Transoral versus Extraoral Reduction of Mandible Fractures: A Comparison of Complication Rates and other Factors

2003 ◽  
Vol 128 (2) ◽  
pp. 215-219 ◽  
Author(s):  
Vincent S. Toma ◽  
Robert H. Mathog ◽  
Roger S. Toma ◽  
Robert J. Meleca
Keyword(s):  
Open Reduction ◽  
Operative Time ◽  
Surgical Approaches ◽  
Mandibular Fractures ◽  
Complication Rates ◽  
Body Angle ◽  
Advantages And Disadvantages ◽  
Surgeon Experience ◽  
Mandibular Body ◽  
Mandible Fractures

OBJECTIVE: This retrospective study evaluates results and complications of the transoral and extraoral approaches for open reduction and internal fixation of mandibular body, angle, and ramus fractures. Our aim was to describe advantages and disadvantages of the techniques and to develop criteria for choosing between surgical approaches. STUDY DESIGN AND SETTING: A retrospective chart review was performed on patients with mandible fractures occurring between August 1999 and October 2001 at a level I trauma center. Only mandibular body, angle, and ramus fractures requiring open reduction were selected for this study. Cases were evaluated for cause, age, gender, dentition, site and extent of fractures, surgical approach, postoperative complications, operative time, and postoperative occlusion. RESULTS: Of the 227 patients with mandibular fractures, 78 had body, angle, or ramus fractures requiring open reduction. Of these, 36 were treated extraorally, and 42 were treated transorally. Criteria for selecting one procedure over another often involved training and surgeon experience and those factors normally considered important in defining the difficulty of treatment and prognosis of the patient. Seven of the 42 patients were converted from a transoral to an extraoral approach because of inadequate exposure. Similar complication rates occurred for the transoral and extraoral approaches, but because of the time required for converting from the transoral to extraoral approach, the average operative time was found to be increased in patients undergoing the transoral approach. CONCLUSION AND SIGNIFICANCE: Decisions regarding treatment approaches for open reduction of mandible fractures often relate to surgeon experience and training, modified by factors that can affect uncomplicated healing such as fracture locations and displacement, comminution of the fracture, infection, dentition, and atrophic changes of the mandible. In some cases, the choice is affected by availability of equipment and experience of operating room personnel. More difficult cases involving an edentulous, atrophic mandible or comminution should be considered for extraoral exposure.

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis

2021 ◽  
pp. 194338752110225
Author(s):  
Matthew E. Pontell ◽  
Eva B. Niklinska ◽  
Stephane A. Braun ◽  
Nolan Jaeger ◽  
Kevin J. Kelly ◽  
...  
Keyword(s):  
Mixed Dentition ◽  
Surgical Removal ◽  
Mandibular Fractures ◽  
Rigid Fixation ◽  
Complication Rates ◽  
Facial Growth ◽  
Age Related ◽  
Significant Difference ◽  
Mandible Fractures ◽  
Unerupted Teeth

Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.

Surgical approaches in juxtarenal and pararenal aortic aneurysms repair

2021 ◽  
pp. 021849232199738
Author(s):  
Eduard R Charchyan ◽  
Anna B Stepanenko ◽  
Andrey P Gens ◽  
Nail A Galeev ◽  
Yuri V Belov
Keyword(s):  
Operative Time ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Reliable Data ◽  
Aortic Aneurysms ◽  
Retroperitoneal Approach ◽  
Surgical Approaches ◽  
Midline Laparotomy ◽  
Advantages And Disadvantages ◽  
Case Basis

Background In this study, surgical tactic features and juxtarenal and pararenal treatment immediate results were analyzed depending on the use of various surgical approaches. Methods Between 2015 and 2019, a total of 89 patients received surgical treatment, of which 52(58%) had juxtarenal aneurysms and 37 (42%) – pararenal aneurysms. During repairs, three types of surgical approaches were used: midline laparotomy, extended retroperitoneal approach and thoraco-phreno-retroperitoneal approach. The patients were divided into three groups accordingly. Results At the immediate postoperative period, mortality rate equaled 2 (2.2%). The reasons were pulmonary embolism and sepsis. Statistically reliable data were obtained, confirming the advantages of midline laparotomic approach over the lateral retroperitoneal ones, which consisted in a shorter operative time, less pronounced pain syndrome, lesser blood loss, fewer postoperative days. The disadvantages were that enteroparesis occurred more often when the midline laparotomy was used in comparison to extended retroperitoneal or thoraco-phrenoretroperitoneal approaches. Conclusion Thus, open repairs of juxtarenal and pararenal aortic aneurysms have some specific technical and strategical features which are associated with intraoperative renal ischemia. During open surgical intervention, it is important to first consider the possibility of repair with midline laparotomy. However, lateral retroperitoneal approaches can also be used on a case-by-case basis noting their advantages and disadvantages.

Open Reduction and Internal Fixation of Mandibular Fractures

1982 ◽  
Vol 90 (5) ◽  
pp. 576-581 ◽  
Author(s):  
James I. Cohen ◽  
William L. Meyerhoff
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Surgical Techniques ◽  
Mandibular Fracture ◽  
Mandibular Fractures ◽  
Intermaxillary Fixation ◽  
Advantages And Disadvantages ◽  
Key Points ◽  
Principles Of Treatment ◽  
Indications For Use

Open reduction and internal fixation of mandibular fractures by intraosseous wiring in conjunction with intermaxillary fixation remains the mainstay of mandibular fracture treatment despite the availability of newer methods. The principles of treatment are reviewed, including indications for use of this technique and its advantages and disadvantages. Various surgical techniques are also reviewed and key points in their application emphasized.

scholarly journals Predictive Factors Associated with Complications after Laparoscopic Distal Pancreatectomy

2020 ◽  
Vol 9 (9) ◽  
pp. 2766
Author(s):  
Ki Byung Song ◽  
Sarang Hong ◽  
Hwa Jung Kim ◽  
Yejong Park ◽  
Jaewoo Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Distal Pancreatectomy ◽  
Predictive Factors ◽  
Operative Time ◽  
Laparoscopic Distal Pancreatectomy ◽  
Complication Rates ◽  
Major Complications ◽  
Surgeon Experience ◽  
Inexperienced Surgeon

Although laparoscopic distal pancreatectomy (LDP) has become more popular, the postoperative complication rate remains high. We sought to identify the risk factors for post-LDP complications. We examined 1227 patients who underwent LDP between March 2005 and December 2015 at a single large-volume center. We used logistic regression for the analysis. The overall (13.2%) and major (3.3%) complication rates were determined. Postoperative pancreatic fistula was the most frequent complication, and 58 patients (4.7%) had clinically significant (grade B) pancreatic fistulas. No 90-day mortality was recorded. Long operative time (≥200 min), large estimated blood loss (≥320 mL), LDP performed by an inexperienced surgeon (<50 cases), and concomitant splenectomy were identified as risk factors for overall complications using a logistic regression model. For major complications, male sex (p = 0.020), long operative time (p = 0.005), and LDP performed by an inexperienced surgeon (p = 0.026) were significant predictive factors. Using logistic regression analysis, surgery-related factors, including long operative time and LDP performed by an inexperienced surgeon, were correlated with overall and major complications of LDP. As LDP is a technically challenging procedure, surgery-related variables emerged as the main risk factors for postoperative complications. Appropriate patient selection and sufficient surgeon experience may be essential to reduce the complications of LDP.

scholarly journals Virtual Surgical Planning and Hardware Fabrication Prior to Open Reduction and Internal Fixation of Atrophic Edentulous Mandible Fractures

2019 ◽  
Vol 12 (2) ◽  
pp. 156-162 ◽  
Author(s):  
KarlDaniel Maloney ◽  
Torin Rutner
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Surgical Planning ◽  
Facial Trauma ◽  
Mandibular Fractures ◽  
Virtual Surgical Planning ◽  
Mandible Fracture ◽  
Edentulous Mandible ◽  
Mandible Fractures ◽  
Trauma Surgeons

Mandibular fractures are a common injury encountered by facial trauma surgeons. A majority of these cases are in dentate patients and can predictably be treated with several different open or closed techniques. Edentulous mandible fractures can be challenging as maxillomandibular fixation, either as the sole treatment or used for fracture reduction and stabilization prior to internal fixation, is not possible. The atrophic edentulous mandible fracture poses an even greater challenge, as there is more sclerotic bone present and less bone volume for bony contact, both of which can impair healing. In addition, with less bone mass, available plate adaptation and fixation are difficult. In recent years, virtual surgical planning (VSP) has been increasingly used in craniofacial and maxillofacial surgeries as well as in dentistry. Utilizing VSP to fabricate the necessary hardware prior to open reduction and internal fixation of atrophic edentulous mandible fractures can be helpful in treating these cases. Two cases where this method was used are presented.

scholarly journals Objective assessment of progressive increase in bite force post surgical correction of mandibular fractures using Nupai bite scan analyser

2021 ◽  
Vol 9 (6) ◽  
pp. 1684
Author(s):  
Soheb Rafique ◽  
Devika Rakesh ◽  
Sanjeev K. Uppal ◽  
Ramneesh Garg ◽  
Rajinder K. Mittal ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Statistical Significance ◽  
Objective Assessment ◽  
Bite Force ◽  
Motor Vehicles ◽  
Time Interval ◽  
Mandibular Fractures ◽  
Force Measurements ◽  
Mandible Fractures

Background: Fracture of mandible is a common condition which is increasing in incidence in the trauma centers due to increasing motor vehicles and failure to abide by traffic regulations. Patients undergo surgical open reduction and internal fixation where post-operative occlusion and normal masticatory functions are targeted. Bite force can be taken as a guide of normal masticatory function of an individual which is dependent upon craniomandibular biomechanics. The aim of the study was to analyse bite force measurements post-operatively in patients who underwent open reduction and internal fixation for mandible fractures at different sites.Methods: Molar bite force was recorded in 31 post-operative patients who underwent open surgical procedure for fracture mandible in the department of plastic surgery from January 2018 to June 2019 by a pre-scale bite force recorder-Nupai bite force prescale system (FujiTM). Various parameters were recorded pre and post-operatively including age, gender, history, comorbidities, requirement of MMF, site and number of fractures and age of injury. Bite force were compared and improvement of bite force every 2 weeks was noted and analyzed upto 6 weeks postoperatively.Results: Bite force improvement was seen in all types of mandible fractures irrespective of the site and type of fractures over a period of 6 weeks post-operatively. This improvement was however not statistically significant. Decreased time interval form injury to surgery resulted in improved bite force measurements though not statistically significant.Conclusions: Although objective improvement in bite force could be demonstrated but extensive study involving more subjects and more patient variables would have statistical significance.

scholarly journals External Unilateral Fixator of Own Design for the Treatment of Selected Mandibular Fractures in Horses

2019 ◽  
Vol 9 (13) ◽  
pp. 2624
Author(s):  
Bernard Turek ◽  
Olga Drewnowska ◽  
Marcin Kapłan
Keyword(s):  
Stainless Steel ◽  
External Fixator ◽  
Good Alternative ◽  
The Body ◽  
Bone Plates ◽  
Mandibular Fractures ◽  
Mandibular Body ◽  
Mandible Fractures

Most of the mandibular fractures occur as a result of accidents, kicks, or falls. The treatment of fractures located in the incisor region is quite successful with the use of the wiring method. Fractures that occur within the body of the mandible are more complicated. Some of them are open and infected and involve the cheek teeth, which makes treatment quite challenging. In these cases, using bone plates mounted directly on the bone would constitute poor technique. External skeletal fixators can be a good alternative for treatment of complicated fractures. In this article we present the construction and the possible use of a unilateral external fixator dedicated for the treatment of mandibular body fractures. The fixator consists of one rod having a diameter of 8 mm and a length of 20 cm, four booms, four connectors, and four self-threading apex pins with a diameter of 6 mm. Stainless steel was used in the production of the fixator. The device has been successfully used for the treatment of open mandible fractures. The stabilizer is light and is small in size, simple to use, and easily assembled and disassembled. It can be adjusted in three planes.

scholarly journals Multi-institutional Analysis of Surgical Management and Outcomes of Mandibular Fracture Repair in Adults

2018 ◽  
Vol 11 (1) ◽  
pp. 041-048 ◽  
Author(s):  
Dmitry Zavlin ◽  
Kevin T. Jubbal ◽  
Anthony Echo ◽  
Shayan A. Izaddoost ◽  
Jeffrey D. Friedman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Techniques ◽  
The United States ◽  
Fracture Repair ◽  
Surgical Approaches ◽  
Facial Trauma ◽  
Mandibular Fractures ◽  
Complication Rates ◽  
Improvement Program ◽  
Concomitant Injuries

Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible. Preoperative, perioperative, and postoperative details were categorized and evaluated for these two cohorts. Multivariate analysis was performed to detect risk factors related to any complications. Patients were predominantly male (85.7%), young with a mean age of 34.0 ± 14.8 years, and relatively healthy with body mass index of 23.6 ± 8.2 and an American Society of Anesthesiologists (ASA) class of 1 or 2 (84.4%). However, more than half were regular smokers (51.1%). The top five most frequent procedures performed for mandibular repair were exclusively open surgical approaches with internal, external, or interdental fixation in both cohorts. Patients with open fractures were more often admitted as emergencies, treated inpatient, required longer operative times, and presented with more contaminated wounds ( p < 0.05). Overall, medical (1.7%) and surgical complications (3.7%) were low. A high ASA class 3 or above and emergency operations were identified as risk factors for medical adverse events. Despite frequent concomitant injuries after trauma and a diverse array of mandibular injury types, our patient sample demonstrated favorable outcomes and low complication rates. Open surgical techniques were the most common procedures in this study representing the American population.

scholarly journals Comparing the outcome of ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a retrospective cohort study

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Said Alfin Khalilullah ◽  
Untung Tranggono ◽  
Ahmad Zulfan Hendri ◽  
R. Danarto
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Operative Time ◽  
Ileal Conduit ◽  
Multivariable Logistic Regression Analysis ◽  
Complication Rates ◽  
Advantages And Disadvantages ◽  
Stoma Stenosis

Abstract Background Most of the outcomes after radical cystectomy (RC) are directly associated with the type of urinary diversion. This study sets out to evaluate the outcomes of ileal conduit (IC) and transuretero-cutaneostomy (TUC) urinary diversion after RC. Methods This retrospective study included 52 patients (IC, n = 30; TUC, n = 22) at Dr. Sardjito Hospital between January 2014 and December 2019. The clinical outcomes were compared using Chi-squared tests and independent t tests. Multivariable logistic regression analysis was performed to determine the odds of developing related complications. Results Demographically, both groups were similar in terms of age, gender, ASA score, staging, body mass index, and comorbidities. IC was associated with a high incidence of postoperative complications than TUC (56.7% vs. 27.3%; p = 0.035). Long-term postoperative complications stoma stenosis was more common in the TUC than IC (p = 0.010). Multivariate analysis showed TUC was a significant predictor for stoma stenotic with odds ratio of 1.29 (95% confidence interval, 1.03–1.62; p = 0.006). Meanwhile, metabolic change was found higher in IC (p = 0.047). No difference between the rate of required blood transfusion, postoperative ileus, re-operation, and anastomotic stricture in both groups. Operative time (p = 0.000) and length of stay (p = 0.002) were lower in patients who underwent TUC. The hospitalized cost was also lower in TUC ($ 2311.8 ± 1448 for IC vs. $ 1844.2 ± 948.8 for TUC; p = 0.005). Nonetheless, the follow-up cost was higher in the TUC but not statistically significant. Additionally, there was no difference between the overall satisfaction and diversion-related symptoms scores in both groups. The psychological score was better in IC groups. Conclusions Both of these techniques can be an option in a urinary diversion after RC with various advantages and disadvantages. TUC provides reduced complication rates, operative time, shorter length of stay, and hospitalized costs, but IC may reduce postoperative stoma stenosis complications and better psychological function.

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