Comparison of functional outcome after open and closed reduction of mandibular subcondylar fracture

Abstract Objective: To compare open reduction with internal fixation of mandibular subcondylar fracture with closed reduction in terms of adequate mouth opening. Method: The randomised clinical trial was conducted from March 2014 to February 2015 at the Oral and Maxillofacial Surgery Department, King Edward Medical University and Allied Hospitals, Lahore, Pakistan, and comprised patients who presented with unilateral subcondylar fractures. The patients were randomly divided into 2 groups. Group-A patients were treated with closed reduction and immobilisation and were discharged the same day, while Group-B patients were treated by open reduction with internal fixation and retained in ward for 1 day. Both were recalled for periodic follow-ups, and were compared in terms of achieving adequate mouth opening. Data was analysed using SPSS 20. Results: Of the 70 patients, 35(50%) were in each of the two groups. The mean age in Group-A was 28.88±11.86 years compared to 28.22±10.80 years in Group-B (p>0.05). Mean mouth opening in the two groups were consistently positive, and significant at the last two follow-ups(p<0.001). Conclusion: The difference in results of both treatment modalities was significant, indicating that open reduction and internal fixation should be the preferred treatment. Key Words: Mandibular sub-condylar fracture, Open reduction, Closed reduction, Internal fixation, Mouth opening.

Download Full-text

Evaluation of Efficacy of 3-Dimensional Delta Versus Trapezoidal Condylar Plates in Internal Fixation of Mandibular Subcondylar Fractures: A Clinical Study

The Traumaxilla ◽

10.1177/2632327319881070 ◽

2019 ◽

Vol 1 (1) ◽

pp. 11-21

Author(s):

Jeevan Lata ◽

Nitin Verma ◽

Sarita Mahajan

Keyword(s):

Internal Fixation ◽

Mouth Opening ◽

P Value ◽

Functional Rehabilitation ◽

3 Dimensional ◽

The Third ◽

Subcondylar Fracture ◽

Group A ◽

Group B ◽

Condylar Fractures

Introduction: Among condylar fractures, surgical treatment is most commonly done for subcondylar fractures. Although 2 plate system is most commonly recommended, specially designed delta plate or trapezoidal condylar single 3-dimensional plate have been found to provide early functional rehabilitation with similar stability. Though studied in vitro, not much in vivo study has been done in clinical scenario. Aim and Objectives: Comparative assessment of functional and radiographic outcomes of patients who underwent subcondylar fracture fixation with trapezoidal and delta condylar plate. Methods: 20 patients presenting with subcondylar fracture requiring open reduction and internal fixation were included in this 2-year study from 2014 to 2016. Patients were randomly assigned to either one of the groups, with 10 being treated by each plate. Patients were evaluated regularly during 3 months follow-up on clinical parameters, such as occlusion, mouth opening, range of jaw movements, and radiologic parameters, such as fracture alignment, plate fracture, plate bending, screw loosening, secondary displacement of condylar fragment and its direction, ramus height, and any deviation. Results: In both groups, statistically significant improvement in occlusion seen from the third day to the third month ( P value = .04). Postoperative mouth opening, right and left lateral movements, and protrusive movements were statistically nonsignificant in both group A and group B. But within a group, improvements in the results were variable with regard to all these parameters at different intervals. Clinical and radiographic complications were nonsignificant in both group A and group B. Conclusion: This study is a preliminary effort to evaluate and compare different special plating systems in the management of condylar fractures with the new 3-dimensional trapezoidal and delta plating system, which gives excellent stability and rigidity. Improvement in occlusion was found to be gradual in both the plating system over a period of 3 months. Delta plate showed significant improvement in mouth opening at all intervals in comparison to Trapezoidal plate. Improvement in protrusive movement was found to be gradual and better with delta plate. A trapezoidal condylar plate holds goods for low subcondylar fractures owing to its wider dimension, though delta plate is versatile for both high and low subcondylar fracture.

Download Full-text

ANTERIOR MANDIBLE AND CONDYLAR FRACTURE;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.01.2590 ◽

2019 ◽

Vol 26 (01) ◽

Author(s):

Soonhan Abdullah ◽

Muhammad Shahzad ◽

Syed Fida Hussain Shah ◽

Syed Ghazanfar Hassan ◽

Suneel Kumar Panjabi

Keyword(s):

Range Of Motion ◽

Closed Reduction ◽

Open Reduction ◽

Mouth Opening ◽

Mean Deviation ◽

Group A ◽

Group B ◽

Condyle Fracture ◽

Anterior Mandible ◽

Good Range

ABSTRACT… Objectives: To compare the outcome of two treatment protocols (open and closed reduction) in the management of Anterior mandible and condyle fracture in our center. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Oral & Maxillofacial Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Hyderabad. This study was conducted from April 2017 to September 2017. Methodology: This study was consisted of total 48 patients which were equally divided into two groups Group-A(Closed Reduction that is Eyelet or Arch Bar) and Group-B(Open Reduction) having anterior mandible were included. For closed reduction technique, maxillomandibular fixation was applied for 4-6 weeks. For open reduction, fracture was fixed with miniplates after achieving the normal occlusion. Post operatively, occlusal disturbances was considered having poor occlusion and patient with maximum intercuspation was considered as good occlusion. Mouth opening more than 25mm was considered as good mouth opening. Results: In group-A 23(95.8%) patients at 3rd month were found with good occlusion. In group-B, good occlusion was found in 21(87.5%) patients at 3rd month. In group-A 22(91.7%) subjects at 3rd month were found with good range of motion and in group-B good range of motion was found in 20(83.3%) subjects at 3rd month.In group-A, mean deviation was 0.54±0.72 mm at 3rd month while in group-B, mean deviation was 1.12±1.65 mm at 3rd month. Conclusion: Open reduction with two correctly positioned plates for the stabilization of anterior mandibular and condylar fractures yielded better function compared to closed reduction.

Download Full-text

THE EFFECT OF THERAPUETIC ULTRASOUND AND PHONOPHORESIS ON TMJ PAIN

10.36106/ijsr/9710456 ◽

2020 ◽

pp. 35-37

Author(s):

Joyce Sequeira ◽

Thejas Girishan

Keyword(s):

Maxillofacial Surgery ◽

Mouth Opening ◽

Oral And Maxillofacial Surgery ◽

Pain Status ◽

Group A ◽

Tmj Pain ◽

Group B ◽

Larger Sample

Temporomandibular disorders (TMD) relate to discomfort of the temporomandibular joint (TMJ). The disorder is multifactorial with a degree of psychogenic influence varying throughout an individual's life with phases of symptoms affecting the quality of life. Taking into consideration the application of different physical therapies for the reduction of this pain, this study is to compare the effect of ultrasonic therapy and phonophoresis on TMJ pain. Material and methods: The study Sample consist of twenty clinically confirmed cases of TMJ pain, visiting the dental clinic of the Department of oral and maxillofacial surgery, Yenepoya Dental College, Mangalore. They were divided into two groups- Group A patients (n=10) received Hydrocortisone Phonophoresis therapy and Group B patients (n=10) received only Ultrasound, daily for a period of 7 days. The outcome were measured by Pain Status & mouth opening, measured using VAS and vernier calliper. Results: After the treatment period score of the Group-A who received Hydrocortisone Phonophoresis is significantly higher than Group-B on the Pain Intensity and Improvement in mouth opening when analysed using independent ‘t’ test at p<0.05 Conclusion: The data suggest that phonophoresis therapy can be used as an treatment modality in controlling pain associated with TMDs. However, further studies on larger sample size with longer follow up periods are required.

Download Full-text

Complications of the Transmasseteric Anteroparotid Approach for Subcondylar Fractures: A Retrospective Study

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211016923 ◽

2021 ◽

pp. 194338752110169

Author(s):

Jared Gilliland ◽

Fabio Ritto ◽

Paul Tiwana

Keyword(s):

Retrospective Study ◽

Facial Nerve ◽

Internal Fixation ◽

Closed Reduction ◽

Open Reduction ◽

Mouth Opening ◽

Facial Nerve Paralysis ◽

Nerve Paralysis ◽

University Of Oklahoma ◽

The University

Study Design: A retrospective analysis of patients with subcondylar fractures treated via a transmasseteric anteroparotid approach by the Oral and Maxillofacial Department at the University of Oklahoma. Objective: The goal of this study was to evaluate complications, morbidity, and safety with the transmasseteric anteroparotid approach for treatment of subcondylar fractures, and compare it to other findings previously reported in the literature. Methods: A retrospective study was conducted that consisted of 23 surgically treated patients in the past 2 years for subcondylar fractures. Only patients with pre-operative malocclusion and who underwent open reduction with internal fixation with the transmasseteric anteroparotid (TMAP) approach were included. Exclusion criteria included 1) patients treated with closed reduction 2) patients who failed the minimum of 1, 3, and 6-week post-operative visits. The examined parameters were the degree of mouth opening, occlusal relationship, facial nerve function, incidence of salivary fistula and results of imaging studies. Results: 20 of the surgically treated patients met the inclusion criteria. Two patients were excluded due to poor post-operative follow up and 1 was a revision of an attempted closed reduction by an outside surgeon that presented with pre-existing complications. There were no cases of temporary or permanent facial nerve paralysis reported. There were 3 salivary fistulas and 2 sialoceles, which were managed conservatively and resolved within 2 weeks, and 2 cases of inadequate post-surgical maximal incisal opening (<40 mm) were observed. Conclusion: The transmasseteric anteroparotid approach is a safe approach for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.

Download Full-text

Comparison study for internal and external modes of fixation for fractures of distal end radius

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20172032 ◽

2017 ◽

Vol 3 (4) ◽

pp. 744 ◽

Cited By ~ 1

Author(s):

Ripple Shah ◽

Suril Shah ◽

Aalok Shah ◽

Sharvil Gajjar ◽

Vijay Chaudhari ◽

...

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Open Reduction ◽

Tertiary Care ◽

Point System ◽

Radius Fractures ◽

Cast Immobilization ◽

Intraarticular Fractures ◽

Group A ◽

Group B

Background: Fractures of the distal radius continue to be one of the most common skeletal injuries. The methods which are commonly practiced are closed manipulation and plaster cast, pins and plaster, percutaneous pinning, external fixation and open reduction and internal fixation with or without bone graft. Surgeons are increasingly faced with the dilemma of when to consider operative management and when cast immobilization is the optimal treatment.Methods: 47 cases of distal end radius fractures were operated in the orthopedic department of a tertiary care centre. The purpose of the present study was to compare the results of external and internal fixation methods for the treatment of fractures of distal end of radius. Patients operated by external fixation were classified as Group A and those operated by internal fixation were classified as group B. Patients were classified according to AO Classification. Patients were followed at regular intervals depending on the case and time of operation and evaluated by Gartland and Werley score.Results: In our study, 29 patients were of extraarticular type, of which 86.20% had an excellent score and 18 patients were of intraarticular type, of which 83.33% had an excellent score. But when compared to groups A and B, the percentage of excellent score obtained in group B was more than that in group A in both extraarticular and intraarticular fractures. Yuan-kun et al did a study on intraarticular distal end radius fractures and evaluated the patients by Gartland and Werley point system, concluding that plating gives better results than external fixation supplemented by K wiring. Conclusions: We concluded that no method of fixation can be said superior to the other. Each method has fracture-specific indication. The results of open reduction and internal fixation can be better than external fixation in initial months, but in the long run, both the methods can have excellent score, provided the fixation is good and properly indicated.

Download Full-text

Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures

Bone and Joint Research ◽

10.1302/2046-3758.107.bjr-2020-0175.r2 ◽

2021 ◽

Vol 10 (7) ◽

pp. 380-387

Author(s):

Jie Shen ◽

Dong Sun ◽

Jingshu Fu ◽

Shulin Wang ◽

Xiaohua Wang ◽

...

Keyword(s):

Surgical Site Infection ◽

Internal Fixation ◽

Open Reduction ◽

Tibial Plateau ◽

Site Infection ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Group A ◽

Group B

Aims In contrast to operations performed for other fractures, there is a high incidence rate of surgical site infection (SSI) post-open reduction and internal fixation (ORIF) done for tibial plateau fractures (TPFs). This study investigates the effect of induced membrane technique combined with internal fixation for managing SSI in TPF patients who underwent ORIF. Methods From April 2013 to May 2017, 46 consecutive patients with SSI post-ORIF for TPFs were managed in our centre with an induced membrane technique. Of these, 35 patients were included for this study, with data analyzed in a retrospective manner. Results All participants were monitored for a mean of 36 months (24 to 62). None were subjected to amputations. A total of 21 patients underwent two-stage surgeries (Group A), with 14 patients who did not receive second-stage surgery (Group B). Group A did not experience infection recurrence, and no implant or cement spacer loosening was noted in Group B for at least 24 months of follow-up. No significant difference was noted in the Lower Extremity Functional Scale (LEFS) and the Hospital for Special Surgery Knee Score (HSS) between the two groups. The clinical healing time was significantly shorter in Group B (p＜0.001). Those with longer duration of infection had poorer functional status (p＜0.001). Conclusion Management of SSI post-ORIF for TPF with induced membrane technique combined with internal fixation represents a feasible mode of treatment with satisfactory outcomes in terms of infection control and functional recovery. Cite this article: Bone Joint Res 2021;10(7):380–387.

Download Full-text

Comparison of Functional Recovery of Infraorbital Nerve Paresthesia Following Open and Closed Reduction of Zygomaticomaxillary Complex Fractures

10.53350/pjmhs2115102875 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2875-2877

Author(s):

Raheel Hassan ◽

Abid Hussain Bukhari ◽

Rashida Hilal ◽

Nofil Ahmad ◽

Ans Ahmad ◽

...

Keyword(s):

Functional Recovery ◽

Closed Reduction ◽

Open Reduction ◽

Infraorbital Nerve ◽

Complex Fracture ◽

Zygomaticomaxillary Complex Fracture ◽

Nerve Recovery ◽

Group A ◽

Group B ◽

Zygomaticomaxillary Complex

Objective: To compare the functional recovery of infraorbital nerve paresthesia following open reduction as compared to closed reduction in zygomaticomaxillary complex fracture management. Study Design: Randomized controlled trial. Place and Duration of Study: Oral and Maxillofacial Surgery Dept. Dentistry Section, Ayub Medical College & Teaching Hospital, Abbottabad from 1st April 2016 to 30th September 2016. Methodology: Eighty two patients of infraorbital nerve recovery were included. They were divided in two groups; group A was treated by closed reduction technique, and group B was treated by open reduction with internal fixation technique using mini plates. Permuted blocks of 6 were used to ensure equal representation in both groups. All patients were underwent surgical management within 1-7 days following trauma. Patients were assessed post-surgery for infraorbital nerve recovery. Results: There were 63.4% males and 36.6% females in group A while 60.9% males and 39.1% females were included in group B with mean age was 28.44±7.15 years in group A and 27.93±7.33 in group B respectively. 51.2% patients have infraorbial nerve recovery in group A while 65.8% have infraorbital nerve recovery in group B. Conclusion: Closed reduction approach was found to be the best reduction technique and open reduction was effective in terms of stability, prevention of relaps and functional recovery of infraorbital nerve injuries. Key words: Functional recovery, Infraorbital nerve, Paresthesia, Closed reduction, Zygomaticomaxillary complex fracture

Download Full-text

Mandibular Ramus Fractures: A Rarity

The Journal of Contemporary Dental Practice ◽

10.5005/jp-journals-10024-1266 ◽

2013 ◽

Vol 14 (1) ◽

pp. 39-42 ◽

Cited By ~ 5

Author(s):

Tejraj Pundalik Kale ◽

SM Kotrashetti ◽

Archana Louis ◽

JB Lingaraj ◽

BU Sarvesh

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Maxillofacial Surgery ◽

Post Treatment ◽

Oral And Maxillofacial Surgery ◽

Mandibular Fractures ◽

Trauma Patients ◽

Mandibular Ramus ◽

Anatomic Reduction ◽

Age Range

ABSTRACT Aim To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. Materials and methods Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. Results Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. Conclusion Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. Clinical significance This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42.

Download Full-text

Use of chlorhexidine 0.2% gel to prevent alveolar osteitis in mandibular third molar surgical extraction.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.08.4264 ◽

2020 ◽

Vol 27 (08) ◽

pp. 1606-1611

Author(s):

Shuja Hamid ◽

Mahwish Memon ◽

Raza Ali ◽

Salman Shams

Keyword(s):

Maxillofacial Surgery ◽

Third Molar ◽

Mouth Opening ◽

Control Group ◽

Dry Socket ◽

Mandibular Third Molar ◽

Surgical Extraction ◽

Alveolar Osteitis ◽

Group A ◽

Group B

Objectives: To evaluate the efficacy of 0.2% chlorhexidine gel placed intra alveolar in the prevention of alveolar osteitis after the surgical extraction of mandibular third molar. Study Design: Randomized Control trial. Setting: Department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro/Hyderabad. Period: January 2016 to July 2016. Material & Methods: This study consisted of 40 patients in control group A and 40 patients of Chlorohexidine gel group B used after surgical extraction. A single dose of 0.2% bio-adhesive gel was introduced in group B while the control group A was left alone. Postoperative complications like pain, swelling, limited mouth opening, and dry socket were seen. Frequency and percentages were calculated. Mean +/- SD were calculated for quantitative variables. Results: On 3rd day patients reported with pain in group A were 24 and in group B were 15. Pain was seen in 4 patients (10%) on 15th day in group A while in group B no patient came with pain. 19 patients reported with dry socket on day 3 in group A and 4 patients in group B, While none of the patient encountered with Dry socket on 15th day in group in both groups. Conclusion: The data presented indicates that the bio-adhesive gel containing 0.2% chlorohexidine, applied post-extraction produced a better patient recovery.

Download Full-text

COMPARISON OF PAIN PERCEIVED BY PATIENTS UNDERGOING INTRA ORAL LOCAL ANESTHESIA USING DIFFERENT NEEDLE GAUGES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70i6.4286 ◽

2020 ◽

Vol 70 (6) ◽

pp. 1702-06

Author(s):

NoorUlSabah Hussain ◽

Shoaib Younus ◽

Uzair Bin Akhtar ◽

Malik Ali Hassan Sajjad ◽

Muhammad Salman Chishty ◽

...

Keyword(s):

Local Anesthesia ◽

Nerve Block ◽

Oral Surgery ◽

Maxillofacial Surgery ◽

Inferior Alveolar Nerve ◽

Oral And Maxillofacial Surgery ◽

Inferior Alveolar Nerve Block ◽

Group A ◽

The Difference ◽

Group B

Objective: To compare the difference in pain perceived by patients undergoing intra-oral local anesthesia withdifferent gauge needles. Study Design: Qausi experimental study. Place and Duration of Study: Oral and Maxillofacial surgery department of Institute of Dentistry, CombinedMilitary Hospital, Lahore Medical College, Lahore, from July 2019 to August 2019. Methodology: One hundred patients were selected by consecutive sampling from the oral surgery OPD clinic.They were divided into two groups A and B randomly. Twenty three gauge needle on a 3cc disposable syringewas used for inferior alveolar nerve block and buccal nerve block for group A and 27 gauge needle on a metaldental syringe was used for the same in group B. Patients gave a verbal pain score, from 0-10 for each injection. Results: One Hundred participants were included in study, 37 (37%) males and 63 (63%) females. Mean painscore for group A for the inferior alveolar nerve block was 4.50 ± 2.1 and group B was 3.86 ± 2. The mean painscore for the buccal nerve block in group A was 4.02 ± 1.7, while that of group B was 3.94 ± 1.8. There was nosignificant difference (p=0.167 & 0.855) in pain perceived by patients undergoing intra oral local anesthesia using needles of different gauges. Conclusion: There is no difference in pain perceived by patients undergoing intra oral local anesthesia usingneedles of different gauges.

Download Full-text