Occurrence and remission of loss of sensitivity of inferior alveolar nerve in mandibular fractures

ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

Surgical Management of a Firearm Injury in the Infraorbital Area / Manejo quirúrgico de una herida por arma de fuego en el área infraorbitaria

Abstract The surgical management of firearm injuries to the zygomaticomaxillary complex is a topic that needs to be addressed with much care. The complications that can arise during treatment, as well as the potential residual problems that can appear, lead to the need of recognizing these injuries as a maxillofacial treatment challenge. The infraorbital zone is the second most common area of injury in the face, accounting for up to 45% of midfacial fractures. The case presented is of a 54 year old man affected by the backward firing of a gun rifle that caused an oblique impaction towards the posterior lateral inferior side of the infraorbital complex. He was rapidly stabilized with an antibiotic and analgesic scheme, yet presented the following: a comminute fracture of the orbit floor with consequent communication towards the maxillary sinus, a non-displacing fracture of the frontomalar suture, a non-displacing fracture of the zygomatic arch and a lesion with loss of osseous tissue in the petrous region of the temporal bone. Rigid fixation followed stabilization, and the area was covered with a titanium mesh. Occasional tinnitus and photopsia were reported by the patient upon return, yet all other evaluated factors were in order. There have been different forms of management described in the literature, and it is recognized that each patient has different needs, therefore each case must be closely evaluated, so it is approached in the most appropriate manner.

Resumen El manejo quirúrgico de las lesiones por armas de fuego al complejo cigomaticomaxilar representa una situación compleja en la práctica maxilofacial que debe ser abordada con extrema cautela, debido a las complicaciones que pueden surgir durante el tratamiento y los potenciales problemas residuales. La zona infraorbitaria es la segunda área más común de lesiones en la cara, representando hasta 45% de las fracturas mediocraneales. El presente caso es de un masculino de 54 años de edad, que sufrió trauma ocasionado por la parte trasera de un rifle de caza que causó un impacto en sentido oblicuo hacia el lado lateral inferior del complejo infraorbitario. El paciente fue estabilizado con esquema antibiótico y analgésico, el diagnóstico fue: fractura cominuta del piso de la órbita, con consecuente comunicación al seno maxilar, fractura no desplazada de la sutura frontomalar, fractura no desplazada del arco cigomático, y lesión con pérdida de tejido óseo en la región petrosa del hueso temporal. El tratamiento quirúrgico consistió en reducción de las fracturas y fijación rígida de las estructuras. Al control post operatorio el paciente refirió acufenos y fotopsia ocasional, no presentando otras alteraciones. Se ha descrito en la literatura diferentes abordajes para el manejo de estos traumatismos, sin embargo cada caso debe ser individualizado y evaluado de forma minuciosa para que éste, sea el adecuado.

Perfil epidemiológico dos pacientes portadores de fraturas de face / Epidemiological profile of patients with facial fractures

Fraturas faciais foram provocadas principalmente por acidentes de trânsito (37,3%), e por agressões físicas (33%), vitimando predominantemente pacientes do gênero masculino (83,7%).Ocorreram mais frequentemente na faixa etária entre 21 e 30 anos (38,2%). A frequência de homens e mulheres vitimados entre a primeira e a terceira décadas de vida foi bastante similar.As fraturas mandibulares isoladas foram significativamente predominantes (48%), seguidas pelas zigomáticas (19,7%) e pelas nasais (19,7%). As agressões físicas foram mais frequente mente responsáveis pelas fraturas mandibulares, zigomáticas, nasais, maxilares e frontais, enquanto as fraturas pan faciais e Le Fort resultaram mais frequentemente de acidentes de trânsito.

Facial fractures were mainly caused by traffic accidents (37.3%) and physical abuse (33%), victimizing mostly male patients (83.7%). Occurred more frequently in the age group between21 and 30 years (38.2%). The frequency of men and women victimized between the first and third decades of life was very similar. Isolated mandibular fractures were significantly predominant(48%), followed by zygomatic (19.7%) and the nose (19.7%). The assaults were mostoften responsible for mandibular fractures, zygomatic, nasal, maxillary and frontal, while the panfaciais fractures and Le Fort resulted more often aciteeth transit.

Manejo de complicación de fractura mandibular en un paciente pediátrico con dentición decidua / Management of a complicated mandibular fracture in a pediatric patient with primary dentition

El trauma maxilofacial en la población pediátrica difiere del trauma en el adulto debido al potencial de crecimiento facial, el menor tamaño de los huesos, la mayor rapidez de regeneración de los tejidos, la presencia de dentición decidua o mixta y la dificultad en el manejo de conducta. Específicamente, el tratamiento de las fracturas mandibulares en niños es controversial y complicado porque puede tener un efecto negativo en el crecimiento mandibular, en la movilidad de la articulación temporomandibular y en el desarrollo y crecimiento de los gérmenes dentales, particularmente en la etapa de dentición decidua o mixta. Entre las opciones de tratamiento que reporta la literatura se incluyen el manejo conservador, el cerrado y el quirúrgico. El propósito del presente caso es relatar la complicación y manejo quirúrgico definitivo de la fractura mandibular desfavorable en un niño de 5 años de edad (dentición decidua) con material de osteosíntesis semirrígido no reabsorbible...

Maxillofacial trauma in the pediatric population differs from trauma in adults because of facial growth potential, smaller bones, faster tissue regeneration, deciduous or mixed dentition and the difficulties managing their behavior. Specifically , treatment of pediatric mandibular fractures is controversial and complicated because it can have a negative effect on mandibular growth, temporomandibular joint mobility, development and growth of tooth germs, particularly at the stage of deciduous or mixed dentition. Among the treatment options reported in the literature, conservative management, close reduction and surgery are included. The purpose of this report is to describe the complication and definitive surgical management of an unfavorable mandibular fracture in a five years old child, in primary dentition, with nonabsorbable material rigid osteosynthesis...

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.

Tooth in the line of fracture: Its prognosis and its effects on healing.

Aims and Objective: The aim of this prospective study was to compare the postoperative results of mandibular angle fracture cases treated by open reduction and internal fixation wherein the third molar in the line of fracture was preserved in one group while it was extracted in the second group. Materials and Methods: Group I consisted of 30 patients in which the mandibular third molar in the line of fracture was preserved and group II consisted of 24 patients in which it was extracted following specific criteria. Various parameters like postoperative healing, infection, occlusion, tooth vitality, and mobility were graded numerically. Statistical analysis using a t-test was done. Data were expressed as mean±SD and a probability (P) value of <0.05 was considered significant. Results: The presence of infection with pain and tenderness was higher in group I. Osteogenesis was higher in group I till the end of the third week but the difference was not significant later. Discrepancy in occlusion was more in group II. Mobility of tooth decreased and status of periodontal tissue improved significantly with time. In the tooth involved, the return of vitality and decrease in pain/tenderness was significant after 1 week and continued till 24 weeks to normalcy. Two teeth showed mild root resorbtion and none showed ankylosis. Conclusion: Postoperative occlusal discrepancy is less but infection is higher when the tooth in the line of fracture is preserved as compared to when it is removed. More than half of the teeth in the fracture line show complete recovery within a period of 6 months to 1 year. Despite the risk of an increase in the rate of complications, the tooth in the line of fracture should be preserved for its merits.

[Prevalence of condylar fractures in patients referred to oral and maxillofacial department at Dr. Shariati hospital, Tehran 1994-2004]

This is an epidemiological study of patterns of condylar fractures. The aim of this study was to assess the incidence and etiology of condylar fractures. In this retrospective study, data were obtained by means of special questionnaire regarding age, gender, anatomic site, pattern, causes of injury, treatment modalities and complications. During an 11 years period [1994-2004] 475 patients represented 134 condylar fractures [28.2%] admitted to Dr. Shariati Hospital of Tehran-Iran. Of the 134 patients, 105 [78%] were men and 29 [22%] were women [ratio 3.6:1]. Patients' age at the time of injury ranged from 2 to 75 years, with a mean age 24.7 years. The highest incidence was seen in the third decade of life [27.6%]. The predominant causative factors in this study was motor vehicle accident [42%] followed by falls and assaults. Most patients [88.8%] were treated by close reduction surgery. The seasonal distribution showed that summer accounted a highest percentage [31%] of all fractures. The condylar fractures included 28.2 percentages of all mandibular fractures in this study. The most common part of condylar fractures was subcondylar site [76.1%]. The most common causes were traffic accidents [42.2%]. The most common treatment method was close reduction [88.2%]. The most common fixation method was maxillomandibular fixation [MMF]. Fracture rate in men was more than women [78.4% Vs. 21.6%]. The most important associated complications with condylar fractures was ankylosis [2.98%]

Fratura de mandíbula: análise de 293 pacientes tratados no Hospital de Clínicas da Universidade Federal de Uberlândia / Mandibular fracture: analysis of 293 patients treated in the Hospital of Clinics, Federal University of Uberlândia

A fratura de mandíbula ocupa o segundo lugar entre as fraturas dos ossos da face, tendo havido aumento significativo de casos nos últimos anos. A não-identificação e o tratamento inadequado podem levar à deformidade estética ou funcional permanente. OBJETIVO: Avaliar os casos submetidos à redução de fratura de mandíbula no Hospital de Clínicas da Universidade Federal de Uberlândia, entre janeiro de 1974 e dezembro de 2002. FORMA DE ESTUDO: coorte historica. PACIENTES E MÉTODO: Duzentos e noventa e três pacientes foram submetidos à redução de fratura de mandíbula e retrospectivamente foram avaliados segundo fatores relacionados a: paciente, trauma, quadro clínico e tratamento cirúrgico. RESULTADOS: Houve uma clara tendência de aumento do número de fraturas de mandíbula ao longo dos anos. Houve um predomínio no sexo masculino (4:1), com pico de ocorrência entre 20 a 29 anos. As principais causas de fratura da mandíbula neste estudo foram acidentes de trânsito e violência, perfazendo juntas 72,4 por cento. Cento e trinta e cinco pacientes apresentavam fratura única. Os sítios mais acometidos foram, em ordem decrescente, sínfise, côndilo, ângulo, corpo, ramo e processo coronóide. Foram realizadas redução incruenta (28), cruenta (213) e associação das duas (11 pacientes), sendo que 56,8 por cento dos pacientes foram tratados nos primeiros 3 dias e 50,4 por cento recebeu a alta hospitalar até o primeiro pós-operatório. Cerca de 10 por cento dos pacientes apresentaram complicações, sendo osteomielite a mais freqüente. CONCLUSÃO: A incidência de fraturas de mandíbula foi marcadamente maior no sexo masculino, durante a terceira década de vida. A causa mais comum foi o acidente de trânsito e as regiões mais atingidas foram sínfise e côndilo. As fraturas isoladas de mandíbula ocorreram em mais de metade dos casos. A maioria dos pacientes foi tratada nos primeiros três dias e recebeu alta até o primeiro pós-operatório. A redução cruenta foi tratamento mais comumente empregado. A complicação mais freqüente foi a osteomielite.

Incidencia, diagnóstico y tratamiento de las fracturas del maxilar inferior en el Hospital Regional Honorio Delgado de Arequipa 1991 - 1995

Se presenta un estudio de tipo descriptivo, retrospectivo de fracturas del maxilar inferior, en el periodo comprendido entre enero de 1991 a diciembre de 1995, de pacientes diagnosticados, tratados y hospitalizados en el Hospital Regional Honorio Delgado de Arequipa. De un total de 93 pacientes con fracturas del maxilar inferior, fueron hospitalizados 50 pacientes de los cuales el pico de incidencia máximo corresponde al año 1994 con 12 pacientes que equivale a una tasa de incidencia de 7,14 x 10,000 en pacientes hospitalizados. La edad en que predominaron las fracturas del maxilar inferior fue entre los 11 y 30 años, 60 por ciento, siendo el sexo masculino el más afectado en una proporción de 4 a 1 con respecto al sexo femenino. Fue la vía pública donde se presentaron con mayor frecuencia 80 por ciento, generalmente por accidente de tránsito 62 por ciento. Los pacientes examinados principalmente presentaron dolor, apertura oral limitada y deformidad. El diagnóstico concomitante más frecuente fue el de traumatismo Encefalocraneano 56 por ciento. De acuerdo al segmento anatómico comprometido predominaron las fracturas corporales 46 por ciento. Por la relación con el medio ambiente las cerradas 60 por ciento, por el número de trazos fractuarios predominaron las únicas 46 por ciento. Dentro de los tratamientos aplicados primó la fijación intermaxilar con un 62 por ciento, que es un tratamiento conservador, no quirúrgico. Los antibióticos más empleados fueron los del grupo de las Penicilinas 92 por ciento, siendo hospitalizados en el Servicio de Ortopedia y Traumatología el 66 por ciento. Permanecieron hospitalizados entre 2 y 3 semanas el 62 por ciento de los pacientes. La complicación más frecuente fue la infección de herida con el 22 por ciento. Tuvieron buena evolución clínico-radiológica el 40 por ciento de los pacientes evaluados.

Complicações das fraturas mandibulares / Complication of mandibular fractures

Os autores apresentam revista da literatura a respeito das complicações das fraturas mandibulares, evidenciando os tipos, sua etiologia e seus aspectos clínicos. Destacam que a ocorrência de infecções, pseudoartrose, consolidação viciosa e anquilose da articulação temporomandibular está relacionada principalmente a procedimentos iatrogênicos

Pseudoartrose em fratura bilateral de mandíbula / Pseudarthrosis in bilateral mandibular fractures

Apresenta-se revista da literatura sobre pseudoartrose em fraturas de mandibula e relata-se um caso clínico da complicaçäo. Comparam-se os dados clínicos e cirúrgicos encontrados com a literatura concernente. Especial enfoque é dado à terapêutica da entidade