Subject(s)
Calcinosis/diagnosis , Fibula/transplantation , Free Tissue Flaps/adverse effects , Mandibular Reconstruction/adverse effects , Postoperative Complications/diagnosis , Radiography, Panoramic , Adult , Calcinosis/surgery , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/surgery , Fibula/pathology , Fibula/surgery , Free Tissue Flaps/transplantation , Humans , Male , Mandibular Neoplasms/diagnosis , Mandibular Neoplasms/surgery , Mandibular Reconstruction/rehabilitation , Myocutaneous Flap/adverse effects , Myocutaneous Flap/transplantation , Postoperative Complications/surgery , X-RaysABSTRACT
INTRODUCTION: Early surgical management is often advocated for fractures of the tooth-bearing portion of the mandible. A 6-hour delay has been mentioned for the fixation of these fractures. Our aim was to bring this paradigm into question. METHODS: All patients referred to our department from September 2012 to May 2014 for fractures of the tooth-bearing portion of the mandible were retrospectively included. For each patient, age, gender, aetiology of the fracture, and characteristics of the fractures were recorded. Tobacco and/or alcohol addictions, diabetes and mandibular dental condition were taken into account. We also noticed the preoperative delay and the occurrence of complications such as: haematoma, infection, wound dehiscence, osteosynthesis failure and pseudarthrosis. RESULTS: Among the 47 patients referred, 36 were treated with a delay of more than 6 hours (76.6%). In 88.8% of the cases, the reason for this delay was unavoidable. The mean delay time from trauma to surgery was 52 hours (range: 7-312). Forty-nine percent of the patients had comorbidities. Complications occurred in 6 patients leading to an overall complication rate of 16.67%. A statistically significant higher complication rate was observed among smokers (P=0.006). No statistical relationship was found between the delay and the occurrence of complications (P=0.994). This study suggests that fractures of the tooth-bearing portion of the mandible should no longer be considered as an emergency that must be treated within a 6-hour delay.
Subject(s)
Fractures, Open/surgery , Mandibular Fractures/surgery , Mandibular Injuries/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Emergencies/epidemiology , Female , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/statistics & numerical data , Fractures, Open/epidemiology , Humans , Jaw Fixation Techniques/statistics & numerical data , Male , Mandible/surgery , Mandibular Fractures/epidemiology , Mandibular Injuries/epidemiology , Middle Aged , Retrospective Studies , Young AdultABSTRACT
The development of new technologies such as three-dimensional (3D) planning has changed the everyday practice in maxillofacial surgery. Rapid prototyping associated with the 3D planning has also enabled the creation of patient specific surgical tools, such as cutting guides. As with all new technologies, uses, practicalities, cost effectiveness and especially benefits for the patients have to be carefully evaluated. In this paper, several examples of 3D planning that have been used in our institution are presented. The advantages such as the accuracy of the reconstructive surgery and decreased operating time, as well as the difficulties have also been addressed.
