Dental trauma in patients with maxillofacial fractures.

PURPOSE: The purpose of this study was to analyze and evaluate the correlation between dental injuries and the pattern of maxillofacial fractures. The correlation with age, gender, trauma mechanism and type of maxillofacial fracture was also investigated. MATERIALS AND METHODS: From January 2000 to December 2009, 1131 patients with facial fractures were registered. Of these, 473 presented with associated dental trauma. The information and data collected and analyzed included: age, gender, mechanism of injury, type of facial fracture, type of dental injury, and the relationship between dental injury and facial fracture. RESULTS: Dental injury was sustained by 473 patients (41.8%), with a total of 2215 injured teeth. Of the 2215 injured teeth, 1191 (53.8%) were in the maxilla and 1024 (46.2%) in the mandible. Fall from a height had the highest risk of dental injuries (OR = 4.145, P = 0.002). The central incisor was the most injured tooth for both the maxilla (388, 36.2%) and mandible (284, 27.7%). The most common type of dental injury was avulsion (1070, 47.4%). More anterior teeth in the maxilla were of crown fracture, avulsion, and intrusion than that in the mandible, whereas more anterior teeth in the mandible were of subluxation and concussion than that in the maxilla. Dental injuries were more prone to occur in patients who sustained only symphysis fractures (OR = 2.817, P < 0.001), only 0.236-fold risk in patients who sustained only mandible angle fracture (P < 0.001). CONCLUSIONS: The occurrence of dental trauma is significantly related to the pattern and position of the maxillofacial fractures.

The initial management of dento-alveolar trauma in general dental practice.

UNLABELLED: Dento-alveolar trauma presents commonly in general dental practice, but may prove difficult to manage for those unfamiliar with it. Timely and well-informed intervention can significantly improve the clinical outcome for the patient. This article aims to inform the clinician on best current practice for the assessment and initial management of dental traumatic injuries, incorporating current international guidelines and practical arrangements for follow-up care. CLINICAL RELEVANCE: The dental trauma patient often presents to the general dental practitioner and the appropriate emergency management plays a vital role in relieving pain, protecting the dentino-pulpal complex, reducing displaced teeth and improving prognosis.

Prevalencia de fracturas en los maxilares de los pacientes que acudieron al Servicio de Cirugía Maxilofacial del Hospital Clínico Universitario (HCU); febrero-noviembre 2004 / Prevalence of jaw fractures in patients attending the Oral and Maxillofacial Surgery Service at the University Clinical Hospital; February-November 2004

El objetivo del presente estudio es determinar la prevalencia de fracturas en los maxilares de los pacientes que acudieron a consulta en el Servicio de Cirugía Maxilo Facial del hospital Clínico Universitario (HCU). Periodo Febrero-Noviembre 2004 y analizar su relación con edad, sexo, etiología, zona anatómica y número de fracturas. (Diagnóstico). Se examinaron 262 pacientes, de los cuales fueron seleccionados los que presentaban fracturas en los maxilares. Se elaboró una tabla de recolección de datos para la obtención de la información. El diagnóstico de las fracturas fue realizado por los especialistas del servicio. El número de pacientes con fracturas en los maxilares fue de 116 (44 por ciento). La causa o etiología más común fue asalto o pelea (n=47; 41por ciento), de los grupos etáreos estudiados se observó una mayor prevalencia en el grupo de 20 a 29 años con un número total de 47 casos (40 por ciento) distribuidos de la siguiente manera (n=7; 6 por ciento) en el maxilar superior y (n=40). La distribución de fracturas de los maxilares de acuerdo al sexo fue en el maxilar superior (n=4; 3 por ciento) en el sexo femenino y n=19; 17 por ciento en el masculino) y en el maxilar inferior (n=16) para el sexo femenino y n=77; (para el sexo masculino). De acuerdo al número de fracturas por maxilares, el maxilar inferior es más susceptible a fracturas; 50 por ciento los que tenían una sola línea de fractura, 25 casos; 24 por ciento con dos líneas de fractura y 8 casos: 7 por ciento con tres líneas de fractura. Con respecto a la localización anatómica el cuerpo del maxilar inferior (n=44); la zona mas susceptible a fractura. De los grupos etáreos estudiados se observó una mayor prevalencia en el grupo de 20 a 29 años. En cuanto a la distribución por sexo, existió un predominio de las fracturas por el sexo masculino. Con relación a la localización anatómica el maxilar inferior ocupó el primer lugar y la etiología más frecuente son las agresiones personales.

Surgical management of sports-related traumatic injuries.

The increasing popularity of all sporting events results in increased potential for injury. Despite helmet, facemask, and mouthguard use, the face often remains an exposed area at risk in many sports. Dentists rehabilitating patients after facial injuries should understand their patients' previous injuries and treatment.

Maxillofacial fractures in a semi-urban Nigerian teaching hospital. A review of 442 cases.

A retrospective review of 442 patients, seen by one maxillofacial unit over a twelve-year period, is presented. Data concerning the patients' demographics and the aetiology, pattern, treatment and complications of the fractures were obtained and evaluated. Approximately 72% of the patients sustained fractures from road traffic accidents and 39% of the fractures occurred in the 21-30-year range. There was a male preponderence and 8% of all cases had postoperative infections. Over 20% of the patients sustained associated body injuries and only one-third reported for treatment within 24 hours of injury. Road traffic accidents continue to be the leading cause of maxillofacial fractures. The late presentation for treatment appears to be related to the rural and semi-urban dwelling of the patients and the attendant transportation and economic difficulties.

Palatal fractures: classification, patterns, and treatment with rigid internal fixation.

A classification of palatal fracture types is developed from patterns observed on CT scans, and success with open reduction techniques is correlated with fracture pattern. The six palatal fracture types are as follows: I, anterior and posterolateral alveolar; II, sagittal; III, parasagittal; IV, para-alveolar; V, complex; and VI, transverse. Associated fractures were LeFort I (100 percent), LeFort II and III (55 percent), mandible (48 percent), and dental (55 percent). Large segment, sagittally oriented palatal fractures could be stabilized with rigid internal fixation. Complete rigid fixation of the palate consists of (1) roof of mouth, (2) pyriform or alveolar, and (3) four LeFort I buttress stabilization. Comminuted palatal fractures were managed by standard LeFort I and alveolar buttress fixation, palatal splinting, and intermaxillary, fixation. If complete rigid fixation was employed in the palate in type II, III, and IV fractures, a palatal splint was avoided in 60 percent of these cases. Rigid internal fixation is therefore concluded to facilitate the treatment of certain types of palatal fractures by reduced length of intermaxillary fixation and avoidance of palatal splinting.

Evaluation and treatment of mandibular and midface fractures.

The classification of mandibular and midface fractures is discussed. Signs and symptoms of fractures are presented and the radiographic examinations described. The latest treatment modalities, including the use of skeletal fixation with titanium plates, are also discussed.

Jaw fractures in the country of Stockholm (1978-1980). Injury dynamics--etiologic factors in relation to anatomic site of fracture.

This paper presents a retrospective review of jaw fractures sustained by 795 individuals in the county of Stockholm from 1978-80. The material comprised 904 mandibular and 249 maxillary fractures, a total of 1.153 fractures. The present part of the study concerns the relationship between etiologic factors and fracture location. Single fractures were noted in 43% of the mandibular fractures and in 4% of the maxillary fractures. The region most frequently fractured was the mandibular condyle (19% of all fractures). Violence was the etiologic in 42% of the total number of fractures and 47% of mandibular fractures. Compared to earlier reports, this seems to represent an increase over the last decades and probably reflects a general trend towards greater incidence of violence in society. Jaw fractures caused by traffic accidents accounted for 25% of all fractures and have decreased, probably as a result of the safety belt law of 1975 and better traffic security reforms. However, the severe Le Fort III fractures, combined with unconciousness and neurological injuries, are mainly the result of on traffic accidents. Falls accounted to 23% of the fractures, mostly localized to the mandible (81%).

[Modern therapy of fractured jaws (author's transl)]. / Moderne Kieferbruch- behandlung

Modern treatment of fractured jaws includes the anatomical and functional restoration of the broken mandible and the middle part of the face. The central feature on the one hand, is the reposition and fixation of the fractured skeletal parts in the correct axial line, and on the other hand, occlusal rehabilitation, which is to be considered the criterion of a correct position for the dentigerous fragments. For this purpose, conservative and/or operative measures cone into question, according to the type of fracture and dislocation. The conservative methods enable reposition and fixation of fragments by means of dental fixation dressings. At the present time, wire suture and wire suspension which are always combined with conservative methods as well as plate osteosynthesis are to be mentioned as the most common operative procedures for fractures of the mandible and the middle part of the face.