Unilateral Mandibular Fractures Research Articles

Comparison of a Single Noncompression Miniplate Versus 2 Noncompression Miniplates in the Treatment of Mandibular Angle Fractures: A Prospective, Randomized Clinical Trial

The aim of this study is to compare the postoperative complications after fixation of mandibular angle fractures with 2 noncompression miniplates, in which a single plate is fixed onto the superior border of the mandible and the other plate to the lateral aspect of the mandible, with the standard technique of a single noncompression miniplate fixed onto the superior border of the mandible. We randomly divided 54 patients with unilateral mandibular angle fractures into 2 groups, with 27 in each group. Randomization was done with lots in closed envelopes. Group I patients were treated with a single noncompression miniplate fixed at the superior border as suggested by Champy et al through an intraoral approach. Group II patients were treated with 2 noncompression miniplates in which 1 plate was fixed in a manner similar to that in group I and the other plate was fixed to the lateral aspect of the angle of the mandible with combined intraoral and transcutaneous access through a trocar and cannula. The patients were assessed for malocclusion, infection, wound dehiscence, and plate exposure. The data were analyzed statistically with the chi(2) test, and statistical analysis was performed with SPSS statistical software for Windows, version 8.0 (SPSS, Chicago, IL). Group I comprised 21 men and 6 women with a mean age of 32.4 years (range, 18-43 years). Group II comprised 23 men and 4 women with a mean age of 29.6 years (range, 21-49 years). No patients complained of malocclusion in either group. Wound dehiscence occurred in 3 patients (11.1%) in group I and 2 patients (7.4%) in group II, which was not statistically significant (chi(2) = 0.0, P > .99). Infection occurred in 1 patient (3.7%) in group I and 2 patients (7.4%) in group II, which was not statistically significant (chi(2) = 0.0, P > .99). One patient from both the groups required plate removal. Scar developed at the transcutaneous incision site in 5 patients (18.5%) in group II. The use of 2 noncompression miniplates for treating noncomminuted fractures of the mandibular angle does not seem to have any advantage over the use of a single plate.

Treatment of Mandibular Angle Fractures Using a Single Bioresorbable Miniplate

This study evaluated the treatment of mandibular angle fractures via a single biodegradable plate and addressed complications such as malocclusion, infection, soft tissue dehiscence, and nonunion in these patients. This prospective study consisted of 19 fractures in 19 patients (18 males and 1 female) with unilateral fractures of the mandibular angle treated by open reduction and rigid internal fixation using 1 biodegradable plate through an intraoral incision. The resorbable plates and screws used consisted of an amorphous injection molded copolymer of L-lactide/D-lactide/trimethylene carbonate (Inion CPS System, Tampere, Finland). Light elastic traction was placed for 14 days postoperatively and patients were followed after operation at 1, 4, 8, and 24 weeks. Panoramic and posteroanterior views of the mandible were taken for evaluation of union. Clinical and radiographic evaluation indicated union of all fractures after 24 weeks. Three of the patients (15.7%) treated with single biodegradable plate experienced some complications. All the complications were minor and treated in the office. Two patients with infection were treated with oral antibiotic administration without plate removal. One patient with mild malocclusion was treated with elastic traction. There were no cases of nonunion or dehiscence. Based on this limited series of patients, the use of a single biodegradable plate for unilateral mandibular angle fractures is a reliable fixation technique with minor complications.

Effect of Intermittent Systemic Administration of Recombinant Parathyroid Hormone (1-34) on Mandibular Fracture Healing in Rats

To establish a rat mandibular fracture model and investigate the short- and long-term effects of recombinant parathyroid hormone (PTH 1-34) on mandibular fracture healing in rats. A controlled unilateral mandibular fracture was created surgically in 29 male Sprague-Dawley rats and then stabilized using an external fixation device. The rats were divided into 2 groups: 1 group received daily subcutaneous injections of 10 microg/kg of PTH(1-34) and 1 group served as the vehicle control. The rats were killed on postoperative days 7 and 21, and radiographic densitometry and histologic evaluation of new bone formation were performed. A novel unilateral mandibular fracture model was established that has significant differences from previously published models, both in the location of the osteotomy site and in the rigid external stabilization device. The PTH(1-34) treated rats showed a statistically significant difference (P < .05) in callous formation compared with the control animals. Radiographic densitometry evaluation of the injury site revealed an increase in bone density, apparent at day 7 in the experimental group. Visual inspection of the histologic sections stained with Masson's trichrome blue showed an apparent increase in new bone formation at 21 days in the PTH-treated group compared with the control group. Intermittent systemic administration of PTH(1-34) might enhance the healing of mandibular fractures in the early phase (7-day period). Long-term administration (21-day period) showed no statistically significant differences between the control and experimental group by radiographic densitometry.

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

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

Poster 273: Treatment of Mandibular Angle Fractures Using 1 Biodegradable Miniplate

This study evaluates the union of the fracture and return to normal function in patients treated for fractures of the mandibular angle with a single biodegradable plate. This research focused on complications such as malocclusion, infection, soft tissue dehiscence and nonunion in these patients. This prospective study consisted of 19 fractures in19 patients (18male and 1woman) with unilateral pure fractures of the mandibular angle that were treated by open reduction and rigid internel fixation using one biodegradable plate through an intraoral incision. The resorbable plates and screws used consisted of an amorphous injection molded copolymer of L-lactide/D-lactide/trimethylene carbonate (Inion CPS system, Tampere, Finland). Light elastic traction was placed for 14 days postoperatively and patients were followed after operation at 1, 4, 8 and 24 weeks. OPG and posteroanterior view of mandible were taken for evaluation of union in fractures. We used percent of outcomes for description of our results. Clinical and radiographic evaluation indicated union of all fractures after 24 weeks. Three of the patients (15.7%) treated with single biodegradable plate experienced some complications. All of the complications were minor and be treated in the office. Two patients with infection were treated with oral antibiotic administration without plate removal. One patient with mild malocclusion was treated with elastic traction. There was no nonunion or dehiscence in any patients. Based on this limited series of patients, the use of a single biodegradable plate for unilateral mandibular angle fracture is a reliable fixation technique with some minor complications that were treated easily.

Treatment of Patients With Double Unilateral Fractures of the Mandible

To analyze the outcomes of treatment for double unilateral mandibular fracture. Retrospective chart review of patients who were treated between 1994 and 2004 for 2 mandibular fractures on the same side of the mandible. Data collected involved age, gender, race, cause of fracture, treatment modality, length of follow-up, occlusal relationship at last visit, preoperative and postoperative clinical photographs and radiographs, and incidence and management of complications. Standard descriptive statistics were used. From a total of 1,287 mandibular fractures for which charts were available, 31 double unilateral mandibular fractures were treated during a 10-year period, for an occurrence rate of 2.4%. Demographic characteristics of these patients were similar to those of patients in other published studies on mandibular fracture. Fractures involved angle + body (18/31, 58%), condyle + body (11/31, 35%), and condyle + angle (2/31, 6%). Various treatments were provided for these fractures, but open reduction and internal fixation were applied to at least 1 of the fractures. Follow-up ranged from 6 weeks to 5 months (average, 9.6 weeks). Eight patients (8/31, 25.8%) developed complications involving visible gonial flaring; 3 of these also had cross-bite. Double unilateral mandibular fracture is a rare event. The difficulty inherent in treating these fractures can be alleviated with the use of proper techniques of open reduction and internal fixation; however, treatment continues to be associated with a high complication rate.

Unilateral mandibular condylar fractures: a 31-year follow-up of non-surgical treatment

At the University Hospital of Malmö, Sweden, standardized trauma charts were used for registration of all jaw fractures from 1972 to 1976. During the year 2005 the aim was to interview all patients treated non-surgically for unilateral mandibular condylar fractures during this period. In total, 49 patients with unilateral condylar fractures were treated non-surgically in 1972–1976. Of these, 23 patients were available for follow-up, 17 were dead, 7 were not found and 2 did not answer letters or phone calls. The follow-up was a telephone interview according to a standardized questionnaire concerning occurrence of pain and headache, function of the jaw and joint sounds. Information from original records, radiographic reports and the standardized trauma charts revealed fracture site, type of fracture and intermaxillary fixation if any. Eighty-seven percent of the patients reported no pain from the jaws, 83% had no problems chewing and 91% reported no impact of the fracture on daily activities. Neck and shoulder symptoms were reported by 39% and back pain by 30%. The 31-year results of non-surgical treatment of unilateral non-dislocated and minor dislocated condylar fractures seem favourable concerning function, occurrence of pain and impact on daily life.

Management of bilateral condylar fractures: Case review

Unilateral mandibular condylar fractures occur approximately three times more frequently than bilateral fractures [1]. Fracture of the mandibular parasymphysis region is usually associated with fracture of contralateral condyle. Unilateral fracture condyle may occur as an isolated case or along with fracture of mandible or other facial bones. Unilateral condylar fractures without displacement, are generally treated conservatively using arch bars and intermaxillary fixation (IMF). It is rare to see bilateral fracture condyle without any other associated fracture. Deranged occlusion, inability to masticate food, difficulty in opening mouth, haemotympanum and pain in preauricular region are some of the complaints of patients. In bilateral subcondylar fractures the dilemma remains whether to manage it conservatively, perform open reduction and bone plating of one side only or perform open reduction and bone plating of bilateral condyles. The age of the patient, the level of fracture, angle of displacement, dislocation of condylar head and presence of other associated fractures influences a surgeon's decision. The growth of the mandible continues throughout childhood and adolescence. So in children, IMF is restricted to fourteen days to facilitate early movement and to prevent ankylosis of temporomandibular joint (TMJ). Four cases of bilateral condylar fractures are being reviewed.

Magnetic Resonance Evidence of Joint Effusion of the Temporomandibular Joint After Fractures of the Mandibular Condyle: A Preliminary Report

To investigate the clinical significance of magnetic resonance (MR) evidence of joint effusion of the temporomandibular joint after mandibular condylar fractures, magnetic resonance imaging (MRI) was performed on 18 joints in 15 patients with either unilateral or bilateral mandibular condylar fractures using a 1.5 Tesla MRI scanner (Signa, General Electric, Milwaukee, WI). MR evidence of joint effusion was evaluated and compared with the types and the positions of the fractures. MR evidence of joint effusion was observed in 11 of 18 TMJs, which was 61% of the condylar fractures. It appeared more frequently after fractures with dislocation than those without dislocation (p<0.05). In addition, MR evidence of effusion appeared more frequently in TMJs after high condylar fractures (head to upper neck) than low condylar fractures (lower neck to subcondylar) (p<0.05). These findings indicate that MR evidence of joint effusion may serve as a marker for the detection of severe intra-articular damage to the TMJ after mandibular condyle fractures.

保存治療を行った片側性関節突起骨折における開口障害持続期間および開口時の下顎偏位についての検討

The aim of this study was to clarify factors affecting the clinical outcomes of conservative treatments for unilateral mandibular condylar fractures. In 41 patients (30 males and 11 females) treated at our hospital, age, sex, clinical findings, image findings, and methods of treatment were investigated. The duration of trismus and mandibular deviation during mouth opening were clinically evaluated. The correlations were studied by multivariate analysis.The results were as follows:There were significant correlations between condylar dislocation and the duration of trismus and between the degree of malposition of bone fragments and mandibular deviation during mouth opening.

片側性下顎骨関節突起骨折の予後の検討

A statistical analysis was performed to determine factors that influence the clinical outcome of unilateral condylar fractures of the mandible. In this study, the fracture location was limited to the condylar neck and base of the condylar process. Twenty-eight patients, 18 males and 10 females, were treated at our clinic between January 1997 and December 2001. The age range was 7 to 79 years, and the average age was 32.6 years. Seventeen cases involved fractures of the condylar neck and 11 cases involved fractures of the base of the condylar process. Fifteen cases were treated conservatively by intermaxillary fixation, and 13 were treated surgically by using a titanium mini-plate or lag screw osteosynthesis system. The clinical outcome was determined according to the classification described by Kamiya 6 months after injury. The outcome was good in 21 cases, whereas 7 cases had restricted mouth-opening or joint sounds during jaw movements. This study revealed that two factors can negatively influence the clinical outcome of unilateral mandibular condylar fractures: one is the type of fracture in all cases and the other is the age of the patient at injury in cases treated conservatively.

Computed tomographic findings of the fractured mandibular condyle after open reduction

The purpose of this study was to evaluate the long-term radiological results obtained with open reduction and fixation of unilateral mandibular condyle fractures in 10 patients. CT images taken at the end of the follow-up period (average of 22 months, range 7 to 33 months), were traced and digitized, and the position and morphology of the fractured condylar process was statistically compared with those of the contralateral non-fractured condylar process in the coronal, transverse and sagittal planes. Little difference was observed in the position or morphology of the condylar process in the operated and non-fractured joints. This study shows that it is possible to anatomically reduce fractured condyles, and thereby to avoid postoperative disadvantageous joint changes.

Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

The purpose of this study was to determine the rate of recovery of mandibular motion in patients treated for fractures of the mandibular condylar process. One hundred and thirty-six patients (111 men, 25 women), 74 treated by closed and 62 by open methods, were included. They underwent testing of mandibular and condyle mobility at 6 weeks, 6 months, and 1, 2, and 3 years post surgery. Their ranges of motion were compared to those of 52 controls (26 men and 26 women). A jaw-tracking device was used to assess mandibular motion. Multilevel statistical models were used to assess differences between groups, and to estimate rate of recovery in the fracture patients. In general, patients with unilateral fractures of the condylar process had maximum excursions that returned to normal values within 3 years after fracture, regardless of treatment. Patients treated open exhibited a faster rate of improvement in maximum interincisal opening than patients treated closed (0.43 mm/month vs 0.15 mm/month, respectively), but part of the difference was due to a significantly smaller opening after 6 weeks for the patients treated open (38 mm vs 42 mm, respectively). Patients treated open also exhibited a faster rate of improvement in maximum excursion toward the fracture side than patients treated closed (0.10 mm/month vs 0.04 mm/month, respectively). Based upon this study, patients with unilateral fractures of the condylar process, who are treated closed and not put into maxillomandibular fixation but are instructed in physical therapy, can be expected to achieve normal maximum excursions within 3 years after treatment. Patients treated open will have reduced maximum opening initially, but may reach normal levels of opening sooner than patients treated without surgery. Patients treated without surgery may have smaller than normal excursion toward the non-fracture side for at least 3 years after fracture, especially if their fracture was at or above the condylar neck. Improvement rates for other maximum excursions are similar for patients treated with or without surgery.

Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Recovery of mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Further displacement of condylar process fractures after closed treatment

Purpose: This study examined the changes in the position of the fractured condylar process immediately before and immediately after application of arch bars and at 6 weeks after surgery in a group of patients who underwent closed treatment. Patients and Methods: Sixty-five patients over the age of 16 years underwent closed treatment of unilateral mandibular condylar process fractures. Coronal and sagittal displacement of the condylar process was examined using Towne's and panoramic radiographs before treatment, immediately after placement of arch bars, and at 6 weeks. The change in position of the condylar process from one time to the next was analyzed statistically. Results: There was a statistically significant difference (mean, −5.5 °) in the coronal position of the condylar processes from immediately after injury to immediately after placement of arch bars. There was great variability, with some segments becoming more medially displaced and some more laterally displaced. In contrast, mean change in the sagittal position of the condylar process was not statistically significant, although some became more anteriorly and others became more posteriorly displaced. Similarly, from immediately after placement of arch bars to 6 weeks, there was great variability in position of the condylar process, but the overall change was not statistically significant. Conclusions: The results of this study showed that position of the condylar process is not static in patients treated for condylar process fractures by closed means. These results suggest that care must be taken in basing treatment decisions on the degree of displacement or dislocation of the condylar process in presurgical radiographs.

Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures

Purpose: This study compared mandibular and condylar mobility after open or closed treatment for fractures of the mandibular condylar process. Patients and Methods: One hundred thirty-six patients (111 male, 25 female), 74 treated by closed and 62 by open methods, were included in this study. They underwent testing of mandibular and condyle mobility at 6 weeks, 6 months, and 1, 2, and 3 years postsurgery. A jaw-tracking device was used to assess mandibular motion. Radiographs that were traced and digitized were used to assess condylar displacement and condylar mobility. Standard statistical methods were used to assess differences between groups. Results: Patients treated by open reduction had significantly greater initial displacement of their condylar processes than did the group treated closed. Immediately after treatment and uprighting of the condyles in the open treatment group, patients treated closed had significantly more displacement. At 6 weeks, patients treated closed had some measures of mandibular mobility that were significantly greater than those in patients treated by open reduction. However, after the 6-week period there were minimal differences in mandibular mobility between groups. At 6 weeks, patients treated by open reduction had significantly greater vertical mobility of the condyle than patients treated closed despite less mouth opening. After the 6-week period, patients treated by open reduction continued to have greater condylar mobility on the fractured side than did patients treated by closed methods. No measures of postsurgical displacement correlated with mobility measures in patients treated by open reduction. However, several measures of mandibular displacement correlated with measures of mobility in patients treated closed, indicating that the more displaced the condylar process, the more limited the mobility of the mandible. Conclusions: Based on this study, patients treated for fractures of the mandibular condylar process by open reduction had somewhat greater condylar mobility than patients treated closed, even though the former group had more severely displaced fractures before surgery. Therefore, open reduction may produce functional benefits to patients with severely displaced condylar process fractures.