A Study Of Mandible Fracture Cases A - Prospective Observational Study

Background:Mandible fractures constitutethe substantial proportion of cases of maxillofacial trauma . This study is to evaluate and compare cases of mandibular fracture based on its etiology, age, gender, anatomical distribution and treatment modalities.Material And Methods:The study was carried out on 72 cases of mandible fracture patients who were admitted in Otorhinolaryngology department of Sir.T.Hospital and Government Medical College, Bhavnagar from August 2019 to August 2020.Result:Age: <10years –12.8%, 11 to 20years –24.8%, 21 to 30years -29%, 31 to 40years –22%, 41 to 50years –6.4%, >50years-5%.Gender:Male-81.3%, Female-18.7% .Etiology:Road traffic accidents-62%, fall down-22%, assault-12.8%, sports-3%. Site Of Fracture:Body of mandible -30%, angle-25%, condyle-20%, parasymphysis-14%, symphysis-6%, ramus-3%, coronoid-2%.Treatment:Plating-24%, wiring-11.9%, Plating+wiring-60%, conservative –4.1%. Conclusion:Age:The age group between 21 to 30years of age were most commonly affected.Gender: Males are more commonly affected than females.Cause:Road Traffic Aaccidentsbeing the most commom cause of mandible fracture.Site:Body of mandible being the most common site to be fractured followed by angle and condyle of mandible. Mode Of Treatment:Plating And Wiring was the most common surgical method required for the fracture treatment.

Design and application of new training device of mouth opening / 医疗卫生装备

Objective To design a new type of mouth opening training device.Methods The device had a semicircular structure,and was composed of upper and lower bite blocks,a spring and a regulation mechanism.The bite blocks were made by one-step injection molding,and the spring and regulation mechanisen were manufactured by metal forming.Totally 88 patients with restriction of mouth opening after mandible fracture surgery in the oral surgery department from January to December 2016 were randomly divided into two groups,and each group had 44 patients.The control group used the traditional bite block for mouth opening training,and the experimental group applied the developed training device.Training was started 10 d after surgery,and the training time lasted 3 to 6 months.Results The experiment group behaved significantly better than the control group in maximal mouth opening (P＜0.05) and patient comfort (P＜0.01).Conclusion The training device gains advantages in easy operation,patient comfort,flexibility for regulation,cleaning and maintenance and patient compliance,and thus is worthy promoting clinically.

A comparative study of three maxillofacial trauma scoring systems in mandible fracture grading / 实用口腔医学杂志

Objective:To compare 3 maxillofacial trauma scoring systems in mandible fracture grading.Methods:Maxillofacial Injury Severity Score(MISS),Maxillofacial Injury Severity Score(MFISS),Mandible Injury Severity Score(S5)were used in the analysis of mandible fracture severity in 313 cases with mandible fractures.The results were statistically analyzed.Results:S5 score showed higher correlation with operation time,operation charge and hospitalization expenses than MFISS and MISS,and it could distinguish single and multiple mandible fractures effectively.It was also a significant factor affecting the cost of hospitalization.Conclusion:The Mandible Injury Severity Score was more suitable for the scoring of mandible fracture.

Tratamiento de fracturas en mandíbulas atróficas: presentación de dos casos clínicos / Management of Atrophic Mandible Fractures: Report of Two Clinical Cases

El siguiente trabajo tiene por objetivo presentar la experiencia del equipo de Cirugía Maxilofacial del Hospital San José, para el manejo de las fracturas en mandíbulas atróficas, reportando el tratamiento médico-quirúrgico y evolución post operatoria de casos clínicos. Se presentan dos casos clínicos de pacientes de sexo femenino, con enfermedades sistémicas de base, edéntulas, con diagnóstico de fractura en mandíbula atrófica consecutivos a caídas de nivel. De los casos tratados, el equipo logró resultados satisfactorios, mediante un tratamiento integral para los pacientes con este tipo de fracturas, basado en protocolos actuales encontrados en la literatura. El tratamiento de elección para este tipo de fracturas corresponde a la reducción anatómica quirúrgica y fijación mediante placas y tornilos de osteosíntesis. Fundamentado por sus favorables resultados y a la rápida rehabilitación funcional del paciente. El manejo multidisciplinario es fundamental para tratar este tipo de pacientes, por la posible concomitancia de enfermedades de base que pudiesen poseer estos pacientes.

The objective of the present case report is to present the experience of the maxillofacial surgery team of the Hospital San Jose in the management of atrophic mandible fracture, through the medical-surgical treatment and post-operatory evolution of two clinical cases. We studied two women with systemic conditions, edentulous with a diagnosis of atrophic mandible fracture subsequent to fall injury. In all treated cases the surgical team achieved satisfactory results through an integral treatment of patients with this type of fracture, based on actual literature reported protocols. The treatment of choice for this type of fractures is an anatomical open reduction, by internal fixation with osteosynthesis plates and screws on the basis of favorable results and functional rehabilitation of patients. The multidisciplinary management is fundamental for treatment of this type of patient due to the concomitant systemic conditions of these patients.

A Case Report: Correction of Facial Asymmetry using Mandible Angle Ostectomy in Patient with Previous Mandible Fracture

PURPOSE: After surgical interventions of mandible fractures, facial asymmetry can be occurred, and it leads to serious problems for patients. This can be solved by mandible angle ostectomy. METHODS: A 19-year-old male underwent percutaneous surgical intervention for left mandibular angle and right parasymphyseal fractures 3.5 years ago. The left angle was protruded compared to the other side. Using a percutaneous approach, 4.5x1cm sized piece of mandible angle was sawed off. For the right angle, intraoral approach was performed for angle ostectomy, and the angle was sawed off by a size of 4x1cm, using a pattern based on the piece from the left side. RESULTS: After surgery, no complications such as subcondylar fractures, refractures, insufficient corrections, secondary angle formations, hematomas, and transient nerve palsies were seen, and symmetric correction of mandible angles were done. CONCLUSION: In facial asymmetries due to mandibular fractures, mandible ostectomy could be a solution. Using the bone section from the contralateral side, measurement of the amount of bone sawed off was possible, and via percutaneous approach on the previously operated site with simultaneous scar revision, and intraoral approach for the contralateral side, cosmetically satisfactory result was obtained.

Post traumatic malocclusion and its prosthetic treatment

Mandible fractures belong to the most common fractures encountered in maxillofacial trauma. Because mandible is such a unique structure with hinge joint and masticatory muscles attached to the body of mandible, attention must be paid to avoid displacement during treatment. Displacement during fracture reduction leads to malocclusion. Many TMJs function with complete comfort and apparent normalcy in adapted centric posture, even though they have undergone deformation caused by trauma. This clinical report describes the patient with post traumatic malocclusion and its prosthetic treatment. His fractured mandible was openly reduced in changed position, as a result his occlusion has been changed. He was treated by prosthetic method in so-called adapted centric posture.

Antibiotic prophylaxis in the operation of the closed mandibular fractures and the efficacy of postoperative antibiotics

PURPOSE: This study compared the frequency of postoperative infections in patients for a closed mandibular fracture with that without the ostoperative antibiotic prophylaxis. Patients and Methods: 48 patients without any specific medical history were divided into two groups depending on whether or not antibiotics had been applied after the surgery. The 24 patients in group 1 received only a second-generation cephalosporin (Cefotetan(R)) ntravenously from admission to immediate after the surgery. Likewise, 24 patients in group 2 received 1.0g of Cefotetan(R) twice daily longer than the third day after surgery. The mean (SD) duration of antibiotics administration after surgery was 6.9 (+/-3.56). The patients were evaluated after surgery for any postoperative infections according to the criteria: purulent drainage from a wound, spontaneous wound dehiscence accompanied by swelling, pain, and fever around the wound. RESULTS: Postoperative infections were encountered in 2 out of 24 patients in group 1, who received antibiotic medication until shortly after surgery, and in 3 out of the 24 patients in group 2, in whom the medication was continued even after the surgery. There was no sig nificant difference in the incidence of postoperative infections between the two groups. CONCLUSION: From this study, postoperative use of antibiotics seems to be unnecessary with view of the little significance of the factors that could affect the wound infection.

Antibiotic prophylaxis in the operation of the closed mandibular fractures and the efficacy of postoperative antibiotics

PURPOSE: This study compared the frequency of postoperative infections in patients for a closed mandibular fracture with that without the ostoperative antibiotic prophylaxis. Patients and Methods: 48 patients without any specific medical history were divided into two groups depending on whether or not antibiotics had been applied after the surgery. The 24 patients in group 1 received only a second-generation cephalosporin (Cefotetan(R)) ntravenously from admission to immediate after the surgery. Likewise, 24 patients in group 2 received 1.0g of Cefotetan(R) twice daily longer than the third day after surgery. The mean (SD) duration of antibiotics administration after surgery was 6.9 (+/-3.56). The patients were evaluated after surgery for any postoperative infections according to the criteria: purulent drainage from a wound, spontaneous wound dehiscence accompanied by swelling, pain, and fever around the wound. RESULTS: Postoperative infections were encountered in 2 out of 24 patients in group 1, who received antibiotic medication until shortly after surgery, and in 3 out of the 24 patients in group 2, in whom the medication was continued even after the surgery. There was no sig nificant difference in the incidence of postoperative infections between the two groups. CONCLUSION: From this study, postoperative use of antibiotics seems to be unnecessary with view of the little significance of the factors that could affect the wound infection.

A Clinical Study of Mandible Fracture for 10 Years at Chuncheon City

The Result of Mandible Fracture Fixations with Biodegradable Materials

PURPOSE: Traditionally, titanium miniplate has been used for rigid fixation of mandible fractures. However, the limitations of metal plate have been reported such as hypersensitivity, interference with the cranio-facial growth of growing child, secondary bone resorption around the plate, foreign body reaction, declination of primary callus formation, and bone atrophy, and so forth. Recently, biodegradable miniplate has been introduced and used as an alternative to the metal plate despite of its lower strength. This study evaluated the usefulness and stability of biodegradable plate and screw for treatment of mandible fractures. METHODS: In this study, 61 patients(92 areas) diagnosed as mandible fracture in the last 2 years have been reviewed. We used titanium plate and screw in 32 patients, and biodegradable plate and screw(INION?) in 29 patients. Stability of plates and screws, bony healing process and its side effects were observed by clinical and radiographic assessment. RESULTS: In the titanium material group, one of malocclusion, two of mouth opening limitation, three of pain, three of palpation were shown. The plate of six patients involved in these complications were removed. In the biodegradable group, two of mouth opening limitation, two of pain, one of localized wound infection were shown and one plate was removed secondarily. CONCLUSION: There was no statistical difference between two groups in bony healing and complication rates. Biodegradable implants show efficient stability during initial bone healing and low side effects in long-term follow up periods.

Fractura de mandíbula por trauma facial: incidencia, clasificación y tratamiento en el servicio de maxilo facial del hospital Luis Vernaza de Guayaquil, enero 2003 – diciembre 2004 / Jaw fracture by facial trauma: incidence, classification and treatment at the maxilla facial service from Luis Vernaza hospital of Guayaquil january 2003-december 2004

Tipo de estudio: retrospectivo, descriptivo, longitudinal. Objetivo: conocer la estadística sobre las fracturas de mandíbula en determinado hospital de nuestro país, con el fin de manejar datos de nuestra realidad y no basarnos solo en estadística extranjera. Materiales y métodos: se estudio la incidencia, clasificación y tratamiento en 42 pacientes con fractura de mandíbula, en los cuales se analizaron las variables: edad, sexo, etiología, tipo de fractura según el sitio anatómico, procedencia, dentición, Diagnóstico por imágenes y tratamiento. Resultados: Los 42 pacientes que se estudiaron con diagnóstico de fractura de mandíbula por trauma facial corresponden al 58.3 dentro de las fracturas maxilofaciales que se atendieron en el servicio de otorrinolaringología. La mayor incidencia según: edad corresponde al grupo entre 15 a 25 años, con un 45.2; sexo: masculino con 92.86; etiología: agresión física 40.48. En la clasificación de fractura de mandíbula según la anatomía se presentaron 19 casos de fractura parasinfisiaria 28.36. En el tratamiento de reducción cerrada, 26 casos utilizaron férula de erich, 59 de todos los casos, en reducción abierta con mini placas fueron 16 los casos, 36.3; y 2 casos injerto óseo, 4.5. Conclusión: La mandíbula es uno de los huesos faciales que con mayor frecuencia se fractura por lo que constituye la lesión osea más frecuente de la región facial.

Type of study: retrospective, descriptive, longitudinal. Objective: Determine the incidence of mandible fractures at “Luis Vernaza” hospital. Material and Methods: We studied incidence, classification and treatment in 42 patients with mandible fracture according to age, sex, etiology, type of fracture, diagnosis and treatment. Results: There were 42 patients with mandible fraction due to facial trauma (58.3 of maxillofacial trauma) which was treated at the ear, throat, and nose service. The highest incidence was in age group 15-25, sex: male 45.2, etiology: physical aggression 40.48. When classifying mandible facture according to anatomic site the most common is the parasymphisis area 28.36. In the treatment of closed reduction erich arch bar was used 59 and in 16 cases the treatment was open reduction and used mini plates 36.3 and 2 cases of bone injert 4.5. Conclusion: The mandible is a facial bone where fractures are very common.

Post operative evaluation for retromandibular approach of subcondylar fractures

PURPOSE: The classic technique for open reduction of subcondylar fractures is the submandibular approach. The aim of this study was to evaluate clinical result of retromandibular approach to displaced subcondylar fractures. MATERIAL AND METHODS: During a period of 24months we perfomed a prospective study with a retromandibular approach in 23 paients with displaced subcondylar fractures. In this article we describe clinical result in 23 patients with follow ups for 3 months after surgery. Preoperatively all patients had malocclusion and radiology demonstrated displacement. RESULT: The retromandibularl approach for ORIF was good in all case. Mouth opening(M/O) was 49mm. Occlusion was good too. Permanent facial nerve palsy was not detected. CONCLUSION: Our findings indicate that the retromandibular approach is a safe technique for subcondylar fractures.

Fratura bilateral de mandíbula atrófica / Bilateral fracture in atrophic mandible

O aumento da população de idosos no Brasil trouxe um maior número de pacientes nessa faixa etária para o atendimento em diversas áreas da Odontologia. Os pacientes idosos estão expostos a vários tipos de agentes agressores, como quedas e acidentes que geram fraturas maxilofaciais, necessitando então do atendimento especializado do cirurgião bucomaxilofacial. Os idosos apresentam uma condição diferenciada, com alterações sistêmicas e utilização de vários fármacos, que precisam ser levados em conta no planejamento terapêutico de cada caso. O tratamento dos traumatismos faciais deve objetivar a rápida recuperação do paciente com a mínima morbidade. Os autores apresentam um caso de fratura bilateral de mandíbula em paciente geriátrico edêntulo, com atrofia severa, tratado com osteossíntese com placa e parafusos de titânio. A recuperação do paciente foi satisfatória, sem complicações pós-operatórias em 18 meses de controle

The increase of the elderly population in Brazil has brought a higher number of patients of this age level for dental treatment in several areas of dentistry. Elderly patients are exposed to many kinds of aggressor agents, such as falling down and accidents that cause maxillofacial fractures, which require the specialized assistance of a maxillofacial surgeon. The elderly present a differentiated condition involving systemic changes and use of several drugs that must be taken into consideration when planning the therapeutics of each case. The treatment of facial trauma must aim fast recovery along with minimal morbidity. The authors present a case of mandible bilateral fracture in edentulous elderly patient with severe atrophy, treated with titanium plate and screws osteosynthesis. The healing period was satisfactory, without postoperative complications in 18 months follow up.

The Operation of Facial Bone Fractures

Plastic surgeons who perform reconstructive surgery of facial injuries have a dual responsibility: repair of the aesthetic defect and restoration of the function. The third goal is to minimize the period of disability. although emergent situations are limited in facial injuries, I would like to emphasize the advantages of prompt definitive reconstruction of the injuries and the contribution of early operative intervention to the superior aesthetic and functional outcomes. Socioeconomic and psychological factors make it imperative that an aggressive, expedient, and wellplanned surgical program be outlined, operated, and maintained to rehabilitate the patient to return to his or her active and productive life as soon as possible while minimizing aesthetic and functional disabilities. Teaching points: the techniques of extended open reduction and immediate repair or replacement of bone and microvascular tissue transfer of bone or soft tissue have made extensive and challenging injuries manageable. The principle of immediate skeletal stabilization in anatomic position has been enhanced by the use of rigid fixation and the application of craniofacial techniques that is safer and less traumatic for facial bone exposure. In this article, I will present mandibular fracture, orbital wall fracture and maxillar fracture, which are commonly encountered facial bone injuries. We can improve both the functional and aesthetic outcomes of facial fracture treatment when we manage the patients with the current concept of craniofacial techniques based on precise anatomic knowledge.

The influence of the presence and impacted state of mandibular third molars on the incidence of mandibular condyle fracture

Two part mini-implant as an efficient tool for intermaxillary fixation

The prognosis of fixation of mandibular fractures with biodegradable plates and screws

Clinical Experiences of Acrylic Splint on Pediatric Mandile Fracture

The goal of open reduction in mandibular fracture is to restore the underlying bony architecture to its pre-injury position in a stable fashion, with a minimal of aesthetic and functional impairment. Many cases of mandibular fracture are treated by intermaxillary fixation using arch bars after open reduction. In this study, after open reduction of fracture, 23 patients were grouped according to acrylic splint appliction. All patients was younger than 15 years old. Open reduction was performed by miniplate or interosseous wire fixation. After open reduction, 8 patients were applied with acrylic splint and 15 patients were applied with arch bar for intermaxillary fixation. Physical examination and postoperative panoramic x-ray were reviewed for the evaluation of occlusion. In the group where acrylic splint was used, 75% of the patients showed excellent subjective satisfaction and 25% showed good satisfaction. In the group where the acrylic splint was not used, 33% showed excellent and good satisfaction, 27% fair satisfaction and 1 patient showed poor satisfaction. On long-term follow- up, the group where acrylic splint was applied showed better occlusion compared to the group where acrylic splint was not applied.

Fixation of Mandibular Fracture with Bioabsorbable Self-reinforced Poly(L/DL)-lactide(70/30%) Plate and Screw

Metal fixation device, titanium miniplate is commonly used in facial bone fixation. But metal fixation device requires secondary removal procedure because of such complications as bony atrophy, metallic corrosion, low carcinogenic risk, growth disturbance of craniofacial skeleton, and endocranial migration of device which may lead to pediatric craniofacial surgery. Bioabsorbable plates lose strength retention after a given period of time unlike metalic plates, are degraded and absorbed completely in human body. Because they yield no metalic complications nor risks, and require no secondary removal, their use has been recently increased in fixation of facial bone. Self-inforced(SR)-poly(L/DL) lactide(70/30%) plate is applied for the fixation of midfacial bone in adult. But its weak strength brings concern about the skeletal stability, and makes surgeons hesitate its application to mandibular fractures. SR-poly(L/DL) lactide are rarely used especially in mandibular fractures. The authors used Biosorb FX 2.0 plate in 58 patients of mandibular fractures by open reduction and internal fixation. The duration of intermaxillary fixation was 7 days in 12 patients of multiple fractures. Follow-up period was 4 to 16 months(mean; 12 months). Complications included 2 cases with malocclusion, 6 cases with sensory disturbance and no infection was reported. The malocclusion was solved by minimal occlusal grinding, and sensory disturbance was temporary. The authors applied bicortical fixation of two plate system(thickness 1.2mm) with long screws or large diameter screws to mandibular fractures and obtained sufficient skeletal stability. The risk of tissue reaction associated with possible postimplantative crystallization of SR-poly(L/DL) lactide(70/ 30%) could be reduced. They report their experiences with review of literature.

Maxillary and/or mandible fractures: Retrospective clinical analysis of 39 cases / 医学研究生学报

Objective: Maxillary and mandible fractures are severe intermaxillary injuries,frequently involving other vital organs,and usually difficult to be treated.This study discusses the treatment of maxillary and mandible fractures.Methods: We retrospectively analyzed the clinical data of 39 cases of maxillary fractures and/or mandible fractures.Results: Of the 39 cases,34 males,5 females and 84.64% aged from 20 to 50,87.17% were caused by vehicle accidents,and 94.87% were accompanied by injuries of other parts of the body.After surgical treatment,78.95% gained normal or basically normal ocular esthetic results and 68% achieved good or improved facial esthetic results.Conclusion: The results of treatment are closely related with the type and severity of fracture and the time and plan of treatment.Preoperative CT scanning and facial profile three-dimensional reconstruction are necessitated for a thorough evaluation of the fractures and an analysis of the causes and extent of facial and ocular changes.The best treatment plan for maxillary and/or mandible fractures would include anatomic reduction by surgery,intermaxillary elastic traction and rigid internal fixation with the Ti plate.