Colles external fixator as alternative in comminuted mandibular fractures treatment

Objective: to report a surgical case of comminuted mandible fracture caused by a firearm projectile treated with external fixation. Methodology: male patient, 18 years old, attended the Emergency Department of the Maxillofacial Surgery service after trauma in the mandibular region by a firearm projectile. On clinical examination, edema was observed in the cervical zone II and mandibular region, penetrating orifice of entry of the projectile in the genial region and mobility in the mandibular body. CT scan revealed a comminuted fracture in the mandible. Transcutaneous perforations were performed with pins, anatomical reduction of the fracture and stabilization to the external nail, adapting to the mandibular anatomy. Following postoperative follow-up, the patient progresses without pain complaints, with functional and satisfactory mouth opening, without mobility in bone fragments, and reestablished mandibular framework. Results and Conclusion: mandibular fractures by firearms are frequent in the routine of the buccomaxillofacial surgeon. Cases of bone comminution present individual peculiarities that must be taken into account in their management. The correct indication of external fixation proved to be adequate and satisfactory for cases of mandible comminution.

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THE EFFICACY OF HIGH CONDYLECTOMY IN INTERNAL DERANGMENT OF THE TEMPOROMANDIBULAR JOINT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i10.1457 ◽

2020 ◽

Vol 4 (10) ◽

Author(s):

Vikas Sarowa ◽

Vishnu Dayal Vyas ◽

D.K. Gupta ◽

Anjali Dave Tiwari

Keyword(s):

Temporomandibular Joint ◽

Small Sample Size ◽

Maxillofacial Surgery ◽

Mouth Opening ◽

Small Sample ◽

Internal Derangement ◽

Age Group ◽

Maxillofacial Region ◽

Anterior Disc Displacement

Background: Temporomandibular joint (TMJ) is a giglymoarthroidal Joint; it is the only mobile joint in the entire maxillofacial region and is a part of craniomandibular articulation. Methods: All the patients with internal derangement of temporomandibular joint having anterior disc displacement without reduction with complaints of pain and limited opening of mouth, of all age group reporting to the Department of Oral & Maxillofacial Surgery, GDC Jaipur were included in the study. Results: At one month follow up out of 20 patients 13 patients were not satisfied and at 6 month follow up 2 patients were not satisfied at all. Conclusion: We conclude that surgical treatment for internal derangement of the TMJ is required; this technique is effective to improve pain and mouth opening without complications. Although this study has a short follow up period and small sample size. Keywords: Mandible, Maxilla, TMJ.

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GEOMETRICAL MODELS OF MANDIBLE FRACTURE AND PLATE IMPLANT

Facta Universitatis Series Mechanical Engineering ◽

10.22190/fume170710028h ◽

2018 ◽

Vol 16 (3) ◽

pp. 369 ◽

Cited By ~ 3

Author(s):

Karim Husain ◽

Mohammed Rashid ◽

Nikola Vitković ◽

Jelena Mitić ◽

Jelena Milovanović ◽

...

Keyword(s):

Maxillofacial Surgery ◽

Fracture Site ◽

Oral And Maxillofacial Surgery ◽

Mandibular Fractures ◽

Anatomical Features ◽

Mandible Fracture ◽

Human Bones ◽

Fixation Techniques ◽

Bone Fragments ◽

The Creation

In the oral and maxillofacial surgery, there is a requirement to provide the best possible treatment for the patient with mandibular fractures. This treatment presumes application of reduction and fixation techniques for proper stabilization of the fracture site. The reduction of the bone fragments and their fixation is much better performed when geometry and morphology of the bone and osteofixation elements (e.g. plates) are properly defined. In this paper, a new healthcare procedure, which enables application of personalized plate implants for the fixation of the mandibular fractures, is presented. Geometrical models of mandible and plate implants, presented in this research, were created by means of the Method of Anatomical Features (MAF), which has been already applied to the creation of accurate geometrical models of various human bones, plates and fixators. By using such geometrically and anatomically accurate models, orthopedic and maxillofacial surgeons can better perform pre-operative tasks of simulating and planning the operation, as well as an intraoperative task of implanting the personalized plate into the patient body.

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Surgical treatment of mandibular fracture resulting from first molar extraction: case report

Research Society and Development ◽

10.33448/rsd-v10i13.20915 ◽

2021 ◽

Vol 10 (13) ◽

pp. e161101320915

Author(s):

Monique Gonçalves da Costa ◽

Anderson Maikon de Souza Santos ◽

Mirela Caroline Silva ◽

Tiburtino José de Lima Neto ◽

Eduardo Dallazen ◽

...

Keyword(s):

Severe Pain ◽

Preoperative Evaluation ◽

Maxillofacial Surgery ◽

Mandibular Fracture ◽

Basic Principles ◽

Pain Complaint ◽

Oral Environment ◽

Mandibular Body ◽

Bone Fragments ◽

Molar Extraction

Extraction is one of the most common procedures performed by dental surgeons in their daily clinical practice. Among the trans and postoperative complications associated with this procedure can be mentioned the occurrence of trismus, infections, edema, alveolitis, paresthesia or fractures. The purpose of this study was to report a clinical case of a mandibular fracture associated with first molar extraction, approaching its main risk factors and treatment. Patient JSS, 24 years old, female, was referred to the service of Maxillofacial Surgery due to complications resulted from the extraction of element 36. On physical examination, was observed the presence of fragment mobility, communication of bone tissue with the oral environment and pain complaint was reported by the patient. Computed tomography showed the presence of a fracture in the region of the mandibular body on the left side. The planned surgical proposal was the intraoral debridement of bone fragments, extraoral access in the base of the mandible, fixation of the fracture with plate 2.4 and intraoral and extraoral access suture. During the surgical procedure, it is of great importance that the dental surgeon be aware to the signals emitted by the patient, such as clicks associated with severe pain, profuse bleeding or crackling as these symptoms may be the result of mandibular fracture. When any of these signs are found during the operation, the professional must investigate the occurrence of a possible fracture. It is concluded that in addition to performing a good preoperative evaluation, the dental surgeon must carry out a correct planning of the surgical act based on the basic principles of the surgical technique.

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Treatment of Complex Mandibular Body Fractures and Functional Reimplantation of the Maxillary Alveolar Fragment

Case Reports in Surgery ◽

10.1155/2020/8853562 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Beatriz Sobrinho Sangalette ◽

Rafaella Ferrari Pavoni ◽

Thayna da Silva Emídio ◽

Tiago Levatti ◽

Marcos Capelari ◽

...

Keyword(s):

Mouth Opening ◽

Mandibular Fracture ◽

Rigid Fixation ◽

Alveolar Process ◽

Favorable Prognosis ◽

Mandibular Body ◽

Mandibular Region ◽

Functional Reduction ◽

The Right ◽

Apical Displacement

Introduction. This report aims at demonstrating the treatment of complex mandibular fracture functional reimplantation of the maxillary alveolar fragment (FRAF), denoting the possibility and feasibility of this reduction with an excellent prognosis. Case Report. Patient E.M.S, 25 years old, male, leucoderma, referred to the Emergency Room of our institute. He reported being a victim of physical aggression, occlusal alteration, limitation of mouth opening, sensibility loss in the mentalis region, right infraorbital, and denied visual alteration. On physical examination, during the inspection and palpation, the crackling was observed in the right mandibular region and apical displacement of the maxillary alveolar process, corresponding to elements 13, 14, and 15. Conclusion. The rigid fixation of the complex jaw fracture and alveolar maxilla process, through functional reduction, indicated satisfactory applicability, and favorable prognosis.

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The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0035-1556050 ◽

2016 ◽

Vol 9 (1) ◽

pp. 020-028

Author(s):

Balasubramanian Krishnan

Keyword(s):

Mouth Opening ◽

Mandibular Fractures ◽

Minimal Intervention ◽

Soft Diet ◽

Arch Bar ◽

Management Protocol ◽

Intervention Protocol ◽

Lost To Follow Up

Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results.

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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............

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ISOLATED ZYGOMATIC BONE FRACTURE

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.05.1576 ◽

2016 ◽

Vol 23 (05) ◽

pp. 526-530

Author(s):

Suneel Kumar Punjabi ◽

Kashif Ali Channar ◽

Munir Ahmed Banglani ◽

Naresh Kumar ◽

Ambreen Munir

Keyword(s):

Maxillofacial Surgery ◽

Mouth Opening ◽

Facial Asymmetry ◽

Fixation Method ◽

Facial Bones ◽

Limited Mouth Opening ◽

Zygomatic Bone ◽

Study Setting ◽

Infraorbital Rim

Introduction: Facial bones injuries results in functional disturbances. Patientsmay presents with flattening of normal malar prominence, lid drop, eye movement limited orwith double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incisiontype, fixation method and occasionally reconstruction, surgeons suggest different methods forrepairing complex fractures of Zygoma. Study Design: Descriptive study. Setting: Departmentof Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro.Period: Mar 2013 to Feb 2014. Materials and methods: Total 20 patients were included.Patients with fracture more than 28 days old were excluded. Zygomatic bone can be approachedby lateral brow or subcilicary incisions and by subgingival buccal sulcus approach. When 3fracture sites were reduced and aligned satisfactorily, application of miniplates was performedat 3 points frontozygomatic suture, Zygomatico maxillary buttress and infraorbital rim, woundwere closed in 2 layers. At 2nd week follow-up patients were assessed for outcome. Results:There were 14 male and 6 female patients. Most were of age <25 years. 45% fractures weredue to RTA. Duration of fracture of 2 patients was 2 days, 7 days of 11 patients, 4 patients had14 days and 3 patients had 28 days. 5 fractures were reduced using Gilies temporal approach,6 with Keen approach, 4 with Hook approach and 5 with Dingman approach. Preoperatively,17 patients had facial asymmetry, 19 had limited mouth opening and postoperatively this wasreduced to 6 cases each for facial asymmetry and limited mouth opening. Conclusion: Itis concluded from this study that three point fixation is most effective and safe method forreduction of fracture of Zygomatic bone.

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Long-term Complications of Isolated and Combined Condylar Fractures: A Retrospective Study

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211026759 ◽

2021 ◽

pp. 194338752110267

Author(s):

Margaux Nys ◽

Tim Van Cleemput ◽

Jakob Titiaan Dormaar ◽

Constantinus Politis

Keyword(s):

Conservative Treatment ◽

Initial Treatment ◽

Late Onset ◽

Maxillofacial Surgery ◽

Mouth Opening ◽

Secondary Treatment ◽

Condylar Fracture ◽

Mandibular Body ◽

Condylar Fractures

Study Design: Fractures of the mandibular condyle are a common injury in maxillofacial trauma. Both conservative treatment (i.e., analgesic therapy and soft diet) and intermaxillary fixation (IMF) or open reduction internal fixation (ORIF) have satisfactory and functional outcomes, though severe late-onset complications have been reported. Objective: We compared the long-term complications of patients with condylar fractures treated conservatively, with IMF, or with combined ORIF and IMF. Methods: We retrospectively analyzed all patients diagnosed with unilateral or bilateral condylar fracture, isolated or combined with a fracture of the mandibular body, admitted to the Department of Maxillofacial Surgery at UZ Leuven between January 2013 and January 2020. We collected data on age, gender, side of condylar fracture, presence of associated fracture of the mandibular body, referrals, initial treatment, long-term complications and secondary treatment. Long-term complications were defined as sequelae still present 6 weeks after initial treatment. Results: Among 192 patients, 68.8% had unilateral and 31.2% bilateral condylar fractures; an associated fracture of the mandibular body was seen in 45.8%, 31% received conservative treatment, 51% IMF only, and 18% combined ORIF and IMF. Forty-eight percent of all patients suffered from 1 or more long-term complications, most frequently malocclusion (24%), reduced mouth opening (15.1%), nerve disturbances (13.5%), pain (8.9%), and facial asymmetry (2.6%). Surgery as a secondary treatment was necessary in 25% of all cases. Conclusions: The presence of bilateral condylar fractures or associated fracture of the mandibular body is a risk factor for developing long-term complications. Most patients with long-term complications were initially treated with combined ORIF and IMF, but long-term complications after initial conservative or IMF treatment were treated with secondary surgery.

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METHODS FOR FIXATION OF BONE FRAGMENTS IN LOWER JAW FRACTURES

The actual problems in dentistry ◽

10.18481/2077-7566-21-17-3-7-12 ◽

2021 ◽

Vol 17 (3) ◽

pp. 7-12

Author(s):

Guzel Gilmanova ◽

Sahil Soltanov ◽

Said Ksembaev ◽

Oleg Ivanov

Keyword(s):

Muscle Tension ◽

Maxillofacial Surgery ◽

Mandibular Fractures ◽

Lower Jaw ◽

Metal Plates ◽

Surgical Methods ◽

Jaw Fractures ◽

Bone Fragments ◽

Methods Of Treatment ◽

Delayed Consolidation

Thing. A review of the literature devoted to the topical problem of maxillofacial surgery and surgical dentistry – methods of treating patients with mandibular fractures was carried out. The aim of the study is to review the materials of publications on the methods of treatment of patients with mandibular fractures. Methodology. The publications of domestic and foreign authors, considering methods of fixation of bone fragments in lower jaw fractures, have been studied. Results. Publications indicate that there are many treatments for mandibular fractures. Research results demonstrate the importance of bone stabilization for bone fusion. A common disadvantage of conservative and surgical methods of treatment is unstable fixation of bone fragments, which is the most common cause of delayed consolidation of a mandibular fracture. The presented studies show that bone osteosynthesis with metal plates is considered the most appropriate method for treating mandibular fractures. Conclusions. Splinting as a method of treating fractures of the lower jaw has a large number of disadvantages. A common disadvantage of methods for splinting the lower jaw is that these structures do not always provide anatomical reduction and stability for the entire period of consolidation or require mandatory intermaxillary fixation, the lower jaw is fixed in the central occlusion position, which is not a position of physiological rest, and leads to passive muscle tension. depriving them of active function. The main disadvantage of the methods of osteosynthesis using a suture and using wires is that it is difficult to achieve stable fixation of fragments using these techniques. Combined methods of fixation of bone fragments (use of a bone suture and dental splints) provide a stronger fixation of the fragments. In the past two decades, in the treatment of mandibular fractures, there has been an increase in the trend towards rigid or semi-rigid osteosynthesis using plates. The disadvantages of compression osteosynthesis is that significant compression can lead to ischemia and slow down the formation of callus. A common disadvantage of conservative and surgical methods of treatment is unstable fixation of bone fragments, which is the most common reason for their delayed consolidation. Bone osteosynthesis with metal plates is considered a more progressive method of treating mandibular fractures.

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State of the art in the treatment of mandibular fractures caused by firearms: case report

RGO - Revista Gaúcha de Odontologia ◽

10.1590/1981-863720180001000123387 ◽

2018 ◽

Vol 66 (1) ◽

pp. 88-95

Author(s):

Erasmo Freitas de SOUZA JÚNIOR ◽

Hécio Henrique Araújo de MORAIS ◽

Eudes Euler de Souza LUCENA ◽

José Rodolfo Lopes de Paiva CAVALCANTI ◽

Fausto Pierdoná GUZEN ◽

...

Keyword(s):

Maxillofacial Surgery ◽

Significant Risk ◽

Gunshot Wounds ◽

Oral And Maxillofacial Surgery ◽

Mandibular Fractures ◽

Long Term Follow Up ◽

The Face ◽

The Individual

ABSTRACT Injuries to the face represent a significant risk to the health of the individual, mainly because of its significance, both functional, because it houses sensory organs and part of the respiratory and digestive systems, as well as esthetic. In this scenario, gunshot wounds in this location cause great concern on account of the magnitude of the damage, and the Oral and Maxillofacial Surgery and Traumatology team must act so that the treatment enables the rehabilitation of the patient in the shortest possible time, with a minimum of complications and sequelae. The objective of this study is to report a clinical case of a 19-year-old female patient with a comminuted fracture of the mandible body caused by a firearm projectile, treated immediately with stable internal fixation using the 2.00 mm plate-screw system for simplification of the fracture and a 2.4 mm reconstruction locking-plate on the bone gap. Relevant aspects of the surgical technique and tactics are reviewed and long-term follow-up of the patient is presented.

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