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RESUMEN: Introducción: Las fracturas mandibulares producen serias comorbilidades, alteraciones en la función, calidad de vida entre otros. Existen distintas alternativas quirúrgicas en las fracturas favorables de ángulo mandibular, siendo las más utilizadas las técnicas de estabilización mediante miniplacas de titanio. No existe consenso sobre si es más efectivo y seguro utilizar una o dos miniplacas de titanio. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 7 revisiones sistemáticas que en conjunto incluyeron 17 estudios primarios, de los cuales 3 son ensayos aleatorizados. Concluimos que el tratamiento de estabilización mediante una miniplaca de titanio probablemente disminuye el riesgo de paresia facial. Por otro lado, el uso de una miniplaca podría aumentar el riesgo de dehiscencia de la herida quirúrgica, disminuir el riesgo de reintervención quirúrgica y podría resultar en poca o nula diferencia en el riesgo de maloclusión, pero la certeza de la evidencia es baja. No está claro si el uso de una en comparación con dos miniplacas de titanio reduce el riesgo de infección y parestesia ya que la certeza de la evidencia disponible es muy baja.
ABSTRACT: Introduction: Mandibular fractures produce severe comorbidities, functional alterations, changes in the quality of life, among others. There are different surgical alternatives for favorable mandibular angle fractures; the most used is the stabilization techniques using titanium miniplates. There is no consensus on which it is more effective and safe; use one or two titanium miniplates. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified seven systematic reviews that included 17 primary studies, in which three were randomized trials. We conclude that stabilization treatment with a titanium miniplate probably reduces the risk of facial paresis. On the other hand, the use of a miniplate could increase the risk of dehiscence of the surgical wound, decrease the risk of reoperation, and could result in little or no difference in the risk of malocclusion, but the certainty of the evidence is low. It is not clear whether the use of one compared to two titanium miniplates reduces the risk of infection and paresthesia since the certainty of the available evidence is very low.
Subject(s)
Humans , Titanium , Dental Plaque , Mandibular FracturesABSTRACT
OBJECTIVES: We compared the transbuccal and transoral approaches in the management of mandibular angle fractures. MATERIALS AND METHODS: Sixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant. RESULTS: No significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up. CONCLUSION: The transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.
Subject(s)
Humans , Cicatrix , Cicatrix, Hypertrophic , Follow-Up Studies , Mandible , Operative Time , Postoperative Complications , Prospective StudiesABSTRACT
Aim: The study aimed to answer for the question whether a tooth in line of fracture predispose to complications such as infection and thereby warranting removal of the plates. Materials and Methods: Surgically rehabilitated patients for unilateral angle of mandible fractures at author’s center from 2000 to 2013 were considered in this study. During the study period, about 116 cases fulfilled the inclusion and exclusion criteria, and hence included in this study. All patients were treated by open, rigid fixation. Results: During the fracture reduction and immobilization, 52.6% (n = 61) cases, the third molar was extracted and in 47.4% (n = 55) cases, the tooth was preserved. Only two cases of infection that required the plate removal occurred by 3 months and another one case within the next 6 months. When the tooth in question was removed, infection did not occur. In all, 52.72% (n = 29) of the 55 cases preserved were needs to be extracted for various reasons. The most common being periodontal causes followed by periapical pathology. Statistically the relationship between demographic data and outcome measures were analyzed using Chi‑square test bivariate statistics. A P ≤ 0.05 was taken as significant. Conclusion: The present study fails to identify any concrete factors that would predict the failure of the retained third molar that were involved in the line of mandibular fractures. The proof presented here, especially with low complication rates indicate that all impacted third molar along the line of fracture be removed and unless necessary, the partially erupted teeth would also be extracted. In such a situation, the rate of infection and survival of the third molar would have been entirely different.
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Rigid internal fixation of the jaw bones is a routine procedure for the management of facial fractures. Titanium plates and screws are routinely used for this purpose. The limitations of this system have led to the development of plates manufactured from bioresorbable materials which, in some cases, omits the necessity for the second surgery. However, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. The following case report tries to evaluate the treatment of mandibular angle fracture via a single biodegradable plate and address complication such as malocclusion, infection, soft tissue dehiscence and nonunion in these patients.
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The study was performed on 40 patients who reported the department of oral & maxillofacial surgery Indira Gandhi Government Dental College Jammu with trauma sustaining mandible, midface injuries along with other body injuries. Those patients were selected who had isolated, unilateral mandibular angle fracture. Patients were selected for the treatment method depending on degree of nerve injury (paresthesia , dysesthesia or anesthesia) & approximate gap between two fractured fragments on OPG. Neurosensory deficit due to inferior alveolar nerve damage was compared with other normal side. The aim of this study was to find out response of inferior alveolar nerve to mandible angle fracture, whether inferior alveolar nerve is always injuried as reported in literature & what type of injuries are most commonly seen. The study also was aimed to know how much displacement/gap between the fragments will lead to paresthesia of lower lip & chin & postoperative recovery thereof.
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Subject(s)
Humans , Dental Occlusion , Incidence , Mandibular Fractures , Medical Records , Molar , Molar, Third , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCTION: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. MATERIALS AND METHODS: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. RESULTS: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. CONCLUSION: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients' discomfort and simplify the surgical procedure.
Subject(s)
Humans , Anesthesia, General , Cicatrix , Facial Nerve Injuries , Heart , Mandible , Mandrillus , Paresthesia , Prospective Studies , Surgery, OralABSTRACT
Subject(s)
Displacement, Psychological , Finite Element Analysis , Mandible , Neck , Polymers , TitaniumABSTRACT
PURPOSE: The aim of this study is to analyze the correlation between incidence of mandibular angle fracture and eruption state of mandibular third molar using clinical and radiographic findings. MATERIALS AND METHODS: The data were obtained from the clinical and radiographic records of 205 patients who visited the Department of Oral and Maxillofacial Surgery, Chonbuk National University Hospital for treatment of the mandibular fracture. Panoramic radiographies were taken for radiographic examination and the mandibular third molars were classified according to age, gender, position and eruption state. Data were analyzed by a chi-square statistics. RESULTS: In this study, the incidence of mandibular angle fracture had a tendency to be greater when a mandibular third molar was present(p>0.05), but there was not a statistically significant difference. Of the 255 cases with a mandibular third molar, 67 had an angle fractures. Of the 155 cases without a mandibular third molar, 138 had not angle fracture. And the incidence of mandibular angle fracture was high at class BII(by Pell & Gregory system) (p<0.05). CONCLUSION: Although there was not a statistically significant difference, mandibular third molar was more susceptible to mandibular angle fracture. When the reduction of mandibular angle fracture, it was recommended that mandibular third molar should be extracted especially in case of pericoronitis, periodontitis and other infections.
Subject(s)
Humans , Incidence , Mandibular Fractures , Molar, Third , Pericoronitis , Periodontitis , Radiography, Panoramic , Surgery, OralABSTRACT
In an open reduction of the mandibular angle fracture, it is crucial to approximate each fracture segment as closer as possible for the reduction of the healing period. In this case report, we proposed a new technique for the mandibular angle fracture. This was designed to minimize the gap between two separated segments using mini-implants and surgical wires. Mini-implants were placed around the fracture line, followed by wire ligation to minimize the fracture gap. And then internal fixation was easily employed with plates and screws. The advantages of this technique were reduced time for operation, the promotion of healing, rapid functional recovery, and few complications.
Subject(s)
LigationABSTRACT
There are various surgical fixation techniques for fractures of the mandible angle due to traumatic facial injuries. Among those surgical treatment modalities, fixation methods using plates, screws, lag screws and wires have been commonly used. With the introduction of absorbable plates, the plate fixation technique has been popularized. However, plate fixation requires an external incision or an external approach using trochar for the direction of screw fixation to be perpendicular to the mandible. The external approach has disadvantages in that it leaves a scar and involves some risk to damage the marginal mandibular branch of the facial nerve. To overcome these disadvantages, the authors used a plate platform formation technique on the fractured mandible angle. The result was satisfactory with no complications. Plate platform formation technique, as performed by the authors, can be a new and simple surgical technique for stable fixation and with minimal postoperative complication by an internal approach to avoid an external scar and nerve injury.
Subject(s)
Cicatrix , Facial Injuries , Facial Nerve , Mandible , Postoperative ComplicationsABSTRACT
0.05). In the extracted or non extracted of mandibular third molar, the post operative infection showed no statistical significant difference(P>0.05). With the results mentioned above, mandibular third molar was significantly more susceptible to mandibular angle fracture. In the reduction of mandibular angle fracture, it was recommended that mandibular third molar should be extracted especially in case of pericoronitis, periodontitis and other infections.
Subject(s)
Humans , Dental Occlusion , Facial Bones , Incidence , Mandibular Fractures , Molar, Third , Pericoronitis , Periodontitis , Tooth, ImpactedABSTRACT
Subject(s)
Humans , Follow-Up Studies , Hospitalization , Jaw Fixation Techniques , OutpatientsABSTRACT
The management of the third molar tooth in mandibular angle fracture is still controversial. Retrospective analysis of 197 cases of mandibular angle fractures associated with third molar tooth was undertaken. Selective prophylactic extraction of the third molar teeth were undertaken in 66 cases. The third molar teeth were retained in 131 fractures. The indication of extraction of the third molar teeth in mandibular angle fracture were as follows: 1) interfering with reduction of the fracture; 2) excessive mobility; 3) exposure of tooth root due to distraction of the fracture; 4) fractured teeth; 5) severely carious tooth 6) infected supporting structure. There were no significant differences between the complication rate in the "tooth removed" group and "tooth retained" group. Complications were minimal. Therefore proper management of the third molar tooth in mandibular angle fracture will minimize complication.
Subject(s)
Molar, Third , Retrospective Studies , Tooth Root , ToothABSTRACT
After miniplate fixation of mandibular angle fractures, fracture line stability during functional loading was evaluated. Using panoramic radiographs, 15 mandibular angle fracture patients who were treated by open reduction and one miniplate fixation along the external oblique ridge, were evaluated at postoperative 1, 4 and 8 weeks. At each time, 2 radiographs were taken: one taken during maximum biting of hardened silicone sheet on the affected side molar area and the other on the non-affected side. The distraction gap of inferior border of mandible at each time and each side was measured and these data were analysed statistically with clinical findings. The differences of inferior border distraction gap during hardened silicone sheet biting on the affected side molar area and on the non-affected side molar area at 4 week radiographs were smaller than those of 1 week's except one case. At 8 week's radiographs, the fracture lines were so stabilized that it was almost impossible to find the gap differences except one case and there were increased radiopacity along the entire fracture lines. Clinically, bony union was confirmed in all cases during plate removal performed at postoperative 6 month. By statistical analysis(paired t-test), the inferior border distraction gap during biting of hardened silicone sheet on the affected side was significantly reduced during 1 and 4 week interval(p<0.01). The differences of inferior border distraction gap during biting on the affected side molar area and on the non-affected side molar area were also significantly reduced at 1 and 4 week interval(p<0.01). But the inferior border distraction(compression) gap during non-affected side biting was not significantly changed. From these findings, it could be concluded that fracture line stability during functional loading after one miniplate fixation of mandibular angle fractures stems mainly from reduction of inferior border distraction gap during affected side biting on time interval. According to these radiographic and clinical findings, the clinical superiority of one miniplate fixation technique in mandibular angle fracture treatment could be confirmed.
Subject(s)
Humans , Mandible , Molar , SiliconesABSTRACT
Until now, many kinds of treatment modalities for mandibular angle fractures have been proposed. about among them, the semi-rigid fixation using miniplates has become a most popular procedure due to its simplicity and good clinical results in nowadays. When we use miniplates according to Champy's ideal osteosynthesis line principles for mandibular angle fracture treatment, we generally perform reduction and fixation procedures under the condition of maxillomandibular fixation(MMF) using arch-bars. But in so doing, due to various reasons, we occasionally observe gapping or torqueing of inferior border of mandibular angle after completion of miniplate fixation. In contrast to MMF state, we can observe intimate reduction of inferior border of mandibular angle due to compressive force and gapping of superior border due to tensile forces during wide mouth opening state. So we developed a new technique which uses bone reduction forceps(or modified towel clips) as a temporary fixation device during wide mouth opening state for intimate reduction and stability along the entire fracture line. By applying this new technique for mandibular angle fracture treatment, it was possible for us to perform easy and accurate miniplate fixation for last 1 year period with clinical success. This article presents some case reports of mandibular angle fracture patients who were treated by this new technique and discussions about the reliability and advantages of this technique.