scholarly journals Atrophic mandibular fracture treatment: prototyping as a tool in surgical planning

2020 ◽  
Vol 9 (9) ◽  
pp. e796997986
Author(s):  
Reginaldo Fernandes da Silva ◽  
Rebeca Valeska Soares Pereira ◽  
Joana de Ângelis Alves Silva ◽  
Gustavo José de Luna Campos ◽  
Mário César Furtado da Costa ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Clinical Case ◽  
Mandibular Fracture ◽  
Facial Trauma ◽  
Mandibular Fractures ◽  
Surgical Time ◽  
3D Technology ◽  
Mandible Fracture ◽  
Intraoperative Period ◽  
Mandible Fractures

Introduction: Atrophic mandibular fractures are injuries found in old age due to facial trauma. Its treatment is a challenge, even for experienced surgeons, due to the different approaches that can be taken from clinical decisions. Taking into consideration the limitations that the age presented by most of the affected patients brigs, there are devices that stand out by seeking benefits in terms of predictability and time gain in the intraoperative period. The additive manufacturing is a valuable resource in the surgical planning and rehabilitation of these patients. Objective: To expose a clinical case that demonstrates the success in the use of surgical planning through a prototype printed in 3D technology. Clinical case: Elderly woman, 75 years old, victim of a fall from her own height who had a bilateral atrophic mandible fracture due to facial trauma. The surgical procedure was planned using a prototype printed in 3D technology providing predictability and reduced surgical time. The patient evolved in the postoperative period without complaints, with function immediately restores and without signs of infection or plate exposure. Conclusions: Atrophic mandible fractures are still related to a challenging treatment, therefore, adequate surgical planning and the use of auxiliary strategies such as 3D prototyping provide greater predictability of results, as well as time gain during the intraoperative.

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 Recovery of Post-Traumatic Temporomandibular Joint after Mandibular Fracture Immobilization: A Literature Review

2021 ◽  
Vol 11 (21) ◽  
pp. 10239
Author(s):  
Carmen Gabriela Stelea ◽  
Doriana Agop-Forna ◽  
Raluca Dragomir ◽  
Codrina Ancuţa ◽  
Roland Törok ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Real Life ◽  
Mandibular Fracture ◽  
Temporomandibular Joint Disorders ◽  
Treatment Modalities ◽  
Mandibular Fractures ◽  
Traumatic Injuries ◽  
Joint Fractures ◽  
Post Traumatic ◽  
Mandible Fractures

Considered as one of the most common traumatic injuries of the maxillofacial region, mandibular fractures remain among the complex causes of temporomandibular joint disorders (TMDs). Due to the complexity of the temporomandibular joint, the management of TMDs represents a challenge in real-life practice; although many treatment modalities have already been proposed, ranging from conservative options to open surgical procedures, a consensus is still lacking in many aspects. Furthermore, despite continuous improvement of the management of mandible fractures, the duration of immobilization and temporary disability is not reduced, and the incidence of complications remains high. The aim of the present study is to (i) review anatomophysiological components of temporomandibular joint; (ii) review concepts of temporomandibular joint fractures; and (iii) describe methods of the recovery of the temporomandibular joint after mandibular fracture immobilization.

scholarly journals Prevention of Mandible Fractures in Medication-Related Osteonecrosis of the Jaws: The Role of Virtual Surgical Planning and Computer-Aided Design and Manufacturing in Two Clinical Case Reports

2021 ◽  
Vol 11 (17) ◽  
pp. 7894
Author(s):  
João André Correia ◽  
José Ricardo Ferreira ◽  
Miguel Amaral Nunes ◽  
António Capelo ◽  
Miguel de Araújo Nobre ◽  
...  
Keyword(s):  
Computer Aided Design ◽  
Surgical Planning ◽  
Necrotic Bone ◽  
Osteonecrosis Of The Jaws ◽  
Virtual Surgical Planning ◽  
Mandible Fracture ◽  
Computer Aided ◽  
Cad Cam ◽  
Mandible Fractures ◽  
Aided Design

Background: Marginal mandible resection is required to achieve healing in some cases of medication-related osteonecrosis of the jaws (MRONJ). Despite the sparsity of the literature, computer-aided design/computer-aided manufacturing (CAD/CAM) materials may provide superior outcomes for patients with an increased risk of mandible fracture. The aim of this study was to report a digital workflow for surgical interventions to prevent mandible fracture in MRONJ patients. Methods: We present two cases in which virtual surgical planning (VSP) and CAD/CAM surgical guides and reconstruction plates were used to prevent mandible fractures in elderly MRONJ patients submitted for marginal resection. Two osteoporotic patients, aged 73 and 84 years, presented with stage 3 MRONJ of the right mandibular body with inferior alveolar nerve involvement. The unaffected bone height was 6 mm in both cases, implying a high risk of mandible fracture. After preoperative VSP, surgery was performed through a combined intraoral–transbuccal approach. CAD/CAM-customized cutting guides and reconstruction plates were used for the marginal resection of necrotic bone and internal fixation. Results: Complete healing was achieved and the patients remained asymptomatic up to 1 year post-surgery. Conclusions: VSP and CAD/CAM-customized materials facilitated the complete resection of necrotic bone and rigid fixation in MRONJ patients, allowing a simplified approach with shorter operative times, reduced morbidity, and predictable results.

scholarly journals Effects of Exogenous Nerve Growth Factor on The Expression of BMP-9 and VEGF in The Healing of Rabbit Mandible Fracture With Local Nerve Injury

2020 ◽  
Author(s):  
Sen Yang ◽  
Jiao Cheng ◽  
Cheng Man ◽  
Lian Jiang ◽  
Guogeng Long ◽  
...  
Keyword(s):  
Nerve Growth Factor ◽  
Growth Factor ◽  
Fracture Healing ◽  
Mandibular Fracture ◽  
Vascular Endothelial ◽  
Lower Lip ◽  
Nerve Growth ◽  
Qrt Pcr ◽  
Mandible Fracture ◽  
Mandible Fractures

Abstract Background: Mandibular fracture healing is a complex process involving nerves and growth factors. Nerve growth factor (NGF) not only facilitates the maintenance of sympathetic neurite growth but also stimulates other growth factors that can promote the essential osteogenesis and angiogenesis for fracture healing. Therefore, it is necessary to analyze the combined effects of NGF, bone morphogenic protein-9 (BMP-9), and vascular endothelial growth factor (VEGF) to accelerate the healing of mandible fractures.Methods: The models of mandible fracture with local nerve injury established in forty-eight rabbits were randomly divided into nerve growth factor group (NGF group), gelatin sponge group (GS group), blank group, and intact group. The recovery of nerve reflex was assessed by observing the number of rabbits with lower lip responses to acupuncture. The fracture healing was observed with visual and CBCT, and then callus tissues from the mandibular fracture area were collected for hematoxylin and eosin (HE) staining observation, and the expression of BMP-9 and VEGF in callus at different stages was detected by quantitative real-time PCR (qRT-PCR).Results: Needling reaction in the lower lip showed the number of animals with nerve reflex recovery was significantly higher in the NGF group than that in the GS and blank groups at the 2nd and 4th weeks after the operation. The combined results of macroscopic observation, CBCT examination, and histological analysis showed that a large number of osteoblasts and some vascular endothelial cells were found around the trabecular bone in the NGF group and the amount of callus formation and reconstruction was better than that in the GS group at the 2nd week after the operation. The qRT-PCR results indicated that the expression levels of BMP-9 and VEGF in the four groups reached the highest values at the 2nd week, while the expression levels of both in the NGF group were significantly higher than that in the GS group.Conclusion: The exogenous NGF could accelerate the healing of mandible fractures. This work will provide a new foundation and theoretical basis for clarifying the mechanism of fracture healing, thereby promoting fracture healing and reducing the disability rate of patients.

Mandible Fractures

2021 ◽  
Author(s):  
John J. Chi ◽  
Emily Konkus
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Penetrating Trauma ◽  
Mandibular Fracture ◽  
Facial Fractures ◽  
Surgical Interventions ◽  
Maxillomandibular Fixation ◽  
Mandible Fracture ◽  
Fracture Management ◽  
Mandible Fractures

Mandible fractures are often caused by blunt or penetrating trauma and are one of the most common facial fractures. It is critical to understand facial and mandibular anatomy to best evaluate, classify, and treat mandible fractures. The primary goal of treatment is to restore the jaw to the preinjury occlusion. This can be achieved through open reduction with internal fixation or closed reduction with maxillomandibular fixation (MMF) in conjunction with dietary changes and/or physiotherapy. The main risks and concerns in mandible fracture management are infection, malunion, airway compromise, pain, and temporomandibular joint (TMJ) dysfunction. This chapter will provide a brief overview of facial and mandibular anatomy as well as common treatment methods and surgical interventions.  This review contains 17 figures, 2 tables, and 43 references Key words: Mandibular fracture, maxillomandibular fixation, occlusion, malunion, closed reduction, open reduction, TMJ dysfunction

scholarly journals Mandibular Fractures: Pre-Operative Panoramic Radiography and Duplication Sign Patterns

2021 ◽  
Vol 5 (5) ◽  
pp. 57-66
Author(s):  
Oleksandr Nosyr ◽  
Serhii Khrulenko
Keyword(s):  
Cortical Bone ◽  
Management Strategy ◽  
Panoramic Radiography ◽  
Mandibular Fracture ◽  
Fracture Line ◽  
Mandibular Fractures ◽  
Panoramic Radiographs ◽  
Sign Patterns ◽  
Precise Diagnosis ◽  
Mandible Fractures

The purpose of this essay is to present the multiple patterns of the duplication sign at the mandibular fracture line/gap visualized at the panoramic radiography as two-line fracture gap or pseudocomminuted fracture. We retrospectively reviewed the orthopantomography of patients with mandible fractures and presented nine patients with 12 duplication signs (also known as lambda course fracture line). On panoramic radiographs the fracture line/gap with duplication sign is visualized as two-line cortical bone discontinuity with or without dislocation due to the fact that the fracture gap runs asymmetrically on the external and internal cortical plates of the jaw. Knowledge of duplication sign patterns, artifacts is also crucial for the precise diagnosis and choice of correct management strategy.

scholarly journals Evaluation of the effectiveness of early or delayed treatment upon healing of mandibular fractures: A retrospective study

2015 ◽  
Vol 09 (01) ◽  
pp. 087-091 ◽  
Author(s):  
Giath Gazal
Keyword(s):  
Clinical Trial ◽  
Substance Abuse ◽  
Retrospective Study ◽  
Mandibular Fracture ◽  
Mandibular Fractures ◽  
Operating Theater ◽  
Delayed Treatment ◽  
Treatment Analysis ◽  
Mandible Fractures ◽  
Fracture Types

ABSTRACT Objectives: This study was aimed to assess the impacts of delay treatment of mandibular fracture and its complications. In addition risk variables related such as time to repair, fracture types, substance abuse, causes, surgical management, muddling or complications and duration of clinic stay were also evaluated. Materials and Methods: The data of patients attending the Newcastle General Hospital, UK for the management of mandibular fractures were probed. This retrospective clinical trial conducted over 6 months, included 91 patients attending trauma operating theatre during weekdays or weekends. Data were analyzed for time to admission and treatment and its relationships to various factors using SPSS version 20 (SPSS Inc., Chicago, IL). Results: Time to treatment from the point of admission was 31.50 ± 3.83 h during week days that has been significantly more for patients attending the hospital at weekends or nights. Similar trend was observed for total summative time from the incident to treatment analysis. Conclusions: This investigation has demonstrated that the rate of infection and postoperative complications following surgical treatment of mandible fractures can be eased off by reducing the waiting time from presentation to the emergency and to the operating theater.

3D CT for Diagnosis of Facial/Mandibular Fractures

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P30-P30
Author(s):  
Paul Schalch ◽  
Jason H Kim
Keyword(s):  
Surgical Planning ◽  
Motor Vehicle ◽  
Imaging Modality ◽  
Mandibular Fractures ◽  
Medical Systems ◽  
Facial Bones ◽  
Vehicle Accidents ◽  
Work Related ◽  
Mandible Fractures ◽  
Improve Planning

Objective To describe how the use of 3-D reformatted computer tomographic (CT) images increases the accuracy of diagnosis of facial and mandibular fractures and influences surgical planning. Methods Retrospective review of 20 patients with facial and/or mandibular fractures between 2005 and 2006, diagnosed with CT facial bones (axial and coronal images and 3-D renderings). The study was conducted at a university- affiliated institution. Standard CT facial bones protocol consisting of 1.5mm contiguous axial and coronal sections were performed on a 40-slice scanner (Philips Medical Systems, Cleveland, OH). 3-D reconstructions were then obtained. Scans were reviewed by the consulting surgeon. Pre-operative diagnoses were confirmed intraoperatively. Results Patient mean age was 31 years (17–46). Pre-operative diagnoses included: 18 mandible fractures, 8 zygomatico-maxillary/orbital floor, and 4 midface fractures. Mechanisms of injury included assault, motor-vehicle accidents, sports- and work-related injuries, and falls. Diagnosis and surgical planning was influenced in 1/3 of fractures after reviewing 3-D reformatted images. 3-D reformatting did not add any cost to the CT scans performed, did not expose patients to additional radiation, nor did it significantly increase the time to obtain the study. Conclusions 3-D CT reformatting is an inexpensive, easy-to-obtain diagnostic imaging modality that increases the accuracy of diagnosis and helps improve planning of surgical repair of facial and mandibular fractures.

scholarly journals Evaluation of in-house, haptic assisted surgical planning for virtual reduction of complex mandibular fractures

2021 ◽  
Author(s):  
Johanna Nilsson ◽  
Fredrik Nysjö ◽  
Ingela Nyström ◽  
Johan Kämpe ◽  
Andreas Thor
Keyword(s):  
Computed Tomography ◽  
Surgical Planning ◽  
Maxillofacial Surgery ◽  
Three Dimensional ◽  
Planning System ◽  
Virtual Surgery ◽  
Mandibular Fractures ◽  
Surgery Planning ◽  
Anatomic Reduction ◽  
Mandible Fractures

Abstract Purpose The management of complex mandible fractures, i.e. severely comminuted or fractures of edentulous/atrophic mandibles, can be challenging. This is due to the three-dimensional loss of bone, which limits the possibility for accurate anatomic reduction. Virtual surgery planning (VSP) can provide improved accuracy and shorter operating times, but is often not employed for trauma cases because of time constraints and complex user interfaces limited to two-dimensional interaction with three-dimensional data. Methods In this study, we evaluate the accuracy, precision, and time efficiency of the haptic assisted surgery planning system (HASP), an in-house VSP system that supports stereo graphics, six degrees-of-freedom input, and haptics to improve the surgical planning. Three operators performed planning in HASP on computed tomography (CT) and cone beam computed tomography (CBCT) images of a plastic skull model and on twelve retrospective cases with complex mandible fractures. Results The results show an accuracy and reproducibility of less than 2 mm when using HASP for virtual fracture reduction, with an average planning time of 15 min including time for segmentation in the software BoneSplit. Conclusion This study presents an in-house haptic assisted planning tool for cranio-maxillofacial surgery with high usability that can be used for preoperative planning and evaluation of complex mandible fractures.

scholarly journals Rehabilitation of atrophic mandible with implants. Strategy and case report of fracture complication

2020 ◽  
Vol 9 (10) ◽  
pp. e2899108588
Author(s):  
Henrique Hadad ◽  
Luara Teixiera Colombo ◽  
Laís Kawamata de Jesus ◽  
Ana Flávia Piquera Santos ◽  
Paulo Sérgio Perri de Carvalho ◽  
...  
Keyword(s):  
Case Report ◽  
Bone Fracture ◽  
Clinical Case ◽  
Mandibular Fracture ◽  
Common Complication ◽  
Mandible Fractures ◽  
Fracture Complication ◽  
Subsequent Rehabilitation ◽  
Plate System

Rehabilitation through implant-supported prosthesis on atrophic jaws presents great deal of difficulty. Mandible fractures related to implants is not a common complication, however when it occurs, it represents serious damage. The aim of this paper was to report a clinical case of a 63-year-old patient with mandibular fracture after implant installation, treated through a buccal access and load-shearing plate system to stabilize the fractured bone and reduce the discomfort. The use of load shearing plate presented good results in this case, stabilizing the bone fracture, and helping with the repairing process, enabling subsequent rehabilitation of the patient, with a 3-year follow-up.

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