Treatment Of Mandibular Fractures Research Articles

Three-Dimensional Analysis of Bone Remodeling After Closed Treatment for Mandibular Condylar Head Fracture.

Closed treatment of mandibular condylar fractures has been used for its indications based on the fracture site, fracture status, and patient age. Posttreatment mandibular condyle size is associated with mandibular function; however, a few studies have reported bone remodeling patterns and volume changes in the condyle and glenoid fossa after mandibular condylar head fractures (CHFs). Therefore, volumetric changes in the mandibular condyle and glenoid fossa were analyzed in the present study, and bone remodeling patterns were evaluated after mandibular CHFs. The present study included 16 condyles from 12 patients who received closed treatment for CHF. After reconstruction of a 3-dimensional skull model, including the mandible, using computed tomography data taken immediately after injury and 6 months after treatment, volume changes in the mandibular condyle and glenoid fossa were analyzed. The condylar volume increased by 0.32±0.66cm3 during the 6-month healing period without statistical significance (P=0.093). Regarding the glenoid fossa, the fossa showed a statistically significant volume increase of 0.41±0.59cm3 (P=0.021), and 12 glenoid fossae (75%) showed downward bone apposition; however, no change or only mild bone resorption was observed in 4 glenoid fossae (25%). The results of this study indicated that the volume changes in the mandibular condyle after closed treatment of a mandibular CHF are not significant, and the glenoid fossa adapts to the displaced mandibular condyle through downward growth accompanied by volume increase.

Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study.

The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF). This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded. Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced (P=0.01) and comminuted (P=0.03) fractures and with the number of nonsurgically treated fracture sites (P=0.002). The angle was the only site associated with nonrigid osteosynthesis (P<0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type. Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.

ПРОЦЕССЫ РЕГЕНЕРАЦИИ КОСТНОЙ ТКАНИ ПРИ ПЕРЕЛОМАХ НИЖНЕЙ ЧЕЛЮСТИ

Item. The review of literature devoted to the actual problem of maxillofacial surgery — processes of bone tissue regeneration in mandibular fractures is presented. The purpose of the study — to study and analyze the materials of publications on the processes of bone tissue regeneration in mandibular fractures. Methodology. The publications of domestic and foreign authors devoted to the processes of bone tissue regeneration in mandibular fractures were studied. The publications were analyzed using scientific search library databases: PubMed Central, Google, Cyberleninka, eLibrary. Materials were selected by keywords. Full-text articles were included in the search. Results. In domestic and foreign literature, the processes of restoration of bone structures of the maxillofacial region as an organism's response to damage have been studied and described in detail. It has been established that two processes are simultaneously launched: resorption of damaged osteocytes and formation of osteoid tissue, one of which may be predominant at the moment. Conclusions. The article presents modern data on the key moments of bone tissue regeneration in the region of the mandible. All stages of the reparative process in bone tissue are described at the cellular level, and information about the main mechanisms, pathways and cell types involved in bone tissue regeneration is presented in detail, taking into account the stage of osteogenesis. Knowledge of the regularities of biological processes in the bone tissue regeneration zone allows scientific search and development of effective methods of treatment of mandibular fractures.

Use of a novel three-dimensional anatomical plating system for treatment of caudal mandibular fractures in cats: 13 cases (2019-2023).

A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively. In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.

Application of Crus of Helix Incision Through the Posterior Parotid Gland Approach in the Mid-Level or High-Level Mandibular Condylar Fractures.

This study is to explore the clinical effect of crus of helix incision through the posterior parotid gland approach in the treatment of Mid-or High-Level mandibular condylar fractures. From September 2020 to June 2023, we performed incision reduction internal fixation of 23 patients with mid-level or high-level fractures of the mandibular condylar through the approach of the posterior parotid gland, and observed the effect of the operation. After a follow-up period of 6 to 12 months, all patients showed no signs of postoperative facial paralysis or salivary gland fistula. In addition, satisfactory scars were observed in the operation area, and the occlusion function had recovered well. The approach of using a crus of helix incision through the posterior parotid gland proved to be an effective method for treating mid-level or high-level fractures of the condylar fractures. This technique offers several advantages, including adequate exposure, minimal facial nerve injury, ease of incision and reduction, inconspicuous scarring, and a more concealed incision.

Ultrasound-guided arthrocentesis for condylar head fracture: a technical report.

Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle. A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle. The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31mm) and pain relief. Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method.

Comparison of Conventional Locking Titanium Miniplates and Three-dimensional Locking Titanium Miniplates in Treatment of Mandibular Fractures

Comparison of Conventional Locking Titanium Miniplates and Three-dimensional Locking Titanium Miniplates in Treatment of Mandibular Fractures

Comparative Evaluation of the Efficacy of Double Y-Shaped Miniplate Versus Conventional Miniplates for the Treatment of Mandibular Anterior Fractures

Comparative Evaluation of the Efficacy of Double Y-Shaped Miniplate Versus Conventional Miniplates for the Treatment of Mandibular Anterior Fractures

Lower Insertional Torque of Fixation Screws for Mandibular Angle Fractures Is Associated With Complications

Open reduction and internal fixation (ORIF) is a common treatment for mandibular angle fractures. It is unknown, however, whether the insertional torque of the fixation screws is a risk factor for postoperative complications. The purpose of the study was to determine the association between fixation screw insertional torque and postoperative inflammatory complications (POICs). The authors conducted a prospective cohort study consisting of all adult patients treated with ORIF of mandibular angle fractures using a single six-hole lateral border plate secured with monocortical screws from January 1, 2020, to October 31, 2022, at a large, urban academic hospital. Patients with gunshot wounds, prolonged maxillomandibular fixation, and bilateral angle fractures were excluded. The predictor variables were the average and lowest insertional torque of the six screws placed for fixation during ORIF. The outcome variable was the presence of POICs, defined as the occurrence of exposed or infected hardware, abscess formation, recurrent swelling/pain, nonunion, osteomyelitis, or fistula formation. Demographics, medical history, mechanism, diagnosis, and treatment-related variables were also analyzed. Descriptive and bivariate analyses were performed. A P value of≤.05 was considered significant. There were 51 patients included in the study, 37 (72.5%) men, with a mean age of 31.2±10.1years. POICs occurred in 15.7% of patients. The average insertional screw torque was 46.9±7.8 Ncm, and the mean lowest insertional screw torque per plate was 34.3±10.2 Ncm. The average torque values were not lower in patients who had POICs versus those who did not (45.0±8.6 Ncm vs 48.4±7.6 Ncm, respectively, P=.16). However, the lowest torque value was less in patients who had POICs compared to those who did not (27.5±11.0 Ncm vs 35.6±9.7 Ncm, respectively, P=.04). Among patients with mandibular angle fractures treated with ORIF, decreased insertional torque for the lowest of the six screws placed for fixation was associated with complications. While previous studies have shown certain plating schemes have been associated with complications, the quality of fixation also plays a role.

Evaluation of graphene oxide-doped poly-lactic-co-glycolic acid (GO-PLGA) nanofiber absorbable plates and titanium plates for bone stability and healing in mandibular corpus fractures: An experimental study

BackgroundOpen reduction with internal fixation is the preferred treatment option for displaced facial bone fractures. The superior mechanical properties of metallic plates have made them the most widely used material in existing bone fixation systems. However, after the healing period, these permanent plates can cause various problems. Alternative bioresorbable materials are being investigated to reduce these potential problems. This study compares bone stability and viability by using graphene oxide (GO)-doped poly-lactic-co-glycolic acid (PLGA) nanofiber plates and titanium plates for rats with fractured mandibles. Materials and methodsThe study included 20 male Sprague-Dawley rats, divided into four groups: a control group (Group I), a mandibular fracture group with no additional application (Group II), a mandibular fracture group repaired with titanium plates (Group III), and a mandibular fracture group repaired with GO-PLGA plates (Group IV). After 2 months, all of the rats were euthanized. A bone compression test was performed to assess bone stability, and a histological examination was performed to evaluate bone healing. ResultsThe osteocyte lacunae, Haversian ducts, canaliculi, and vascular structures of Group IV were found to be higher. In the compression test, vertical compression was applied to the bone axis, and Group IV had a higher maximum load and maximum stretch. GO-PLGA plates were found to be statistically superior to titanium plates in terms of both bone stability and bone healing (p < 0.05). ConclusionsThe present study found that GO-PLGA plates are more effective than titanium plates for the treatment of mandibular corpus fractures.

Analysis of Effect of Melatonin on Postoperative Sensory Nerve Recovery Following Open Reduction and Internal Fixation of Anterior Mandible Fractures: A Prospective Randomized Control Trial.

Open reduction and internal fixation (ORIF) of the anterior mandibular fractures are commonly associated with mental nerve paraesthesia. This study evaluates the efficacy of melatonin on postoperative sensory functional recovery and pain following surgical treatment of anterior mandibular fractures. Forty patients were randomly allocated to two groups: Group I-melatonin, and Group II-control group. Postoperative neurosensory recovery was evaluated both subjectively and objectively at 1-week, 1-month, and 3-month intervals. The pain was assessed during the immediate postoperative period, postoperative days 1, 2, 3, and 7 using a visual analog scale. Statistical significance was set at P value < 0.05. The statistically significant difference was noticed in both subjective and objective recovery of sensory nerve function at 1-month follow-up. All patients in the melatonin group showed complete recovery of nerve function as compared to the control group where 10% of patients showed limited recovery. Neurosensory recovery following ORIF of mandibular fractures was better in the melatonin group as compared to the control group and therefore the perioperative administration of 10mg. Melatonin can be recommended for quicker and better nerve recovery in the anterior mandibular fractures requiring close manipulation of the mental nerve during treatment.

"Air Sign" in Misdiagnosed Mandibular Fractures Based on CT and CBCT Evaluation.

Diagnostic errors constitute one of the reasons for the improper and often delayed treatment of mandibular fractures. The aim of this study was to present a series of cases involving undiagnosed concomitant secondary fractures in the mandibular body during preoperative diagnostics. Additionally, this study aimed to describe the "air sign" as an indirect indicator of a mandibular body fracture. A retrospective analysis of CT/CBCT scans conducted before surgery was performed on patients misdiagnosed with a mandibular body fracture within a one-year period. Among the 75 patients who underwent surgical treatment for mandibular fractures, mandibular body fractures were missed in 3 cases (4%) before surgery. The analysis of CT/CBCT before surgery revealed the presence of an air collection, termed the "air sign", in the soft tissue adjacent to each misdiagnosed fracture of the mandibular body. The "air sign" in a CT/CBCT scan may serve as an additional indirect indication of a fracture in the mandibular body. Its presence should prompt the surgeon to conduct a more thorough clinical examination of the patient under general anesthesia after completing the ORIF procedure in order to rule-out additional fractures.

Patterns of Craniomaxillofacial Trauma at an Urban Level I Trauma Center.

There is a paucity in the literature concerning craniomaxillofacial trauma (CMF) in the USA. Better recognition of these fracture patterns and their management clarifies how to best evaluate and treat them. A retrospective chart review was conducted of CMF trauma patients who required surgical intervention at a level I trauma center between 2015 and 2018. Descriptive statistics and univariate and bivariate analyses were conducted (α = 0.05). A total of 1001 patients were included. Most patients were Black (n = 665; 66%) and/or male individuals (n = 813; 57%) with an average age of 37 years (range 15 -110). The most common etiologies were assault (n = 471; 44%), motor vehicle collision (n = 238; 22%), and fall (n = 117; 11%). The mechanism of injury was a determinant of fracture type (P = 0.045). The most common CMF injuries were mandibular fracture (n = 953; 95%), maxillary fracture (n = 815; 81%), and orbital fracture (n = 206; 21%). Male sex predicted panfacial fractures (P = 0.045). Black patients experienced more severe CMF trauma compared with other races (P < 0.001). ORIF was the most common treatment for mandibular (n = 481; 73%) and maxillary (n = 62; 66%) fractures. Etiology and patterns of CMF trauma differ globally, with assault and motor vehicle collisions being the leading causative factors in our patient population. Patient demographics are relatively consistent worldwide, with most injuries occurring in 30- to 40-year-old men. This study offers insight into at-risk populations and guidance on their management.

Surgical treatment of clinically infected mandibular fractures.

To clarify reasons for infections, surgical techniques, and occurrence of postoperative surgical site complications in infected mandibular fractures. Patients with clinically infected mandibular fracture of the dentate part without preceding surgery were studied retrospectively. Clinical infection was defined to occur if pus, abscess, or a fistula in the fracture area was present. Patient-, fracture-, and surgery-related variables were evaluated, and predictors for postoperative complications were analysed. Of 908 patients with surgically treated fracture in the dentate part of the mandible, 41 had infected fracture at the time of surgery (4.5%). Of these patients, 46.3% were alcohol or drug abusers. Median delay from injury to surgery was 9days. Patient-related factors were the most common cause for delayed surgery (n = 30, 73.2%), followed by missed diagnosis by a health care professional (n = 8, 19.5%). Twenty-two fractures were treated via extraoral approach (53.7%) and the remaining 19 intraorally (46.3%). Postoperative surgical site complications were found in 13 patients (31.7%), with recurrent surgical site infections predominating. Notable differences between total complication rates between intraoral and extraoral approaches were not detected. Secondary osteosynthesis for non-union was conducted for one patient treated intraorally. Postoperative surgical site complications are common after treatment of infected mandibular fractures, and these occur despite the chosen surgical approach. Infected mandibular fractures heal mainly without bone grafting, and non-union is a rare complication. Due to the high complication rate, careful perioperative and postoperative care is required for these patients.

Surgical treatment of mandibular fractures: Review Article

Surgical treatment of mandibular fractures: Review Article

Digitally driven surgical guide planning.

To investigate the role of a fully digital process in the surgical treatment of mandibular fractures in children. We analyzed a complete dataset from 22 children with mandibular fractures treated with digital surgical assistance. The patient's treatment process included preoperative thin layer CT (Computed Tomography) scanning, computer-aided design (3D reconstruction, virtual reduction, and internal fixation device determination and shaping), and 3D printing (jaw model, bite plate). We used occlusal and shaping plates during surgery to assist in fracture reduction and fixation. During the follow-up, we observed the occurrence of fracture healing, occlusal relationships, opening degrees, and complications in pediatric patients after surgery. Next, we used the 3D overlay function of MIMICS software to compare the preoperative surgical design with postoperative jaw imaging data to evaluate the overall surgical effect. The postoperative imaging data showed good fracture healing, normal occlusion during follow-up, and significant improvement in opening degrees. The mean preoperative opening degree was 23.59 ± 2.89 mm, and the mean postoperative opening degree was 29.82 ± 1.79 mm; there was a significant difference between these two parameters (p < 0.05). There were no complications such as tooth germ injury, nerve injury or fracture block displacement. The postoperative mandibular imaging data was imported into MIMICS software for 3D overlay visualization, and the postoperative mandibular morphology recovery was well-matched with the preoperative design. We measured the average upper deviation (0.65 ± 0.09) mm and the average lower deviation (-0.57 ± 0.14) mm. The fully digital process has a precise, minimally invasive, and safe effect in the surgical treatment of mandibular fractures in children, and the clinical effect is satisfactory.

Streamlining complex mandibular fracture treatment: Integration of virtual surgical planning and short-segment drilling guides

This study aimed to evaluate the feasibility and accuracy of a combined virtual surgical planning (VPS) and short-segment drilling guides (SSDGs) workflow for the treatment of complex mandibular fractures.Consecutive patients with complex mandibular fractures underwent treatment using the VPS and SSDGs workflow from August 2020 to April 2022. Various mandibular landmarks were compared between the preoperative virtual surgical plan and postoperative data, including condylar distance (CoD), mandibular angle width (GoL-GoR), GoMeGo angle (∠GoL-Me-GoR), the difference in mandibular angles between the left and right sides (Δ∠Co-Go-Me), and the difference in length between the left and right mandibular body (ΔGo-Me). Additionally, preoperative preparation time and surgical duration were retrospectively analyzed and compared to conventional surgery.All 14 consecutive patients with complex mandibular fractures achieved successful reduction using the VPS and SSDGs workflow. Three-dimensional comparison revealed a mean deviation distance of 0.91 ± 0.50 mm and a root-mean-square deviation of 1.75 ± 0.47 mm between the preoperative designed mandible model and the postoperative mandible model. The percentage of points with deviation distances less than 2 mm, 1 mm, and 0.5 mm between preoperative and postoperative models were 78.47 ± 8.87 %, 60.02 ± 14.28 %, and 38.64 ± 15.48 %, respectively. There were no significant differences observed in CoD, GoL-GoR, ∠GoL-Me-GoR, Δ∠Co-Go-Me, and ΔGo-Me between preoperative virtual surgical planning and postoperative measurements. Furthermore, no significant differences were found in the injury-to-surgery interval, admission-to-surgery interval, and surgical duration between the workflow and conventional surgery.The combined VPS and SSDGs workflow proved to be an accurate and feasible method for treating complex mandibular fractures. It offers advantages such as minimal preoperative preparation time and the ability to precise transfer screw positions of the pre-bent reconstruction plate during surgery. This approach is particularly suitable for managing complex mandibular fractures.

The usege of rigid fixation of dental splints in the treatment of patients with fractures of the lower jaw

The aim of our research was to study the effectiveness of rigid fixation in mandibular fractures. For this purpose, a study of 200 inpatients of the maxillofacial department was conducted. The study included 64 patients with jaw fractures who passed the criteria for inclusion in the study and the formation of the main group and the comparison group. The research methods were: assessment of the hygienic state of the oral cavity, clinical and radiological examination, electromyographic examination. The results of the study were evaluated at 3, 14, 22 days and after 3 months. After 3 months from the moment of hospitalization in all patients of the main group, a newly formed callus, complete bone radiological consolidation of fragments is clearly visible. In patients of the comparison group, a newly formed callus was clearly visible in the fracture gap. In 7 patients, complete bone radiological consolidation of fragments occurred. According to the results of electromyography, we found that in patients of the main group, whose treatment consisted in the imposition of rigid fixation of dental splints, a more complete recovery of the bioelectric activity of the masticatory muscles proper – 3 months after the injury, the comparison group – 380±10 μV, the main group – 510±10 µV. Conclusions: The use of rigid fixation in the treatment of mandibular fractures significantly reduces the duration of treatment in patients by 8 days of treatment compared with the traditional method.

Fixation of Mandibular Fractures with Lag Screw: Integrative Review

Introduction: The mandible is the only movable bone of the face and plays a crucial role in masticatory, swallowing, phonation, and aesthetic functions. Mandibular fractures have the potential to cause numerous important changes. Angle, parasymphysis, body and condyle are the anatomical regions most affected by trauma. Rigid Internal Fixation (RIF) facilitated the process of treatment and recovery of mandibular functions. The Lag Screw fixation technique is based on the use of screws that manage to compress the bone fragments without the use of plates.Objective: This integrative review aims to review the fixation of mandibular fractures using the Lag Screw technique.Methods: Through a complete search in PubMed, Web of Science, Embase, and Cochrane databases, nine articles that contemplated the method of fixation of mandibular fractures using the Lag Screw technique were included.Results: The studies showed that the technique was associated with a lower number of intra and postoperative complications, provided safe RIF, greater compression between the stumps, facilitating primary bone healing, and presented a shorter surgical time, economic advantage. On the other hand, the technique proved to be sensitive and limited only to specific cases.Conclusion: The application of the Lag Screw fixation technique is an effective and stable RIF method that can be performed in the treatment of mandibular fractures.

Efficacy of the titanium double ‘Y’- shaped mini plate compared with conventional mini plates in fixation of anterior mandibular fractures: A prospective clinical study

: Anterior mandibular fracture management is commonly dealt in oral and maxillofacial surgery and most accepted treatment modality is open reduction and internal fixation with miniplates. With ongoing research, various shapes of miniplates were tried for osteosynthesis and biomechanical properties tested in invitro studies, but they lack testing in clinical scenarios. The present study was conducted to compare clinically and radio graphically, the efficacy of double Y-shaped mini plate with two conventional 4 hole mini plates in management of anterior mandibular fractures. : Study consisted of 20 patients, 10 in each group with anterior mandibular fractures. 10 patients (group 1) were treated with double ‘Y’ shaped miniplate with bar and 10 patients (group 2) with conventional 4 hole two miniplates. Clinically post-operative Pain, edema, occlusion, neurosensory deficit and wound healing were assessed. Clinical evaluation was done at 1st postop day, 1st week, and 1st and 3rd month postoperatively. Radiographic evaluation was done to record fracture gap in both the groups and timing for plate adaptation and fixation was recorded intra-operatively. The data was recorded and statistical analysis was done.: Clinical and radiographic evaluation done for each group did not show any statistical difference at 3 months postoperatively. However significant difference was noted in time taken for adaptation and fixation of plates and screws. Double ‘Y’ shaped miniplate was found to be easier to place and required less time to adapt and fix to bone compared to 4-hole miniplates. The study concluded that the double ‘Y’ miniplate and conventional 4-hole miniplates are found to be equally effective for clinical use in treatment of anterior mandibular fractures. The double ‘Y’ miniplate were found to be superior in terms of handling characteristics, less hardware and better radiographic outcome when compared to conventional 4-hole miniplates.