RESUMEN
In addition to the clinical burden of trauma, the financial burden is an important aspect of care globally, especially for patients in low- and middle-income countries. The current retrospective review was done of data from January 2015 to December 2020 related to patients of oral maxillofacial trauma management in a tertiary care setting. Analysis of variance was used to determine the mean difference in the cost incurred depending upon the type of trauma and the number of bone plates used in fracture management. Pearson correlation was applied to explore any correlation involving patient age, aetiology and type of fracture, number of bone plates employed and the length of stay in the hospital. No statistically significant differences were noted in the cost among the different groups. The cost of care was significantly (p<0.001) correlated to the length of stay. Other variables, such as the type of fractures and the number of plates, had no significant impact (p>0.05).
Asunto(s)
Tiempo de Internación , Traumatismos Maxilofaciales , Centros de Atención Terciaria , Humanos , Pakistán , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/economía , Estudios Retrospectivos , Centros de Atención Terciaria/economía , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos Maxilofaciales/economía , Traumatismos Maxilofaciales/terapia , Traumatismos Maxilofaciales/epidemiología , Adulto Joven , Adolescente , Placas Óseas/economía , Fracturas Mandibulares/economía , Fracturas Mandibulares/terapia , Fracturas Mandibulares/cirugía , Fijación Interna de Fracturas/economía , Fijación Interna de Fracturas/métodos , Anciano , Niño , Costos de la Atención en Salud/estadística & datos numéricos , Fracturas Maxilares/economía , Fracturas Maxilares/cirugía , Fracturas Maxilares/terapiaRESUMEN
This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures.
Asunto(s)
Fijación Interna de Fracturas , Fracturas Mandibulares , Humanos , Placas Óseas , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/terapiaRESUMEN
OBJECTIVES: 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. METHODS: 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 20 mm. 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. RESULTS: 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 (31 mm) and pain relief. CONCLUSIONS: 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.
Asunto(s)
Artrocentesis , Cóndilo Mandibular , Fracturas Mandibulares , Ultrasonografía Intervencional , Humanos , Femenino , Anciano , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/cirugía , Fracturas Mandibulares/terapia , Fracturas Mandibulares/complicacionesRESUMEN
BACKGROUND: There is a lack of consensus on the optimal triage pathway for emergency department (ED) patients with mandibular fractures. It remains unclear if patient insurance payers predict hospital admission given potentially competing logistical and health system incentives. PURPOSE: To generate nationally representative estimates of the frequency of hospital admission and its association with primary insurance payers for ED patients with mandible fractures. METHODS: This retrospective cohort study used the 2018 Nationwide Emergency Department Sample, the largest all-payer database in the United States, to identify patients with mandible fractures. The database includes a stratified sample with discharge weights to generate nationally representative estimates. Patients with other facial fractures and/or concomitant injuries that independently warranted admission were excluded. PREDICTOR: The primary predictor variable was primary payer (public, private, self-pay, and other/no charge). OUTCOME VARIABLE: The primary outcome variable was hospital admission (yes/no). COVARIATES: Covariates included patient-, medical/injury-, and hospital-related variables. ANALYSES: Descriptive statistics, along with bivariate and multivariate logistic regression with Bonferroni correction, were used to produce national estimates and identify predictors of admission. P < .01 was considered significant. RESULTS: The cohort included 27,238 weighted encounters involving isolated mandible fractures, of which 5,345(20%) were admitted. The payers for admitted patients were 46% public, 25% private, 22% self-pay, and 7% no charge/other. In bivariate analyses, public insurance was associated with a higher likelihood of admission than private insurance (RR 1.24, 95% CI 1.06 to 1.45), though there was no association in the multivariate model (OR 1.03, 95% CI 0.83 to 1.28). In multivariate analysis, higher Charlson Comorbidity Index (OR 1.32, 95% CI 1.18 to 1.48), alcohol-related disorder (OR 3.47, 95% CI 2.74 to 4.39), substance-related disorder (OR 1.43, 95% CI 1.20 to 1.71), and more mandible fractures (OR 3.08, 95% CI 2.65 to 3.59) were associated with admission. Compared to body fractures, subcondylar (OR 3.83, 95% CI 2.39 to 6.14), angle (OR 3.53, 95% CI 2.84 to 6.09), and symphysis (OR 4.14, 95% CI 2.84 to 6.09) fractures had higher odds of admission. Finally, level I (OR 4.11, 95% CI 2.41 to 6.98) and level II (OR 3.16, 95% CI 1.85 to 5.39) trauma centers had higher odds of admission. CONCLUSIONS: In 2018, 20% of ED patients with isolated mandible fractures were admitted. Several patient and hospital characteristics were predictors of admission. Insurance status was not associated with admission.
Asunto(s)
Servicio de Urgencia en Hospital , Fracturas Mandibulares , Humanos , Fracturas Mandibulares/economía , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Estudios Retrospectivos , Femenino , Masculino , Estados Unidos , Adulto , Persona de Mediana Edad , Seguro de Salud/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitalización/economía , Anciano , Adolescente , Adulto Joven , Cobertura del Seguro/estadística & datos numéricosRESUMEN
PURPOSE: The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire. METHODS: A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients. RESULTS: Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed. CONCLUSION: The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.
Asunto(s)
Fracturas Mandibulares , Humanos , Niño , Fracturas Mandibulares/terapia , Tratamiento Conservador , Cuarzo , Estudios Retrospectivos , Férulas (Fijadores)RESUMEN
Anatomic differences of the primary dentition may hinder traditional methods of intermaxillary fixation. Furthermore, the presence of both the primary and permanent dentition can complicate establishing, and maintaining, the preinjury occlusion. The treating surgeon must be aware of these differences for optimal treatment outcomes. This article discusses and illustrates methods that facial trauma surgeons can use to establish intermaxillary fixation in children aged 12 years and younger.
Asunto(s)
Dentición Mixta , Fracturas Mandibulares , Niño , Humanos , Fracturas Mandibulares/terapia , Técnicas de Fijación de Maxilares , Resultado del Tratamiento , Fijación Interna de FracturasRESUMEN
BACKGROUND/AIM: The first objective of this study was to identify predictive factors for oral and maxillofacial fractures at the initial response to the patient. The second objective was to determine the factors influencing the incidence of treatment duration of more than 1 month using the information shown in the medical record. MATERIALS AND METHODS: Hospital records from 2011 to 2019 were reviewed to identify patients who had sustained oral and maxillofacial injuries by falling or falling from a height. Patterns and types of oral and maxillofacial injury, injury severity, and background of the injury were collected from the hospital records. The variables independently associated with a treatment duration of more than 1 month were determined by logistic regression analysis. RESULTS: In total, 282 patients (150 men, 132 women; median age, 17.5 years) were selected for analysis. Maxillofacial fractures were observed in 20.9% of patients (59/282); among these, mandibular fractures were the most common (47/59). Logistic regression analysis showed that age (odds ratio [OR], 1.026), nighttime occurrence (OR, 2.192), and upper face injury (OR, 20.704) were independent predictive factors for having a maxillofacial fracture. Additionally, the number of injured teeth (OR, 1.515) and the use of intermaxillary fixation (OR, 16.091) were independent predictors of treatment duration of more than 1 month. CONCLUSIONS: These results may be useful in the initial management of maxillofacial injuries in terms of better-informing patients injured by falling their expected treatment duration and managing the psychological impacts of a long treatment duration.
Asunto(s)
Fracturas Mandibulares , Traumatismos Maxilofaciales , Fracturas Craneales , Masculino , Humanos , Femenino , Adolescente , Duración de la Terapia , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/terapia , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/terapia , Incidencia , Estudios Retrospectivos , Fracturas Craneales/epidemiología , Fracturas Craneales/terapia , Accidentes de TránsitoRESUMEN
Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.
Asunto(s)
Fracturas Abiertas , Fracturas Mandibulares , Fracturas Maxilares , Humanos , Fracturas Maxilares/complicaciones , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/terapia , Antibacterianos/uso terapéutico , Fracturas Abiertas/complicaciones , Mandíbula , Estudios RetrospectivosRESUMEN
BACKGROUND: The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. MATERIAL AND METHODS: A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. RESULTS: Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. CONCLUSIONS: Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality.
Asunto(s)
Fracturas Mandibulares , Traumatismos Maxilofaciales , Masculino , Femenino , Humanos , Niño , Preescolar , Adolescente , Recién Nacido , Lactante , Adulto Joven , Adulto , Jordania/epidemiología , Estudios Retrospectivos , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/terapia , Fracturas Mandibulares/etiología , Accidentes de Tránsito , Traumatismos Maxilofaciales/epidemiología , Traumatismos Maxilofaciales/etiología , Traumatismos Maxilofaciales/terapiaRESUMEN
BACKGROUND/AIMS: Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses. MATERIAL AND METHODS: Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury. RESULTS: Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury. CONCLUSIONS: There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.
Asunto(s)
Fracturas Mandibulares , Fracturas Craneales , Humanos , Persona de Mediana Edad , Anciano , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/terapia , Mandíbula , Trastornos de la Memoria/complicaciones , Estudios RetrospectivosRESUMEN
Mandibular fractures are frequently diagnosed in trauma centres. Tympanic plate and mandibular fossa fractures can be associated with those fractures and can pass unnoticed if a careful evaluation and adequate imaging exam are not performed. This descriptive study was made to evaluate the incidence of condylar fractures associated with mandibular fossa and/or tympanic plate fractures in a large trauma hospital. Twenty-nine patients were diagnosed with such fractures between July/2019 and July/2020. A total of 81.5% of the patients were diagnosed with condylar fracture associated with tympanic plate fracture, 11.1% with a condylar fracture with mandibular fossa fracture, and 7.4% with condylar fracture associated with both tympanic plate and mandibular fossa fracture. Otorrhagia, trismus, malocclusion, and mouth opening deviation were the most observed clinical signs. Treatments performed were speech therapy, open reduction, and closed reduction. A total of 7.4% of the patients evolved with complications after the treatment. This study suggests that fractures of the tympanic plate and mandibular fossa may go unnoticed if an adequate imaging exam is not performed and rated by the surgeon. The early and corrected treatment prevents future sequelae, and a long-term follow up is essential.
Asunto(s)
Cóndilo Mandibular , Fracturas Mandibulares , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/terapia , Hueso Temporal , Incidencia , Fijación Interna de Fracturas/métodos , Resultado del TratamientoRESUMEN
AIMS: Fractures to the maxillofacial region can have a serious impact on quality of life. The over-representation of males in the occurrence of almost all types and mechanisms of these injuries has tended to divert attention away from maxillofacial fractures in females. This study aimed to describe trends in maxillofacial trauma in a New Zealand tertiary trauma centre over a 12 year period, with a particular focus on gender differences. METHOD: A retrospective audit was undertaken of records for maxillofacial fracture cases referred to Dunedin Hospital and Southland Hospital Maxillofacial Units during the period January 2009 to December 2020. Information on age, gender and ethnicity, aetiology, alcohol and/or drug involvement, fracture type, and management was obtained from the Southern District Health Board - Health Connect South Network. RESULTS: Over the observation period, 1,561 patients presented for a total of 2,480 fractures. There was an increase in the proportion of fractures arising from falls and involving the orbit, while those due to interpersonal violence (IPV) or involving the mandible fell. Additionally, the proportion of cases treated conservatively rose, while the use of surgical fixation fell. While overall just over one in five patients were female, that proportion increased from one in six in 2009-2011 to one in four in 2018-2020. Fractures among females were due mainly to falls (55.6%) and road traffic accidents (23.2%), and frequently involved the orbit (46.3%). The proportion of presentations involving people aged 50 or older also increased over time. CONCLUSIONS: A greater proportion of women are suffering from facial fractures in the past decade than they have previously. Public health interventions for those at risk and their families are necessary. Interventions should have a focus on preventing falls and domestic violence, with a particular focus on older people and Maori/Pasifika populations. Improved and continued monitoring of these changing patterns is important for addressing the issues they present to New Zealand.
Asunto(s)
Fracturas Mandibulares , Fracturas Craneales , Accidentes de Tránsito , Anciano , Femenino , Humanos , Masculino , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/epidemiología , Fracturas Mandibulares/terapia , Nueva Zelanda/epidemiología , Calidad de Vida , Estudios Retrospectivos , Fracturas Craneales/epidemiología , Fracturas Craneales/terapiaRESUMEN
PURPOSE: To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment. METHODS: A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment. RESULTS: A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7-99.3), a specificity of 38.6 (35.0-42.3), and a negative predictive value of 99.3 (97.3-99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6-100.0), a specificity of 39.1 (33.2-45.4), and a negative predictive value of 100.0 (96.1-100.0). CONCLUSION: The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov with the identifier NCT03314480.
Asunto(s)
Maloclusión , Fracturas Mandibulares , Movilidad Dentaria , Estudios de Cohortes , Técnicas de Apoyo para la Decisión , Humanos , Fracturas Mandibulares/diagnóstico , Fracturas Mandibulares/terapia , Estudios ProspectivosRESUMEN
OBJECTIVE: The aim: On the basis of radiological data to evaluate the effectiveness of our developed treatment complex of patients with temporomandibular joint dysfunction after mandibular fractures. PATIENTS AND METHODS: Materials and methods: To achieve this goal, 92 patients hospitalized in the department of surgical dentistry of the Chernivtsi Regional Clinical Hospital were examined for traumatic fractures of the mandible with functional disorders of the TMJ. 46 patients (main group) were treated according to the treatment method developed by us, and 46 patients (control group) were treated with the traditional method. Patients underwent orthopanthography and radiography of the temporomandibular joint according to Schuller. Statistical processing of research results was carried out using commonly used methods of variation statistics. RESULTS: Results: After 12 months of studies in patients of the main group, unilateral narrowing of the joint space was determined in 6,52 ± 1,83% of persons p, p1 0.05.The number of persons with unilateral expansion of the joint space according to Rtg, in the main group decreased by 2,3 times relative to the data before treatment. CONCLUSION: Conclusions: Timely treatment of musculoskeletal disorders with the help of pharmacological and physiotherapeutic methods proposed by us, allowed, to a large extent, to eliminate clinical, radiological and ultrasound symptoms of temporomandibular joint dysfunction in patients with post-traumatic lesions of mandibule. This was confirmed by the improvement of the data of the conducted functional researches.
Asunto(s)
Fracturas Mandibulares , Trastornos de la Articulación Temporomandibular , Humanos , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/terapia , Radiografía , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/etiología , Trastornos de la Articulación Temporomandibular/terapia , Rayos XRESUMEN
The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes. The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1-2 years of follow-up. In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% - including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1-2 years. Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.
Asunto(s)
Fracturas Mandibulares , Adolescente , Niño , Fijación Interna de Fracturas , Humanos , Cóndilo Mandibular/diagnóstico por imagen , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Iatrogenic mandible fracture is a rare complication of a tooth extraction with an incidence between 0.0033-0.0034%. This study retrospectively analyzes a total of 8 patients who underwent lower molar extraction associated with mandible fracture during tooth removal in the period from April 2006 to March 2019. The assessed parameters were age and sex of patients, method of tooth extraction, side distribution of fracture, type of extracted tooth, the position of a lower third molar, presence of bone pathological lesion formed in connection with a tooth, displacement of bone fragments, and sensory impairment in the innervation area of the mental nerve. The position and impaction of the lower third molars were evaluated according to Pell and Gregory's classification and Winter's classification. One fracture was left-sided, and 7 fractures were right-sided. In 6 cases, Winter's extraction elevator was used. In 7 patients, the mandible fracture was treated surgically by performing stable osteosynthesis with the plates and screws. One patient was treated conservatively. This work analyzes the causes of iatrogenic mandible fractures and provides recommendations to reduce the risk of their occurrence.
Asunto(s)
Fracturas Mandibulares/etiología , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Fracturas Mandibulares/terapia , Estudios RetrospectivosRESUMEN
The condyle is the most common site of mandibular fracture. In the present study, an attempt was made to utilize three-dimensional computed tomography (3D-CT) images to evaluate mandibular condyle fractures and identify prognostic indicators of malocclusion after closed treatment. Accurate morphometric measurements were performed using 3D-CT images obtained before trauma, after trauma, and after healing. Morphometry revealed significant differences in loss of ramus height (LRH) and lateral movement length in patients with malocclusion, and significant LRH differences in patients with other maxillomandibular fractures after healing, or in those with dislocation-displacement. The present method of 3D-CT image analysis appears useful for evaluation of condylar fractures.
Asunto(s)
Maloclusión , Fracturas Mandibulares , Humanos , Imagenología Tridimensional , Maloclusión/diagnóstico por imagen , Maloclusión/terapia , Cóndilo Mandibular/diagnóstico por imagen , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Mandibulares/terapia , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: Mandibular collum fractures among growing patients can lead to abnormal growth, function, esthetics and ultimately quality of life. Among the proposed treatment alternatives, orthopaedic treatment with functional appliances has been suggested, with encouraging results. Aim of the present systematic review was to critically appraise existing evidence on the outcome of functional appliance treatment among growing patients with mandibular collum fractures. MATERIALS AND METHODS: Eight databases were searched up to October 2020 for randomised and non-randomised clinical studies assessing functional appliance treatment outcome for children with mandibular fractures. After duplicate study selection, data extraction and risk of bias assessment, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. RESULTS: A total of 8 unique studies (one prospective and nine retrospective non-randomised) with 223 children could be identified. Functional appliance treatment was associated with greater anteroposterior condyle dimensions of the injured condyle compared with the contralateral healthy condyle (3 studies; MD = 0.87 mm; 95% CI = 0.30 to 1.45 mm; p = .003). No difference was found in the mesiodistal condyle size between the injured and the contralateral healthy joint (3 studies; MD = -0.05 mm; 95% CI = -1.05 to 0.95 mm; p = .92), but collum length was smaller at the injured side compared with the contralateral one (1 study; MD = -2.89 mm; 95% CI = -5.29 to -0.49 mm; p = .02). Treatment outcome might be influenced by patient age, patient sex and severity/localisation of the fracture, but the quality of evidence for all analyses was very low due to methodological limitations leading to bias. CONCLUSIONS: While some evidence exists that functional appliances might lead to good clinical rehabilitation of fractured mandibular condyles, including considerable bone remodelling, available studies are small and have methodological weaknesses.
Asunto(s)
Fracturas Mandibulares , Niño , Estética Dental , Humanos , Fracturas Mandibulares/terapia , Estudios Prospectivos , Calidad de Vida , Estudios RetrospectivosRESUMEN
BACKGROUND: Cell-based treatments have demonstrated the capacity to enhance reconstructive outcomes in recent decades but are hindered in clinical utility by regulatory hurdles surrounding cell culture. This investigation examines the ability of a noncultured stromal vascular fraction derived from lipoaspirate to enhance bone healing during fracture repair to further the development of translatable cell therapies that may improve outcomes in irradiated reconstruction. METHODS: Isogenic male Lewis rats were divided into three groups: fracture, irradiated fracture, and irradiated fracture with stromal vascular fraction treatment. Irradiated groups received a fractioned dose of 35 Gy before mandibular osteotomy. Stromal vascular fraction was harvested from the inguinal fat of isogenic donors, centrifuged, and placed intraoperatively into the osteotomy site. All mandibles were evaluated for bony union and vascularity using micro-computed tomography before histologic analysis. RESULTS: Union rates were significantly improved in the irradiated fracture with stromal vascular fraction treatment group (82 percent) compared to the irradiated fracture group (25 percent) and were not statistically different from the fracture group (100 percent). Stromal vascular fraction therapy significantly improved all metrics of bone vascularization compared to the irradiated fracture group and was not statistically different from fracture. Osteocyte proliferation and mature bone formation were significantly reduced in the irradiated fracture group. Bone cellularity and maturity were restored to nonirradiated levels in the irradiated fracture with stromal vascular fraction treatment group despite preoperative irradiation. CONCLUSIONS: Vascular and cellular depletion represent principal obstacles in the reconstruction of irradiated bone. This study demonstrates the efficacy of stromal vascular fraction therapy in remediating these damaging effects and provides a promising foundation for future studies aimed at developing noncultured, cell-based therapies for clinical implementation.