically treated for mandibular fractures or combinations of fractures with luxation of the temporomandibular joint. Surgical technique and results are described in detail.

チタンスクリューを固定源とした懸垂固定による顎骨骨折治療の試み

チタンスクリューを固定源とした懸垂固定による顎骨骨折治療の試み

Metal release from plates used in jaw fracture treatment : Moberg LE, Nordenram A, Kjellman O. Int J Oral Maxillofac Surg 18:311, 1989

Metal release from plates used in jaw fracture treatment : Moberg LE, Nordenram A, Kjellman O. Int J Oral Maxillofac Surg 18:311, 1989