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1.
Artigo em Inglês | MEDLINE | ID: mdl-36554879

RESUMO

Maxillofacial trauma is associated with facial deformation, loss of function, emotional and social impacts, and high financial costs. This study investigated cases of maxillofacial trauma in a large Brazilian city through a cross-sectional study conducted at two public and two private hospitals. Primary data of 400 patients were collected through a questionnaire, clinical examination, and tomography. Statistical analysis at the 5% significance level was performed. Motorcycle accident was the major cause of trauma (41%); the most frequent trauma and treatment were mandibular fracture (24.3%) and surgery (71%), respectively. The female sex was more affected only regarding domestic accidents (p = 0.041) and falls (p < 0.001). Motorcycle accidents were more prevalent among 20 to 29 year-olds (p < 0.001), followed by physical aggression (p < 0.001) and sports accidents (p = 0.004). Falls were more frequent among 40 to 59 year-olds (p < 0.001). Mandibular fracture affected males and 20 to 29 year-olds more and was mainly associated with motorcycle accidents (48.2%) and physical aggression (22.7%) (p = 0.008). Nose fracture was more frequent in falls (29.6%), physical aggression (22.5%), and sports accidents (21.1%) (p < 0.001). Compound fracture was associated with motorcycle accidents (84.2%; p = 0.028). Maxillofacial trauma (mandibular, nasal, and zygomatic fractures) was associated with motorcycle accidents, physical aggression, and falls. Surgical treatment, hospital care, and public services were the most frequent.


Assuntos
Fraturas Mandibulares , Traumatismos Maxilofaciais , Masculino , Humanos , Feminino , Estudos Transversais , Brasil/epidemiologia , Estudos Retrospectivos , Traumatismos Maxilofaciais/epidemiologia , Traumatismos Maxilofaciais/terapia , Hospitais , Acidentes de Trânsito
2.
Rev. Odontol. Araçatuba (Impr.) ; 43(3): 17-23, set.-dez. 2022. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1381053

RESUMO

O nervo mandibular V3 é a terceira divisão do nervo trigêmeo, apresenta fibras motoras e sensitivas, sendo a ramificação mista deste nervo. Seus ramos eferentes são responsáveis pela motricidade dos músculos mastigatórios, inerva os músculos milo-hióideo, ventre anterior do digástrico, tensor do véu palatino e tensor do tímpano. Suas fibras aferentes são responsáveis pela sensibilidade da região inferior da face e cavidade oral, dentes inferiores, parte da língua e propriocepção da cápsula da articulação temporomandibular ATM. O objetivo deste estudo é explanar as possíveis lesões no nervo mandibular, suas ramificações e estruturas adjacentes no caso de fraturas na mandíbula, colaborando com informações detalhadas para posterior estudo de acadêmicos e cirurgiões dentistas. Foi realizada uma pesquisa de campo, exploratória e descritiva, com abordagem quanti-qualitativa, para descrição e análise do trajeto do V3 até a sua chegada no osso mandibular, assim como de estruturas que compõem a topografia adjacente a mesma utilizando uma hemiface intacta de um cadáver do sexo masculino no Laboratório de Anatomia Humana das Faculdades Nova Esperança, na cidade de João Pessoa. Devido à proximidade do nervo mandibular com o processo coronoide, fraturas nesta parte do osso mandíbula, podem ocasionar lesões no V3, além de traumas no osso temporal, e consequentemente de todo o gânglio trigeminal. Além destas, estruturas adjacentes como a glândula parótida, artérias maxilar e facial, ATM, e os nervos alveolar inferior, mentual e lingual, podem ser lesionadas em uma fratura mandibular. As lesões nestes nervos, podem resultar em redução grave da qualidade de vida e dor crônica, gerando desconfortos para o paciente. Diante do exposto fica evidente a importância de conhecer a anatomia topográfica da mandíbula e suas estruturas vasculonervosas, seu trajeto e a localização. Houve dificuldade na discussão devido à escassez da literatura em relação à temática proposta. Dessa forma, é necessário motivar novos estudos sobre a temática a fim de ampliar o conhecimento dos profissionais de saúde e estimular novas técnicas para diagnóstico precoce e melhorar os resultados terapêuticos, impactando positivamente na sobrevida de pacientes com fraturas de mandibulares(AU)


The mandibular nerve V3 is the third division of the trigeminal nerve, has motor and sensory fibers, being the mixed branch of this nerve. Its efferent branches are responsible for the motricity of the masticatory muscles, innervating the mylohyoid muscles, anterior belly of the digastric, soft palate tensor and tympanic tensor. Its afferent fibers are responsible for the sensitivity of the lower face and oral cavity, lower teeth, part of the tongue and proprioception of the capsule of the temporomandibular joint TMJ. The aim of this study is to explain the possible injuries to the mandibular nerve, its ramifications and adjacent structures in the case of mandible fractures, collaborating with detailed information for further study by academics and dentists. A field research, exploratory and descriptive, with a quantitative-qualitative approach, was carried out to describe and analyze the path of the V3 until its arrival in the mandibular bone, as well as structures that make up the topography adjacent to it using na intact hemiface of a male cadaver at the Human Anatomy Laboratory of Faculdades Nova Esperança, in João Pessoa city. Due to the proximity of the mandibular nerve with the coronoid process, fractures in this part of the mandible bone can cause injuries to the V3, in addition to trauma to the temporal bone, and consequently to the entire trigeminal ganglion. In addition to these, adjacent structures such as the parotid gland, maxillary and facial arteries, TMJ, and the inferior alveolar, mental and lingual nerves can be injured in a mandibular fracture. Damage to these nerves can result in severely reduced quality of life and chronic pain, causing discomfort for the patient. Given the above, the importance of knowing the topographic anatomy of the mandible and its vascular-nervous structures, its path and location is evident. There was difficulty in the discussion due to the scarcity of literature regarding the proposed theme. Thus, it is necessary to motivate further studies on the subject in order to expand the knowledge of health professionals and encourage new techniques for early diagnosis and improve therapeutic results, positively impacting the survival of patients with mandibular fractures(AU)


Assuntos
Humanos , Masculino , Traumatismos do Nervo Trigêmeo , Traumatismos do Nervo Mandibular , Fraturas Mandibulares , Mandíbula/anatomia & histologia , Nervo Mandibular , Nervo Mandibular/anatomia & histologia
3.
Sci Rep ; 12(1): 19596, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36379971

RESUMO

Mandibular fractures are among the most frequent facial traumas in oral and maxillofacial surgery, accounting for 57% of cases. An accurate diagnosis and appropriate treatment plan are vital in achieving optimal re-establishment of occlusion, function and facial aesthetics. This study aims to detect mandibular fractures on panoramic radiographs (PR) automatically. 1624 PR with fractures were manually annotated and labelled as a reference. A deep learning approach based on Faster R-CNN and Swin-Transformer was trained and validated on 1640 PR with and without fractures. Subsequently, the trained algorithm was applied to a test set consisting of 149 PR with and 171 PR without fractures. The detection accuracy and the area-under-the-curve (AUC) were calculated. The proposed method achieved an F1 score of 0.947 and an AUC of 0.977. Deep learning-based assistance of clinicians may reduce the misdiagnosis and hence the severe complications.


Assuntos
Aprendizado Profundo , Fraturas Mandibulares , Humanos , Radiografia Panorâmica/métodos , Fraturas Mandibulares/diagnóstico por imagem , Algoritmos , Área Sob a Curva
4.
Sci Rep ; 12(1): 19924, 2022 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-36402809

RESUMO

This study aimed to explore and impart understanding of bone remodelling in children with intracapsular fractures treated conservatively. Records of children (less than 12 years), who sustained intracapsular fractures and treated conservatively, were retrieved consecutively for the period of March 2011 to February 2016. Data about age, gender, date of injury, dates of admission and discharge, mechanism of trauma, location and pattern of fracture, other mandibular fractures, treatment methods and time of review were recorded and analysed. Image dates of pre- and post-treatments, including date of review, were also recorded. A total of 22 patients complete their follow-up and show bone remodelling process. During their follow-up, all the displaced condylar fragments fused with the ramus stump at the displaced position. Regardless of the type of conservative procedure, both treatments cannot promote the spontaneous fracture reduction in patients with intracapsular condylar fractures. During follow-up, the absorption of the lateral process of the condyle after the closed treatment becomes close to the 'horizontal absorption', until the height (or articular surface) of the lateral condylar process dropped and aligned to the articular surface of the medial process. In children with intracapsular condylar fractures, the fracture fragment of the condyle determines the ramus height of the mandible. Closed treatment cannot restore the fracture fragment. If the height of the fracture fragments dropped remarkably, then open reduction and rigid internal fixation become more suitable.


Assuntos
Côndilo Mandibular , Fraturas Mandibulares , Humanos , Criança , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/cirurgia , Mandíbula , Fixação Interna de Fraturas , Fixação de Fratura
5.
Artigo em Alemão | MEDLINE | ID: mdl-36323292

RESUMO

The first part of this case report describes the surgical treatment of a unilateral mandibular fracture in the standing horse by using a fixateur type I. By the time of implant removal, the fracture had completely healed. However, during implant removal, an implant failure of 2 of the 4 implants occurred with fragments remaining in the bone. The second part of the report focuses on the development of a special surgical instrument that was designed for removal of the implant fragments. Furthermore, the surgical method allowing the entire extirpation of the fragments within a second surgery is described.According to the authors' knowledge, this is the first case report showing the use of the presented surgical technique for the treatment of a mandibular fracture in the standing horse. Additionally, this report also provides an approach for removing implant fragments from the depth of the bone which may occur in case of implant breakage as a potential complication of the described surgery.


Assuntos
Remoção de Dispositivo , Fraturas Mandibulares , Animais , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/instrumentação , Remoção de Dispositivo/veterinária , Falha de Equipamento/veterinária , Cavalos , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/veterinária
6.
J Craniofac Surg ; 33(7): e754-e758, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36201692

RESUMO

INTRODUCTION: The aim of this study is to follow-up and evaluate the treatment result of mandibular subcondylar (MSC) fractures by osteosynthesis via endoscopy-assisted intraoral approach. MATERIALS AND METHODS: This is a prospective study, in which 47 patients with 51 sites of MSC fractures treated osteosynthesis via endoscopic-assisted intraoral approach at the Department of Maxillofacial Surgery, National Hospital of Odonto-Stomatology HoChiMinh City-Vietnam were followed-up and evaluated clinically and radiographically up to 6 months postoperative. RESULTS: Before surgery, all of the patients were malocclusion, 15% of patients were isolated MSC fractures, the rate of concomitant midface fractures were 30%, 92.2% of fracture sites with moderate displacement, 7.8% of fracture sites with severe displacement, 5.9% of fracture sites with dislocation. After surgery, all of the patients had preinjured centric occlusion; no patient had facial paralysis; 6% of patients had surgical site infection within 1 week; pain frequency were 56.9% at 1 month, 35.3% at 2 months, 7.8% at 3 months, and 2.0% at 6 months with Visual Analog Scale (VAS) means of pain were 1.74±1.85 at 1 month, 0.55±1.12 at 2 months, 0.08±0.27 at 3 months and 0.02±0.14 at 6 months; 90% of fracture sites had precise anatomy at 1 week and 96% at 6 months; 96% fracture sites had no displacement the of correlation between condyle and articular fossa at 1 week and 98% at 6 months; 1 fracture site had screw loosening at 2 months; 88% fracture sites had stage-4 radiographic bone healing at 6 months. CONCLUSION: Endoscopic-assisted intraoral approach for osteosynthesis of MSC fractures have provided the esthetic and functional success and good bone healing.


Assuntos
Côndilo Mandibular , Fraturas Mandibulares , Placas Ósseas , Endoscopia , Estética Dentária , Fixação Interna de Fraturas , Humanos , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia , Dor , Estudos Prospectivos , Resultado do Tratamento
7.
Niger J Clin Pract ; 25(10): 1629-1634, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36308231

RESUMO

Background: The mandibular bone is the largest and strongest bone in comparison to the other bones in the face skeleton. However, it is the most commonly fractured in facial injuries. The location of the fracture in mandible depends on various factors. The relationship of the impacted lower third molar teeth to mandibular angle fracture has been the subject of many epidemiological studies. It is argued that the risk of fracture in mandibular angle is two to four times more when there are particularly an impacted or partially impacted third molar teeth. However, the effect of the position of the impacted tooth on mandibular angle fracture is not clear yet. Aim: This study seeks to reveal the effect of third molar teeth that are impacted in various positions on the angle fragility. Materials And Methods: This study was performed using three-dimensional finite element stress analysis and static linear analysis methodology. Computed tomography (CT) images obtained previously from a patient were used to construct models of the bone tissue. An ILUMA CBCT device (3M Imtec, OK, USA) was used for tomographic scans. Impacted teeth in various positions were digitally modeled separately. Different direction forces were applied to the mandible, the stress values on the bone surrounding the third molar teeth impacted in different positions were determined. Results: Third molar teeth are impacted in mandibular bone in the following positions: mesioangular, vertical, horizontal, and distoangular positions. The study showed that the force that created the highest stress in the Mandibular angle among the modelled groups is the force by ipsilateral angle. Conclusion: For all kinds of impacted teeth, there was more stress accumulation in the buccal area than in the lingual area when the force is from the symphisis.


Assuntos
Fraturas Mandibulares , Dente Impactado , Humanos , Dente Serotino/diagnóstico por imagem , Dente Impactado/diagnóstico por imagem , Análise de Elementos Finitos , Mandíbula/diagnóstico por imagem
8.
Mymensingh Med J ; 31(4): 931-936, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36189535

RESUMO

Among all mandibular fracture 25.0 to 40.0% fractures are regarded as condylar and subcondylar fracture. Commonly, reduction of subcondylar fracture is done under general anaesthesia. Different approaches were found for the surgical treatment of condylar fractures besides intraoral approaches such as the pre-auricular, submandibular, rhytidectomy, retromandibular. This is a prospective observational study which was performed to find out the outcome of retromandibular approach for subcondylar fracture treatment of mandible i.e. to find out correction of occlusion and establishment of jaw function, infection, hematoma, salivary fistula, facial nerve damage, haematoma etc complication. Surgical treatment of subcondylar fractures of 15 patients was done in Dhaka Dental College and Hospital and different private centres in Dhaka and Mymensingh, Bangladesh from January 2019 to December 2021 in retromandibular transparortid approach. The patients were evaluated for hematoma, infection, Frey's syndrome, salivary fistula, facial nerve damage, occlusion, fracture site stability, chronic pain in the fracture site and temporomandibular joint movements in the post operative period. Facial nerve injury was not observed. Postoperative swelling of parotid region developed in first two patients. Single patient developed paresis in zygomatic branch of facial nerve causing left upper eyelid muscle weak and after two weeks of physiotherapy it became normal. Salivary fistula developed in three patients which resolved spontaneously. Outcome of this approach like good anatomy and function was found in all cases. Good articular function was obtained in all the cases. By this retromandibular approach condylar fracture reduction; fixation and healing were managed comfortably. However, direct vision of facial nerve fibres has limited the risk of facial nerve injury.


Assuntos
Côndilo Mandibular , Fraturas Mandibulares , Bangladesh , Fixação Interna de Fraturas , Hematoma/etiologia , Humanos , Côndilo Mandibular/lesões , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/etiologia , Fraturas Mandibulares/cirurgia , Resultado do Tratamento
9.
Ann Plast Surg ; 89(4): 459-464, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36149985

RESUMO

BACKGROUND: Mesenchymal stem cells have immense potential in applications of bone healing and regeneration. However, few studies have evaluated the therapeutic efficacy of adipose-derived stem cells (ASCs) and bone marrow stromal cells (BMSCs) in irradiated bone. The purpose of this study is to compare the ability of ASCs versus BMSCs to enhance healing outcomes in a murine model of irradiated mandibular fracture repair. METHODS: Forty-eight isogenic male Lewis rats underwent radiation therapy followed by mandibular osteotomy with intraoperative placement of either ASCs or BMSCs. Animals were killed on postoperative day 40. Mandibles were analyzed for union rate, biomechanical strength, vascularity, and mineralization. Groups were compared at P < 0.05 significance. RESULTS: The ASC and BMSC groups demonstrated 92% and 75% union rates. Compared with the BMSC group, the ASC group demonstrated a trending increase in maximum load ( P = 0.095) on biomechanical strength analysis and a significant increase in vessel number ( P = 0.001), vessel thickness ( P = 0.035), and vessel volume fraction ( P = 0.007) on micro-computed tomography angiography analysis. No significant differences in bone mineralization were identified on micro-computed tomography analysis. CONCLUSION: This study demonstrates the superior therapeutic efficacy of ASCs over BMSCs in irradiated fracture healing as evidenced by union rate, vascular morphometry, and a trend in biomechanical strength. We posit that the robust vascular response induced by ASCs better recapitulates the sequence and synchronicity of physiologic bone healing compared with BMSCs, thereby improving the reliability of irradiated fracture repair.


Assuntos
Fraturas Mandibulares , Células-Tronco Mesenquimais , Tecido Adiposo , Animais , Células da Medula Óssea , Masculino , Células-Tronco Mesenquimais/fisiologia , Camundongos , Ratos , Ratos Endogâmicos Lew , Reprodutibilidade dos Testes , Células-Tronco , Células Estromais , Microtomografia por Raio-X
10.
J Oral Maxillofac Surg ; 80(11): 1757-1768, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36055371

RESUMO

PURPOSE: Interfacility hospital transfer for isolated mandibular fractures is common but rarely clinically necessary. The purpose of this study was to generate nationally representative estimates regarding the incidence, risk factors, and cost of transfer for isolated mandibular fractures. METHODS: This was a retrospective cohort study using the Nationwide Emergency Department Sample 2018 to identify patients with isolated mandibular fractures. The primary predictor variable was hospital trauma center designation (Level I, Level II, Level III, and nontrauma center). The primary outcome variable was hospital transfer. Total emergency department (ED) charges were also assessed. Covariates were demographic, medical, injury-related, and hospital characteristics. Descriptive, bivariate, and multiple logistic regression statistics were used to evaluate the incidence and predictors of interfacility transfer. RESULTS: A total of 28,357 encounters with mandibular fracture as the primary diagnosis were included. Within this cohort there were 2,893 hospital transfers (10.2%). In unadjusted analysis, evaluation at a nontrauma center, level III trauma center, metropolitan nonteaching hospital, nonmetropolitan nonteaching hospital, micropolitan region, and history of cerebrovascular event was associated with hospital transfer (P ≤ .001). In the adjusted model, independent predictors (risk factors) for hospital transfer were evaluation at a nontrauma center (P ≤ .001, odds ratio [OR] = 12.8, 95% confidence interval [CI] = 6.43 to 25.4), level III trauma center (P ≤ .001, OR = 10.7, 95% CI = 5.25 to 21.7), nonmetropolitan nonteaching hospital (P ≤ .001, OR = 2.45, 95% CI = 1.73 to 3.46), metropolitan nonteaching hospital (P ≤ .001, OR = 1.57, 95% CI = 1.20 to 2.06), cervical spine injury (P = .002, OR = 3.53, 95% CI = 1.61 to 7.75), fractures of the mandibular body (P = .007, OR = 1.33, 95% CI = 1.08 to 1.64), and unspecified mandibular fractures (P = .006, OR = 1.49, 95% CI = 1.12 to 1.99). The average ED charge per encounter was $7,482 ± 565 for a total nationwide charge of $212,172,264. Transferred subjects had total ED charges of $25,632,974, not including additional charges incurred at the recipient hospital. CONCLUSION: Isolated mandibular fractures are common injuries that are frequently transferred and cost the healthcare system millions of dollars annually. Hospital characteristics rather than medical or injury-related variables were the strongest predictors of transfer, suggesting that transfers are primarily driven by need to access maxillofacial surgical services. Programs evaluating necessity of transfer and facilitating specialist evaluation in the outpatient setting may reduce healthcare expenditures for this injury.


Assuntos
Fraturas Mandibulares , Transferência de Pacientes , Humanos , Serviço Hospitalar de Emergência , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/cirurgia , Estudos Retrospectivos , Centros de Traumatologia , Estados Unidos/epidemiologia
11.
PLoS One ; 17(9): e0275515, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36174089

RESUMO

INTRODUCTION: Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern, and predictors of soft tissue and bony injuries. MATERIALS AND METHODS: This study was conducted in the department of maxillofacial surgery Lady Reading hospital Pakistan from Jan 2019 to June 2021. The nonprobability consecutive sampling technique was used for the selection of patients. All patients were assessed clinically and radiologically. The neurosensory examination was done for any altered sensation, anesthesia, or paresthesia. Motor nerve function was also assessed clinically. Data were analyzed using SPSS version 26. The etiology and pattern of maxillofacial trauma were stratified among age and genders using the chi-square test to see effect modifiers. Tests for regression analysis were also applied. P≤0.05 was considered significant. RESULTS: A total of 253 patients meeting inclusion criteria were included in this study. The majority of these patients were males, 223 (88.1%), while only 30 (11.9%) were females. The mean age for the group was 25.4 ± 12.6 years. RTAs were the most common causes of trauma (63.6%) followed by assault (15.0%), falls (11.5%), FAIs (5.9%), and sports (0.4%). The most vulnerable skeletal part was the mandible (22.9%) followed by Zygoma (7.1%), significantly predicted by RTAs. Soft tissue laceration analysis showed a high frequency of multiple lacerations (38%) significantly predicted by FAIs. The frequency of trigeminal nerve injury was 5.5% (14 patients) and that of the facial nerve was 1.6% (4 patients). The strongest association of nerve injury was with firearm injury (47%), followed by road traffic accidents and sports injuries. CONCLUSION: Road traffic accident was the most common etiological factor and mandible fracture was commonly predicted by RTA. Trigeminal nerve injuries were common, frequency of nerve injuries was highly associated with mandible fracture and was predicted by FAI.


Assuntos
Armas de Fogo , Lacerações , Fraturas Mandibulares , Traumatismos Maxilofaciais , Traumatismos do Nervo Trigêmeo , Ferimentos por Arma de Fogo , Adolescente , Adulto , Causalidade , Criança , Feminino , Humanos , Masculino , Traumatismos Maxilofaciais/epidemiologia , Traumatismos Maxilofaciais/etiologia , Traumatismos do Nervo Trigêmeo/epidemiologia , Traumatismos do Nervo Trigêmeo/etiologia , Adulto Jovem
12.
Br J Oral Maxillofac Surg ; 60(9): 1224-1227, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36180319

RESUMO

Unlike fractures of the remaining facial skeleton, fractures of the non-condylar part of the mandible are invariably treated surgically, with the potential risk of further iatrogenic injury. There is, however, a substantial evidence gap pertaining to the potential non-surgical management of such injuries. The aim of this study was to determine the outcomes of mandibular fractures treated with non-surgical management. All patients with mandibular fractures who were referred to a large regional major trauma service over a one-year period (1 January-31 December 2021) were identified. Those treated with surgery or who sustained fractures of the condylar portion of the mandible were excluded. Of all the patients referred to our unit with mandibular fractures, 34/155 (22%) underwent non-surgical management. In all cases plain radiographs demonstrated minimal displacement. Thirty-two (94%) fractures were unilateral, of which 24 (70%) involved the angle. Two of 34 patients subsequently required open reduction and internal fixation due to pain that did not improve over time, one of whom declined. A minimally extruded tooth in the fracture line, which altered the occlusion in one additional patient, required minimal reduction of the enamel. The remaining patients healed without complication six weeks after injury. Non- surgical management requires careful case selection and regular follow up, so is of value to only a small proportion of patients. Twenty-two per cent of all mandibular fractures were managed non-surgically at our unit in one year, with a 97% success rate, demonstrating the potential utility of this strategy in carefully selected cases.


Assuntos
Fraturas Mandibulares , Humanos , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Côndilo Mandibular/lesões , Fixação Interna de Fraturas , Mandíbula , Oclusão Dentária , Resultado do Tratamento , Estudos Retrospectivos
13.
Schweiz Arch Tierheilkd ; 164(9): 609-622, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-36047817

RESUMO

INTRODUCTION: Mandibular fractures are among the most common fractures in cattle. The medical records of 108 cattle with a mandibular fracture, that were referred to the University of Zurich Veterinary Hospital from 2005 to 2019, were analysed to document the types of treatment, complications and long-term outcomes. Cattle, still alive at the time of retrospective analysis, underwent clinical and radiographic examinations. A fall was the single most common cause of a mandibular fracture (48,1 %), and a third of all cattle had a concomitant disease at the time of referral. Seventy-five cattle (69,4 %) had a single fracture, 26 (24,1 %) had two fractures and seven (6,5 %) had three fractures of the mandible. The molar part of the mandibular body was most commonly (40,7 %) fractured followed by the diastema (23,6 %), the pars incisiva (13,4 %), the ramus (12,1 %) and the symphysis (10,2 %) of the mandible. The majority of cattle (84/108, 77,8 %) had open fractures. Treatment was instituted in 63/108 animals (58,3 %) with 77/148 fractures. Of these fractures, 28 were treated with plate osteosynthesis, 25 with an external fixator, 8 with cerclage wire, 7 using mixed techniques, 4 with fragment excision, 4 underwent conservative treatment and one a mucosal suture. In total, 45/108 animals (41,7 %) were culled because of multiple fractures, concomitant diseases and because of economic reasons. Complications occurred in 34 (54,0 %) treated cattle; 22 had abnormal wound healing of which 18 developed osteomyelitis complicated by a sequestrum (14). Of the treated 63 cattle, 56 (88,9 %) were discharged. The mean postoperative productive life was 46 ± 29,2 months for animals that were deceased at the time of the study. Thirteen of the cattle with a sequestrum remained in the herd for 15 to 92 months (mean, 47 months) and one for 2 months. The life expectancy after treatment did not differ significantly from that of the Brown Swiss and Swiss Holstein dairy cattle populations, where the cattle of this study mainly came from. Eleven cattle were available for long-term follow-up; all had a good general health status but nine had dental abnormalities including missing teeth, steps or enamel points, which did not noticeably affect the body condition of the animals. Surgical treatment of selected mandibular fractures had a favourable prognosis (52/63 healed, 82,5 %) in cattle.


INTRODUCTION: Les fractures mandibulaires font partie des fractures les plus fréquentes chez les bovins. Les dossiers médicaux de 108 bovins présentant une fracture mandibulaire, référés à l'hôpital vétérinaire de l'Université de Zurich entre 2005 et 2019, ont été analysés afin de documenter les types de traitement, les complications et les résultats à long terme. Les bovins, encore vivants au moment de l'analyse rétrospective, ont subi des examens cliniques et radiographiques. Une chute était la cause la plus fréquente d'une fracture mandibulaire (48,1 %), et un tiers des bovins présentaient une maladie concomitante au moment de la consultation. Septante-cinq bovins (69,4 %) avaient une seule fracture, 26 (24,1 %) avaient deux fractures et sept (6,5 %) avaient trois fractures de la mandibule. La partie molaire du corps mandibulaire était le plus souvent (40,7 %) fracturée, suivie du diastème (23,6 %), de la pars incisiva (13,4 %), du ramus (12,1 %) et de la symphyse (10,2 %) de la mandibule. La majorité des bovins (84/108, 77,8 %) présentaient des fractures ouvertes. Un traitement a été institué chez 63/108 animaux (58,3 %) avec 77/148 fractures. Parmi ces fractures, 28 ont été traitées par une ostéosynthèse par plaque, 25 par un fixateur externe, 8 par cerclage, 7 par des techniques mixtes, 4 par une excision du fragment, 4 par un traitement conservateur et une par une suture muqueuse. Au total, 45/108 animaux (41,7 %) ont été abattus en raison de fractures multiples, de maladies concomitantes et pour des raisons économiques. Des complications sont survenues chez 34 (54,0 %) des bovins traités ; 22 ont présenté une cicatrisation anormale dont 18 ont développé une ostéomyélite compliquée par un séquestre (14). Sur les 63 bovins traités, 56 (88,9 %) sont sortis de clinique. La vie productive postopératoire moyenne était de 46 ± 29,2 mois pour les animaux qui étaient décédés au moment de l'étude. Treize des bovins avec un séquestre sont restés dans le troupeau pendant 15 à 92 mois (moyenne, 47 mois) et un pendant 2 mois. L'espérance de vie après traitement ne différait pas significativement de celle des populations de vaches laitières Brown Swiss et Swiss Holstein d'où provenaient principalement les bovins de cette étude. Onze bovins étaient disponibles pour un suivi à long terme ; tous avaient un bon état de santé général mais neuf présentaient des anomalies dentaires, notamment des dents manquantes, des différences de niveau de la table dentaire ou des pointes d'émail, ce qui n'a pas affecté de manière notable l'état corporel des animaux. Le traitement chirurgical de certaines fractures mandibulaires a donc eu un pronostic favorable (52/63 guéries, 82,5 %) chez les bovins.


Assuntos
Doenças dos Bovinos , Fraturas Mandibulares , Animais , Placas Ósseas , Bovinos , Doenças dos Bovinos/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/veterinária , Estudos Retrospectivos , Resultado do Tratamento
14.
Dent Traumatol ; 38(6): 487-494, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35950946

RESUMO

BACKGROUND/AIMS: Delayed treatment of a mandibular fracture can lead to complications. Therefore, early diagnosis is important. The aim of this study was to clarify the specific features of mandibular fractures in aged patients and the effect of age on possible missed diagnoses. MATERIAL AND METHODS: Patients aged over 60 years with a recent mandibular fracture were included in the study. The outcome variable was a missed mandibular fracture during the patient's first assessment in the primary health care facility. Predictor variables were age group, categorized as older adults (aged ≥60 and <80 years), elders (aged >80 years), patient's age as a continuous variable and age sub-group divided into decades. Additional predictor variables were the patient's memory disease and injury associated with intracranial injury. Explanatory variables were gender, injury mechanism, type of mandibular facture, combined other facial fracture, edentulous mandible/maxilla/both, surgical treatment of the mandibular fracture, and scene of injury. RESULTS: Mandibular fractures were missed in 20.0% of the 135 patients during their first healthcare assessment. Significant associations between missed fractures and age group, gender, fracture type, or injury mechanism were not found. By contrast, memory disorder (p = .02) and site of injury (p = .02) were significantly associated with missed fractures. Fractures were missed more frequently in patients who were in hospital or in a nursing home at the time of injury. CONCLUSIONS: There is an increased risk of undiagnosed mandibular fractures in the aged population. Small injury force accidents may cause fractures in old and fragile individuals. Careful examination is necessary, especially in patients with memory disorder.


Assuntos
Fraturas Mandibulares , Fraturas Cranianas , Humanos , Pessoa de Meia-Idade , Idoso , Fraturas Mandibulares/complicações , Fraturas Mandibulares/terapia , Mandíbula , Transtornos da Memória/complicações , Estudos Retrospectivos
15.
J Oral Maxillofac Surg ; 80(11): 1731-1739, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35952723

RESUMO

Dental occlusion ties (Minne Ties®) are a new example of the concept of an oral zip tie used to establish maxillomandibular fixation (MMF). Each tie uses a blunt introducer that is easily passed between embrasures and fed through a self-locking, unidirectional clasp. Five to six ties are used to establish MMF. They are fast, easy to use, and relatively safe because there are no sharps or wires associated with their use. The authors report their experience using this MMF method for temporomandibular joint replacement surgery, where over the last 2 years, over 65 collective cases have been completed using this method.


Assuntos
Fios Ortopédicos , Oclusão Dentária , Técnicas de Fixação da Arcada Osseodentária , Fraturas Mandibulares , Articulação Temporomandibular , Humanos , Fraturas Mandibulares/cirurgia , Articulação Temporomandibular/cirurgia
16.
J Oral Maxillofac Surg ; 80(10): 1641-1654, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35922010

RESUMO

PURPOSE: Despite decades of study, a consensus on therapeutic approaches to condylar fractures remains elusive, and the vexing question of invasive or noninvasive therapy remains to be definitively answered. This randomized clinical study aimed to compare the outcomes of mandibular condylar fractures (MCFs) treated by closed reduction (CR) with those treated by open reduction and internal fixation (ORIF). METHODS: The investigators designed and implemented a randomized controlled trial composed of patients with unilateral or bilateral MCFs. Patients were randomly allocated into the ORIF and CR groups. The primary predictor variable was treatment, either CR or ORIF. The primary outcome variable was temporomandibular joint function (pain and range of motion) assessed at 1 and 6 weeks and at 3, 6, and 12 months. The secondary outcomes included occlusion and complications (deviation, facial nerve injury, and scarring). Perioperative covariates included fracture displacement, ramus height loss, and associated mandibular fractures. The effect of treatment group on each of the 12-month outcomes was assessed using the χ2 test or the independent samples t test. A 5% significance level was used. RESULTS: A total of 116 patients with MCFs were included in the study. Sixty-eight (59%) and 48 (41%) patients were treated by CR and ORIF, respectively. No statistically significant differences were observed between the 2 groups for mouth opening (P = .073, protrusion (P = .71), laterotrusive movements toward fractured side (0.080), and nonfractured side (P = .28). The median pain scores decreased from 4 (interquartile range [IQR] 3 to 4) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks and 6 (IQR 5 to 6) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks in the CR and ORIF groups, respectively. Statistically significant differences between the groups were observed for the outcome of malocclusion (P = .040) and deviation (P < .0001). Ramal height loss (P = .013) and angle of displacement (P = .0084) were significantly associated with the presence of complications in the CR group. CONCLUSIONS: The results of the present study have shown that both treatment options for MCFs yield acceptable results. However, CR yielded more complications, especially in patients with bilateral MCFs, ramus height loss greater than 5 mm, and angle of displacement greater than 15°.


Assuntos
Fraturas Mandibulares , Fixação Interna de Fraturas/métodos , Humanos , Côndilo Mandibular/lesões , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/cirurgia , Dor , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
17.
J Nepal Health Res Counc ; 20(1): 207-212, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35945877

RESUMO

BACKGROUND: Mandibular angle fracture are frequently associated with presence of third molar. This study aimed at assessing the role of third molar with angle fracture in relation to its positioning and the remaining bone between the apex of third molar and inferior border of mandible. METHODS: A retrospective study of all patients who reported for treatment of mandibular fracture between January 2019 to January 2021 were undertaken. Patient's data and orthopantamogram radiographs were obtained from there medical records. The collected data included presence/absence of mandibular angle fracture, presence/absence of mandibular third molar, angulation and positioning of third molar along with residual bone height. Statistical analysis was done in SPSS version 20 with p-value set at p<0.05 Results: Total of 86 mandibular fracture reported in the study period, of which 34 (39.53%) had angle fracture. Third molar was present in 31 (45.6%) cases and was associated with angle fracture with statistical significance of p<0.026. Mesioangular impaction (86.4%) with class II (57%) ramus relation and position B (72.7%) in occlusal relation were associated with angle fracture in comparison to non-angle fracture group where angulation and occlusal position were statistically significant p<0.001 and p=0.002, respectively. Residual bone height was also found to be less in angle fracture group in comparison to other mandibular fracture group showing statistical significance (p<0.023). CONCLUSIONS: Patient with partially erupted mandibular third molar are more frequently associated with angle fracture and the residual bone height could also be a good predictor for risk of angle fracture.


Assuntos
Fraturas Mandibulares , Humanos , Mandíbula/diagnóstico por imagem , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/etiologia , Dente Serotino/diagnóstico por imagem , Nepal/epidemiologia , Estudos Retrospectivos
18.
J Oral Maxillofac Surg ; 80(10): 1628-1632, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35841943

RESUMO

PURPOSE: Literature describing the number of patients that had a facial fracture that required surgical intervention in the United States is very limited. The purpose of this study was to evaluate the percentage of patients who required surgical intervention after presenting to a Level 1 Trauma Center with 1 or more facial fractures. MATERIALS AND METHODS: This was a retrospective cross-sectional study of all patients who presented with facial fracture(s) to University Hospital, a Level 1 Trauma Center (San Antonio, Texas), over a 5-year period from July 2015 to July 2020. Patients' charts that had 1 or more International Classification of Diseases 10 codes pertaining to facial fractures were collected. Cases were subdivided by fracture location: mandible, midface, upper face, or a combination of any of the aforementioned locations (predictor variables). After subdividing based on location, each chart was then reviewed and separated based on whether or not surgical intervention was provided (primary outcome variable). Data were tabulated and analyzed with descriptive and inferential statistics. RESULTS: Over the 5-year period, 3,416 patients presented with facial fractures. Of the 3,126 patients who survived their injuries and were not lost to follow-up, the vast majority (80.9%) did not require surgical intervention for their facial fractures. Mandible fractures required surgical intervention, whether isolated or in combination, much more frequently than in patients who did not have any type of mandible fracture (RR 8.01, 95% CI 6.92-9.27, P < .05 and RR 4.60, 95% CI 3.42-6.18, P < .05, respectively). Patients aged 50 years or less were also more likely to receive surgical intervention than those aged 51 years and more (RR 1.98 95% CI 1.63-2.41, P < .05). CONCLUSIONS: The vast majority of facial fractures that present to a Level 1 Trauma Center do not require surgical intervention. Patients who present with any type of mandible fracture and are aged 50 years or less are more likely to need surgical intervention.


Assuntos
Fraturas Mandibulares , Fraturas Cranianas , Estudos Transversais , Ossos Faciais/lesões , Ossos Faciais/cirurgia , Humanos , Fraturas Mandibulares/cirurgia , Estudos Retrospectivos , Fraturas Cranianas/cirurgia , Centros de Traumatologia , Estados Unidos
19.
Br J Oral Maxillofac Surg ; 60(9): 1202-1208, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35817638

RESUMO

This single-centre retrospective study aimed to characterise the epidemiology, management, and outcomes of mandibular trauma presenting to the same tertiary trauma centre 30 years apart, including key paradigm shifts in management and techniques. A total of 393 patients presenting with 665 mandibular fractures were managed by the Oral and Maxillofacial Surgery department at The Royal Melbourne Hospital (RMH), Australia, between 2011 and 2016. Data from a previous RMH paper of 205 patients presenting with 376 mandibular fractures between January 1985 and April 1990 were compared. Results showed an increase in presentations (205 to 393 patients) with an increase in the incidence of mandibular trauma (p = 0.0001), females (12% to 14%), and mean age (29 to 31.1) years. Young males remained the dominant cohort (86%) and interpersonal violence (IPV) the most common aetiology (46% to 43%). Mandibular fractures remained commonly associated with other systemic injuries (49% to 42%), occurring most frequently on the left (49%), and at the angle (29.8%), with most occurring at two sites (53%). Significant paradigm shifts in the management of mandibular trauma saw a reduced need for intermaxillary fixation (76% to 30%, p = 0.0001), increased use of extraoral approaches to the fracture, and the use of semi-rigid internal fixation along ideal lines of osteosynthesis (29% to 87%, p = 0.0001). This demonstrated decreased complications including malocclusion, non-union and delayed union, and permanent nerve injury. There was no significant change in infection, dehiscence rates, and temporary nerve damage.


Assuntos
Má Oclusão , Fraturas Mandibulares , Masculino , Feminino , Humanos , Adulto , Fraturas Mandibulares/epidemiologia , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/etiologia , Estudos Retrospectivos , Fixação Interna de Fraturas/métodos , Má Oclusão/etiologia , Centros de Traumatologia
20.
J Craniofac Surg ; 33(6): e636-e641, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35882243

RESUMO

PURPOSE: The purpose of this study is to use a digital guide plate for joint positioning to assist the reduction of condylar neck fractures and evaluate the accuracy of the reduction after surgery. MATERIALS AND METHODS: In this study, 20 patients were selected from January 2016 to October 2020, and the reduction of the mandibular condyle neck fracture was designed virtual and digital based on the computed tomography data of the patients, based on the position of the condyle in the articular socket, the height of the ascending mandibular ramus, and the joints. The average value of the anterior space and the posterior space of the joint is these indicators, the position of the condyle is reconstructed, and the fracture reduction finger guide plate is designed. During the operation, the digital guide plate is used to assist the reduction of the condyle neck fracture. The postoperative follow-up was 4 to 12 months to check the accuracy of the reduction. RESULTS: A total of 20 patients, all fractures achieved complete bone healing, the patients' mouth opening was normal, no obvious complications were found, and none of the patients had facial paralysis. In the postoperative evaluation and preoperative virtual design plan, the chromatographic error was within 2 mm, and the magnetic resonance of the temporomandibular joint showed no displacement of the articular disc. CONCLUSION: The digital joint guide can reduce the fracture of the condyle neck while ensuring the position of the condyle in the joint socket, which is beneficial to reduce the occurrence of subsequent temporomandibular joint complications.


Assuntos
Luxações Articulares , Fraturas Mandibulares , Transtornos da Articulação Temporomandibular , Humanos , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Tomografia Computadorizada por Raios X/métodos
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