Open reduction and internal fixation of mandibular angle fractures: does the transbuccal technique produce fewer complications after treatment than the transoral technique?

PURPOSE: The study's purpose was to answer the following clinical question: in patients with mandibular angle fractures requiring open reduction and internal fixation, do those who have fixation screws inserted using a transbuccal approach compared with those with fixation screws inserted using a transoral approach have fewer complications after treatment? The investigators hypothesized that the transoral approach was associated with a higher risk of complications. MATERIALS AND METHODS: A multicenter retrospective cohort study was performed in patients who had open reduction and internal fixation of mandibular angle fractures from 2008 to 2010 within Western Australia. Patients were divided into transbuccal and transoral groups and then further subdivided into groups with and without fixation failures (primary outcome variable) and statistically compared. Binary logistic regression was used to control for possible confounders, which included patient gender, age, a wisdom tooth within the fracture not extracted, dental caries, partial dentition, bilateral/unilateral fractures, and smoking. RESULTS: In total 597 patients were in the study. Sixteen percent of patients in the transoral group had complications after treatment versus 10% in the transbuccal group. For the transoral technique, the odds of having fixation failure was 1.71 times greater than with the transbuccal technique (95% confidence interval, 1.02 to 2.93; P = .04). Incidences of all complication variables (hardware loosening/fracturing, wound dehiscence, secondary infection, surgery redo, nonunion/malunion of fracture, and removal of plate) were lower in the transbuccal group apart from plate fracture. CONCLUSION: The transbuccal technique was associated with fewer complications after treatment compared with the transoral technique.

The effect of mouthguard design on respiratory function in athletes.

OBJECTIVE: To test the hypothesis that 2 types of custom-made mouthguards will have no effect on ventilation (.V(E), L·min⁻¹), oxygen uptake (.VO2, mL·kg⁻¹·min·â»¹), and heart rate (beats per minutes) at varying exercise intensities (10 km·h⁻¹ and 12 km·h⁻¹) and at subjective maximal effort (.VO2peak) in male field hockey and water polo players. DESIGN: A randomized, prospective, crossover study. SETTING: The Physiology Testing Laboratory, School of Sports Science, Exercise and Health at the University of Western Australia, a tertiary educational institution. PARTICIPANTS: Twenty-seven male team-sport athletes. INTERVENTIONS: Each athlete participated in 3 experimental exercise sessions separated by 1-week intervals. Testing involved a graded exercise test (GXT) performed on a treadmill wearing either a custom laminated mouthguard with normal palatal surface, a custom laminated mouthguard with palatal coverage up to the gingival margin, or no mouthguard. The experimental trials were performed in a random counterbalanced order. MAIN OUTCOME MEASURES: .V(E) (L·min⁻¹) and .VO2 (mL·kg⁻¹·min·â»¹) were measured during the GXT at intensities that equated to 10 km·h⁻¹, 12 km·h⁻¹ and subjective maximal effort (.VO2peak). RESULTS: There were no significant differences between trials for .V(E) (L·min⁻¹) and .VO2 (mL·kg⁻¹·min·â»¹) at any of the intensities assessed (P < 0.05). CONCLUSIONS: The wearing of 2 different custom-made mouthguards during a GXT did not impair .V(E) or .VO2 during varying levels of exercise intensity in team sport athletes.