Quality of life in treatment of mandibular fractures using closed reduction and maxillomandibular fixation in comparison with open reduction and internal fixation--a randomized prospective study.

Treatment of mandibular fractures by open reduction and internal fixation (ORIF) is often assumed to be superior to treatment by close reduction and maxillomandibular fixation (MMF) because patients managed by ORIF seem to be rehabilitated earlier according to functional and social aspects. This assumption is often from surgeon's perspective, not taking into account patient's view point. This study highlights a comparative assessment between ORIF and MMF from the patients' perspective. Fifty six patients with mandibular fractures within the tooth bearing areas of the mandible were prospectively studied in a randomized controlled pattern for postoperative Quality of Life (QoL) after ORIF versus MMF. Both groups were analyzed preoperatively, at 1 day, 6 and 8 weeks regarding their QoL using the General Oral Health Assessment Index questionnaire (GOHAI). No significant statistical difference was found between the groups regarding overall QoL. Patients managed by MMF were more affected by psychosocial and physical domains whereas patients managed by ORIF were more affected by the pain domain. The results demonstrate that the treatment affects the psychosocial, physical and pain domain differentially. When both treatments are possible the patient's should be enlightened on the advantages and disadvantages of both treatment modalities to guide their choice of treatment.

Management of fascial space infections in a Nigerian teaching hospital: A 4-year review.

BACKGROUND: Fascial space infections of the head and neck region, usually odontogenic in origin, are routinely treated as an out-patient procedure. Untreated or rapidly spreading odontogenic infections can be potentially life threatening. The present study is a review of patients with orofacial infections who required emergent incision and drainage in the maxillofacial unit of our institution. The need for early presentation is highlighted. MATERIALS AND METHODS: This is a retrospective study of patients with orofacial space infections between January 2007 and December 2010. Patients' case files were retrieved and demographic as well as clinical characteristics were obtained and analyzed. A P value of <0.05 was considered significant. RESULTS: A total of 53 patients with fascial space infection were seen over the period of study. Of the 41 patients reviewed, males accounted for 26 (63.4%) and females 15 (36.6%). Their ages ranged from 4 months to 80 years (mean 32.8± 18.3 years). There was no statistical difference between the mean age of male and female patients (t=-962, P=0.342). Submandibular space was the most frequently involved single space and accounted for 43.9% of the cases. This was followed by multiple space involvement (Ludwig angina) which accounted for 36.6%. Buccal space and submasseteric space infection represented 7.3% each. Sources of infections were of odontogenic origin in 92.7% of cases and were unknown in the remaining 7.3%. The outcome was satisfactory with complete resolution in 48.8% of cases. Resolution with some morbidities in the form of persistent limitation of mouth opening, orocutaneus fistula, and necrotising fascitis were seen in an almost equal proportion of 46.3% of cases. The outcome was observed to be significantly associated with the presence of underlying systemic conditions (χ(2) =21.66; r=0.73; P=0.0001), time of presentation (χ(2) =12.28; r=0.55; P=0.002), and age (χ(2) =54.48; r=0.69; P=0.0001). CONCLUSION: Fascial space infections of the head and neck region, though potentially life threatening, can be prevented by regular dental visits. Early recognition and treatment of established cases are necessary to prevent considerable morbidity and mortality, especially in older patients with an underlying systemic condition.