Comparison of Conventional Versus Right Angled Fixation Technique in Management of Mandibular Angle Fractures - A Prospective Randomized Clinical Study.

PURPOSE: The treatment of mandibular angle fractures ranges from observation to closed reduction with maxillomandibular fixation to open reduction and internal fixation. The study aims to compare the effectiveness of three different techniques (transoral, transbuccal, and right-angled fixation technique) for single adaptational monocortical upper border plating in mandibular angle fracture. METHODS: The study conducted at our center was a prospective randomized study. The study duration was from November 2019 to August 2021. The three groups included in our study were transoral, transbuccal, and transoral approach using the right-angled drill. Patients who required open reduction and internal fixation of mandibular angle fracture were included in the study. Computer-generated randomization method was used to assign the participants among the 3 groups, ie, transoral, transbuccal, or right-angled fixation technique. The primary outcome clinical variables were mouth opening (MO), occlusion stability, scar or laceration, facial nerve weakness, infection, and the radiological variables were gap between the fracture segments and displacement of the fracture segment. The secondary outcome of our study is a comparison of the perioperative complications including plate exposure during the entire fracture healing period. The covariates of the study were age, sex, etiology, and tooth in line of fracture. Statistical analysis was done using ANOVA, post hoc Tukey test, and Pearson χ2 test. A P value less than 0.05 was considered statistically significant. RESULTS: A total of 48 patients were included in our study. According to randomization, each group was allotted 16 patients. In the study, 66.7% of the study population were male and 33.3% were female; 75% of the study population were victims of road traffic accidents, and 25% were injured due to assault. The mean and standard deviation for MO at 1 month were 31.3 ± 2.9 for the transoral group, 35.8 ± 1.7 for the transbuccal group, and 35.5 ± 1.3 for the right-angled fixation group. On intergroup comparison, statistically significant results were seen at the 1-month postoperative MO clinical parameter. The P value here was 0.02 which was statistically significant. CONCLUSION: The comparison of the right-angled fixation technique to transoral and transbuccal fixation methods have not been documented. Our study is the first of its kind to compare the right-angled fixation technique to various other approaches. Our study showed that the MO was better postoperatively with the transbuccal approach. The other variables showed no difference among the three techniques.

Assessment of clinical outcome of surgically managed panfacial fractures with or without ancillary procedures. A 10-year retrospective study.

Purpose: The aim of this retrospective study is to analyze the demographic factors, different patterns, complications, and clinical outcomes based on various ancillary surgical procedures performed during the management of panfacial fractures. Materials and methods: Patients diagnosed with panfacial fractures, who underwent surgical management from 2011 to 2020 were included. The predictor variable was five ancillary surgical procedures, orbital reconstruction with autogenous bone graft, primary nasal bone grafting, open reduction and internal fixation or custom-made palatal splint for palatal fractures, ORIF for zygomatic arch fractures, and reattachment of Medical Canthal Ligament. The outcome variable was post-operative complications. Age, sex, etiology of trauma and pattern of panfacial fractures were the co-variates for the study. The incidence of complications with or without performing ancillary surgical procedures was analyzed. Results: A total of 1028 patients were treated for various maxillofacial trauma from 2011 to 2020.103 patients were diagnosed with panfacial fractures. 27 of 103 patients were excluded, 76 patients were included in the study with strict adherence to the inclusion criteria. Statistical Analysis was done using SPSS software version 23.0. Chi-Square test was performed to analyze the incidence of complication and fracture pattern. The results were statistically significant for three procedures which included orbital reconstruction, primary nasal bone grafting, and ORIF for palatal fractures with p-value, 0.032, 0.022, and 0.012 respectively. Conclusion: The results suggested that performing ancillary procedures in the management of panfacial fractures significantly reduces the incidence of postoperative complications and improves the clinical outcome.

Association between shape of the mandibular condylar head and the occurrence of unilateral condylar fracture - A retrospective computed tomographic study.

This retrospective study aims to evaluate the correlation between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture using computed tomography. Medical records of patients diagnosed with unilateral condylar fractures from the year 2012-2019 were reviewed. The shape of the condylar head on the non - fractured side was analysed using a Radiant Dicom Viewer. The analysis was done using both visual and analytical methods. In the analytical method, a horizontal line was drawn at the base of the curvature of the condylar head. The highest peak point of the head was marked, and a perpendicular line was drawn connecting the highest point to the horizontal line. The shape was categorized into four types as convex, flat, angled, and round based on these lines. 201 CT scans were examined, of which 69 were excluded as they did not meet the inclusion criteria. The remaining 132 were included in our study. On examining the shape, flat-shaped condyle was seen in 57 scans (43.2%), followed by convex in 31 scans (23.4%), angled in 30 (22.7%) and round in 14 scans (10.6%). The relationship between the shape of the mandibular condylar head and the incidence of unilateral condylar fracture was analysed using a chi-square test, which showed high statistical significance (p value 0.0001). The flat-shaped condylar head was more prone to fracture, and the round-shaped condylar head was least prone to fracture. In conclusion, the shape of the mandibular condylar head had a statistically significant association with the incidence of unilateral condylar fracture. The assessment of the shape of the condylar head can be taken as a guide to suspect condylar fractures and other associated mandibular fractures.

Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study.

PURPOSE: The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures. MATERIALS AND METHODS: A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ2 test and student's t test with P value less than 0.05 indicating statistical significance. RESULTS: Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6 ± 0.9 minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively. CONCLUSIONS: Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.

Intraoperative Findings of Extraocular Muscle Necrosis in Linear Orbital Trapdoor Fractures.

PURPOSE: Orbital trapdoor fractures can constitute a relative surgical emergency. The reason for poor surgical outcomes in ocular motility disturbances and diplopia is not apparent in these fractures. The purpose of this retrospective study was to analyze the possibility of ischemic necrosis of the orbital contents in linear trapdoor fracture of the orbital floor and to evaluate the recovery period of trapdoor fractures. PATIENTS AND METHODS: The study included 11 patients with linear trapdoor fracture of the orbital floor over 5 years with minimum 1-year follow-up. Patients with associated facial bone fractures were excluded. Demographic, etiologic, and radiologic characteristics, interval from trauma to surgery, and surgical techniques were recorded. RESULTS: Patients' age range was 9 to 29 years (mean, 16.3 yr). Mean time to surgical intervention from time of injury was 3.9 days (range, 0 to 11 days). Intraoperatively, macroscopic segmental necrosis of the entrapped inferior rectus muscle was observed in 3 patients. Postoperative review was conducted for a minimum of 12 months at 1-week and 1-, 3-, 6-, and 12-month intervals. At the end of the follow-up period, incomplete recovery was observed in 5 patients, including the 3 patients with intraoperative necrosed muscle, and the other 2 patients were operated on at days 7 and 8 from time of injury. CONCLUSION: This study showed that segmental necrosis of the entrapped inferior rectus muscle is possible in linear trapdoor fracture of the orbital floor. In addition, incomplete recovery correlated with clinical evidence of inferior rectus muscle necrosis and late surgical intervention.

Use of adsorption using granular activated carbon (GAC) for the enhancement of removal of chromium from synthetic wastewater by electrocoagulation.

The present work deals with removal of hexavalent chromium from synthetic effluents in a batch stirred electrocoagulation cell with iron-aluminium electrode pair coupled with adsorption using granular activated carbon (GAC). Several working parameters such as pH, current density, adsorbent concentration and operating time were studied in an attempt to achieve higher removal capacity. Results obtained with synthetic wastewater revealed that most effective removal capacities of chromium (VI) could be achieved when the initial pH was near 8. The removal of chromium (VI) during electrocoagulation, is due to the combined effect of chemical precipitation, coprecipitation, sweep coagulation and adsorption. In addition, increasing current density in a range of 6.7-26.7mA/cm2 and operating time from 20 to 100min enhanced the treatment rate to reduce metal ion concentration below admissible legal levels. The addition of GAC as adsorbent resulted in remarkable increase in the removal rate of chromium at lower current densities and operating time, than the conventional electrocoagulation process. The method was found to be highly efficient and relatively fast compared to existing conventional techniques.