Noninvasive Management of Pediatric Isolated, Condylar Fractures: Less Is More?

BACKGROUND: The purpose of this study was to examine injury patterns in pediatric mandibular condylar fractures and to propose and evaluate the validity of an institutional treatment algorithm for such fractures. METHODS: A retrospective chart review was conducted on pediatric patients who presented to the authors' institution with isolated mandibular condylar fractures between 1990 and 2016. Patients were categorized by dentition, and information regarding demographics, injury characteristics, management, and complications was compiled. RESULTS: Forty-three patients with 50 mandibular condylar fractures were identified. Twelve patients (27.9 percent) had deciduous dentition, 15 (34.9 percent) had mixed dentition, and 16 (37.2 percent) had permanent dentition. The most common fracture pattern in all groups was diacapitular [n = 30 (60 percent)]; however, older groups showed higher rates of condylar base fractures and bilateral fractures (p = 0.029 and p = 0.011, respectively). Thirty-one patients (72.1 percent) were treated with nonoperative management, 10 (23.2 percent) with closed treatment and mandibulomaxillary fixation, and two (4.7 percent) with open treatment and mandibulomaxillary fixation; nonoperative treatment was more common in younger patients (p = 0.008). Management for 10 patients (23.2 percent) was nonadherent to the treatment algorithm. Eight patients had complications (18.6 percent). Common complications included temporomandibular joint ankylosis (n = 2) and malocclusion (n = 2). Although complications were seen in all groups, adherence to the algorithm was associated with an 81.8 percent reduction in odds of complications (p = 0.032). CONCLUSIONS: Nonoperative management has a low complication rate in deciduous children. Children with permanent/mixed dentition may undergo closed treatment and mandibulomaxillary fixation if they have malocclusion/contralateral open bite, significant condylar dislocation, and ramus height loss greater than 2 mm. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Estabilidad esquelética postoperatoria en la cirugía ortognática bimaxilar convencional vs. rotación del complejo maxilomandibular / Postoperative skeletal stability in conventional bimaxillary orthognathic surgery vs rotation of the maxillomandibular complex

Introducción: La estabilidad esquelética postoperatoria en cirugía ortognática ha sido objeto de evaluación durante el paso del tiempo. Diversos autores han reportado que se produce una disminución de la misma en diversos movimientos de los maxilares en ocasiones utilizados en casos de rotación del complejo maxilomandibular. El objetivo del presente trabajo fue comparar la estabilidad esquelética postoperatoria de la cirugía ortognática bimaxilar convencional vs. cirugía ortognática bimaxilar con rotación del complejo maxilomandibular en pacientes sometidos a cirugía ortognática en el Servicio de Cirugía Oral y Maxilofacial del Hospital Militar Central de Bogotá, entre enero de 2012 hasta julio de 2016. Materiales y métodos: Se trata de un estudio retrospectivo. Se llevó a cabo análisis cefalométrico para comparar la estabilidad esquelética entre los pacientes de cirugía ortognática bimaxilar convencional vs. los pacientes de cirugía ortognática bimaxilar con rotación del complejo maxilomandibular durante tres momentos: preoperatorio (T1), postoperatorio inmediato (T2), postoperatorio al menos de seis meses (T3). Resultados: Se obtuvo una cohorte de 45 pacientes sometidos a cirugía ortognática bimaxilar convencional o cirugía ortognática bimaxilar con rotación del complejo maxilomandibular. La mayoría de las medidas realizadas mostraron que no existe diferencia significativa de estabilidad a largo plazo en ambos grupos. Conclusiones: La cirugía ortognática con rotación del complejo maxilomandibular, tanto en sentido horario como antihorario, es un procedimiento estable cuando se utiliza fijación interna rígida, cuando se está en presencia de articulacion temporomandibular (ATM) sanas y cuando la rotación se lleva a cabo en un punto a través del cóndilo mandibular

Introduction: Postoperative skeletal stability in orthognathic surgery has been evaluated over time, several authors have reported a decrease of it in movements of the jaws occasionally used in cases of alteration of the maxillo-mandibular complex. The aim of the present study was to compare the postoperative skeletal stability of conventional bimaxillary orthognathic surgery versus bimaxillary orthognathic surgery with rotation of the maxillo-mandibular complex in patients undergoing orthognathic surgery at the Oral and Maxillofacial Surgery Service of the Central Military Hospital of Bogotá between January 2012 until July 2016. Materials and methods: A retrospective study was conducted. We performed a cephalometric analysis to compare the skeletal stability between patients with conventional bimaxillary orthognathic surgery versus bimaxillary orthognathic surgery patients with maxillo-mandibular alteration during 3 moments: before surgery (T1), right after the surgery (T2), at least 6 months after surgery (T3). Results: A cohort of 45 patients undergoing conventional bimaxillary orthognathic surgery or bimaxilar orthognathic surgery with rotation of the maxillo-mandibular complex was obtained. Most of the measurements showed that there is no significant difference in long-term stability in both groups. Conclusions: Orthognathic surgery with rotation of the maxillo-mandibular complex both clockwise and counter-clockwise is a stable procedure when rigid internal fixation is used, when the temporomandibular joints (TMJs) are healthy and stable and when rotation is performed at a point through the mandibular condyle

Are open mandibular fractures still an emergency?

INTRODUCTION: Early surgical management is often advocated for fractures of the tooth-bearing portion of the mandible. A 6-hour delay has been mentioned for the fixation of these fractures. Our aim was to bring this paradigm into question. METHODS: All patients referred to our department from September 2012 to May 2014 for fractures of the tooth-bearing portion of the mandible were retrospectively included. For each patient, age, gender, aetiology of the fracture, and characteristics of the fractures were recorded. Tobacco and/or alcohol addictions, diabetes and mandibular dental condition were taken into account. We also noticed the preoperative delay and the occurrence of complications such as: haematoma, infection, wound dehiscence, osteosynthesis failure and pseudarthrosis. RESULTS: Among the 47 patients referred, 36 were treated with a delay of more than 6 hours (76.6%). In 88.8% of the cases, the reason for this delay was unavoidable. The mean delay time from trauma to surgery was 52 hours (range: 7-312). Forty-nine percent of the patients had comorbidities. Complications occurred in 6 patients leading to an overall complication rate of 16.67%. A statistically significant higher complication rate was observed among smokers (P=0.006). No statistical relationship was found between the delay and the occurrence of complications (P=0.994). This study suggests that fractures of the tooth-bearing portion of the mandible should no longer be considered as an emergency that must be treated within a 6-hour delay.

Is the frequency of temporomandibular dysfunction different in various mandibular fractures?

PURPOSE: Trauma has been considered an important factor of temporomandibular dysfunction (TMD) etiology. The aim of the present study was to compare the frequency of TMDs in various mandibular fractures. MATERIALS AND METHODS: This was a retrospective cohort study. Mandibular fractures were subcategorized into 3 groups: group 1 had a unilateral condylar fracture, group 2 had a unilateral condylar fracture with a fracture of the contralateral body or angle of the mandible, and group 3 had a unilateral fracture of the body or angle of the mandible. TMD signs (click, pain) and maximum mouth opening (MMO) were the outcomes of the study, and fracture pattern was considered a predictor factor. Age, gender, and fixation methods were study variables. A χ(2) test was applied to compare TMD signs among groups. One-way analysis of variance was applied to compare MMO and age among groups. RESULTS: Ninety-nine patients in the 3 groups were examined for TMD signs. Results showed that 54.54% of patients in group 1, 69.69% of patients in group 2, and 24.24% of patients in group 3 had click in the temporomandibular joint (TMJ; unilaterally or bilaterally). Analysis of the data showed a significant difference among groups (P < .05). According to the results, 24.24% of patients in group 1, 73.91% of patients in group 2, and 12.12% of patients in group 3 had pain at the TMJ (unilaterally or bilaterally). There was a significant difference among groups for pain (P < .05). Analysis of the data did not show any difference for MMO among groups (P > .05). CONCLUSION: Patients who had a condylar fracture and a contralateral angle or body fracture seemed to have more TMD signs than those with a unilateral fracture.

[Intermaxillary intraoperative fixation of mandibular fractures: arch bars or fixation screws?]. / Blocage maxillo-mandibulaire peropératoire des fractures de mandibule : arcs ou vis de blocage ?

INTRODUCTION: The gold standard management of mandibular fractures is open reduction and osteosynthesis associated with intermaxillary fixation. The use of intermaxillary fixation screws for 20 years has considerably reduced the number of intermaxillary fixation with arch bars. The aim of our review was to identify current indications and contraindications of each technique. INTERMAXILLARY FIXATION TECHNIQUES: We present a short history and compare the two techniques with recently published assets, drawbacks, and complications. DISCUSSION: The indications of intermaxillary fixation screws are uni- or bifocal fractures without or with minimal displacement. Their use is contraindicated in any other type of fracture, which should still be treated with arch bar fixation.

Mandibular ramus fractures: a rarity.

AIM: To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. MATERIALS AND METHODS: Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. RESULTS: Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. CONCLUSION: Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. CLINICAL SIGNIFICANCE: This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article: Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42. Source of support: Nil Conflict of interest: None declared.

Incidence, aetiology, treatment outcome and complications of maxillofacial fractures. A retrospective study from Northern Greece.

AIM: To analyse the pattern of maxillofacial injuries and treatment outcomes in Northern Greece. METHODS: A tertiary referral single centre hospital; retrospective chart review. Demographics, aetiology, fixation technique (Rigid Internal Fixation: RIF; Maxillomandibular Fixation: MMF) post-surgical infections, aesthetics and occlusion were recorded. RESULTS: One thousand and ten males and 229 females were operated between 1998 and 2008. Mean age was 29.6 ± 13. Mean number of plates per patient was 3.96 ± 2.28. For those with midfacial fractures (n = 379) mean was 4.02 ± 2.05. For those with mandibular fractures (n = 333), mean was 2.74 ± 0.94 while those with combined mandible and midface fractures (n = 216) were treated using 5.74 ± 2.87 plates per patient. Among those treated with plates, an unadjusted 22% increased risk for post-surgical infection per plate used (OR = 1.22, 95%CI: 1.13-1.32) was found. Patients with mandibular fractures were more satisfied with their post-surgical facial appearance in contrast to those with midfacial or combined midfacial and mandibular fractures. Female patients were less satisfied with their post-surgical facial appearance than males. DISCUSSION: This study verified a young males predominance, a shift towards more assault related fractures -especially in females- and similar post-surgical results for MMF and RIF modalities in mandibular fractures. In those patients treated with RIF, placement of fewest plates possible to obtain stability better serves aesthetics at the same time reducing risk for post-surgical infections and malocclusion.

Treatment and complications of mandibular fractures: a 10-year analysis.

The surgical treatment and complications of patients with mandibular fractures in Amsterdam over a period of 10 years are analysed. Between January 2000 and January 2009 225 patients were surgically treated for a mandibular fracture (mean age of 32.6 (SD±14.6) years). A total of 426 fracture lines were identified. Of 213 dentate patients 29 patients were treated primarily with intermaxillary fixation (IMF). IMF combined with osteosynthesis was performed on 99 patients. Seventy-nine patients received IMF only per-operatively to make open reduction and internal fixation (ORIF) possible. Of 12 edentulous patients three patients were treated with Gunning splints. Nine patients were treated by manual reduction and internal fixation. A total of 1965 screws and 442 plates were used. Sixty (26.7%) patients presented with complications, including (transient) hyposensibility of the lip and chin (34 patients), dysocclusion (15 patients), infected osteosynthesis material (six patients) and temporomandibular dysfunction (five patients). Four patients needed surgical retreatment for correction of a dysocclusion. The results of this report are partly in line with other studies and provide important data for improving the treatment of the fractured mandible.

Maxillofacial fractures in older patients.

PURPOSE: The purpose of the present study was to analyze the trends and characteristic features of maxillofacial fractures in older patients. PATIENTS AND METHODS: The data from 247 patients aged 65 years old or older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University, from October 1981 to March 2010, were retrospectively analyzed. RESULTS: Of the 247 patients, 127 were men and 120 were women; 50 patients had been treated in the first third of the period, 87 in the second, and 110 in the third. Injury had most frequently occurred because of falling on a level surface (n = 126), followed by a traffic accident (n = 84). Of the fractures, 140 were in the mandible, 90 in the midface, and 17 in both. In the mandible, the fracture lines were most frequently observed at the condyle, followed by the body, exclusively in edentulous patients. In the midface, the zygoma was mostly involved. The facial injury severity scale score ranged from 1 to 10 (average 1.81). Injury at other sites of the body was found in 45 patients. Observation was most frequently chosen (n = 127), primarily for those of older age, followed by open reduction and internal fixation in 46 and maxillomandibular fixation in 41 patients. The facial injury severity scale score was greatest in patients treated by open reduction and internal fixation, followed by those treated by maxillomandibular fixation. CONCLUSION: Maxillofacial fractures in older patients have been increasing and showed the characteristic features of etiology, patterns, and treatment modalities.

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey.

OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70 percent) males and 162 (30 percent) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65 percent) in young patients and traffic accidents (38 percent) in adults. The most common fracture sites were the symphysis (35 percent) and condyle (36 percent) in young patients, and the symphysis in adults (36 percent). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67 percent) and adult (39 percent) patients, and 43 percent of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.

Estudio descriptivo de los accesos quirúrgicos utilizados en el tratamiento de fracturas del complejo zigomático orbitario / Descriptive study of surgical approach for zygomatic complex fractures

El objetivo del presente estudio fue evaluar los accesos quirúrgicos utilizados para el abordaje del complejo zigomático orbitario (CZO) y arco zigomático (AZ). Fue diseñado un estudio de tipo retrospectivo, evaluando las fichas clínicas de pacientes atendidos entre el 1 de Abril del año 1999 y el 31 de Diciembre del año 2008. Fueron estudiadas variables sociodemográficas y características de la fractura, tales como presencia de más de una fractura facial y desplazamiento del fragmento óseo. Se realizo un estudio descriptivo de los diferentes accesos quirúrgicos utilizados y cuando fue necesario se estudió la asociación estadística con la prueba chi-cuadrado para variables nominales, estableciendo significancia si p<0,05. Ciento cincuenta y tres pacientes fueron sometidos a tratamiento quirúrgico de fractura de CZO con 251 accesos quirúrgicos. El acceso más efectuado fue el intrabucal, seguido del acceso subciliar y supraciliar. Siempre existió mayor utilización de accesos para pilar zigomaticomaxilar, seguidos por accesos para reborde infraorbitario y sutura frontozigomática, con pocas diferencias entre ellos. No fue posible encontrar asociación estadística entre las variables estudiadas y la cantidad de accesos para el tratamiento quirúrgico de fracturas de CZO. Los accesos quirúrgicos deben responder a las necesidades individuales de cada caso, intentando obtener indicaciones precisas, más que preferencias individuales de cada cirujano.

The aim of this research was to evaluated the surgical approach for zygomatic complex and zygomatic arch fracture. Was doing a retrospective study, evaluating clinical charts of patients with treatment between April 1 of 1999 and December 31, 2008. Were study sociodemographic variables, type and quantitative fracture and displacement of osseous fragment. A descriptive analysis was do it surgical approach used and when was necessary, realized a statistical analysis with Chi-Square test for nominal variables, with p<0.05 for significant statistic. One hundred fifty tree patients was surgically treated for ZC fracture, doing 251 surgical approach. More realized approach was intraoral, follow for subciliary and superciliary approach. Always exist more approach for zygomatimaxillary pillar, follow to infraorbitary rim and frontozygomatic suture, with a little difference. Was not possible show statistic association between de variables and the quantity of surgical approach for ZC fractures. Surgical approach was response to individual necessity, obtained certain indications more than surgeon preferences.

[Surgical site infections in orthognathic surgery and risk factors associated]. / Les infections du site opératoire en chirurgie orthognathique et leurs facteurs de risque.

INTRODUCTION: Surgical site infections (SSI) in orthognathic surgery are considered infrequent and without any important consequence for the final operative result. A procedure of epidemiological surveillance was implemented to determine the frequency of SSI in orthognathic surgery and to better document their risk factors. MATERIAL AND METHOD: This prospective study included all interventions in our orthognathic surgery department between September 1(st) 2006 and August 31(st) 2007. SSI and their risk factors were documented for up to one year of follow-up. Risk factors were correlated to SSI using monovariate and multivariate analyses. RESULTS: Ten (7%) out of 143 consecutive interventions in orthognathic surgery were complicated by a SSI. All the SSI were secondary to a mandibular ramus sagittal split osteotomy. The two significantly correlated risk factors with the SSI in multivariate analysis were the length of surgery and the type of antibiotic prophylaxis. DISCUSSION: This rate of SSI correlates to published data. To decrease this rate, it would be necessary, in association with the usual precautionary measures, to limit the operating time and to recommend an antibioprophylaxis combining amoxicillin plus clavulanic acid (Augmentin).

[Mandibular fracture: a 10-year review of 685 cases treated in Charles-Nicolle Hospital (Tunis-Tunisia)]. / Particularités épidémiologiques et thérapeutiques des fractures de mandibule au CHU Charles-Nicolle de Tunis.

INTRODUCTION: The epidemiology and treatment of mandibular fracture vary from one country to another. The aim of this study was to present the current demographic pattern and treatment regimens of mandibular fractures in Tunisia. METHODS: The medical records and radiographs of 685 patients treated for mandibular fracture at the Maxillofacial and Plastic Surgery Department in the Tunis Charles-Nicolle Hospital between 1995 and 2004 were retrospectively studied. The relevant parameters were: age, sex, etiology, anatomical site of fracture, and treatment. RESULTS: The prevalence of mandibular fractures was higher in male patients (sex ratio 6:1). Traffic accidents were the main cause of these lesions (45%), followed by assault (22%). Angle fractures were the most common (24.8%) followed by parasymphyseal fractures (22.2%). The most frequent treatment was closed reduction with maxillo mandibular locking in 388 patients (56.6%). Transosseous wiring was the most commonly used method in open reductions. Tooth loss and neurological sensitive deficiency were the most common sequels. DISCUSSION: Our epidemiological data correlates to published data for developing countries. Analyzing this data can help to improve the management of maxillo-facial trauma in Tunisia. Therapeutic options vary according to the type of fracture but also depend on the economical status of the country.

Is the use of arch bars or interdental wire fixation necessary for successful outcomes in the open reduction and internal fixation of mandibular angle fractures?

PURPOSE: The purpose of this retrospective cohort study was to analyze the complications associated with a series of mandibular angle fractures treated by open reduction and internal fixation and to determine if the method of intraoperative maxillomandibular fixation (MMF) affected patient outcome. PATIENTS AND METHODS: The records of 162 consecutive patients with isolated mandibular fractures that were treated by the senior author (R.B.B.) with open reduction and internal fixation were retrospectively reviewed and a number of clinical variables were recorded. Of these, all patients with fractures involving the mandibular angle, alone or in combination with other mandibular fractures, were identified. Only patients in the permanent dentition with angle fractures treated with a single 2.0 mm titanium plate placed at the superior border using standard Champy technique were included in the study. Patients with less than 6 weeks follow-up, concomitant midface fractures, edentulous patients, patients with comminuted fractures or gunshot wounds, and those patients presenting with infected fractures were excluded from the primary study group, which totaled 75 patients with 83 angle fractures. Postoperative complications, including infection, malunion/nonunion, wound dehiscence, osteomyelitis, pain, and the need for secondary operative intervention, were tabulated. For purposes of comparison, patients were divided into 3 groups based upon the type of intraoperative MMF utilized: group 1, Erich arch bars (n = 24); group 2, 24 gauge interdental "Stout" wires (n = 25); and group 3, manual reduction alone (n = 26). Outcome measures were defined as successful bone healing, acceptable occlusion, minor complications, and major complications. Descriptive statistics were recorded and an analysis of variance was calculated to evaluate differences between the 3 groups. The Fisher's exact test was used to evaluate whether a complication occurred more frequently in any one particular group. RESULTS: The mean age of the 75 patients included in the study was 28.2 years (M = 63, F = 12) and there were no significant demographic differences between the 3 groups (P = 0.22). All patients eventually achieved successful bony union with an acceptable occlusion. Thirty-two percent of patients in the cohort required a second procedure, usually outpatient removal of loose or symptomatic hardware under local anesthesia or intravenous sedation, but there was no difference in re-operation rate based upon the method of intraoperative fixation (P = .47). Major complications occurred in 2 patients that required secondary operations due to malunion and nonunion (2.7%). Twenty-two minor complications occurred in 16 patients (21.3%) and were evenly distributed amongst the 3 groups (P = .074), including infection (n = 4), wound dehiscence (n = 1), and/or symptomatic hardware (n = 16) that required hardware removal. All of the minor complications were treated in an outpatient setting under local anesthesia or under intravenous sedation. When the complications were pooled together, the Fisher exact test again yielded no difference in complications between the 3 groups (P = .33). CONCLUSION: The use of Erich arch bars or interdental wire fixation to assist with MMF during the open reduction and internal fixation of noncomminuted mandibular angle fractures treated in Champy fashion is not always necessary for successful outcome.

A prospective audit over a six month period of condylar fractures at Chris Hani Baragwanath Hospital.

OBJECTIVE: To determine the frequency of occurrence, patterns, aetiology and outcome of treatment of mandibular condylar fractures at Chris Hani Baragwanath Hospital. MATERIALS AND METHODS: All patients with condylar fractures seen at Chris Hani Baragwanath Hospital over a six-month period from January to June 2003 were included in the study. Data was recorded on sex, age, date of injury, cause of trauma, status of the occlusion and presence of associated facial injuries. The type of condylar fracture was recorded and classified following the radiographic examination according to Spiessl and Schroll. The type of treatment rendered and its outcome were also documented. Patients were followed up from 1 week to 6 months post-treatment. RESULTS: The sample comprised 84 patients with 95 condylar fractures; 69 (82%) males and 15(18%) females. 73.8% of the fractures were caused by interpersonal violence followed by road traffic accidents (16,67%) and falls (7.14%). 73 (87%) patients had unilateral fractures and 11 (13%) had bilateral condylar fractures. Of the 95 condylar fractures, there were 16 medially dislocated condylar fractures in 13 patients. Type I, Type II and Type III fractures accounted for 31%, 26% and 25% of the total fractures respectively. CONCLUSION: A relationship exists between the type of condylar fracture and the cause of the fracture: road traffic accidents and falls produce more bilateral and dislocated fractures than interpersonal violence. Prolonged intermaxillary fixation, failure to use training elastics, absence of active physiotherapy and poor patient compliance results in increased risk of hypomobility.

Changing patterns of hospital length of stay after orthognathic surgery.

PURPOSE: The purpose of this study was to estimate the hospital length of stay (LOS) and identify factors associated with LOS in orthognathic surgery patients. MATERIALS AND METHODS: Using a retrospective cohort study design, we enrolled a sample composed of patients who underwent orthognathic surgery at Massachusetts General Hospital between January 1994 and July 2006. The primary predictor variables were fixation type (rigid/nonrigid), anesthesia technique (hypotensive/normotensive), and perioperative steroid use (yes/no). The outcome variable was LOS. Descriptive statistics were computed for all variables. Bivariate analyses were used to identify factors associated with duration of LOS with P values less than .15. Multiple regression modeling was used to assess the relationship between the primary predictor variables and LOS. The level of statistical significance was set at P less than .05. RESULTS: The study sample was comprised of 627 subjects (58.5% female) with a mean age of 26.1 +/- 10.2 years. The overall mean LOS was 1.7 +/- 1.2 days. During the study period, LOS decreased from 2.3 to 1.3 days (P < .001). In the adjusted multiple regression model, rigid fixation, procedure type, and length of operation were statistically significantly associated with LOS (P < .05). CONCLUSION: The results of this study indicate that individual variables associated with duration of LOS are complexity of the orthognathic procedure and type of fixation used. In the multiple logistic regression model, LOS decreases significantly when rigid fixation, hypotensive anesthesia, and perioperative steroids are used in combination.

Craniomaxillofacial injuries in the United Arab Emirates: a retrospective study.

PURPOSE: To analyze craniomaxillofacial injuries in selected hospitals in the United Arab Emirates (UAE). PATIENTS AND METHODS: This is a retrospective study of craniomaxillofacial injuries treated in 3 major hospitals in the UAE. Patient files were retrieved, reviewed, and analyzed. The main analysis outcome measures were the patients' name, age, and gender and the injuries' time, site, type, treatment and outcome. RESULTS: A total of 288 patients sustained 475 craniomaxillofacial injuries; road traffic accidents caused the majority of injuries. The patients ranged in age from 2 to 82 years (mean, 27.3 years), and the male-to-female ratio was 7:1. The yearly distribution of fractures peaked during 2001, and the monthly distribution peaked in January. The greatest number (41%) of patients were UAE nationals. Most patients (70.5%) had mandibular fractures, and the most common site was the body. There were 139 patients (48.3%) with a total of 171 midface fractures (36%); the most common fracture site was the zygomatic complex (29.8%). The most common treatment for jaw fractures was plating plus intermaxillary fixation. Stable zygomatic complex fractures were closely reduced (elevated), and unstable ones were treated by internal fixation. About 25% of the cases had 1 or more postoperative complication. CONCLUSIONS: Craniomaxillofacial injuries in the UAE included in this study are somewhat similar to those reported in other countries. Differences from other countries are probably related to factors peculiar to the UAE, such as climate, social trends, and the cosmopolitan population.

[Surgical management of mandibular condylar fractures in adults in France, 2005]. / Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005.

INTRODUCTION: The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005. MATERIAL AND METHODS: One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery. RESULTS: The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability. DISCUSSION: This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.