Mandibular Bone Fractures in elderly patients with reference to etiology of trauma

Aim: to explore the mandibular bone fractures in elderly patients with reference to etiology of trauma. Methodology: This was a descriptive study conducted in the department of Oral and Maxillofacial Surgery KEMU/ Mayo Hospital Lahore. Elderly patients (age 60-100years) with mandibular bone fractures. Results: Aetiology of trauma leading to mandibular fractures was as follows; there were 79(65.83%) cases of RTA, 32(26.66%) falls, 4(3.33%) assaults and there were only 3(2.5%) cases of industrial injury. Conclusion: To conclude, this study depicts that road traffic accidents were the predominant cause of injury in the studied age group. Elderly patients need more care and attention, especially after traumatic incidents and lead to financial burden in hospitals Keywords: Maxillofacial trauma, Elderly population, Mandibular injuries, Elderly fractures

Central giant cell lesions with an unusual behavior in patient with Noonan syndrome: A case report with 8-year follow-up

This study describes a patient with Noonan syndrome affected by multiple Central Giant Cell Lesions (CGCL) in jaws. The lesions presented an unusual behavior since there was no regression size after puberty. The syndrome was diagnosed by collecting clinical information, represented by ocular hypertelorism, low insertion of ears, pulmonary stenosis, cryptorchidism, cardiac abnormalities, short stature, multiple CGCL in the jaws, and blood analysis that found a mutation of the PTPN11 gene. The treatment consisted of systemic calcitonin for a period of 14 months and three surgical procedures at distinct moments. The patient is currently with 20 years and in the eighth-year of follow-up. Although he presented an improvement in deformity, radiological findings showed remodeling without resolution of mandibular injuries, making it clear that injuries will did not always regress after puberty and not confirm previously publications in the literature. We therefore advocate a larger time of follow-up before patient discharge in these cases.

THE POSSIBILITIES OF CONE-BEAM COMPUTER TOMOGRAPHY IN THE DIAGNOSTIC OF FRACTURES OF THE MANDIBLE WITHIN THE DENTAL ROW

The aim: To establish the possibilities and advantages of cone-beam tomography in the primary diagnostic of mandibular fractures within the dental row compared with traditional methods of radiation diagnosis. Materials and methods: The research was performed involving of 28 patients who had traumatic injuries of the maxillofacial area. The age of the victims was 18-56 years. The injured people were selected who were examinated by traditional radiological methods of diagnosis in the first hours after injury, and for final diagnostic in hospital were used cone-beam tomography of the mandible. The comparison of the results obtained with the help of traditional X-ray examinations with the data of cone-beam tomography allowed to conduct a comparative analysis of the diagnostic capabilities of these methods and to determine the advantage of the last one. Results: A comparative analysis of the results of the examination of injured people, which were obtained by using of traditional methods and cone-beam tomography of the mandible, shows the diagnostic advantages of the last one, which allows to determine the extent of traumatic injuries of the mandible and identify hidden fractures that were not determined by traditional X-ray methods. Conclusions: For the primary diagnostics of traumatic mandibular injuries, traditional X-ray examinations may be informative, but for complex, combined injuries, as well as fractures that raise doubts,it is advisable to use cone-beam computed tomography. The use of cone-beam computed tomography in mandibular fractures makes it possible to better assess the degree of damage and determine the displacement of fragments.

Tratamento conservador versus cirúrgico das fraturas condilares: revisão integrativa

As fraturas condilares são as fraturas maxilofaciais com maior controvérsia na literatura a respeito das formas de tratamento, uma vez que, no procedimento de escolha, envolve questões relacionadas à idade, localização e tipo de fratura, grau de deslocamento do segmento fraturado, presença de outras fraturas faciais associadas, ausência de dentes, o restabelecimento da oclusão dentária e o tempo decorrido do trauma, fatores estes que direcionam a escolha do tipo de abordagem terapêutica (cirúrgica ou conservadora, estática ou funcional). Este estudo teve como objetivo principal realizar uma revisão integrativa da literatura atual sobre o tratamento das fraturas condilares, destacando suas indicações, limitações, vantagens e desvantagens. A metodologia utilizada foi uma revisão integrativa da literatura por meio de pesquisa bibliográfica, por meio de uma busca de artigos científicos na base de dados eletrônica PubMed e Medline, utilizando os descritores mandibular condyle, mandibular fractures, mandibular injuries, indexados no período de 2015 a 2020, que tratavam de estudos transversais, ensaios clínicos e randomizados. Após os critérios de elegibilidade, foram analisados 27 artigos integralmente publicados em língua inglesa. Os estudos demonstraram qual conduta de tratamento traz mais segurança para a intervenção, apresentando alta confiabilidade, permitindo uma evidência científica previsível e rápida, além de proporcionar um tratamento com menor custo e tempo de internação.

TRATAMENTO CIRÚRGICO DE FRATURA COMINUTIVA DE MANDÍBULA: RELATO DE CASO

ResumoUm dos maiores desafios no tratamento de fraturas cominutivas da mandíbula é restaurar o contorno anatômico das áreas fraturadas, pois, a maioria dos casos apresenta deslocamento ósseo severo e perda óssea que diminuem a previsibilidade da redução dos fragmentos. Nesse contexto o tratamento deste tipo de fraturas mandibulares ainda permanece um desafio para a cirurgia maxilofacial no que se refere à técnica de redução. Nesse sentido, a redução aberta com fixação interna rígida se apresenta como uma boa opção de tratamento, por encurtar o tempo de reabilitação orofuncional e diminuir as chances de infecção. O presente trabalho tem como objetivo apresentar o caso clínico de um paciente do sexo masculino vítima de acidente com animal cursando com múltiplas fraturas de face. A abordagem cirúrgica eleita para o tratamento da fratura mandibular cominutiva foi a redução aberta e instalação de placa de reconstrução e parafusos de titânio. A abordagem aberta evitou o bloqueio maxilo-mandibular pós-operatório em um paciente jovem. Esta técnica permitiu a redução precisa dos fragmentos devolvendo a função mastigatória de maneira precoce.Palavras-chave: Fraturas maxilomandibulares, traumatismos mandibulares, redução aberta, fixação de fratura.AbstractOne of the biggest challenges in treating comminuted jaw fractures is restoring the anatomical contour of the fractured areas. Most cases have severe bone dislocation and bone loss that decreases reduction predictability. In this context, the treatment of this type of mandibular fractures still remains a challenge for maxillofacial surgery regarding the reduction technique. In this sense, open reduction with rigid internal fixation is a good treatment option because it decreases orofunctional rehabilitation time and reduces the chances of infection. The present work aims to present the clinical case of a male patient victim of animal accident with multiple facial fractures. The chosen surgical approach for the treatment of comminuted mandibular fracture was open reduction and installation of reconstruction plate and titanium screws. The open approach favored not performing postoperative maxillomandibular block in a young patient. This technique allowed the precise reduction of fragments and the early masticatory function.Key-words: Jaw fractures, mandibular injuries, open fracture reduction, fracture fixation.

Surgical Treatment of Gunshot Injuries to the Mandible

OBJECTIVES: Our goal was to review and identify risk factors for complications from treatment of mandible fractures due to gunshot wounds. STUDY DESIGN AND SETTING: We conducted a retrospective review of treatment outcomes in 90 patients with gunshot wounds to the mandible treated over a 10-year period at 2 tertiary care centers. RESULTS: Our series of 90 patients with mandibular injuries due to gunshot wounds included 68 patients who underwent surgical procedures on the mandible. There were 14 complications in this group. Complications were more common in patients whose mandibles were rigidly fixated; however, these patients' injuries were more severe. Complications were significantly increased in patients who lost a segment of mandible in the injury. CONCLUSIONS: Complications were related to severity of injury and independent of treatment modality. SIGNIFICANCE: The complication rate for patients with gunshot injuries can be very high, particularly if bone is missing. Stabilization of remaining mandibular segments with potentially multiple subsequent reconstructive procedures is often required to restore mandibular continuity in these patients.