Long-term outcome assessment of closed treatment of mandibular fractures.

Mandibular fractures are among the most common trauma injuries of the craniomaxillofacial region. This study evaluated the late results of mandibles fractures treated with arch bar. Forty-nine patients were examined clinically and by questionnaires for late results of arch bar treatment. Demographic data (age, sex, etc), trigeminal nerve sensation (Weber test), temporomandibular joint evaluation, masticatory muscle function, and occlusion were recorded. The data were analyzed by χ test using Sigma Stat 2.0 software. Fifty-one percent of the patients with angular fractures complained of sensory disturbances. Condylar and angular fractures demonstrated higher levels of pain. According to Pearson χ test, a statistically significant relation between angular fracture and tenderness of the internal pterygoid muscles (P = 0.047), angular fracture and cross-bite (P = 0.021), parasymphysial fracture and pain upon wind blowing (P = 0.026), and body fracture and mastication discomfort (P = 0.038) was found. In closed reduction therapy, fracture location of the mandible seems to be more likely correlated in producing particular long-term complications. Regular follow-ups for functional treatments and physiotherapy of chewing muscles and temporomandibular joint, along with removal of occlusal abnormalities, should be considered following arch bar reduction of mandibular fractures.

Magnetic resonance imaging assessment of temporomandibular joint soft tissue injuries of intracapsular condylar fracture.

We evaluated the soft tissue of the temporomandibular joint (TMJ) with magnetic resonance imaging (MRI) after intracapsular condylar fracture. Eighteen consecutive patients (19 TMJ) were diagnosed between 1 January 2010 and 30 October 2011. They were examined using bilateral sagittal and coronal MRI, which were obtained immediately after injury to assess the displacement of the disc, whether there was a tear in capsule or the retrodiscal tissue, and whether there was an effusion in the joint. On the affected side MRI showed disc displacement in 15 of 19, tears in the capsule in 9, and tears in the retrodiscal tissue in 16. All 19 had joint effusions. It also showed 2 joints with abnormalities on the unaffected side. We conclude that MRI is useful for diagnosis and for estimating the amount of damage to the TMJ, and is helpful in planning treatment.

An alternative method in mandibular fracture treatment: bone graft use instead of a plate.

In the treatment of the mandibular fractures, one of the main principles is to use the least amount of foreign material. We present an alternative technique that the bone grafts harvested from the fracture borders or from the iliac crest were used instead of plates and the fixation was done with screws. In the study including 24 mandible fractures, the bone grafts harvested from the fracture borders were used in the 10 favorable fractures and the bone grafts harvested from the iliac crest were used in the 14 unfavorable fractures. In the combined mandible fractures, four fractures were fixated with titanium plates and the other side with the bone graft. The patients, who were followed up for 12 to 20 months, were evaluated with macroscopic occlusion, panoramic graphs, and three-dimensional computerized tomographs. The advantage of this technique of fixation with the autogenous tissue is reduced infection rates and reduced operation costs. In the pediatric patients, the second session operation of plate removal is not necessary.

[Enteral feeding by nasogastric tube in mandibular fracture osteosynthesis]. / Alimentation entérale par sonde naso-gastrique: intérêt après ostéosynthèse des fractures mandibulaires.

INTRODUCTION: Mandibular fractures are among the most common fractures of the face; their treatment consists in a reduction by intermaxillary blocking then miniplate osteosynthesis. In our unit we systematically insert a nasogastric tube for enteral feeding to improve nutrition and to protect healing. Since the beginning of 2002, a series of patients operated for simple mandibular fractures were fed immediately after the operation by a semiliquid food. The purpose of this work is to verify the real advantage of enteral feeding by nasogastric tube in patients operated for simple fractures of the mandible. MATERIAL AND METHOD: This retrospective study includes all the patients operated for closed fractures of the toothed portion of the mandible from January 1999 to October 2003. There were two series, a first series of patients operated between 1999 and 2002 fed by nasogastric tube until mouth healing and the second series of patients operated between 2002 and 2003 fed by mixed oral-enteral nutrition from the first postoperative day. We analyzed demographic features, time between trauma and operation, type of fracture, feeding modalities, duration of use of the nasogastric tube, duration of hospital stay and postoperative complications. RESULTS: A total of 111 patients were included in the study. The first group of 81 patients fed by nasogastric tubes included 19 women and 62 men with an average age of 29.7 years (from 15 to 81 years). The average time from trauma to operation was 2.3 days (0 to 5 days), the feeding by nasogastric tubes was maintained 5.9 days after the operation (4 to 12 days), the average hospital stay was 7.2 days (5 to 13 days). Eleven immediate complications were observed (13.6%). The second group of 30 patients fed orally the day after the intervention included 7 women and 23 men. The average time from trauma to operation was 2.2 days (0 to 7 days), the average hospital stay was 2.5 days (2 to 3 days). One complication was observed (3.3%). DISCUSSION: Immediate oral feeding the day after the operation for simple closed mandibular fractures provides certain comfort for the patient by avoiding the inconveniences of nasogastric feeding tubes without increasing the rate of postoperative complications such as disunion, delayed healing or infection. The hospital stay is significant shortened, enabling a real cost savings.

An assessment of maxillofacial fractures: a 5-year study of 237 patients.

PURPOSE: This descriptive analytical study assesses the cause, type, incidence, demographic, and treatment data of maxillofacial fractures managed at our medical center during a 5-year period and compares them with the existing body of literature on the subject. PATIENTS AND METHODS: A 5-year retrospective clinical and epidemiologic study evaluated 237 patients treated for maxillofacial fractures from 1996 to 2001 at one medical center. There were 211 male patients (89%) and 26 (11%) female patients. The patients ranged in age from 3 to 73 years, with 59.0% (140 patients) in the 20- to 29-year age group. A number of parameters, including age, gender, cause of injury, site of injury, type of injury, treatment modalities, and complications, were evaluated. All maxillofacial injuries were assessed and treated by a single oral and maxillofacial surgeon. Other concomitant bodily injuries were treated by appropriate consultant specialists. RESULTS: There were 173 (72.9%) mandibular, 33 (13.9%) maxillary, 32 (13.5%) zygomatic, 57 (24.0%) zygomatico-orbital, 5 (2.1%) cranial, 5 (2.1%) nasal, and 4 (1.6%) frontal injuries. Car accidents caused 73 (30.8%), motorcycle accidents caused 55 (23.2%), altercations 23 (9.7%), sports 15 (6.3%), and warfare caused 23 (9.7%) of the maxillofacial injuries. Regarding distribution of mandibular fractures, 32% were seen in the condylar region, 29.3% in the symphyseal-parasymphyseal region, 20% in the angle region, 12.5% in the body, 3.1% in the ramus, 1.9% in the dentoalveolar, and 1.2% in the coronoid region. The distribution of maxillary fractures was Le Fort II in 18 (54.6%), Le Fort I in 8 (24.2%), Le Fort III in 4 (12.1%), and alveolar in 3 (9.1%). Of the 173 mandibular fractures, 56.9% were treated by closed reduction, 39.8% by open reduction, and 3.5% by observation only. Of 33 maxillary fractures, 54.6% were treated using closed reduction, 40.9% using open reduction, and 4.5% with observation only. Approximately 52.1% of the patients were treated under general anesthesia, and 47.9% were treated under local anesthesia and sedation. Postsurgical complications were recorded in 5% of patients. These complications included infection, asymmetry, and malocclusion. Overall mortality in this series was 0.84% (2 patients); mortality was caused by pulmonary infection. CONCLUSION: The findings of this study, compared with similar studies reported in the literature, support the view that the causes and incidence of maxillofacial injuries vary from 1 country to another.

Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques.

PURPOSE: The goals to study different lines of intracapsular fractures of the mandibular condyle and to evaluate their influence on the prognosis after closed treatment. PATIENTS AND METHODS: Clinical, radiologic, and axiographic follow-up of 40 patients with 50 intracapsular fractures of the mandibular condyle was carried out after closed treatment. The examinations were performed an average of 22 weeks after treatment. Three types of intracapsular fractures were distinguished: type A, or fractures through the medial condylar pole; type B, or fractures through the lateral condylar pole with loss of vertical height of mandibular ramus, and type M, multiple fragments, comminuted fractures. RESULTS: Moderate to serious dysfunction was observed in 33% of the cases. Radiologic examination of fracture types B and M revealed a reduction in the height of the mandibular ramus of up to 13% compared with the contralateral side. These 2 fracture types also resulted in the most prominent deformations of the condylar head. Axiography revealed irregular excursions and a limitation of condylar movement in comminuted fractures of up to 74% compared with the nonfractured side. CONCLUSION: Lesions to the osseodiscoligamentous complex of the temporomandibular joint caused by intracapsular fractures of the mandibular condyle can be severe. The poor functional and radiologic results encountered in the fracture types B and M showed the limitations of closed functional treatment.

Intermaxillary fixation is not usually necessary to reduce mandibular fractures.

We undertook a retrospective study of all isolated mandibular fractures which had required active management over a 1-year period at the Maxillofacial Unit at Newcastle General Hospital. Patients with single or multiple fractures of the mandible were included in the study, if there were other simultaneous fractures of the facial skeleton, those patients were excluded. All case notes and radiographs were reviewed by a single operator. A total of 202 cases of fractured mandible were identified of which 115 fulfilled the selection criteria of: isolated fracture, no previous facial fracture, treatment by open reduction and internal fixation using titanium osteosynthesis miniplates, and all case notes and radiographs available to study. Sixty-six patients had their fractures reduced manually to obtain anatomical reduction without the use of peroperative intermaxillary fixation (IMF). Forty-nine were treated conventionally using peroperative IMF. The two groups were broadly similar in severity and type of fracture, and the method of reduction seemed to be decided by the operator according to their preference. IMF was not used routinely postoperatively. Overall there were significantly fewer occlusal discrepancies in the early postoperative period in those patients treated by anatomical reduction (6/66 compared with 16/49, P = 0.002) but there was no difference in the final outcome of the occlusion between the two methods of reduction. Avoidance of the use of peroperative IMF is more economical in time and cost, is safer for the operator, and more comfortable for the patient. As this technique produces comparable results in the long term with fewer early complications, we conclude that IMF is not usually necessary to reduce fractures confined to the mandibular bone.