Management of diacapitular mandibular condyle fracture using a single lag screw fixation: case report / Manejo de fractura de cóndilo mandibular diacapitular mediante fijación con tornillo de tracción único: reporte de caso

Introduction: Mandibular fractures are the most common facial fractures affecting various anatomical sites of the mandible. Among the various mandibular fractures, management of condylar fractures remains a challenging task for surgeons. Case Report: We report the case of a 28 year old male patient who presented with pain in the chin and restricted mouth opening. Computed tomography revealed a sagittal fracture of the right condylar head with medial displacement of the fractured fragments. Management of diacapitular fractures includes open reduction and internal fixation of the right condyle using a single lag-screw. Results: The postoperative outcomes were favorable, where normal mandibular movements, desired dental occlusion and exact positioning of the condyle with rigid fixation were established thereby maintaining the shape of the condyle. Conclusion: Use of single lag screw fixation is highly recommended as it greatly supports the stabilized fracture fragments and also aid in prevention of fracture fragment rotation medially.

Introducción: Las fracturas mandibulares son las fracturas faciales más comunes que afectan a diversos sitios anatómicos de la mandíbula. Entre las diversas fracturas mandibulares, el manejo de las fracturas condilares sigue siendo una tarea desafiante para los cirujanos. Reporte del Caso: Presentamos el caso de un paciente masculino de 28 años que consultó por dolor en el mentón y restricción de la apertura de la boca. La tomografía computarizada reveló una fractura sagital de la cabeza condilar derecha con desplazamiento medial de los fragmentos fracturados. El tratamiento de las fracturas diacapitulares incluye la reducción abierta y la fijación interna del cóndilo derecho con un solo tirafondo. Resultados: Los resultados postoperatorios fueron favorables, donde se establecieron los movimientos mandibulares normales, la oclusión dentaria deseada y el posicionamiento exacto del cóndilo con fijación rígida manteniendo así la forma del cóndilo. Conclusión: Se recomienda encarecidamente el uso de una fijación con un solo tornillo de tracción, ya que soporta en gran medida los fragmentos de fractura estabilizados y también ayuda a prevenir la rotación medial de los fragmentos de fractura.

Condylar Dislocation for Intracranial Fossa: a Review of the Last 10 Years

The displacement of the mandibular condyle into the cranial fossa is an uncommon event; when it occurs, there is a need for immediate and multidisciplinary surgical intervention. Due to its rare advent, there is still no consolidated service dynamics, as this condition has not yet been described in a sedimented way in the literature databases. In the present article, we performed a literature review of condylar dislocation for the intracranial fossa described in the past 10 years in the PubMed and Lilacs search databases.

Three-dimensional finite element analysis of traumatic mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures / 北京大学学报(医学版)

OBJECTIVE@#To analyze the biomechanical mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures using finite element analysis (FEA).@*METHODS@#Maxillofacial CT scans and temporomandibular joint (TMJ) MRI were performed on a young male with normal mandible, no wisdom teeth and no history of TMJ diseases. The three-dimensional finite element model of mandible was established by Mimics and ANSYS based on the CT and MRI data. The stress distributions of mandible with different angles of traumatic loads applied on the symphyseal region were analyzed. Besides, two models with or without disc, two working conditions in occlusal or non-occlusal status were established, respectively, and the differences of stress distribution between them were compared.@*RESULTS@#A three-dimensional finite element model of mandible including TMJ was established successfully with the geometry and mechanical properties to reproduce a normal mandibular structure. Following a blow to the mandibular symphysis with different angles, stress concentration areas were mainly located at condyle, anterior border of ramus and symphyseal region under all conditions. The maximum equivalent stress always appeared on condylar articular surface. As the angle between the external force and the horizontal plane gradually increased from 0° to 60°, the stress on the mandible gradually concentrated to symphysis and bilateral condyle. However, when the angle between the external force and the horizontal plane exceeded 60°, the stress tended to disperse to other parts of the mandible. Compared with the condition without simulating the disc, the stress distribution of articular surface and condylar neck decreased significantly when the disc was present. Compared with non-occlusal status, the stress on the mandible in occlusal status mainly distributed on the occlusal surface, and no stress concentration was found in other parts of the mandible.@*CONCLUSION@#When the direction of external force is 60° from the horizontal plane, the stress distribution mainly concentrates on symphyseal region and bilateral condylar surface, which explains the occurrence of symphyseal fracture and intracapsular condylar fracture. The stress distribution of condyle (including articular surface and condylar neck) decreases significantly in the presence of arti-cular disc and in stable occlusal status when mandibular symphysis is under traumatic force.

Fixação funcionalmente estável no tratamento de sequela de fratura cominutiva de mandíbula por PAF / Functionally stable fixation in the treatment of comminuted jaw fracture by firearm projectile

Introdução: em traumas de alta energia por projéteis de arma de fogo (PAF), pode ocorrer a cominuição da mandíbula. Quando não identificadas ou tratadas de maneira equivocada, essas injúrias podem comprometer a saúde do indivíduo, com graves complicações estéticas e funcionais. Objetivo: o objetivo deste trabalho é relatar um caso de tratamento cirúrgico de sequela de ferimento por arma de fogo com fratura cominutiva em região de sínfise mandibular. Relato do caso: paciente procurou o serviço de cirurgia e traumatologia bucomaxilofacial após tratamento cirúrgico insatisfatório de fratura mandibular por PAF. Observou-se clinicamente mobilidade em manipulação, exposição óssea e drenagem purulenta. Na tomografia, observou-se gap ósseo, descontinuidade na base mandibular e material de osteossíntese inadequado. Foi proposta uma abordagem cirúrgica para instalação de placa de reconstrução do sistema 2.4 mm. Em acompanhamento pós-operatório, o paciente evoluiu com abertura bucal funcional e satisfatória, sem mobilidade nos fragmentos ósseos, arcabouço mandibular restabelecido e adequado posicionamento do material de fixação. Considerações finais: os casos de cominuição óssea apresentam características individuais que devem ser levadas em consideração em seu manejo. Nesses casos, a escolha do material de fixação é fundamental para o sucesso terapêutico e o uso de prototipagem soma para uma condução satisfatória do caso, garantindo menor tempo cirúrgico e melhor adaptação da placa. (AU)

Introduction: in high energy traumas caused by firearm projectiles may occur comminutive mandibular fractures. When it is not identified or inappropriately treated, these injuries can compromisse the individual's health, with serious aesthetics and funcional complications. Objective: the aim of this study is report a case of surgical treatment of sequelae from firearm injury with comminutive fracture in the region of mandibular symphysis. Case report: patient sought the service of Oral and Maxillofacial Surgery and Traumatology after 1 month of unsatisfactory surgical treatment of a mandibular fracture caused by firearm projectile. Clinical examination revealed mobility to manipulation and bone exposure with purulent drainage. Computed tomography of the face shows bad fracture consolidation in the anterior region of the mandible with bone gap and discontinuity in the mandibular base and inadequate and poorly positioned osteosynthesis material. It was then proposed a new surgical approach with instalation of the reconstruction plate of 2.4mm locking system. In postoperative follow-up, the patient evolved with a functional and satisfactory mouth opening, with no mobility in bone fragments, restored mandibular framework and adequate positioning of the fixation material. Final considerations: the cases of comminutive bone fractures show particular features that should be considered in their handling. In these cases, the choice of the fixation material is critical to therapeutic success and the use of prototyping sum for a satisfactory conduction of the case, ensuring shorter surgical time and better adaptation of the plate.(AU)

CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Tratamento fechado em fratura mandibular: parassinfisária e côndilar bilateral ­ relato de caso clínico / Closed treatment in mandibular fracture: bilateral parasymphyseal and condyle ­ clinical case report

Objetivo: relatar um caso de fratura na região parassinfisária e côndilar bilateral após acidente ciclístico, tratada pela técnica de bloqueio maxilomandibular. Relato de caso: paciente do gênero feminino, 21 anos, deu entrada no Hospital Municipal Waldemar das Dores, Barão de Cocais, MG, vítima de acidente ciclístico, apresentando fratura de esmalte e dentina nos dentes 11 e 21, mordida aberta anterior, com incapacidade de atingir a máxima intercuspidação, juntamente com uma limitação de excursão lateral para o lado direito. Após exames tomográficos, foi constatada fratura completa de colo de côndilo direito, fratura em galho verde em côndilo esquerdo e fratura de cortical lingual parassinfisária. Por se tratar de uma paciente jovem e por apenas uma de suas fraturas apresentar-se completa (colo do côndilo direito), foi proposto tratamento fechado, por meio do bloqueio maxilomandibular. Conclusão: o bloqueio maxilomandibular foi considerado um tratamento eficaz no caso em questão, no qual foi possível estabelecer a consolidação das fraturas sem ocorrência de complicações pós-tratamento.(AU)

Objective: to report a case of fracture in the bilateral parasymphyseal and condylar region after a cycling accident, treated with the maxillomandibular block technique. Case report: a 21-yearold female patient was admitted to the Waldemar das Dores Municipal Hospital, Barão de Cocais, MG, Brazil, victim of a cycling accident, showing enamel and dentin fracture in teeth 11 and 21, anterior open bite, inability to reach maximum intercuspation, and a lateral excursion limitation to the right side. Tomographic examinations showed complete fracture of the right condyle neck, greenstick fracture in the left condyle, and parasymphyseal lingual cortical fracture. Considering it is a young patient with only one complete fracture (neck of the right condyle), a closed treatment was proposed through maxillomandibular block. Conclusion: maxillomandibular block was considered an effective treatment for the case in question, allowing to establish fracture consolidation without post-treatment complications.(AU)

Fratura condilar em criança de 4 meses: relato de caso / Condylar fracture in a 4-month-old-child: case report and literature review

Objetivo: apresentar um relato de caso clínico de uma criança de 4 meses de idade que sofreu uma fratura do côndilo após queda e foi submetida a tratamento conservador, discutindo aspectos que determinaram a opção por esta conduta. Relato de caso: paciente apresentava, no exame clínico, discreto edema na região do mento e não apresentava limitação da abertura bucal. Devido a estes achados clínicos e à idade do paciente, mesmo com imagem tomográfica evidenciando a fratura condilar, optou-se pela realização de tratamento conservador e acompanhamento clínico do paciente. Considerações finais: a decisão da conduta terapêutica deve ser baseada em exames físicos, clínicos e imaginológicos do paciente. Em pacientes muito jovens, como o relatado neste caso, é preciso ter cautela com a indicação dos procedimentos a serem realizados, pois é um paciente que está em intenso desenvolvimento e crescimento. O acompanhamento em longo prazo da manutenção de movimentação fisiológica da articulação temporomandibular do paciente também é fundamental para que se tenha sucesso no tratamento escolhido, evitando-se patologias como a anquilose ou outras alterações que dificultem uma abordagem mais conservadora ou minimamente invasiva. (AU)

Objective: the present study report a clinical case of a 4-month-old child who suffered a condyle fracture after falling and submitted to a conservative treatment, discussing issues that determined the option for this management. Case report: patient presented, on clinical examination, mild edema in the ment region and did not presented limitation of the oral opening. Due to these clinical findings and the patient's age, even with a tomographic image evidencing the condylar fracture, we chose to perform conservative treatment and clinical follow-up of the patient. Final considerations: the therapeutic management decision should be based in patient's physical, clinical and imaging examinations. In very young patients, as reported here, care should be taken to indicate the procedures to be performed, as it is a patient who is in intense development and growth. Long-term follow-up of the maintenance of the physiological movement of TMJ is also fundamental for the success of the treatment, avoiding pathologies such as ankylosis or other changes that hinder a more conservative or minimally invasive approach. (AU)

Printing 3D models of canine jaw fractures for teaching undergraduate veterinary medicine

Abstract Purpose To develop 3D anatomical models, and corresponding radiographs, of canine jaw fractures. Methods A base model was generated from a mandibular bone scan. With this model it was possible to perform fracture planning according to the anatomical location. Results The 3D base model of the canine mandible was similar in conformation to the natural bone, demonstrating structures such as canine tooth crowns, premolars and molars, mental foramina, body of the mandible, ramus of the mandible, masseteric fossa, the coronoid process, condylar process, and angular process. It was not possible to obtain detail of the crown of the incisor teeth, mandibular symphysis, and the medullary channel. Production of the 3D CJF model took 10.6 h, used 150.1 g of filament (ABS) and cost US$5.83. Conclusion The 3D canine jaw fractures models, which reproduced natural canine jaw fractures, and their respective radiographic images, are a possible source of educational material for the teaching of veterinary medicine.

Manejo cirúrgico de fratura de mandíbula: relato de caso / Surgical management of mandibular fracture: case report

Objetivo: descrever, por meio de um relato de caso, uma fratura de mandíbula em região de parassínfise esquerda, causada com agressão física. Relato de caso: paciente do sexo feminino, 26 anos de idade, ASA I, melanoderma, vítima de agressão física, procurou o serviço de Cirurgia e Traumatologia Bucomaxilofacial da Faculdade de Odontologia da Universidade Federal da Bahia. Ao exame físico, referiu queixas álgicas espontâneas em região mandibular esquerda e presença de degrau ósseo em região passinfisária esquerda. Ao exame de imagem, observaram-se sinais sugestivos de fratura em região de parassínfise esquerda. Na paciente em questão, foi realizado o manejo cirúrgico da fratura com auxílio de miniplacas e parafusos do sistema 2 mm em acesso intraoral. No acompanhamento pós-operatório, observaram-se material de osteossíntese e odontossíntese em posição, fratura adequadamente reduzida e ausência de sinais de deslocamento dos cotos fraturados. Considerações finais: o uso do sistema de fixação interna rígida é indicado em casos de fraturas desfavoráveis de mandíbula, uma vez que apresenta resultados satisfatórios referentes a estabilização e cicatrização óssea. A redução e a fixação com auxílio de miniplacas e parafusos tendem a evitar o deslocamento dos cotos fraturados e a formação de pseudoartrose. (AU)

Objective: to describe, through a case report, a mandible fracture in the left paraphysis region caused by physical aggression. Case report: female patient, 26 years old, ASA I, melanomedma, victim of physical aggression, researched at the Department of Oral and Maxillofacial Surgery and Traumatology from the Federal University of Bahia. In the physical exam, the patient referred spontaneos pain in the left parasymphysis and bone stepping in passinfisary left region. At the imaging examination observed suggestive signs of a fracture in the region of the left parasymphysis. The patient in question was approached by a surgical procedure of the fracture with miniplates and screws of the 2.0 mm system in an intraoral approach. Postoperatively, osteosynthesis and odontosynthesis material was observed in position, adequately reduced fracture and absence of signs of displacement of fractured stumps. Final considerations: the use of the internal fixation system is indicated in cases of unfavorable mandibular fractures once it presents satisfactory results regarding bone stabilization and healing. The reduction and fixation with miniplates and screws tend to avoid the displacement of fractured stumps and formation of pseudoarthrosis. (AU)

Fracturas Mandibulares Conminutadas por Impacto de Proyectil Balístico: Propuesta de Tratamiento Inicial Mediante Método de Fijación Alternativo / Mandibular Fractures Comminuted by Ballistic Projectile Impact: Initial Treatment Proposal Using Alternative Fixation Method

RESUMEN: El trauma maxilofacial por arma de fuego representa un desafío terapéutico principalmente debido a la gran conminución de tejidos que genera. Específicamente, en casos de fracturas mandibulares conminutadas, las modalidades de tratamientos incluye la reducción cerrada, fijación con tutor externo, fijación interna con alambres y reducción abierta y fijación interna utilizando placas y tornillos. El objetivo del presente trabajo es describir un tratamiento inicial con un método de fijación para fracturas mandibulares conminutadas como dispositivo alternativo al tutor externo clásicamente utilizado. Se desarrolla una revisión de la literatura actual acerca del tratamiento inicial o de urgencia de fracturas mandibulares conminutadas por impacto de proyectil balístico, haciendo énfasis en las indicaciones de cada modalidad de tratamiento y sus respectivas ventajas y desventajas. Luego se describe detalladamente el proceso de confección de un método de fijación alternativo junto con la exposición de casos clínicos donde fue utilizado como alternativa de tratamiento. La reducción y fijación obtenida por el dispositivo presentado logra resultados satisfactorios, sin encontrarse diferencias significativas a los elementos de fijación clásicos. Tanto el uso de placas de reconstrucción como el de tutor externo constituyen alternativas válidas para el tratamiento de fracturas mandibulares conminutadas. El dispositivo descrito y utilizado en los pacientes es una alternativa eficiente, de fácil confección y bajo costo económico demostrando buenos resultados en relación a la consolidación de fracturas conminutadas. Se debe conocer las indicaciones para la aplicación de cada modalidad de tratamiento.

ABSTRACT: Ballistic maxillofacial trauma represents a challenge for surgeons because of the important comminution process it presents. Specifically, in cases of mandibular comminuted fractures, the different treatment modalities include closed reduction, external fixation and internal fixation. The purpose of this case series is to describe an initial treatment modality, with a fixation method for comminuted mandibular fractures as an alternative for the classic external fixator. We conducted a literature review about the initial treatment for ballistic comminuted mandibular fractures, emphasizing indications of each treatment modality and their respective advantages and disadvantages. Next, we described the preparation process of an alternative fixation method along with a case series, where it was used as a therapeutical alternative. The reduction as well the fixation achieved by the external fixator, showed satisfactory results without significant differences noted with traditional fixation methods. Both, reconstruction plates and external fixators, are valid alternatives for treating comminuted mandibular fractures. The method described and used in these patients is and efficient alternative, easy to make and at a low cost, with good results in relation to fracture consolidation. We propose that every treatment modality and its indications should be evaluated in order to treat each case adequately.

Fractura condílea / Condylar fracture

Introducción: el cóndilo representa un punto estructural débil en el esqueleto mandibular. Objetivo: realizar una revisión bibliográfica sobre consideraciones anatómicas, diagnóstico, clasificación, tratamiento y complicaciones de las fracturas condíleas. Métodos: se realizó una revisión bibliográfica en agosto de 2016. Se evaluaron revistas de impacto de Web of Sciencies (17 revistas), 2 libros y 1 CD. Se consultaron las bases de datos MEDLINE, PubMed y SciELO con los descriptores: condilar fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 111 artículos. El estudio se circunscribió a 34. Análisis e integración de la información: las consideraciones anatómicas de la región condílea son un punto de partida en este tema. El diagnóstico se basa en el interrogatorio, examen físico y medios auxiliares de diagnóstico. La clasificación precisa permite escoger la modalidad terapéutica a emplear y evitar complicaciones. Conclusiones: la revisión de la bibliografía permite precisar que hay razones anatómicas para la alta incidencia de las fracturas del proceso condilar mandibular. El primer objetivo del interrogatorio es obtener una historia exacta del paciente. El examen físico regional debe ser exhaustivo. La radiografía panorámica es una buena opción en el diagnóstico. El primer paso en el desarrollo de un plan de tratamiento es establecer qué tipo de lesión se ha sufrido para proporcionar una solución adecuada usando técnicas abiertas y cerradas, y evitar complicaciones posteriores(AU)

Introduction: the condyle represents a weak structural point in the mandibular skeleton. Objective: to perform a bibliographic review on anatomical considerations, diagnosis, classification, treatment and complications of condylar fractures. Methods: abibliographic review was carried out in August 2016. Journals of impact in the Web of Sciences (17 journals), 2 books and 1 CD were evaluated. The databases MedLine, PubMed and ScieELO were consulted with the descriptors: condylar fracture, treatment, and epidemiology. Articles in English were included, preferably from the last 5 years. 111 articles were obtained. The study was circumscribed to 34. Analysis and integration of information: the anatomical considerations of the condylar region are a starting point in this topic. The diagnosis is based on the interrogation, physical examination and diagnostic aids. Accurate classification allows choosing the therapeutic modality to be used and avoiding complications. Conclusions: the review of the literature makes it possible to specify that there are anatomical reasons for the high incidence of fractures of the mandibular condylar process. The first objective of the interrogation is to obtain an accurate history of the patient. The regional physical examination must be comprehensive. The panoramic radiograph is a good option for the diagnosis. The first step in the development of a treatment plan is to establish what type of injury has been suffered, in order to provide an adequate solution using open and closed techniques and avoid later complications(AU)

Fractura mandibular / Mandibular fracture

Introducción: las fracturas mandibulares son frecuentemente atendidas en cirugía bucal y maxilofacial. Objetivo: realizar una revisión bibliográfica sobre consideraciones anatómicas, diagnóstico, clasificación, tratamiento y complicaciones de las fracturas mandibulares. Métodos: se realizó una revisión bibliográfica de julio a agosto de 2016. Se evaluaron revistas de impacto de Web of Sciencies (35 revistas) y 3 libros. Se consultaron las bases de datos de MEDLINE, PubMed y ScieELO con los descriptores: mandibular fracture, treatment, epidemiology. Se incluyeron artículos en idioma inglés, preferentemente de los últimos 5 años. Se obtuvieron 120 artículos. El estudio se circunscribió a 51. Análisis e integración de la información: las consideraciones anatómicas de la región mandibular son un punto de partida en este tema. El diagnóstico se basa en el interrogatorio, examen físico y medios auxiliares de diagnóstico. La clasificación precisa permite escoger la modalidad terapéutica a emplear y evitar complicaciones. Conclusiones: la revisión de la bibliografía permite precisar que hay razones anatómicas para la alta incidencia de las fracturas de ángulo mandibular. El primer objetivo del interrogatorio es obtener una historia exacta del paciente. El examen físico regional debe realizarse de forma ordenada y precisa. La radiografía panorámica es una buena opción en el diagnóstico. El primer paso en el desarrollo de un plan de tratamiento es establecer qué tipo de lesión se ha sufrido para proporcionar una solución adecuada usando técnicas abiertas y cerradas, y evitar complicaciones posteriores(AU)

Introduction: mandibular fractures are often treated by oral and maxillofacial surgery. Objective: conduct a bibliographic review about the anatomical considerations, diagnosis, classification, treatment and complications of mandibular fractures. Methods: a bibliographic review was conducted from July to August 2016. The evaluation included high impact journals from the Web of Sciences (35 journals) and 3 books. The databases MEDLINE, PubMed and SciELO were consulted, using the descriptors mandibular fracture, treatment, epidemiology. Papers written in English were included, preferably if published in the last five years. Of the 120 papers obtained, the study considered 51. Data analysis and integration: anatomical considerations about the mandibular region are a starting point in this topic. Diagnosis is based on interrogation, physical examination and auxiliary diagnostic means. An accurate classification makes it possible to choose the therapy to be used and prevent complications. Conclusions: the bibliographic review permitted to confirm that there exist anatomical reasons for the high incidence of mandibular angle fractures. The first goal of interrogation is to obtain an exact patient history. The regional physical examination should be performed in an orderly, accurate manner. Panoramic radiography is a good choice of diagnostic technique. The first step in developing a treatment plan is to determine the type of lesion so as to provide an appropriate solution based on open and closed techniques, thus avoiding later complications(AU)

Análisis de las fracturas mandibulares causadas por accidentes laborales: estudio descriptivo retrospectivo / Analysis of mandibular fractures caused by work related accidents: retrospective descriptive study

El objetivo de este estudio fue evaluar la tendencia de los pacientes con fracturas mandibulares asociados a accidentes laborales. Se realizó un estudio descriptivo retrospectivo en todos los casos de fracturas mandibulares que asistieron al servicio de cirugía maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago de Chile en un periodo de 4 años (enero 2009 - diciembre 2012). Todas las fracturas mandibulares fueron consignadas. La información fue recopilada a través de revisión de fichas clínicas electrónicas. Entre los años 2009 al 2012 se presentaron un total de 74 pacientes incluidos en el estudio con 102 rasgos de fracturas mandibulares. La fractura más común fue la de cóndilo mandibular (35 pacientes). Se observó una tasa de complicaciones del 8%. Los resultados mostrados en este estudio están en línea con la literatura y el análisis de este reporte provee información para el diseño de planes de prevención de riesgos, especialmente para desarrollar medidas de protección facial. Nivel de Evidencia: Tipo II. Estudio descriptivo.

The objective of this study was to evaluate the tendency of patients with mandibular fractures associated with working accidents. A retrospective descriptive study was performed in all cases of mandibular fractures who attended the maxillofacial surgery service at the Clinical Hospital Mutual Seguridad C.CH.C. Santiago de Chile, in a 4-year period (January 2009 - December 2012). All mandibular fractures were recorded. The information was collected through review of electronic medical records. Between 2009 and 2012, 74 patients were included in the study with 102 lines of mandibular fractures. The most common fracture was the mandibular condyle (35 patients). The complication rate was 8%. The results shown in this study are in line with the literature and the analysis of this report provides information for the design of risk prevention plans, especially in developing measures of facial protection.

X-cephalometric study of different parts of the upper airway space and changes in hyoid position following mandibular fractures / Estudio cefalométrico con rayos X de diferentes partes del espacio de las vías respiratorias superiores y cambios en la posición hioidea tras fracturas mandibulares

OBJECTIVE: This study analyses the different parts of the upper airway space and the changes in hyoid position. The results provide a clinical reference for developing timely and effective treatment programmes for patients with mandibular fractures caused by maxillofacial trauma. METHODS: Standard X-cephalometric measurements of the lateral skull of 210 subjects were taken. The subjects were divided into four fracture groups: condylar, mandibular angle, mandibular body, and parasymphyseal. RESULTS: The radiographs of the mandibular fracture groups were compared with the normal occlusion group to analyse the upper airway space and the changes in hyoid position. Different types of fractures have different effects on the upper airway space. Bilateral mandibular body fracture and the parasymphyseal fracture have a significant influence on the lower oropharyngeal and laryngopharyngeal airway spaces, with serious obstructions severely restricting the ventilatory function ofpatients. CONCLUSIONS: Fractures at different parts of the mandibular structure are closely related to the upper airway and hyoid position.

OBJETIVO: Este estudio analiza las diferentes partes del espacio de las vías respiratorias superiores y los cambios de posición hioidea. Los resultados proporcionan una referencia clínica para desarrollar programas de tratamiento oportuno y eficaz para los pacientes con fracturas de la mandíbula, causadas por trauma maxilofacial. MÉTODOS: Se hicieron mediciones X-cefalométricas estándares del cráneo lateral a 210 sujetos. Los sujetos fueron divididos en cuatro grupos de fractura: ángulo mandibular, condilar, cuerpo mandibular y parasinfisaria. RESULTADOS: Las radiografías de los grupos de fractura mandibular fueron comparadas con el grupo de oclusión normal para analizar el espacio de las vías respiratorias superiores y los cambios de posición hioidea. Diferentes tipos de fracturas tienen diferentes efectos sobre el espacio de las vías respiratorias superiores. La fractura de cuerpo mandibular bilateral y la fractura de parasinfisaria tienen una influencia significativa en los espacios de las vías respiratorias orofaríngea y laringofaríngea inferiores, con serios obstáculos restringiendo severamente la función respiratoria de los pacientes. CONCLUSIONES: Las fracturas en diferentes partes de la estructura mandibular se hallan estrechamente vinculadas a las vías respiratorias superiores y a la posición hioidea.

Férula de acrílico y alambres circunmandibulares para el tratamiento de una fractura de mandíbula / Splint made from acrylic and circummandibular wires for treatment of mandible fracture

Se presenta el caso de una niña que sufrió una caída desde una altura de varios metros y presentó una fractura en el fémur izquierdo y en el cuerpo mandibular del lado izquierdo. Como tratamiento se empleó una férula de acrílico y alambres circunmandibulares para reducir y estabilizar la fractura de la mandíbula; la fractura del fémur fue reducida por método abierto con placa y tornillos. La férula se retiró a las semanas de la fractura. Se le realizó un seguimiento clínico y radiográfico durante 3 meses, y se constató una excelente evolución, con excelente consolidación ósea y oclusión. Los resultados demostraron la utilidad de este medio de fijación de fracturas, sobre todo porque es poco agresivo para los niños y con él se evitan muchas complicaciones(AU)

This is the case of a girl fell from some meters height and had a fracture of left femur and in the left side of mandibular body. As treatment we used an acrylic and circummandibular wires to reduce the mandible fracture; the femur's fracture was reduced by open method using plates and screws. A few weeks later splint was removed. A clinical and radiographic follow-up was made over three months, confirming an excellent course, bone consolidation and occlusion. Results showed the usefulness of this method of fracture's fixation mainly because it is not much aggressive for children avoiding in this way many complications(AU)

Reduction and fixation of mandibular body fracture among children using two different types of acrylic splints

The use of single jaw fixation by acrylic splint fixed to the mandible by two circumferential wires was recommended by many investigators for fixation of mandibular body fractures among children. The success of fixation of fractured segments will depend on the acrylic splint and its ability to clasp teeth, alveolar process between the labial and lingual splints. Thirty two child below the age of twelve years with mandiblar body fractures were classified randomly into two equal groups. The first group were treated by reduction and fixation using acrylic splint, while the second group used reinforced acrylic splint with 10% glass filler particles. The results of this study recommended the use of reinforced glass filler acrylic splints for reduction and singla fixation for managment of fracture mandibular body among children as the incorporation of glass particles into acrylic resin significantly improved its transverse strength, modulous of elasticity and fracture toughness. This was manifested by the less complication especially fracture of splints during manipulation and the post operative malunion

Les Fractures mandibulaires : a propos de deux observations

Les Fractures mandibulaires representent 15 pour cent des fractures squelettiques; 70 pour cent des fractures de la face. Elles predominent chez l'adulte jeune (40 pour cent); notamment de sexe masculin (80 pour cent). Les circonstances de survenue sont; par ordre de frequence; les accidents de la voie publique; les rixes; le sport; les accidents de travail. Le traitement orthopedique consiste en une reduction puis une contention par blocage inter-maxillaire