Factors contributing to the surgical retreatment of mandibular fractures

The purpose of this retrospective study was to evaluate contributing factors in patients requiring surgical retreatment of mandibular fractures. Of all the patients with mandibular fractures who were treated using internal fixation at a trauma hospital over a seven-year period, 20 patients (4.7%) required a second surgery and thus composed the “reoperated” group. The control group comprised 42 consecutive patients with mandibular fractures who were treated at the same clinic and who healed without complications. Medical charts were reviewed for gender, age, substance abuse history, dental condition, etiology, location of fracture, degree of fragmentation, fracture exposure, teeth in the fracture line, associated facial fractures, polytrauma, time elapsed between trauma and initial treatment, surgical approach and fixation system. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0; descriptive statistics and the chi-squared test were used to determine differences between groups. Significant differences in substance abuse (p = 0.006), dental condition (p < 0.001), location of fracture (p = 0.010), degree of fragmentation (p = 0.003) and fracture exposure (p < 0.001) were found. With regard to age and time elapsed between trauma and initial treatment, older patients (31.4 years, SD = 11.1) and a delay in fracture repair (19.1 days, SD = 18.7) were more likely to be associated with reoperation. It was concluded that substance abuse, age, dental condition, location of fracture, degree of fragmentation, fracture exposure and the time between trauma and initial treatment should be considered contributing factors to the occurrence of complications that require surgical retreatment of mandibular fractures.

Fratura de mandíbula como complicação pós-operatória da instalação de implantes dentários / Mandibular fracture a postoperative complication after dental implant placement

A fratura espontânea da mandíbula é uma rara complicação pós-operatória da instalação de implantes dentários. O objetivo deste trabalho é relatar um caso de fratura da mandíbula ocorrida uma semana após a instalação de implantes osseointegrados por outra equipe e discutir os possíveis fatores predisponentes ligados à sua ocorrência. Não havia história prévia de trauma na região e o paciente relatava parestesia no lábio inferior e mento no lado esquerdo desde a instalação dos implantes. No exame clínico havia dor à palpação com discreta movimentação óssea na região de corpo mandibular esquerdo e foi observada oclusão dentária apenas na região anterior em decorrência de edentulismo mandibular posterior bilateral. Nos exames de imagens foram visualizados dois implantes longos que invadiam a região do canal mandibular e uma fratura completa da mandíbula na região de corpo esquerdo e associada ao implante mais posterior. O tratamento de escolha foi a remoção dos implantes seguida de redução aberta da fratura e imobilização com placa e parafusos de titânio. Com base nas características clínicas acima mencionadas, pôde-se especular que o padrão oclusal e as alterações proprioceptivas devido a parestesia parecem ser fatores importantes que contribuem para o aumento das tensões na região posterior da mandíbula e consequente fratura após instalação de implante dentário.

Spontaneous mandibular fracture is a rare postoperative complication after dental implant placement. The aim of this study was to report a case of mandibular fracture one week after placement of dental implants by another surgical team, and to discuss possible predisposing factors associated to it. There was no history of previous trauma and the patient reported paresthesia in the lower lip and chin on the left side since implant placement. On clinical examination, there was pain on palpation with discrete bone mobility and dental occlusion only in the anterior region as a result of bilateral, posterior mandibular edentulism. Two long implants impinging the mandibular canal were viewed on radiographs, and a complete mandibular fracture on the left mandibular body associated to the most posterior implant, as well. The treatment of choice was the removal of implants followed by open reduction of fracture and fixation with titanium plate and screws. Based on the aforementioned clinical characteristics, it can be speculated that occlusal patterns and proprioceptive changes due to paresthesia seem to be important factors contributing to the increase of stress in the posterior mandibular region and the accompanying fracture after dental implant placement.