scholarly journals Mandibular fractures in different pediatric age groups and their current management modalities

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Muhammad Usman Akhtar ◽  
Rafique Chatha ◽  
Adnan Ali Shah ◽  
Muhammad Anwaarul Haq

Background: A number of cases of growing age trauma within oro-facial region have been observed in Pakistan, unlike developed countries of world. Mandibular fractures occur in greater frequency than those of the middle third of the face in children, later being very small and plastic comparative to mandible. These fractures of mandible do not demonstrate different clinical features as compared to adults but there is relative difference in treatment management due to, different patterns and plasticity of the facial bones in children, developing tooth buds at different levels in the jaws, mixed dentition, shedding deciduous teeth and incomplete roots of anterior teeth. The causes and patterns of fracture in children older than 12 years resemble to those found in adults. Mandibular fractures are common in Pakistan and commonly related etiology is accidental fall. Method: 57 patients presented with mandibular fractures at Oral and Maxillofacial Surgery department of Punjab Dental Hospital and Children Complex Hospital, Lahore from September 2003 to September 2005. The age of the patients ranged from infancy to early teenage (6 month to 15 years). After confirming diagnosis, the children were divided into following four groups; Group "A" (Infants), Group "B" (Pre-school), Group "C" (School) and Group "D" (Teenage). All patients were treated with one of the following treatment modalities, depending upon the site of fracture and age group of the patients; Micro and miniplates, Eric arch bar splints, Acrylic splints, Ivy eyelet wires, Trans-osseous wiring and Conservative treatment. Results: Group "A" of only 3 patients was managed with open reduction and microplate rigid fixation. Six months follow up showed healing without any complications. Group `B` with 60% males, had mostly body fractures, was treated with acrylic splints and circummandibular wires. Two bilateral body fractures, with avulsed few teeth, were fixed with rigid fixation. Five patients of about age 3 with minimally displaced body fractures were man aged with Eric arch bar fixation alone. Two bilateral condylar bowing fractures were treated conservatively (no active treatment) with no TMJ complications during follow up. The mandibular trauma was noticed exceedingly high in group `C` with overall 50.87% and exclusively in males (90%). Acrylic splints were utilized to treat either condyle with body fractures or condyles alone. Two children had postoperative ipsilateral jaw deviation on opening, which was improved with reverse elastic exercises during follow up. Five patients of high condylar fractures with either no or minimum occlusal disturbance, were conservatively managed. Early mobilization was the prime concern in them to avoid late complications. 17.54 % patients were of group `D` with again high male (90%) ratio. Two horizontally unfavorable angle fractures were managed by trans-osseous wires. Five with minimum displacement were managed with miniplates rigid fixation. All others` with associated condylar fractures were treated with Eric arch bar splint with one plate at body and intermaxillary fixation for two weeks. Conclusion: The patterns and management modalities of pediatric mandibular fractures vary in different age groups. The pediatric fractures should be managed as early as possible to avoid complications. Majority of trauma results in school going and teenage groups with definite high male proportion. High condylar fractures should be treated with extra care, keeping in mind of post traumatic TMJ ankylosis. Acrylic splints showed ideal results in body and condylar fractures, whereas, microplates may be the treatment of choice in infants with no or few deciduous teeth. No serious complications were observed during 6 months follow up.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1510.1-1511
Author(s):  
T. Kuga ◽  
M. Matsushita ◽  
K. Tada ◽  
K. Yamaji ◽  
N. Tamura

Background:Cardiovascular disease (CVD) is detected in up to 50% of systemic lupus erythematosus (SLE) patients1and major cause of death2. Even clinically silent SLE patients can develop left ventricular (LV) diastolic dysfunction3. Proper echocardiographic follow up of SLE patients is required.Objectives:To clarify how the prevalence of LV abnormalities changes over follow-up period and identify the associated clinical factors, useful in suspecting LV abnormalities.Methods:29 SLE patients (24 females and 5 men, mean age 52.8±16.3 years, mean disease duration 17.6±14.5 years) were enrolled. All of them underwent echocardiography as the baseline examination and reexamined over more than a year of follow-up period(mean 1075±480 days) from Jan 2014 to Sep 2019. Patients complicated with pulmonary artery hypertension, deep venous thrombosis or pulmonary embolism and underwent cardiac surgery during the follow-up period were excluded. Left ventricular(LV) systolic dysfunction was defined as ejection fraction (EF) < 50%. LV diastolic dysfunction was defined according to ASE/EACVI guideline4. LV dysfunction (LVD) includes one or both of LV systolic dysfunction and LV diastolic function. Monocyte to HDL ratio (MHR) was calculated by dividing monocyte count with HDL-C level.Prevalence of left ventricular abnormalities was analysed at baseline and follow-up examination. Clinical characteristics and laboratory data were compared among patient groups as follows; patients with LV dysfunction (Group A) and without LV dysfunction (Group B) at the follow-up echocardiography, patients with LV asynergy at any point of examination (Group C) and patients free of LV abnormalities during the follow-up period (Group D).Results:At the baseline examination, LV dysfunction (5/29 cases, 13.8%), LV asynergy (6/29 cases, 21.7%) were detected. Pericarditis was detected in 7 patients (24.1%, LVD in 3 patients, LV asynergy in 2 patients) and 2 of them with subacute onset had progressive LV dysfunction, while 5 patients were normal in echocardiography after remission induction therapy for SLE. At the follow-up examination, LV dysfunction (9/29 cases, 31.0%, 5 new-onset and 1 improved case), LV asynergy (6/29 cases, 21.7%, 2 new-onset and 2 improved cases) were detected. Though any significant differences were observed between Group A and Group B at the baseline, platelet count (156.0 vs 207.0, p=0.049) were significantly lower in LV dysfunction group (Group A) at the follow-up examination. Group C patients had significantly higher uric acid (p=0.004), monocyte count (p=0.009), and MHR (p=0.003) than Group D(results in table).Conclusion:LV dysfunction is progressive in most of patients and requires regular follow-up once they developed. Uric acid, monocyte count and MHR are elevated in SLE patients with LV asynergy. Since MHR elevation was reported as useful marker of endothelial dysfunction5, our future goal is to analyse involvement of monocyte activation and endothelial dysfunction in LV asynergy of SLE patients.References:[1]Doria A et al. Lupus. 2005;14(9):683-6.[2]Manger K et al. Ann Rheum Dis. 2002 Dec;61(12):1065-70.[3]Leone P et al. Clin Exp Med. 2019 Dec 17.[4]Nagueh SF et al. J Am Soc Echocardiogr. 2016 Apr;29(4):277-314.[5]Acikgoz N et al. Angiology. 2018 Jan;69(1):65-70.Numbers are median (interquartile range), Mann-Whitney u test were performed, p value less than 0.05 was considered statistically significant.Disclosure of Interests: :None declared


2020 ◽  
Vol 27 (09) ◽  
pp. 2007-2013
Author(s):  
Mohammad Umar ◽  
Jawad Ahmad Kundi ◽  
Muhammad Sulaiman ◽  
Muhammad Zaib Khan ◽  
Ali Altaf

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.


Author(s):  
Masaharu Masuda ◽  
Mitsutoshi Asai ◽  
Osamu Iida ◽  
Shin Okamoto ◽  
Takayuki Ishihara ◽  
...  

Introduction: The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (AF) patients with LVAs. To compare long-term AF/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts during a > 2-year follow-up period. Methods: An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with paroxysmal AF, divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, p=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, p<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, p<0.0001), especially biatrial tachycardia (20% vs. 0%, p=0.01). Conclusion: Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate iatrogenic ATs.


1970 ◽  
Vol 9 (4) ◽  
pp. 204-207 ◽  
Author(s):  
Dilruba Siddiqua ◽  
Shamim Ara ◽  
Abu Sadat Mohammad Nurunnabi ◽  
Rukshana Ahmed ◽  
Ara Parven Hosne

Objective: A cross-sectional descriptive type of study was designed to find out the difference in weight of the right and left adrenal glands of Bangladeshi people in relation to age and to compare with the previous studies. Materials & Methods: The study was done in the Department of Anatomy, Dhaka Medical College, Dhaka from July 2008 to June 2009 and performed on 140 post mortem human adrenal glands collected from 70 unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into four age-groups including group A (11-20 years), group B (21-30 years), group C (31-40 years) & group D (41-60 years) and the weight of the adrenal glands were measured and recorded. Results: There was no difference found in weight in between the right and the left adrenal glands in any age group. For the right adrenal gland, the differences in weight between group A & group B and group A & group D were statistically significant (p<0.05). For the left adrenal gland, the differences in weight between group A & group D and group C & group D were statistically significant (p<0.05). Key words: Adrenal gland; weight of adrenal gland. DOI: 10.3329/bjms.v9i4.6686Bangladesh Journal of Medical Science Vol.09 No.4 July 2010 pp.204-207


2011 ◽  
Vol 77 (12) ◽  
pp. 1584-1588 ◽  
Author(s):  
Xiao Dong Xu ◽  
You Cheng Zhang ◽  
Pen Gao ◽  
Farah Bahrani-Mougeot ◽  
Ling Yi Zhang ◽  
...  

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3854-3854
Author(s):  
Marco Montanaro ◽  
Roberto Latagliata ◽  
Michele Cedrone ◽  
Nicoletta Villivà ◽  
Raffaele Porrini ◽  
...  

Abstract Abstract 3854 Increasing age is a well-recognised risk factor for thrombotic events in patients with Essential Thrombocythemia (ET): however, few data exist on the role of other clinical and biological features in different age groups. To address this issue, we analysed retrospectively 1090 ET patients (M/F 403/687, median age 63 years, IR 17 – 96) diagnosed at 11 Hematological Institutions in the Lazio region from 1980 to 2010 and with a median period of follow-up of 84 months (IR 1 – 371). Based on the commonly adopted age threshold, 480 patients (44 %) were < 60 years (Group A) and 610 (56 %) were ≥ 60 years (Group B). Clinical and biological features as well as cardiovascular risk factors analyzed for the impact on the thrombotic risk in the two age groups are reported in the Table.Group A < 60 yearsGroup B ≥ 60 yearsPutative risk factorsRisk ratio (95% CI)P valueRisk ratio (95% CI)P valueM/F167/3132.68 (1.03–6.94)0.0029236/3741.12 (0.17–2.59)0.73WBC median (range) x 109/l8.9 (4.29–22.35)0.387 (0.149–1,004)0.06458.9 (1.2–57.7)0.79 (0.41–1.47)0.445PLTS median (range) x 109/l837 (451–3582)0.37 (0.258–1.70)0.66802 (450–3104)0.52 (0.28–0.99)0.0052Hb median, g/dL (range)14.1 (6.0–18.4)0.86 (0.33–2.24)0.76914.0 (7.0–17.8)0.87 (0.45–1.67)0.674*JAK-2 mutational status: wild type/mutated (%)53.2/46.81.57 (0.50–4.87)0.4434.1/65.90.498 (0.17–1.48)0.209Previous thrombotic events: n° (%)· All events72 (15)2.18 (0.59–7.96)0.12149 (24.4)3.01 (1.38–6.57)0.0004· within 24 months from diagnosis48 (10)1.43 (0.19–10.4)0.7464 (10.5)0.506 (0.18–1.39)0.189· within 60 months from diagnosis60 (12.5)NA0.5191 (14.9)0.323 (0.11–0.95)0.023Cardiovascular risk factors: Y/N %○ Arterial hypertension41.7/58.31.68(0.64–4.36)0.2880.7/19.30.96 (0.36–2.57)0.935○ Diabetes10.2/89.81.11 (0.23–5.15)0.8925.0/75.01.09 (0.38–3.11)0.86○ Smoking attitude45.6/54.42.78 (1.01–7.65)0.06758.3/41.71.04 (0.35–3.09)0.94○ Hyperlipidemia31.0/69.03.11(0.917–10.592)0.03951.6/48.42.31 (0.70–7.55)0.203 In Group A, 39 patients (8.1%) had at least one thrombotic event during follow-up; there were 20 (51.3%) arterial thrombosis and 19 (48.7%) venous thrombosis. In Group B, 63 patients (10.3%) had at least one thrombotic event during follow-up; there were 38 (69.4%) arterial thromboses and 25 (39.6%) venous thromboses. In group A univariate analysis for thrombosis-free survival performed by Kaplan-Meier method, disclosed a significant impact of male gender (p=0.0029, CI 1.03–6.94, HR 2.68), > 2 cardiovascular risk factors (p=0.0002, CI 1.87 – 190, HR 18.94) and isolated hyperlipidemia (p=0.039, CI 0.917 – 10.59, HR 3.11), while previous thrombotic events had no significant impact (p=0.27). By contrast, the presence of a previous thrombotic event was the only feature with a significant impact on thrombotic risk in Group B (p=0.0004, CI 1.38 – 6.55, HR 3.01). WBC and PLTS values at different cut-off levels as well as JAK-2 mutational status did not have any impact on thrombosis in either age groups. However, in group B, we observed a trend (p=0.052, CI 0.28–0.99, HR 0.52) towards a protective effect of higher PLTS values (> 800 × 109/l). In conclusion, our data seem to reinforce the need of a different thrombotic risk assessment in distinct age groups: in particular, younger patients could benefit from early recognition and treatment of well-known cardiovascular risk factors. Disclosures: No relevant conflicts of interest to declare.


2017 ◽  
Vol 8 (3) ◽  
pp. 83-89
Author(s):  
Johnny Holanda De Gauw ◽  
Lara Maria Melo Costa ◽  
Rodrigo Neves Silva ◽  
Natanael Barbosa Santos ◽  
Maria Dânia Holanda Tenorio

Objective: This study aimed to evaluate the effect of ferrous sulfate (FS) on demineralized and non-demineralized human deciduous teeth. Additionally, it was evaluated the penetration extent of FS and its remineralizing effect on the enamel of deciduous teeth using Polarized Light Microscopy (PLM). Method: The sample comprised 44 human deciduous teeth. The 44 crowns were divided randomly into four groups: group A (FS after demineralization), group B (FS without demineralization), group C (only demineralization), and group D (control group). FS at 0.45 mol/L-1 was used daily (15 days) and demineralization was done by pH cycling (7 days). Then, three longitudinal slices of the crowns were photographed using PLM. The degree of penetration of the lesion or stain was measured in micrometers, as well as the distance between the external enamel surface and the core of lesion. Results: Group A showed a dark stain on the outer surface of enamel larger than the group B. It is suggested, a remineralizing effect when comparing groups, A and C. The mean depth and standard deviation for groups A, B, and C were 4.27µm (±1.49), 3.72 µm (±1.68) and 5.00 µm (±1.84), respectively. No dark stains were observed in group D. Conclusion: FS stained the demineralized and non-demineralized human deciduous teeth. However, dark stains in the non-demineralized teeth were smaller or absent, than in the demineralized teeth. Therefore, FS may have a protective effect against demineralization.


2018 ◽  
Vol 11 (2) ◽  
pp. 118-123
Author(s):  
Sanjay Rastogi ◽  
Tousif Ahmed ◽  
Kolli Giri ◽  
Ramakant Dandriyal ◽  
Indra B. Niranjana Prasad ◽  
...  

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.


2020 ◽  
Vol 7 (10) ◽  
pp. 2041
Author(s):  
Neha Thilak ◽  
Sundeep K. Hedge ◽  
Sham S. Bhat

Background: The aim of the study is to compare the erosive potential of three different commonly used pediatric syrups on deciduous teeth enamel. The objectives of the study were to assess the endogeneous pH and titratable acidity of mefenamic acid syrup (meftal P), cetrizine syrup (alerid) and multivitamin syrup (zincovit) and to evaluate the microhardness of the enamel after successive immersion cycles in each of the syrups.Methods: 40 non carious deciduous teeth were included for the study The samples were then randomly allocated into 4 groups (10 in each group): Group A- mefenemic acid syrup (meftal P), Group B- cetrizine syrup (alerid), group C- multivitamin syrup (zincovit) and group D- control (distilled water). The samples were then subjected to the immersion cycles in the syrups. Assessment of enamel surface microhardness was done using Vickers hardness tester at 7th day and 14th day. The pH and titrable acidity of the syrups were also assessed. One way analysis of variance (ANOVA) and post hoc tests were used for the statistical analysis.Results: Out of the test groups, group C showed the lowest pH of around 4.2 and exhibited the largest titrable acidity (22.8 ml) compared with 21 ml in group A and 15.5 ml in group B. At the end of 14th day, group A had microhardness of about 293.43.84±6.34, group B had 299.930±6.85, group C had 313.380±6.23 and group D had 334.190±5.51.Conclusions: All the pediatric liquid medications assessed in the study, meftal P, alerid and zincovit showed acidic pH, high titrable acidities and all the syrups showed loss of microhardness after exposure to the syrups for 14 days. Loss of microhardness was highest for meftal P followed by alerid and least for zincovit.


2013 ◽  
Vol 2 (2) ◽  
pp. 8-12
Author(s):  
Rubina Qasim ◽  
Humaira Naushaba ◽  
Md Enayet Ullah ◽  
Hasna Hena ◽  
Hosna Ara Perven

Background : Ovarian diseases and infertility are the very common health problems among the female population. Alteration in the volume of the ovary occurs throughout the reproductive life which may predispose to ovarian diseases such as cyst, polycystic ovary and ovarian carcinoma. Moreover, the reduction in ovarian volume leading to decrease the fertility of a women also. So the present study is designed to assess the volume of the ovary in Bangladeshi women in different age groups which will provide a complete and standarize the data in Bangladeshi population and also compare the data with other countries. It will provide resourcefull information which may further determine the ovarian reserve and reproductive age of female for improving the accurate diagnosis and management of ovarian diseases as well as infertility problems. Study design: Cross sectional and analytical type of study. Materials: The present study was performed on 65 cadaveric ovaries of both side in Bangladeshi female age ranging from 5 years to 65 years. Methods: The samples were divided into four different age groups. They were group A or prepubertal group (5-12years), group B or reproductive group (13-45 years), group C or perimenopausal group (46-51years) and group D or postmenopausal group (52-65years). Results: The mean (±SD) volumes were 2.84 + 0.22 milliliter and 2.83±0.24 milliliter in group A, 8.64 + 0.89 milliliter and 8.61± 0.89 milliliter in group B, 6.85 + 0.79 milliliter and 6.84±0.76 milliliter in group C and 2.62 + 0. 52 milliliter and 2.61± 0.50 milliliter in group D in the right & left ovaries respectively. The highest mean volume was observed in group B and lowest mean volume was in group D in both ovaries. Statistically highly significant difference (P<0.001) were found when group A was compared with group B & C, group B was compared with group C & D and group C was compared with group D. But when group A was compared with group D, it was not significant (P<0.50).The mean difference in volumes of right and left ovary between group A, group B, group C and group D were statistically not significant. Conclusion: In this study, volume of the ovary does not vary in between right and left ovary in any age group. DOI: http://dx.doi.org/10.3329/updcj.v2i2.15482 Update Dent. Coll. j: 2012; 2 (2): 08-12


Sign in / Sign up

Export Citation Format

Share Document