Evaluation of surgical retreatment of mandibular fractures.

INTRODUCTION: Mandibular fractures are frequent, and treatment for these fractures involves rigid fixation. Complications can occur after treatment and may require a new surgical procedure; however, there are limited studies evaluating surgical retreatment. AIM: The purpose of this retrospective study was to evaluate the characteristics and the types of treatment carried out in patients requiring surgical retreatment of mandibular fractures. MATERIALS AND METHODS: From all patients with mandibular fractures treated by rigid internal fixation at a trauma hospital during a 7-year-period, 20 patients (4.7% of the cases) required a second surgery. RESULTS: The most common complaints were pain, infection with the presence of fistula, and abnormal mobility. There was a predominance of Staphylococcus aureus in the bacterial culture. The most frequent radiographic images were diffuse bone resorption, loosening of screws, and a visible fracture line. The diagnoses were nonunion in 10 (50%) cases, soft tissue infection associated with screw loosening or plate exposure in 7 (35%) cases, osteomyelitis in 2 (10%) cases, and malunion in 1 (5%) case. Seven cases of nonunion presented with fistula, and four of these patients had bone sequestration. The required procedures included new fixation in 6 (30%) patients, removal of bone sequestration and new fixation in 4 (20%) patients, surgical exploration and removal of fixation material in 7 (35%) patients, removal of bone sequestration in 2 (10%) patients, and refracture in 1 (5%) patient. CONCLUSION: It was concluded that most cases requiring surgical retreatment of mandibular fractures comprised nonunion or soft tissue infection associated with screw loosening or plate exposure. Consequently, the main procedures needed were new fixation or surgical exploration with the removal of fixation material.

TMJ total joint prosthesis for condylar fracture malunion / Prótesis articular total de ATM para malunión de fractura condilar

In the international literatura exist some information related to temporomandibular joint (TMJ) involvement in condylar fracture malunion; the treatment is variated being executed with a bone reconstruction, ramus vertical osteotomy or condilar plate. This case demonstrates that TMJ replacement with prosthetic joint is technically possible and appropriate in the case of malunion of condylar fracture.

La literatura internacional presenta información asociada a la mal unión de fracturas condilares de laarticulación temporo mandibular; el tratamiento es variado siendo ejecutado con reconstrucciones óseas, osteotomía vertical de rama mandibular o instalación de placas con forma condilar. Este caso demuestra que el reemplazo de ATM con prótesis articular es técnicamente posible y apropiado en casos de malunion de fracturas condilares.

Two-flap palatoplasty for treatment of oronasal fistula by trauma sequel.

The oronasal fistula is a chronic communication between the oral and nasal cavity that often affects patients with cleft palate. However, others uncommon causes of oronasal fistula are associated with facial traumas, infections and neoplasias. In this report we present a case of oronasal fistula as consequence of facial trauma that was treated by two flaps technique for palatoplasty. In this sense, we discussed treatment indications, surgical technique and patient prognostic of a relatively simple option that can provide a definitive repair with minimal morbidity.

Complications of mandible fractures related to substance abuse.

PURPOSE: To analyze different epidemiologic factors related to patients who abuse legal and illegal substances, and the relationship between substance abuse and postsurgical complications of mandibular fractures. PATIENTS AND METHODS: The study was performed over a 5-year period by the Division of Oral and Maxillofacial Surgery, State University of Campinas, São Paulo, Brazil. In total, 1,399 patients were analyzed via a data form covering age, gender, socioeconomic activity, etiology, and time lapse between trauma and medical attention. Patients were categorized according to whether they reported no substance abuse, smoking, chronic abuse of alcohol, or abuse of intravenous or nonintravenous drugs. Information on the complications presented and corresponding treatments was also included. RESULTS: Of 1,399 patients, 472 presented with 699 mandibular fractures, and 11.4% of these patients had postsurgical complications. The breakdown of subgroup size in terms of percentage of the total, and the corresponding incidence of postsurgical complications, were: for those reporting no substance abuse (52.5%), 8.5% of total complications; for smokers (35.3%), 14.9% of total complications; for patients who self-reported chronic alcohol abuse (30.9 %), 17.1% of total complications; for the nonintravenous drug user subgroup (6.1%), 14.2% of total complications; and for the intravenous drug user subgroup (1.8%), 37.5% of total complications. CONCLUSIONS: There is evidently a close correlation between substance abuse and postsurgical complications in patients with mandibular fractures, because of both physiologic alterations and patient behavior. Assault-related injuries were the primary cause of trauma in the substance abuse groups, and infections represented the predominant complication.

Fixation of mandibular fractures with 2.0-mm miniplates: review of 191 cases.

PURPOSE: Our goal was to study the use of 2.0-mm miniplates for the fixation of mandibular fractures. PATIENTS AND METHODS: Records of 191 patients who experienced a total of 280 mandibular fractures that were treated with 2.0-mm miniplates were reviewed. One hundred twelve of those patients, presenting 160 fractures, who attended a late follow-up were also clinically evaluated. Miniplates were used in the same positions described by AO/ASIF. No intermaxillary fixation was used. All patients included had a minimum follow-up of 6 months. Demographic data, procedures, postoperative results, and complications were analyzed. RESULTS: Mandibular fractures occurred mainly in males (mean age, 30.3 years). Mean follow-up was 21.92 months. The main etiology was motor vehicle accident. The most common fracture was the angle fracture (28.21%). Twenty-two fractures developed infection, for an overall incidence of 7.85%. When only angle fractures are considered, that incidence is increased to 18.98%. Although only 1 patient (0.89%) described inferior alveolar nerve paresthesia, objective testing revealed sensitivity alterations in 31.52% of the patients who had fractures in regions related to the inferior alveolar nerve. Temporary mild deficit of the marginal mandibular branch was observed in 2.56% of the extraoral approaches performed and 2.48% presented with hypertrophic scars. Incidence of occlusal alterations was 4.0%. Facial asymmetry was observed in 2.67% of the patients, whereas malunion incidence was 1.78%. Fibrous union, mostly partial, occurred in 2.38% of the fractures, but only 1 of those presented with mobility (0.59%). Condylar resorption developed in 6.25% of the fixated condylar fractures. Mean mouth opening was 42.08 mm. CONCLUSION: The overall incidence of complications, including infections, was similar to those described for more rigid methods of fixation.