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1.
Int. j. morphol ; 38(2): 309-315, abr. 2020. graf
Artículo en Inglés | LILACS | ID: biblio-1056440

RESUMEN

Stability is necessary to ensuring proper bone repair after osteotomies and fractures. The aim of this research was to analyze how the repair of pseudoarthrosis sites was affected by different conditions in related to soft tissue. An experimental study was designed with 18 New Zealand rabbits. Six study groups were formed. An osteotomy was performed on the mandibular body of each animal and muscle was installed at the osteotomy site to model pseudoarthrosis. Fixation by surgery was then carried out, using plates and screws. The animals were submitted to euthanasia after 21, 42 and 63 days to make a descriptive comparison of the histological results. No animal was lost during the experiment. In all the samples, bone formation was observed with different degrees of progress. Defects treated with or without removal of the tissue involved in pseudoarthrosis presented comparable bone repair, showing that stability of the bone segments allows the repair of adjacent tissue. In some samples cartilaginous tissue was associated with greater bone formation. Stabilization of the fracture is the key in bone repair; repair occurs whether or not the pseudoarthrosis tissue is removed.


La estabilidad de las osteotomías y de las fracturas son fundamentales para asegurar la adecuada reparación ósea; el objetivo de esta investigación fue analizar la reparación presente en sitios de pseudoartrosis realizando la limpieza de la zona previo a la fijación o manteniendo el tejido de la nounión en el mismo lugar durante la osteosíntesis. Se diseñó un estudio experimental incluyendo 18 conejos de raza Neozelandesa. Se formaron 6 grupos de estudios a quienes se relizó una osteotomía en el cuerpo mandibular y posterior instalación de músculo en el lugar de la osteotomía para fabricar un modelo de pseudoartrosis. En cirugía posterior se fijó con placa y tornillos. Se realizaron eutanasias a los 42 y 63 días para comparar los resultados de forma descriptiva mediante estudio histológico. No fue perdido ningún animal durante el experimento. En todas las muestras evaluadas se observó formación ósea en diferentes niveles de avance; defectos tratados con o sin el retiro del tejido involucrado en la pseudoartrosis presentaron una condición de reparación ósea comparables, determinando que la estabilidad de los segmentos óseos permite la reparación del tejido adyacente. El tejido cartilaginoso se presentó en algunas muestras asociadas a sectores con mayor presencia de formación ósea. La estabilización de la fractura es clave en la reparación ósea; la reparación se produce manteniendo o retirando el tejido presente en la pseudoartrosis.


Asunto(s)
Animales , Conejos , Curación de Fractura , Fracturas Mal Unidas/terapia , Fracturas Mandibulares/terapia , Osteotomía/efectos adversos , Fracturas Mandibulares/cirugía
2.
J Craniomaxillofac Surg ; 47(12): 1929-1934, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810843

RESUMEN

INTRODUCTION: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented. METHODS: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay. RESULTS: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study population was 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p < .0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p < .05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries. CONCLUSIONS: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites.


Asunto(s)
Fijación Interna de Fracturas/métodos , Arcada Edéntula/cirugía , Fracturas Mandibulares/cirugía , Anciano , Atrofia , Europa (Continente)/epidemiología , Femenino , Humanos , Arcada Edéntula/epidemiología , Masculino , Fracturas Mandibulares/epidemiología , Resultado del Tratamiento
3.
Plast Reconstr Surg ; 144(6): 1393-1402, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31764658

RESUMEN

BACKGROUND: Mandibular angle fractures are common and frequently involve a tooth in the fracture line. Despite trends toward more conservative indications for tooth extraction during open repair, the literature remains heterogeneous. This review aims to ascertain the effect of tooth extraction/retention on patient outcomes following mandible open reduction and internal fixation and to evaluate the evidence surrounding indications for extraction. METHODS: PubMed, EMBASE, the Cochrane Library, Elsevier text mining tool database, and clinicaltrials.gov were queried through March of 2018 for English language publication on adults with traumatic mandibular fractures. The review protocol was not registered online. Quality of evidence was assigned using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses were performed when definitions of outcomes were deemed similar. RESULTS: Overall, 26 of 1212 identified studies met inclusion criteria. Indications for tooth extraction and rates of extraction varied considerably across studies. The quality of evidence was low or very low for all outcomes. Tooth retention was associated with lower overall complications (OR, 0.54; 95 percent CI, 0.37 to 0.79), major complications requiring readmission or reoperation (OR, 0.47; 95 percent CI, 0.24 to 0.92), and malocclusion (OR, 0.56; 95 percent CI, 0.32 to 0.97); there was no difference in wound issues or nonunion. Removal of asymptomatic teeth was associated with inferior alveolar nerve injury (39.4 percent versus 16.1 percent). CONCLUSIONS: The literature is limited by retrospective study deign and poor follow-up; however, when indicated, tooth extraction is not associated with an increased risk of infection or nonunion. Removal of asymptomatic teeth was associated with a risk of inferior alveolar nerve injury. Additional high-quality studies are needed to evaluate potentially expanded indications for tooth extraction.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Mandibulares/cirugía , Reducción Abierta/métodos , Extracción Dental/métodos , Humanos , Mandíbula/cirugía , Tercer Molar/cirugía , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Infección de la Herida Quirúrgica/etiología
4.
Facial Plast Surg ; 35(6): 602-606, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31783415

RESUMEN

Mandible fractures represent a common sequela of craniomaxillofacial trauma encountered by reconstructive surgeons. Management of complex mandibular fractures, and reestablishment of the occlusal relationship, represents a challenging reconstructive endeavor for even the most skilled surgeon. In this article, the authors review the treatment options for particularly complex presentations of this injury pattern.


Asunto(s)
Fracturas Mandibulares , Procedimientos Quirúrgicos Reconstructivos , Humanos , Mandíbula , Fracturas Mandibulares/cirugía
5.
Facial Plast Surg ; 35(6): 627-632, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31783419

RESUMEN

Mandibular fractures are the most common facial fractures that need surgical intervention. If untreated, these fractures affect a patient's occlusion, degree of mouth opening, and facial symmetry, and could cause infection with significant pain. The goal of any surgical intervention is to restore the preinjury occlusion, even if the preinjury occlusion is abnormal. Initial therapies, whether surgical or conservative, are not always successful, however, and revision or delayed surgical intervention can be challenging. Herein, we review common causes of failure of primary surgical management of mandibular fractures and provide tips to successful secondary intervention.


Asunto(s)
Fracturas Mandibulares , Fijación Interna de Fracturas , Humanos , Mandíbula , Cóndilo Mandibular , Fracturas Mandibulares/cirugía , Resultado del Tratamiento
6.
J Craniofac Surg ; 30(7): 2111-2114, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31568159

RESUMEN

INTRODUCTION: Despite there being several clinical studies reporting promising outcomes of resorbable plates for fixation of pediatric mandible fractures, the literature is devoid of large studies or comprehensive reviews assessing safety rates, complications and long-term outcomes. The purpose of the current review is to obtain a global consensus, shed light on efficacy and complications, and provide the reader with evidence-based data to help guide clinical management. METHODS: A systematic review of clinical studies assessing outcomes for resorbable plates in pediatric mandibular fractures was carried out. The main outcomes included infection, hardware failure, hardware exposure, malocclusion, reoperation and nonunion. Overall rates were pooled and stratified by fracture and implant type. RESULTS: Ten studies were included yielding 232 patients with 269 fractures. The mean age at surgery was 8.24 years with a mean follow up of 1.03 years. The overall complication rate was 5.2% (n = 12). Complications included infection (n = 4, 1.7%), hardware exposure (n = 3, 1.29%), wound dehiscence (n = 2, .86%) and intra-oral fistula formation (n = 2, .86%). One patient (0.43%) had malocclusion and none (0%) had hardware failure, nonunion or revision surgery. Patients with multiple fractures (≥ 2) had higher complication rates compared to isolated fractures (12.5% versus 1.7%). CONCLUSION: The use of resorbable plates for pediatric mandibular fractures is a viable option with similar rates of post-operative complications and outcomes compared to standard metallic counterparts. In the absence of large studies or systematic reviews, this study provides craniofacial surgeons with an evidence-based reference to guide decision making and improve informed consent.


Asunto(s)
Fracturas Mandibulares/cirugía , Adolescente , Placas Óseas , Niño , Preescolar , Humanos , Lactante , Maloclusión/cirugía , Complicaciones Posoperatorias , Reoperación , Resultado del Tratamiento
7.
J Craniofac Surg ; 30(8): 2573-2575, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31633662

RESUMEN

Recently, absorbable plates have been used for various types of facial fractures. However, in the case of mandibular fractures, a large amount of force is applied after fixation. Thus, a firm fixation is necessary. In particular, unfavorable fractures are more frequent in mandibular fractures. Therefore, plates should be strong enough to withstand forces at the time of surgery. The purpose of this study was to determine clinical efficacy and usefulness of unsintered hydroxyapatite (u-HA)/poly (L-lactide) (PLLA) composite system by clinical application and follow-up of fixation in patients with mandible fracture. A total of 13 patients with mandible fractures were assessed for compliance with the selection criteria. Fracture site was confirmed with radiographic findings including X-ray and facial computed tomography images. Subjects who fulfilled all criteria underwent operation using HA/PLLA composite fixation system (OSTEOTRANS; Takiron Co Ltd, Osaka, Japan). After reduction of fracture site through oral or skin incision, we placed OSTEOTRANS plates on fracture line and performed rigid fixation with OSTEOTRANS-MX screws. Follow-up was performed at 1 week, 1, 3, and 6 months after surgery. Occlusion and mouth opening were checked by physical examination and radiographic finding. We also confirmed bone approximation status, bony gap change, and bone union status. All patients finished every follow-up. They were satisfied with outcomes without complications such as malocclusion, foreign body sensation, or tenderness. This study confirms that OSTEOTRANS can be used appropriately for mandibular fractures.


Asunto(s)
Fracturas Mandibulares/cirugía , Resinas Acrílicas , Adolescente , Adulto , Placas Óseas , Niño , Resinas Compuestas , Oclusión Dental , Durapatita , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Poliésteres , Poliuretanos , Tomografía Computarizada por Rayos X , Adulto Joven
8.
Prague Med Rep ; 120(2-3): 64-73, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31586505

RESUMEN

Sub-condylar fractures of the temporomandibular joint can be treated by an extraoral or intraoral approach. Trans-masseteric antero-parotid approach (TMAP) is an extraoral approach utilising a retromandibular incision. The authors evaluated patients' status and any complications of using TMAP from the years 2013-2017. There were 39 patients (44 fractures). When using TMAP, in 43 fractures the fragments were favourably positioned, in one case the position was compromised. Of the complications, postoperative palsy of the facial nerve was reported 6.8% - in all cases this was only temporary. Late occlusion had an equal number of complications (in 2 cases this was as a result of an infectious complication of the wound, and in 2 cases due to resorption of the proximal fragment). Muscular pain and dysfunction of the temporomandibular joint following trauma were observed consistently in 6.8% of patients. Sialocoele, a non-conforming scar, and infectious complications were observed in 4.5% of patients. TMAP allows rapid surgical performance, with a good view for perfect repositioning and fixation of fragments of sub-condylar fractures of the temporomandibular joint. The complications associated with this approach are, for the most part, temporary, the aesthetic handicap of a scar is considered by patients to be acceptable. Overall, it is possible to evaluate retromandibular TMAP as safe, and the authors recommended it for treatment of sub-condylar fractures of the mandible.


Asunto(s)
Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Músculo Masetero , Glándula Parótida , Complicaciones Posoperatorias , Articulación Temporomandibular/cirugía , Humanos , Fracturas Mandibulares/complicaciones , Músculo Masetero/cirugía , Glándula Parótida/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
9.
Br J Oral Maxillofac Surg ; 57(10): 1063-1067, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31594713

RESUMEN

The intraoral approach is favoured by many patients and surgeons for the treatment of fractures of the condylar neck, but the limited space offered by this approach can make positioning and fixation of the osteosynthesis plate difficult. A rhombic-shaped plate was designed specifically for use with the intraoral approach, and introduced into our clinical practice in 2012. We present the clinical and functional results in 81 patients with 98 fractures of the condylar neck who we have treated with this technique. Of these six required surgical revision, and ultimately all but two had satisfactory occlusion and mandibular function. Our complication rate of 6/81 (7.4%) compares favourably with those reported elsewhere, and confirms that open reduction and internal fixation of condylar fractures using the Rhombic plate through an intra-oral approach provides good outcomes.


Asunto(s)
Placas Óseas , Fijación Interna de Fracturas , Fracturas Mandibulares , Humanos , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Reducción Abierta , Resultado del Tratamiento
10.
J Craniofac Surg ; 30(7): e653-e655, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31490443

RESUMEN

The management of victims of gunshot fractures is a challenge for surgeons, mainly due to the complexity of the injury itself and degree of bone comminution. The titanium functionally dynamic bridging plate has often been used in reconstructive surgery after mandibular fractures. The classic indication for bridge plate use is comminuted fractures with or without associated substance losses. The aim of this article is report the case of gunshot victim and to discuss the bridge plate technique utilized for treatment. A 21 years-old, melanoderma, male patient was victim of a firearm-related assault, with comminutive fracture of the mandibular body. The protocol for the bridging plate technique was performed. The patient is in postoperative follow-up of eight months, not present aesthetic or functional complaints, stable occlusion, satisfactory mouth opening and no clinical signs of infection.


Asunto(s)
Fracturas Conminutas/cirugía , Mandíbula/cirugía , Fracturas Mandibulares/cirugía , Heridas por Arma de Fuego/cirugía , Humanos , Masculino , Procedimientos Quirúrgicos Reconstructivos , Resultado del Tratamiento , Adulto Joven
11.
Medicine (Baltimore) ; 98(37): e16814, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31517812

RESUMEN

The purpose of this study was to compare outcomes of open reduction and internal fixation (ORIF) versus closed reduction (CR) for mandibular condylar fractures.Patients included in the National Inpatient Sample (NIS) database (2005-2014) who were admitted to the hospital for unilateral mandibular condylar fracture were included in the analysis. Patient characteristics and clinical outcomes were compared between those who received ORIF and those receiving CR. Logistic regression analysis was performed to estimate odds ratios (ORs) for each aspect of the main observed events.NIS data of 12,303 patients who underwent ORIF and 4310 patients who underwent CR were analyzed. Compared to CR, ORIF had an increased risk of longer hospital stay (adjusted OR [aOR] = 1.78, 95% confidence intervals [CIs] = 1.51-2.09), higher total medical cost (aOR = 2.57, 95% CI = 2.17-3.05), and hematoma development (aOR = 10.66, 95% CI = 1.43-75.59), but had a lower risk of having wound complications (aOR = 0.86, 95% CI = 0.79-0.93).Patients with mandibular condylar fractures who receive ORIF have greater risk of having an extended hospital stay, higher total medical costs, and hematoma development but lower risk of experiencing wound complications compared to those who receive CR.


Asunto(s)
Fijación Interna de Fracturas , Cóndilo Mandibular/lesiones , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Reducción Abierta , Adulto , Comorbilidad , Estudios Transversales , Femenino , Fijación Interna de Fracturas/economía , Costos de la Atención en Salud , Hematoma/epidemiología , Hematoma/etiología , Humanos , Pacientes Internos , Tiempo de Internación/economía , Masculino , Fracturas Mandibulares/economía , Fracturas Mandibulares/epidemiología , Reducción Abierta/economía , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Resultado del Tratamiento
12.
Br J Oral Maxillofac Surg ; 57(10): 1019-1024, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31521410

RESUMEN

The choice of treatment for diacapitular condylar fractures remains in dispute among oral and maxillofacial surgeons. A multivariate retrospective study was designed to compare the prognosis after conservative treatment and surgery, and to explore further indications for management. From 1 July 2013 to 30 June 2017, 169 patients with diacapitular condylar fractures were included. Relevant preoperative data were collected, and the prognoses assessed. Three ordinal logistic regression models were constructed to study the factors that affected prognosis, and these showed that all patients treated by open reduction and internal fixation (ORIF) tended to have a better prognosis than those treated with conservative treatment (adult: odds ratio (OR)=6.166, p=0.000, and children: OR=12.195, p=0.029). Adult patients with lateral dislocation of the stump of the ramus out of the glenoid fossa tended to have the highest risk of a poor prognosis, followed by those with anteromedial displacement of the disc and loss of the height of the ramus of over 5mm. Only the type of treatment affected the prognosis for children. In conclusion, these findings suggest that ORIF is the preferred method of treatment for patients with diacapitular condylar fractures. The absolute indications for ORIF in adult patients with diacapitular condylar fractures include lateral dislocation of the stump of the ramus out of the glenoid fossa, anteromedial displacement of the disc, and loss of height of the ramus of over 5mm. There are no absolute indications for ORIF in children.


Asunto(s)
Fijación Interna de Fracturas , Fracturas Mandibulares , Adulto , Niño , Humanos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , Resultado del Tratamiento
13.
J Craniofac Surg ; 30(7): 2253-2256, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31513037

RESUMEN

This paper describes the application of a modified digital surgical guide, an occlusal template and a pre-formed reconstruction titanium plate in the open reduction and internal fixation of a bilateral mandibular fracture. Bilateral mandibular fracture is a commonly encountered simple type of fracture. However, even for an experience surgeon, achieving precise treatment remains a challenge due to the movable temporomandibular joint, unstable fractured segments, the difficulty in forming a reconstruction plate, and the lack of an effective stabilizing and locating device. In this case, the surgeon used a specially-designed modified guide together with a reconstruction plate and an occlusal template to treat a bilateral mandible fracture, effectively improving the accuracy and the medical outcome of the operation, saving operation time and reducing postoperative complications.


Asunto(s)
Fracturas Mandibulares/cirugía , Reconstrucción Mandibular , Adulto , Placas Óseas , Fijación Interna de Fracturas , Humanos , Masculino , Fracturas Mandibulares/diagnóstico , Reconstrucción Mandibular/instrumentación , Tempo Operativo , Complicaciones Posoperatorias , Cirugía Asistida por Computador , Articulación Temporomandibular/cirugía , Titanio
14.
J Craniofac Surg ; 30(7): 2128-2130, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31503123

RESUMEN

BACKGROUND: The lag time between injury and treatment (LTIT) plays an important role in reduction of complications in mandibular fractures. The aim of this study was to measure the effect of LTIT on recovery of the inferior alveolar nerve (IAN) neurosensory disturbances (NSDs) following surgical management of mandibular body fractures. METHODS: This was a prospective cohort study. Patients who had a unilateral mandibular body fracture with paresthesia were studied. Paresthesia was evaluated by 2-point discrimination (TPD) test, brush stroke test and self-reporting before and 6 months after the surgical procedure. RESULTS: Forty-five patients were studied. There was a correlation between LTIT and TPD test result and self-reported paresthesia at 6 months, postoperatively (P = 0.001). Fifteen patients (33.3%) had complete improvement in NSD 6 months after treatments (group 1) and 30 patients (group 2) had hyposthesia (N = 17, 37.77%) and paresthesia (N = 13, 28.88%). There was a significant difference in LTIT between groups 1 and 2 at 6 months postoperatively (P = 0.001). Cox regression model demonstrated the hazard ratio increased significantly for self-reported NSD when treatment was done 10 days after trauma (P = 0.001, confidence level = 95%). CONCLUSION: It seems that conduction of open reduction with internal rigid fixation shortly after mandibular fracture may shorten the recovery time of NSDs of the IAN following mandibular body fractures.


Asunto(s)
Fracturas Mandibulares/cirugía , Nervio Mandibular/cirugía , Traumatismos del Nervio Trigémino/cirugía , Adulto , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Fracturas Mandibulares/complicaciones , Reducción Abierta/efectos adversos , Parestesia/etiología , Estudios Prospectivos , Traumatismos del Nervio Trigémino/etiología , Adulto Joven
15.
Chin J Traumatol ; 22(5): 261-269, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31493976

RESUMEN

PURPOSE: The fractures of anterior mandible are subject to severe torsional forces due to muscles acting in opposite directions. 3D miniplate has been suggested as a good alternative by some researchers. However, finite element model (FEM) studies indicate that labio-inferior positioning of two miniplates perpendicular to each other offers better stability as compared to labial positioning. This study aims at combining the advantages of a single 3D miniplate and labio-inferior positioning of two conventional miniplates, which was assessed by finite element analysis along with a pilot clinical trial. METHODS: Two FEM models were created using CT data of a 24-year-old patient with Angle class I occlusion: control model with labial plating and study model with labio-inferior plating. The models were processed with MIMICS® (materialise, Leuven, Belgium), CATIA® (Dassault Systemes) and finite element analysis softwares. Parameters adopted for analysis were (1) displacement (mm) of fracture fragments during each screw fixation, (2) lingual splay and post fixation stability of fracture fragments with masticatory load, and (3) stress distribution (MPa) across fracture fragments. Moreover, a pilot clinical trial including five patients with anterior mandible fracture was conducted. The fractures were managed by intraoral open reduction and 3D miniplate fixation in labio-inferior position. Intraoperative interfragmentary gap, post fixation lingual splay and radiographic fracture union and complications were assessed clinically. RESULTS: Labio-inferior plating demonstrated less displacement (mm) of fracture fragments during screw fixation (0.059 vs. 0.079) as well as after application of masticatory load (1.805 vs. 1.860). Negligible lingual splay and less stress distribution (MPa) across fracture fragments (1.860 vs. 1.847) were appreciated in the study group as compared to control group. Clinical trial support the favorable outcome related to intraoperative and postoperative assessment parameters. CONCLUSION: FEM analysis and clinical trial reveal better results with labio-inferior positioning of 3D miniplate when compared to labial positioning.


Asunto(s)
Placas Óseas , Tornillos Óseos , Análisis de Elementos Finitos , Fijación Interna de Fracturas/métodos , Fracturas Mandibulares/cirugía , Proyectos Piloto , Adulto , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Mandíbula , Fracturas Mandibulares/diagnóstico por imagen , Estrés Mecánico , Resultado del Tratamiento , Adulto Joven
16.
Br J Oral Maxillofac Surg ; 57(9): 880-885, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31402192

RESUMEN

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.


Asunto(s)
Traumatismos del Nervio Facial , Cóndilo Mandibular/lesiones , Fracturas Mandibulares , Adulto , Traumatismos del Nervio Facial/epidemiología , Traumatismos del Nervio Facial/prevención & control , Femenino , Fijación Interna de Fracturas/métodos , Humanos , Masculino , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Estudios Prospectivos , Resultado del Tratamiento
18.
Cir Cir ; 87(5): 587-594, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31448782

RESUMEN

Background: Over the years, the treatment to be chosen for the resolution of condylar fractures has been discussed with great concern. Treatment depends on the type and location of the fracture, as well as other associated factors such as facial injuries and concurrent diseases. Aim of the study: The aim of the study was to make a review of the different criteria to establish a diagnosis and treatment to resolve mandibular condyle fractures, according to the evolution of the years and what this entails. Discussion: Management of condylar fractures remains controversial among surgeons. However, as time goes by and as comparative and analytical studies are carried out within the issue, parameters and criteria are established to facilitate the decisions taken regarding the management and treatment of condylar fractures. Conclusion: Condylar fractures must be managed according to the clinical and case presentation.


Asunto(s)
Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Adolescente , Adulto , Factores de Edad , Niño , Toma de Decisiones Clínicas , Humanos , Maloclusión/prevención & control , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/complicaciones , Fracturas Mandibulares/diagnóstico , Complicaciones Posoperatorias/prevención & control , Recuperación de la Función , Estudios Retrospectivos
19.
J Craniofac Surg ; 30(7): e681-e683, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31449226

RESUMEN

Intraosseous hemangioma (IH) in the maxillofacial area is a very uncommon neoplasm. Here, the authors show an exceptional case not previously reported in the literature of a 65-year-old man who presented with a pathological mandibular fracture following a facial trauma that was the first sign of an occult cavernous IH. Complete excision of the tumor in the mandibular ramus reduced the risk of severe bleeding and prevented long-term recurrence, whereas immobilization of the fracture obtained an excellent functional result. This clinical report highlights the possibility that a previously unknown primary IH may debut as a pathological fracture and the importance of differential diagnosis in this location.


Asunto(s)
Diagnóstico Diferencial , Fracturas Espontáneas/diagnóstico por imagen , Hemangioma Cavernoso/diagnóstico , Fracturas Mandibulares/diagnóstico por imagen , Anciano , Fracturas Espontáneas/cirugía , Humanos , Masculino , Fracturas Mandibulares/cirugía , Recurrencia Local de Neoplasia/diagnóstico
20.
J Craniomaxillofac Surg ; 47(11): 1752-1757, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31445877

RESUMEN

PURPOSE: The recent development of bioresorbable bone plates and screws allows plates to be applied to the load-bearing regions of the mandible and to remain in place over time without the need for removal. We hypothesized that the stability of composite plates and screws forged from unsintered hydroxyapatite particles and poly-l-lactide (u-HA/PLLA) is comparable to that of standard titanium fixation systems for the reduction of fractures of load-bearing regions of the mandibular body. MATERIALS AND METHODS: 40 patients underwent open reduction and internal fixation of the fractured mandibular body with either a titanium or u-HA/PLLA bone plate. Cone-beam CT images were obtained immediately postoperatively and at 6-month follow-up, and were analyzed for positional changes of the affected mandible. RESULTS: There were no significant differences in the postoperative positional changes of reference points between the titanium and u-HA/PLLA miniplates, except for that for the coronoid process (p-value = 0.03). Multivariate regression analysis revealed no significant differences in spatial changes between the immediate postoperative and 6-month follow-up images, after adjusting for age and sex. CONCLUSION: The stability of bioresorbable u-HA/PLLA miniplates and screws was comparable to that of titanium miniplates and screws immediately postoperatively and at 6-month follow-up, following surgical reduction of fractures of load-bearing regions of the mandibular body. Bioresorbable osteosynthesis can be considered a viable alternative to titanium osteosynthesis.


Asunto(s)
Implantes Absorbibles , Placas Óseas , Fracturas Mandibulares/cirugía , Procedimientos Quirúrgicos Ortognáticos/instrumentación , Poliésteres/química , Titanio/química , Tomografía Computarizada de Haz Cónico , Durapatita , Fijación Interna de Fracturas , Humanos , Mandíbula/diagnóstico por imagen , Resultado del Tratamiento
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