Fractura de mandíbula en pacientes parcialmente edéntulos. Alternativa de tratamiento cerrado. Serie de casos / Mandibular fractures in partially edentulous patients. Closed treatment alternatives. A Cases series

Para el tratamiento de fracturas mandibulares existen protocolos cuyo propósito primordial es la función temprana. Existen diversos motivos por los cuales no se puede ejecutar ciertas técnicas en Venezuela, principalmente por problemas económicos para la adquisición de materiales de osteosíntesis especializados. Por esta razón, se ha recurrido a técnicas quirúrgicas antiguas. Se presenta un estudio con diseño longitudinal de tipo descriptivo, para el reporte de serie de 5 casos clínicos de fracturas de mandíbula, con los siguientes criterios de inclusión: presentar fractura mandibular en pacientes dentados parcialmente con imposibilidad al acceso al material de osteosíntesis del sistema de cargas soportadas. Tratados bajo procedimiento quirúrgico cerrado, la condición de edentulismo parcial confiere a la fractura de mandíbula inestabilidad, dificulta la reducción anatómica, pérdida de dimensión vertical y transversal, las que se recuperan a través de la elaboración de férulas tipo Gunning modificadas. Estas férulas se mantuvieron en posición con alambrados de suspensión ósea tipo circummandibulares y circumzigomáticos, como medios para establecer estabilidad en el tiempo. Se obtuvieron resultados satisfactorios, por lo que, aún hoy en día se pueden plantear como opciones de tratamiento.

For the treatment of mandibular fractures, there are protocols whose primary purpose is early function. However, several reasons prevent the execution of these techniques in Venezuela, mainly due to economic problems regarding the acquisition of specialized osteosynthesis materials. As a result, there is a necessity to resort to old surgical techniques. A study with a descriptive longitudinal design is presented, reporting 5 clinical cases of jaw fractures with the following inclusion criteria: presenting a mandibular fracture in partially dentate patients with impossibility of accessing the osteosynthesis material of the load-bearing system. The treatment conducted under closed surgical procedures. The condition of partial edentulism confers instability to the mandible fracture, hindering anatomical reduction and causing a loss of vertical and transverse dimension. These issues are addressed through the utilization of modified Gunning-type splints, which help in recovery. The splints were maintained in position with circum-mandibular and circum-zygomatic bone suspension wiring as a means to establish stability over time. Satisfactory results were obtained, indicating that these techniques can still be considered as treatment options today.

Pediatric Mandible Fractures.

The management of pediatric facial fractures requires several considerations by the treating surgeon. Pediatric facial fractures occur less commonly than in adults. Among fracture patterns in children, studies have repeatedly demonstrated that mandible fractures are the most common facial fracture particularly the condyle. Most fractures in children are amenable to nonsurgical or closed treatment; however, certain indications exist for open treatment. The literature describing epidemiology, treatment trends, and long-term outcomes are limited in comparison with adult populations. The purpose of the article is to review the etiology, workup, and management of mandible fractures in children.

Diagnostic properties of sensitivity changes in patients with maxillofacial fractures: a systematic review

Aim: Verify the accuracy of objective assessments compared to subjective tests in detecting changes in somatosensory perception in individuals affected by maxillofacial trauma. Methods: The review (PROSPERO n ° CRD42019125546) used the databases: MEDLINE, Cochrane, EMBASE, LILACS and other bibliographic resources. Prospective and retrospective studies that used objective and subjective methods of assessing facial sensitivity in maxillofacial fractures were included. There was no restriction on language or publication date. Risk of bias was assessed using the QUADAS-2. Data extraction and analysis were performed using a form developed for the study. Results: 21 studies were included. The clinical objective examination mainly includes assessments of: tactile sensitivity (95.24%) and nociceptive sensitivity (57.14%). The subjective assessment was based on the patient's report, spontaneously (61.90%), guided by structured questionnaires (33.33%) and/or using scales (9.52%) to measure the degree of impairment. In risk of bias assessment, were observed no adequate interpretation and classification of changes in subjective sensitivity, subject to inappropriate analysis of the data. In addition, the studies bring several instruments without standardization for assessing sensory modalities. Conclusion: The objective assessment is a complement to the subjective assessment, using the touch assessment as the main parameter in the profile of the facial peripheral integrity, associated or not with nociceptive assessment. Lack of consensus on the indication of specific instruments for testing is a limiting factor. Thus, based on the studies, is proposed a minimum battery of sensitivity assessment to obtain an overview of the patient's peripheral nervous situation

Treatment of Mandible Fractures Using a Miniplate System: A Retrospective Analysis.

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital Münster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.

Management of Multiple Mandibular Fractures in a Child with Osteogenesis Imperfecta Using Arch Bar Retained Thermoformed Splints: A Novel Technique.

Osteogenesis Imperfecta (OI) is a heterogeneous group of autosomal dominant and recessive inherited disorders of type I collagen metabolism. Clinical features of OI include multiple bone fractures, muscle weakness, joint laxity, skeletal deformities, blue sclerae, hearing loss, and dentinogenesis imperfecta. This report presents a challenging case of multiple mandibular fractures in a five years old child with OI, which was successfully treated with a new, minimally invasive technique of closed reduction with arch bar retained thermoformed splint.

Application of IMF screws to assist internal rigid fixation of jaw fractures: our experiences of 168 cases.

Intermaxillary fixation (IMF) screws were first introduced to achieve IMF as a kind of bone borne appliance for jaw fractures in 1989. Because this method can overcome many disadvantages associated with tooth borne appliance, IMF screws have been popularly used for jaw fractures since then. From March 2011 to February 2014, we treated 168 cases with single or multiple jaw fractures by open reduction and a total of 705 IMF screws were intraoperatively applied in all the cases to achieve IMF and maintain dental occlusion as an adjuvant to open reduction. The numbers, implantation sites and complications of IMF screws were retrospectively analyzed. In our experience, we found that IMF screws were important to assist open reduction of jaw fractures but their roles should be objectively assessed and the reliability of open reduction and internal rigid fixation must be emphasized. Much attention should be paid when implanting.

The Importance of Immediate Bone Block Autograft to Successfully Restore the Function and Aesthetic of the Anterior Alveolar Process and Teeth.

Maxillofacial traumatic injuries can damage the jaw, teeth, and soft tissues of the head and neck region. When these injuries occur, best practice is to reconstruct as comprehensively as is clinically prudent at time of injury. Smart and efficient procedures during the initial surgery can minimize subsequent reconstructive procedures in scope and number, minimize expense, and result in a better final aesthetic and functional outcome. Restoration of anterior alveolar jaw fractures with comminuted or avulsed segments becomes a complex prospect when left untreated after initial trauma or injury and can result in alveolar ridge defects that are difficult, costly, and cumbersome to repair. This case report details one 19-year-old woman who had a traumatic injury in these areas and has a best result outcome because of immediate reconstruction efforts involving a bone block autograft to preserve alveolar process anatomy.

The cost and inpatient burden of treating mandible fractures: a nationwide inpatient sample database analysis.

OBJECTIVE: To discuss patient demographics, hospitalization characteristics, and costs associated with the treatment of mandible fractures. STUDY DESIGN: Cross-sectional study. SETTING: The 2009 Nationwide Inpatient Sample (NIS) database. SUBJECTS/METHODS: Patient demographics, hospital characteristics, fracture locations, and common comorbidities for patients with isolated mandible fractures were analyzed, and variables associated with increased cost and length of hospitalization stay were ascertained. RESULTS: A total of 1481 patients were identified with isolated mandible fractures. The average age was 32, 85.4% were male, 39% were Caucasian, and 25% African American. Forty percent were from the lowest median household income quartile, and 77% were uninsured or government funded. The average length of stay (LOS) was 2.65 days, and average hospitalization cost was $35,804. A statistically significant increased LOS was associated with alcohol abuse, drug abuse, mental illness, diabetes mellitus type 2, cardiovascular disease, HIV, and age over 40. There was a statistically significant increased total cost associated with drug abuse, alcohol abuse, mental illness, cardiovascular disease, and age over 40. CONCLUSION: The average cost for treatment of mandible fractures was $35,804 per person with increased expenditures for older patients and those with a history of mental illness, cardiovascular disease, or substance abuse. To improve outcomes and reduce hospital charges, outpatient resources and inpatient protocols should be implemented to address the factors we identified as contributing to higher costs and increased hospital stay.

A Clinical Study of Mandibular Angle Fracture.

PURPOSE: To establish management protocol for mandibular angle fracture, we describe pertinent factors including cause, impacted third molar and recent treatment tendency. METHODS: We examined the records of 62 patients who had unilateral mandibular angle fracture. Sixty patients who had open reduction surgery were examined at postoperative weeks 1, 4, 8, 12, and 28. RESULTS: Left mandibular angle fracture is frequent in younger males. Presence of the mandibular third molar can increase fracture risk. Because of attached muscle, favorable fractures occurred primarily in the mandibular angle area. CONCLUSION: Extracting the mandibular third molar can prevent angle fractures, and open reduction with only one plate adaptation is generally the proper treatment method for mandibular angle fracture.

Teeth in the line of mandibular fractures: epidemiology, management and complications / Dentes em linhas de fraturas mandibulares: epidemiologia, manejo e complicações

Objetivo: avaliar a incidência, as regiões mais afetadas, o manejo bem como as complicações encontradas em dentes envolvidos em linhas de fraturas mandibulares. Métodos: Os dados foram coletados a partir de prontuários de pacientes tratados com fraturas mandibulares. Foram incluídas informações como dados demográficos, localização da fratura, presença de dentes na linha de fratura e complicações. Resultados: a amostra apresentou um total de 310 linhas de fratura, e destas 144 tinham dentes envolvidos. a região mais afetada foi o ângulo, seguido da parassínfise, pelo corpo, pelo processo alveolar e pela sínfise. Observaram-se 196 dentes nas linhas de fraturas, 60 dos quais tinham sido retirados. Complicações pós-operatórias ocorreram em 8,6% da amostra. Dos casos que apresentaram complicações, pacientes sem dentes envolvidos na linha de fratura corresponderam a 43,75%, e os pacientes com dentes envolvidos na linha de fratura foram de 56,25%. Quando o dente foi removido, 8,47% dos pacientes apresentaram complicações, e, quando o dente foi mantido, 2,85%. Conclusão: este estudo demonstrou que a presença de dentes da linha de fratura não é um fator limitante para o tratamento. As complicações são mais frequentemente relacionadas com o método de tratamento escolhido do que para o envolvimento de dentes na linha de fratura.

Purpose: To examine the incidence, the regions most affected, the management as well as the complications found in teeth involved in the line of mandibular fractures. Methods: Data were collected from patients records treated of mandibular fractures. It was included information such as demographic data, fracture location, presence of teeth in the line of fracture, treatment and complications. Results: The sample has presented a total of 310 lines of fracture, from these, 144 had teeth involved. The most affected area was the angle, followed by the parasymphysis, body, alveolar process and symphysis. There were 196 "fracture line" teeth, 60 of which had been removed. Postoperative complications occurred in 8.6% of the sample. From the cases that presented complications, patients without teeth involved in the fracture line ranged 43.75% and patients with teeth involved in the fracture line reached 56.25%. When the tooth was removed 8.47% of the patients presented complications and when the tooth was retained 2.85%. Conclusion: This study demonstrated that the presence of teeth in the line of fracture is not a limiting factor for the treatment. The complications are more frequently related to the chosen method of treatment than to the involvement of teeth in the line of fracture.

Fratura de mandíbula provocada por projétil não letal: Relato de caso / Mandible fracture caused by non-lethal projectile: Case report

As armas de fogo são largamente utilizadas para a prática de homicídios, suicídios e lesões corporais. Utilizadas pelas forças policiais em todo o mundo, provocam lesões caracterizadas por extensa destruição tecidual, cujo tratamento é complexo e requer, muitas vezes, grandes reconstruções. Na tentativa de controlar situações de agitação social, manifestações, tumultos ou depredações sem, contudo, matar ou ferir gravemente os participantes, a polícia vem utilizando armas de munição não letal. embora não letal, se a munição atingir partes delicadas do corpo, pode causar danos importantes ou, até mesmo, levar à morte da vítima. O objetivo deste trabalho foi relatar um caso clínico de um paciente atendido no Serviço de emergência do Hospital Municipal Salgado Filho/RJ-Brasil, vítima de fratura de mandíbula, em decorrência de uma agressão por projétil não letal bem como discutir a capacidade de morbidade dessas munições que, embora consideradas não letais, se incorretamente utilizadas, podem levar ao óbito.

Firearms are widely used for the practice of homicides, suicides and injuries. Used by police forces around the world, causing lesions characterized by extensive tissue destruction, whose treatment is complex and often requires, large reconstructions. In an attempt to control situations of social unrest, demonstrations, riots or vandalism without, however, kill or seriously injure the participants, the police have been using non-lethal weapons ammunition. While not lethal, if the ammunition reaches delicate parts of the body can cause serious damage or even lead to death of the victim. The aim of this study was to report a case of a patient treated at the emergency Service of the Salgado Filho Municipal Hospital / RJ-Brazil, victim of mandible fracture as a result of an assault by non-lethal projectile, as well as discuss the ability of morbidity this ammunition that, while considered non-lethal, if used incorrectly, can lead to death.

A simple jaw splint for minimally displaced mandible fractures with undisplaced occlusion.

A 35-year-old patient presented with a minimally displaced jaw fracture with normal occlusion. She was treated conservatively with a soft diet and told to avoid doing things that hurt to prevent movement at the fracture site. She had the most difficulty with pain generated by walking, driving on bumpy roads and waking up with an unfavourable jaw position during her sleep. She created a simple Velcro (Velcro Industries BV, USA) splint, that removed all of her pain with walking, driving and sleeping and went on to heal her fracture uneventfully. The occupational therapist easily fabricated this splint for a second patient, who also found it very helpful.

Une patient de 35 ans s'est présentée avec une fracture très peu déplacée de la mandibule et une occlusion normale. Elle a reçu un traitement classique, consistant à lui conseiller un régime de consistance molle et d'éviter de faire des choses douloureuses pour prévenir les mouvements au foyer de la fracture. Elle éprouvait surtout des douleurs causées par la marche, la conduite sur des routes cahoteuses et les réveils parce que sa mâchoire s'était déplacée pendant son sommeil. Elle a créé une simple attelle, à l'aide de Velcro (Velcro Industries BV, États Unis), qui a soulagé toutes ses douleurs causées par la marche, la conduite et le sommeil, et sa fracture a guéri sans complication. L'ergothérapeute a facilement fabriqué cette attelle pour un deuxième patient, qui l'a également trouvée très utile.