Condylar Fractures: An Argument for Conservative Treatment

Introduction: The treatment of mandibular condyle fractures remains a controversial topic in maxillofacial surgery. No uniform treatment protocol is currently available. Purpose: We performed a retrospective monocentric cohort study of patients with condylar fractures and their treatment, including long-term follow-up by telephone, followed by a short review of the literature. Patients and Methods: The available data on condylar fractures presenting at Leuven University Hospitals between January 1, 2009, and December 31, 2015, were analyzed. Cause, age, sex, fracture level, degree of displacement, associated facial fractures, malocclusion, type of treatment, and complications were noted. Follow-up by telephone was performed after an average 261 weeks for the conservative group. Results: A total of 109 condylar fractures were observed with a male/female ratio of 1.14:1. Most fractures were subcondylar, unilateral, displaced, caused by road traffic accidents, and treated conservatively. Discussion: In children and intracapsular fractures, conservative management remains the first choice. Maxillomandibular fixation should be used sparingly in children and for as short a time as possible. Some patients indicated for surgery can still have acceptable results if treated conservatively.

Download Full-text

Comparison of outcome of two plate fixation with one plate fixation along with arch bar in management of parasymphysis; A Randomized Control Trial.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.09.4607 ◽

2020 ◽

Vol 27 (09) ◽

pp. 2007-2013

Author(s):

Mohammad Umar ◽

Jawad Ahmad Kundi ◽

Muhammad Sulaiman ◽

Muhammad Zaib Khan ◽

Ali Altaf

Keyword(s):

Plate Fixation ◽

Maxillofacial Surgery ◽

Treatment Protocol ◽

Advantages And Disadvantages ◽

Arch Bar ◽

Group A ◽

Group B ◽

Inferior Border ◽

Two Miniplates

Objectives: The aim of this study is to compare two plate fixation and one plate along with arch bar in the treatment of parasymphsis, and to analyze the advantages and disadvantages over one another. Study Design: Randomized Clinical Trial. Setting: Department of Oral and Maxillofacial Surgery Sardar Begam Dental College and Northwest General Hospital Peshawar. Period: Over a period of one year from June 2017 to August 2018. Material & Methods: 60 patients with parasymphysis fracture after diagnosis established on clinical and radiological examination were equally divided into two groups, 30 patients in each. Group (A) were treated with two miniplates, while Group (B) one miniplate along with arch bar under general anesthesia with proper antibiotics coverage in the pre- and post-operative period. Results: The infection rate 4 (13.3%) patients in Group B while 0 in Group A. No Loosening /fracture of screw or plate occur in any subject in group A at any follow up visit, while it occurred in 4 subjects in group B at 15 days follow up period. 9 patients in Group A and 6 in Group B presented with immediate post of paresthesia, which was reduced to 7 patients in group A and 6 in group B at 15 days follow up, and to 4 patients in Group A and 5 in Group B at 1 month follow up. Similarly, no subject had inferior border misalignment in group A at any follow up period while 3 subjects have immediate post -op inferior border discrepancy in group B and 6 subjects in the same group shows inferior border discrepancy at 15 days , but the overall result of this variable was also statistically non-significant. Conclusion: Isolated mandibular parasymphysis fracture can be treated with either two miniplates or one miniplate along with arch bar for 6 weeks. Both treatment protocol shows advantages and disadvantages with the aim of achieving the best treatment outcome for the patients.

Download Full-text

Clinico-epidemiologic review of 91 cases of non-odontogenic sarcomas of the orofacial region in a Nigerian population

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0012.8109 ◽

2019 ◽

Vol 8 (2) ◽

pp. 25-31 ◽

Cited By ~ 1

Author(s):

ROWLAND AGBARA ◽

BENJAMIN FOMETE ◽

KELVIN OMEJE ◽

POLYCARP ONYEBUCHI

Keyword(s):

Malignant Tumors ◽

Maxillofacial Surgery ◽

Osteogenic Sarcoma ◽

University Teaching ◽

Oral And Maxillofacial Surgery ◽

Female Ratio ◽

Oncological Treatment ◽

Orofacial Region ◽

Surgery Department

Introduction: Sarcomas are a rare group of malignant tumors. This study highlights important findings in 91 cases of non-odontogenic sarcomas of the orofacial region. Materials and Methods: Patients who presented with orofacial sarcoma at the Oral and Maxillofacial Surgery Department of a regional University Teaching Hospital between January 1997 and June 2017 were retrospectively studied. Excluded were cases of Kaposi and odontogenic sarcomas. Data obtained were analyzed using the Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA). Results from descriptive statistics were represented in the form of charts. Results: A total of 91 cases were reviewed and consisted of 51 (56.0%) males and 40 (44.0%) females, with a male to female ratio of 1.3:1. The mandible (n=47; 51.6%) and the maxilla (n=26; 28.6%) were the major sites involved. Osteogenic sarcoma (n=44; 48.4%) and rhabdomyosarcoma (n=16; 17.6%) occurred more frequently. A total of 41 (45.1%) patients had surgery and the common hard tissue procedures were mandibulectomy (n=26; 28.6%) and maxillectomy (n=10; 11.0%). Non-surgical oncological treatment was administered to 32 (35.2%) patients, and this was the only modality of treatment in 8 (8.8%) cases. The period of follow-up Arranged from 1-43 months and within this period; there were 7 (17.1%) recurrences with 1 case of pulmonary metastasis. Discussion: Most recurrences were noted less than one-year post-treatment. There is a tendency for patients to present late and compliance with follow up review is poor in this environment.

Download Full-text

Prospective study of clinical, radiological and functional outcome of anterior bridge plating for shaft of humerus fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204592 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1245

Author(s):

Abhishek Kumar ◽

Rahul Bade

Keyword(s):

Los Angeles ◽

Minimally Invasive ◽

Internal Fixation ◽

Functional Outcome ◽

Road Traffic ◽

Plate Osteosynthesis ◽

Treatment Protocol ◽

Minimally Invasive Plate Osteosynthesis ◽

Bridge Plating

Background: Shaft of humerus (SOH) fracture has been conventionally treated with either open reduction internal fixation with plate osteosynthesis or immobilization as conservative treatment. Intramedullary interlocking nailing (IMIL) and anterior bridge plating (ABP) are both newer modalities of internal fixation for SOH fracture. Rotator cuff irritation is a known complication of IMIL nailing of the humerus. Here, we present clinical, radiological, and functional outcome of SOH fracture fixation by ABP using a minimally invasive method.Methods: Thirty patients with SOH fracture were treated surgically via an anterior minimally invasive plate osteosynthesis (MIPO) approach with ABP. There were 21 male and 9 female patients, and the average age was 38.6±10.45 years. The mechanism of injury was road traffic accidents (60%) and ground level fall (40%). Functional assessments were obtained with University of California at Los Angeles (UCLA) score and mayo elbow performance index (MEPI) during the follow-up period.Results: At the end of 6 months follow-up, 29 (96.7%) patients had excellent to good UCLA and MEPI scores. Varus/valgus angulation was reported in 4 (13.3%) patients. Two patients (6.7%) had radial nerve neuropraxia and delayed union, while 1 (3.3%) patient had screw back-out or loosening. The mean duration of radiation exposure was 178±41.2 seconds. ABP for SOH fractures is a safe and effective treatment modality.Conclusions: This treatment protocol produces high rates of union, excellent functional recovery, and minimal biological disruption.

Download Full-text

Primary Intraosseous Squamous Cell Carcinoma of the Anterior Mandible Arising in an Odontogenic Cyst in 34-Year-Old Male

Reports ◽

10.3390/reports3020012 ◽

2020 ◽

Vol 3 (2) ◽

pp. 12

Author(s):

Sara Negrello ◽

Arrigo Pellacani ◽

Mattia di Bartolomeo ◽

Giuditta Bernardelli ◽

Riccardo Nocini ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Dentigerous Cyst ◽

Treatment Protocol ◽

Lower Canine ◽

First Choice ◽

Fibula Free Flap ◽

Anterior Mandible

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare and aggressive malignancy arising exclusively within the jaws, without any initial connection with the oral mucosa. The etiology and the epidemiology are unclear due to the rarity of the disease, and there is no current universally accepted staging or treatment protocol. Clinically, the posterior mandible is the most affected site, and common symptoms are swelling and pain. The diagnosis is often difficult either because it requires stringent criteria to be satisfied or because of the absence of a pathognomonic histological pattern. Aggressive surgery is the first-choice treatment, often followed by radiotherapy. The lymph nodal status seems to be the most important factor influencing the prognosis, which is usually poor, with a 5-year survival rate ranging from 30% to 40%. In the present article, we report an unusual case of cystogenic PIOSCC interesting the anterior mandible of a young 34-year-old male, which came to our attention after complaint about recurrent infective episodes affecting a dentigerous cyst (impacted lower canine) discovered ten years before. The age, site, and extension are uncommon. Extensive surgical treatment with fibula free flap reconstruction, adjuvant therapy, and salvage surgery was carried out. The patient was disease-free at a 31-month follow-up.

Download Full-text

Treatment and Short-Term Follow-up of Symptomatic Atherosclerotic Intracranial Artery Stenosis by Stent-Assisted Angioplasty

Interventional Neuroradiology ◽

10.1177/159101990300900204 ◽

2003 ◽

Vol 9 (2) ◽

pp. 153-162 ◽

Cited By ~ 2

Author(s):

Miao Zhongrong Ling Feng ◽

Li Shengmao ◽

Zhu Fengshui ◽

Hua Yang ◽

Wang Moli

Keyword(s):

Treatment Protocol ◽

Artery Stenosis ◽

Minor Stroke ◽

Intracranial Artery ◽

Technical Success ◽

Short Term ◽

Female Ratio ◽

Intracranial Artery Stenosis ◽

Basilar Arteries

Atherosclerotic intracranial artery stenosis can cause hypoperfusion of brain tissues and embolus formation, causing stroke. Conservative medical treatment seemed to have little effect on the natural history and prevent the stroke attack caused by artery stenosis. The purpose of stent-assisted angioplasty is to reconstruct the damaged vessels: the indications, feasibility, effectiveness, complications and follow-up for this new treatment method are discussed. A series of 32 cases with symptomatic intracranial artery stenosis were accepted from 1998 to 2002. The mean age was 42 yrs (31∼76 yr), male/female ratio=23/9. All patients were refractory to optimal medical therapy. Lesions included 12 middle cerebral arteries (37.5%), six basilar arteries (18.75%), three distal ICAs (9.38%) and 12 intracranial Vas (37.5%). All patients were treated by methods of transluminal stent-assisted angioplasty under general anesthesia. Patients were premedicated with Aspirin (300mg/per day) and Ticlopidine (250mg/per day), this was continued for six weeks after the procedure. Medical history, anamnesis, and treatment protocol were reviewed and evaluated retrospectively, short-term follow-up (2mths ∼ 1 yr) was also obtained. Primary clinical presentations were TIAs (21/32, 65.63%), minor stroke (8/32, 25%) and severe stroke (3/32, 9.38%). 31 cases (96.86%) were successfully implanted with coronary stents within the stenosed vessels; technical success rate was 96.86%. Instant angiographic results showed the stenosed extent had decreased from 72.36%±5.69 to 10.16%±6.94. One vessel ruptured during the procedure, the patient recovered after surgical repair of the ruptured vessel. Clinical follow-up demonstrated symptoms resolved in most patients (30/32, 93.75%) within the follow-up period, two cases with MCA stenosis had TIAs within two months after the procedure. 12 cases accepted angiographic follow-up. Velocities of stented vessels of five cases (5/21, 23.81%) increased compared to instant results, suggesting restenosis, three of them were confirmed by angiography which included two cases with MCA stenosis (figure 3) and one with distal VA, one of the five cases had recurred TIAs. With the newer generation of coronary stent, this technique seemed safe, feasible and effective to prevent stroke attack, but the indication is very important for the technical success. Restenosis remains a common problem as with coronary stenting. Long-term follow-up will be needed.

Download Full-text

Association of Midfacial Fractures with Ophthalmic Injury

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1599228 ◽

2017 ◽

Vol 10 (2) ◽

pp. 099-105 ◽

Cited By ~ 1

Author(s):

Constantinus Politis ◽

Alexandra Kluyskens ◽

Titiaan Dormaar

Keyword(s):

Traffic Accidents ◽

Road Traffic ◽

Time Window ◽

Maxillofacial Surgery ◽

Oral And Maxillofacial Surgery ◽

University Hospitals ◽

Initial Management ◽

Midfacial Fractures ◽

The Mean ◽

The University

The aim of this study is to evaluate the incidence of ophthalmic complications following midfacial fractures and investigate its relation to surgical or nonsurgical treatment. This article is a retrospective study, describing the spectrum and incidence of ophthalmic injury in 106 patients presenting with midfacial fractures at the Department of Oral and Maxillofacial Surgery of the University Hospitals Leuven over a period of 16 months (January 2013 to April 2014). The mean age of the patients was 45.6 years with a gender distribution of 68 men and 38 women. The main cause of trauma was road traffic accidents. Forty-one patients suffered an ophthalmic injury following the fracture. Twelve of them had a persistent ophthalmic problem. Ophthalmic examination is necessary during the initial management. The time window for preservation of sight is small and treatment should be started immediately. Development of an emergency trauma scale that includes fractures, symptoms of visual impairment, and patient history is recommended and should stimulate a multidisciplinary approach of complex cases.

Download Full-text

CLINICAL AND RADIOLOGICAL OUTCOMES OF MANDIBULAR CONDYLAR FRACTURES AFTER CONSERVATIVE TREATMENT

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.5251 ◽

2021 ◽

Vol 71 (2) ◽

pp. 667-71

Author(s):

Humaira Sarwar ◽

Irfan Shah ◽

Ali Akhtar Khan ◽

Adnan Babar ◽

Saad Mehmood ◽

...

Keyword(s):

Conservative Treatment ◽

Conservative Management ◽

Maxillofacial Surgery ◽

Radiological Finding ◽

Mouth Opening ◽

Armed Forces ◽

P Value ◽

Oral And Maxillofacial Surgery ◽

Condylar Fractures

Objective: To assess the clinical as well as radiological outcomes of the conservative management of mandibular condyle fractures. Study Design: Cross-sectional comparative study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery (OMFS), Armed Forces Institute of Dentistry (AFID), Rawalpindi, from Feb 2018 to Aug 2019. Methodology: A total of 60 patients diagnosed as isolated mandible trauma with unilateral condyle fractures were studied. All patients were assessed radiologically on orthopantomogram (OPG) before the start of treatment. They were assessed clinically for maximum mouth opening (MMO), occlusion, pain and masticatory satisfaction before the start of treatment and after conservative management. Conservative Management includes soft diet only or maxillomandibular fixation (MMF) followed by active physical therapy. After 6 months of follow up, pre-treatment and post-treatment clinical parameters and radiological finding were compared. Results: Sixty patients were managed conservatively, among them 37 (62%) were male and 23 (38%) were female with age range of 21-53 years. There was statistically significant decrease in pain (p-value 0.002) and improvement in mastication (pvalue 0.079) before and after the conservative treatment of mandibular condylar fractures. Overall 46 (77%) patients treated with conservative management were satisfied with their mastication and 40 (67%) patients had mild pain on mastication. All the patients showed satisfactory occlusion and had no occlusal discrepancy on last follow up visit. Maximum mouth opening improved from 32.38 ± 4.54 to 40.90 ± 1.75 after treatment. The mean of preoperative ramus length difference of both sides of the mandible was 4.23 ± 2.3 mm............

Download Full-text

Characteristics of and Survival in Oral Squamous Cell Carcinomas in Norway (NOROC) 2005-2009

10.21203/rs.2.10893/v1 ◽

2019 ◽

Author(s):

Inger-Heidi Bjerkli ◽

Olav Jetlund ◽

Gunnhild Karevold ◽

Ása Karlsdóttir ◽

Ellen Jaatun ◽

...

Keyword(s):

Squamous Cell ◽

Squamous Cell Carcinomas ◽

University Hospitals ◽

Curative Intent ◽

Female Ratio ◽

Oral Squamous Cell Carcinomas ◽

Starting Point ◽

Male Female Ratio ◽

N Status

Abstract Background: Incidence of oral squamous cell carcinomas (OSCC) is rising worldwide, and population characterization is important to follow future trends. Methods: Patients treated for primary OSCC at all four University Hospitals in Norway between 2005 and 2010 were retrospectively included in this study. The median follow up time was 48 months (range 0-125 months). Results: 535 patients with primary OSCC were identified. The overall survival (OS) was found to be 47%, disease specific survival (DSS) was 52%. When extracting the patients given treatment in curative intent the OS was found to be 56.2% and DSS 62.3%. Median age at diagnosis was 67 years (range 24-101 years), and men were in general eight years younger than women. The male/female ratio was 1.2. No gender difference was found in T status or N status, but both factors influenced significantly on survival. Conclusions: We present a large and validated cohort of primary OSCC. Patients with small tumors and stage I-II at time of diagnosis had better outcome, and habitual examination of the oral cavity by patients, dentists and physicians may shift more tumors to a more beneficial starting point.

Download Full-text

Etiology, pattern and outcome of management of facial lacerations in Dar es Salaam, Tanzania

Tanzania Journal of Health Research ◽

10.4314/thrb.v21i2.4 ◽

2020 ◽

Vol 21 (2) ◽

pp. 1-10

Author(s):

Karpal Singh Sohal ◽

Jeremiah Robert Moshy

Keyword(s):

Road Traffic ◽

Tissue Injury ◽

Maxillofacial Surgery ◽

Soft Tissue Injury ◽

Health Facilities ◽

Road Traffic Crash ◽

Oral And Maxillofacial Surgery ◽

Muhimbili National Hospital ◽

National Hospital ◽

Female Ratio

Background: Facial laceration is amongst the commonly encountered soft tissue injury in the care of the traumatized patients, and its optimal treatment is important for minimizing subsequent complications. This study aimed at determining the etiology, pattern, and outcome of management of facial lacerations among patients attended at Muhimbili National Hospital, Tanzania. Methods: This was a four months’ prospective study of all consecutive patients with facial lacerations who were attended in the department of oral and maxillofacial surgery of the Muhimbili National Hospital (MNH). The variables examined included socio-demographic characteristics, etiology of a facial laceration, prior management before referral to MNH, and the outcome of treatment. The data were analysed using IBM SPSS statistics for windows version 22 (Armonk, NY: IBM Corp) software. Results: Seventy-six patients with facial lacerations were included in the study. The male to female ratio was 8:1. The age of the patients ranged from 16 to 57 years, with a mean age of 31.63 ± 10.02 years. Motor traffic crashes (51, 67.1%), violence (18, 23.7%) and falls (7, 9.2%) were the etiological factors. The commonest affected facial esthetic zones were forehead (25, 32.9%), and the upper lip (24, 31.6%). The majority (60%) of wounds that were sutured/repaired in other health facilities prior to referral to MNH had a poor approximation of wound edges. Scarring was the commonest complication. Conclusion: Facial laceration affected males eight times more than females. Road traffic crash was the most common etiological factor. The forehead was the most frequently affected facial esthetic zone. The majority of patients treated in other health facilities prior to referral to a tertiary hospital had poorly approximated wound edges. Scarring was the most common complication of facial lacerations.

Download Full-text

Pattern of Maxillofacial Trauma among Patients with Head Injuries

Update Dental College Journal ◽

10.3329/updcj.v7i1.33304 ◽

2017 ◽

Vol 7 (1) ◽

pp. 14-20 ◽

Cited By ~ 2

Author(s):

Abul Hasnat ◽

AKM Erfanul Hoque ◽

Md Selim Ul Azam ◽

Mohammad Kamrujjaman ◽

Mahmuda Akhtar

Keyword(s):

Head Injury ◽

Motor Vehicle ◽

Road Traffic ◽

Head Injuries ◽

Maxillofacial Surgery ◽

Maxillofacial Trauma ◽

Adult Males ◽

Facial Bone ◽

Cross Sectional ◽

Female Ratio

Background: Patients with maxillofacial trauma are at high risk of having traumatic cranial injuries. Prompt determination of head injury in these patients is crucial for improving patients survival and smooth recovery.Objective: The purpose of this study was to find out the pattern of maxillofacial injuries in a patient with head injuries and to study their relationship.Study design: A prospective Cross-sectional descriptive study was made over 60 patients.Study setting and period: The study was conducted in the Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka-1000 from May 2010 to April 2011.Participants: Sixty patients with maxillofacial and head injuries were selected for the study.Methods: It was a prospective cross-sectional descriptive hospital based study. 60 patients who were diagnosed of having concomitant maxillofacial and head injuries were included in this study. Informations based on age, sex, mode of injury, pattern of facial and head injury, GCS score and type of head injury were taken for each case. Appropriate skull X-ray was done for all patients with maxillofacial injury and patients with initial sign of neurological deficit an initial CT scan of brain was done. Data was analyzed using the SPSS program.Results: Majority of the patients were in the 2nd to 4th decade (75%) with a male to female ratio of 7.57:1 Motor vehicle accidents were the most common cause of injury (60%), followed by fall from height (13.3%).- Mandible was the most commonly fractured facial bone (36.67%), followed by midface fracture (18.3%).Majority of the patients had moderate head injury and were managed conservatively. Among depressed fracture of skull, frontal bone was most commonly affected. Conclusion: Adult males were most common victims in craniofacial trauma, and road traffic accidents were responsible for the majority. Most of the patients sustained moderate head injuries and were managed conservatively. Open reduction and internal fixation with miniplates were used for displaced facial bone fractures.Update Dent. Coll. j: 2017; 7 (1): 14-20

Download Full-text