What Is the Effect of Treating Mandibular Fractures on Weight and Prealbumin?

PURPOSE: Fracture healing relies on the body to coordinate an inflammatory and anabolic reaction to re-establish osseous union. Although many factors affect this process or even disrupt it, the role of the body's nutritional reserves is not well understood. The purposes of this study were to describe the weight changes and to identify trends in laboratory values commonly used in nutritional assessment during mandibular fracture treatment. MATERIALS AND METHODS: A prospective cohort study was designed. The study cohort included patients who sustained a mandibular fracture from September 1, 2017, to March 31, 2018. The primary outcome variable was the percentage weight change from baseline. Secondary outcome variables included serum albumin and serum prealbumin levels. Weight change was analyzed using a linear mixed model. Paired Wilcoxon tests were used to compare laboratory values with baseline levels. RESULTS: Thirty-nine patients met the inclusion criteria with sufficient follow-up data for analysis. The linear mixed model predicted a peak weight loss of 4.1% of the initial body weight by day 34. The serum prealbumin level increased over the study period (P < .001), and the albumin level was increased from baseline at week 3 (P < .05) but not significantly different from baseline after that time. CONCLUSIONS: During the course of treatment for mandibular fractures, patients lost an average of more than 4% of their body weight. However, the study did not show any meaningful change in nutritional laboratory values. Although it is important for patients and surgeons to be able to anticipate a weight loss of about 4 to 5% during mandibular fracture treatment, it is unlikely that this represents a large challenge to the nutritional status of patients.

Exposure to Ti4Al4V Titanium Alloy Leads to Redox Abnormalities, Oxidative Stress, and Oxidative Damage in Patients Treated for Mandible Fractures.

Due to the high biotolerance, favourable mechanical properties, and osseointegration ability, titanium is the basic biomaterial used in maxillofacial surgery. The passive layer of titanium dioxide on the surface of the implant effectively provides anticorrosive properties, but it can be damaged, resulting in the release of titanium ions to the surrounding tissues. The aim of our work was to evaluate the influence of Ti6Al4V titanium alloy on redox balance and oxidative damage in the periosteum surrounding the titanium miniplates and screws as well as in plasma and erythrocytes of patients with mandibular fractures. The study included 31 previously implanted patients (aged 21-29) treated for mandibular fractures and 31 healthy controls. We have demonstrated increased activity/concentration of antioxidants both in the mandibular periosteum and plasma/erythrocytes of patients with titanium mandibular fixations. However, increased concentrations of the products of oxidative protein and lipid modifications were only observed in the periosteum of the study group patients. The correlation between the products of oxidative modification of the mandible and antioxidants in plasma/erythrocytes suggests a relationship between the increase of oxidative damage at the implantation site and central redox disorders in patients with titanium miniplates and screws.

[Immunological aspects of delayed regeneration of mandibular fractures].

The level of complications in patients with the mandibular fractures does not have a tendency to the decline. A research purposes is a study of the basic laws of immunological reactions and possibility of optimizing processes osteogenesis by drugs-cytokines at patients with the mandibular fractures with delayed consolidation of bone tissue. 46 patients with the mandibular fractures were observed. The maintenance of cytokines IL - 1ß, TNF - α, IL - 4, SICAM-1 in the blood serum, IgA, IgM, IgG in a mouth liquid was probed. It is set that in pathogenesis of delayed consolidation a basic role is played by changes reactivity of organism, which realized in three directions: immunodeficit of humoral immunity, immunodepression of cellular factors of defence, disbalance in functioning of the cytokines system. It is necessary to count the levels of products SICAM-1 and cytokine IL-1ß in the blood serum by the diagnostic criteria of bone repair features at patients with the mandibular fractures: development of delayed consolidation of mandibular fragments is accompanied the increase of their parameters at the control group more than in 2 and in 15 times (668,2±10,3 pg/ml and 363,4 ±6,6 pg/ml relatively). Includding in the complex treatment of the mandibular fractures of immunomodulator Ronkoleukin showed clinico-immunological efficiency for the patients with impaired bone repair.

Genotoxicity of fixation devices analyzed by the frequencies of sister chromatid exchange.

BACKGROUND: Metal alloys utilized in the management of jaw fractures may exert genotoxic effects. Our purpose was to compare the genotoxicity of intermaxillary fixation devices containing nickel and chromium to that of titanium miniplates utilized in treatment of jaw fractures through the analysis of sister chromatid exchange. METHODS: In this prospective study, in a total of 28 non-smoker patients (10 females, 18 males; mean age 33.43±10.76; range 15 to 60 years) with jaw fractures, 14 were treated with intermaxillary fixation by administration of nickel-chromium wire and arch bar and 14 with titanium miniplates to investigate the genotoxicity of different metal alloys. The outcome variable was the frequency of sister chromatide exchange in peripheral lymphoctyes, determined through the analysis of venous blood samples obtained preoperatively and 4 to 6 weeks postoperatively. RESULTS: The frequency of the average sister chromatid exchange was found to be significantly higher in patients treated with the nickel-chromium intermaxillary fixation devices than those treated by titanium miniplates (1.29±0.29 vs. 0.46±0.39, p<0.001). CONCLUSION: Although titanium miniplate osteosynthesis is an invasive technique in comparison with the nickel-chromium-containing intermaxillary fixation devices, titanium seems to exert less genotoxic effect than the nickel-chromium alloy. However, this finding should be supported in clinical studies with a larger sampling size.

Collagen type I and III metabolism in assessment of mandible fractures healing.

PURPOSE: The aim of this work was estimation of the PIIINP, PICP and ICTP concentrations in blood serum during non-complicated mandible fracture healing; settlement of dependences between kinetics of changes of examined markers with reference to particular bone fracture phases and applied treatment methods; the determination of usefulness of collagen metabolism markers type III and I for the monitoring of mandibular fracture healing. MATERIAL AND METHODS: The material was blood serum of men aged 20-30 years, who were treated for mandible fractures in Maxillofacial Clinic Medical University of Bialystok. Depending on the treating method, examined patients were divided into two groups. Patients treated with non-operative method were I group (n = 31), II group was made of patients treated with surgery (n = 33). The concentrations of markers measured on the 2nd, 14th, 42nd, 90th day after trauma and in II group these substances were measured additionally on the 2nd and 14th day after surgery. Control group consisted of 20 healthy men the same age. Concentrations of markers were measured with the radioimmunological method (RIA). RESULTS: Regular process of mandible fracture healing in men in various periods occurs with PICP, PIIINP and ICTP concentration changes in blood serum. CONCLUSIONS: Changes of maker concentration show that, mandible fracture healing treated non-operatively is a more dynamic process than stable osteosynthesis method applied. Lack of positive correlation of the PIIINP and PICP concentration in blood serum of patients in two examined groups can indicate on the different mechanisms of mandible fracture healing connected with different methods of the treatment.

The concentration of C-terminal propeptide of type I procollagen in blood serum in the course of mandibular fracture healing (preliminary report).

One of the basic measures of quality of repairing processes of soft tissue and bone injury is collagen synthesis. C-terminal propeptide of type I procollagen (PICP) is admitted index of type I collagen biosynthesis. The aim of the study was estimation of PICP concentrations in the course of fracture repair process in relation to the treatment method. The material of investigations was blood serum of 25 men (age 20-30 years) with fracture of mandible. The patients were divided into 2 groups depending on the method of treatment: I group was patients treated non-surgical method (n = 12); II group--surgical method (n = 13). Blood samples in the first group were taken on 2nd, 14th, 42nd, 90th day of healing process and additionally on 2nd and 14th day after surgery--in the second group. The PICP concentrations in blood serum were determined by RIA method. Statistical analysis of results shown significant increase of PICP concentrations in I group of patients in 14th (167.1 +/- 42.8 micrograms/L) and in 42nd (216.0 +/- 59.1 micrograms/L) day of healing process in comparison to the values in the second day after injury--the first study (124.3 +/- 41.8 micrograms/L). In the II group of patients the statistically significant increase of PICP concentration in 14th day after surgical procedure (156.9 +/- 30.5 micrograms/L), 42nd (163.1 +/- 35.3 micrograms/L) and in 90th (153.1 +/- 40.2 micrograms/L) day of healing process after injury in comparison to the values in the second day after injury--the first study (119.9 +/- 35.8 micrograms/L). The results indicate, that a normal course of mandibular fracture healing influences the change in PICP concentrations in serum in examined men. A different dynamics of PICP concentrations, observed in the serum in patients with mandibular fractures treated surgically and non-surgically, suggests various mechanisms of bone tissue reconstruction connected with the method of treatment.

Insulin-like growth factor-I (IGF-I) in serum and bone tissue during rat mandible fracture healing.

Insulin-like growth factor-I (IGF-I) is potent stimulator of proliferation and differentiation of osteoblasts, the biosynthesis of collagen type-I and noncollagenous proteins and alkaline phosphatase activity. The role of IGF-I in bone repair has not as yet been clearly defined. The aim of the present study was the quantitative analysis of IGF-I in the serum and tissue in four phases of fractured jaws healing in rat models. IGF-I concentrations in the serum and bone extracts were determined by RIA. In respect to the control group (K) the significant increase of IGF-I occurred in the serum in phase I (211 +/- 68 ng/ml, K-153 +/- 50 ng/ml) (p < 0.05). At the tissue levels a statistically significant increase in IGF-I was confirmed in phase II (262 +/- 60 ng/g, K-182 +/- 56 ng/g) (p < 0.05). The present results demonstrate that in rat models with fractured jaws in the first two phases of healing elevated levels of IGF-I in the serum and bone tissue were observed which indicate the significant role of this polypeptide in the early healing stages.

[The use of intravenous laser irradiation of the blood for the prevention and treatment of suppurative infectious complications in mandibular fractures]. / Primenenie vnutrivennogo lazernogo oblucheniia krovi dlia profilaktiki i lecheniia gnoino-infektsionnykh oslozhnenii perelomov nizhnei cheliusti.

Fifty-nine patients with mandibular fractures were treated making use of intravenous laser irradiation of the blood. Laser exposure had a marked antiinflammatory and analgesic effect, compensated for changes in disordered immunity status, and normalized red cell membrane structure and function as well as its energy supply.

Changes in C-reactive protein associated with surgical treatment of mandibular fractures.

C-reactive protein (CRP) levels were determined in 80 patients (67 male, 13 female), each with a single mandibular fracture in either the symphysis, body, or angle region. All patients underwent osteosynthesis (63 with rigid plate fixation following the AO/ASIF principle, 17 with miniplates). C-reactive protein levels were measured on admission and daily during hospitalization. Preoperative CRP levels (mean, 28.5 mg/L) varied according to the time that had elapsed since injury. After surgery, there was always an increase in CRP level. The level reached its maximum (mean, 73.2 mg/L) on the second day after operation. Postoperative CRP levels were significantly influenced by the time between trauma and surgery. Significant differences were also observed with different types of fixation. Fixation with rigid plates was associated with smaller increases in CRP level than was fixation with miniplates. The location of the fracture, associated condylar fractures, the use of maxillomandibular fixation, the presence or absence of a tooth at the fracture site, and the surgical approach did not affect the CRP levels. The significance of CRP measurement for interpretation of postoperative situations is discussed and examples of cases in which there was infection are described.