Biomechanical analysis of subcondylar fracture fixation using miniplates at different positions and of different lengths

Background Many types of titanium plates were used to treat subcondylar fracture clinically. However, the efficacy of fixation in different implant positions and lengths of the bone plate has not been thoroughly investigated. Therefore, the primary purpose of this study was to use finite element analysis (FEA) to analyze the biomechanical effects of subcondylar fracture fixation with miniplates at different positions and lengths so that clinicians were able to find a better strategy of fixation to improve the efficacy and outcome of treatment. Methods The CAD software was used to combine the mandible, miniplate, and screw to create seven different FEA computer models. These models with subcondylar fracture were fixed with miniplates at different positions and of different lengths. The right unilateral molar clench occlusal mode was applied. The observational indicators were the reaction force at the temporomandibular joint, von Mises stress of the mandibular bone, miniplate and screw, and the sliding distance on the oblique surface of the fracture site at the mandibular condyle. Results The results showed the efficacy of fixation was better when two miniplates were used comparing to only one miniplates. Moreover, using longer miniplates for fixation had better results than the short one. Furthermore, fixing miniplates at the posterior portion of subcondylar region would have a better fixation efficacy and less sliding distance (5.46–5.76 μm) than fixing at the anterolateral surface of subcondylar region (6.10–7.00 μm). Conclusion Miniplate fixation, which was placed closer to the posterior margin, could effectively reduce the amount of sliding distance in the fracture site, thereby achieving greater stability. Furthermore, fixation efficiency was improved when an additional miniplate was placed at the anterior margin. Our study suggested that the placement of miniplates at the posterior surface and the additional plate could effectively improve stability.

Acute Airway Compromise After Isolated Mandibular Subcondyle Fracture in a Patient With a Hemi-Mandible: A Case Report

Evaluation of the airway is the first step in any trauma protocol, and this is particularly important in instances of facial trauma. While airway compromise is not uncommon in blunt or penetrating facial trauma, it is rarely a significant concern in instances of an isolated mandibular fracture. We report a rare case of immediate airway compromise in an elderly, edentulous female who sustained an isolated mandibular subcondyle fracture, complicated by her history of a remote hemimandibulectomy for management of her oral cancer. Initial airway management was performed conservatively with prone or lateral positioning under continuous pulse oximetry monitoring in the intensive care unit, followed promptly by open anatomic reduction and internal fixation of the fracture under more optimal operative conditions. After stabilizing the subcondylar fracture, the patient followed a mechanical soft/no-chew diet for 6 weeks until the fracture was healed. She has experienced no airway concerns since her surgery. This case report stresses the importance of a comprehensive evaluation of the airway in facial trauma patients with altered baseline anatomy, as well as highlights the considerations for emergent surgical airway versus immediate or delayed surgical fracture fixation.

Management‌ ‌of‌ ‌dentofacial‌ ‌trauma‌ ‌in‌ ‌an‌ ‌adolescent‌ ‌patient:‌ ‌The‌ ‌ conservative‌ ‌and‌ ‌the‌ ‌preservative‌ ‌approach‌

Mandibular fractures are one of the most frequent occurrences in maxillofacial trauma. Age of the patient, presence of additional injuries, co-morbid diseases of the patient, trauma type, and localization of the fracture must be considered while choosing the treatment strategy. A 12-year-old female patient reported with the complaint of fallen teeth due to trauma three days back. Clinical and radiographic findings revealed symphysis fracture with left sided parasymphysis and subcondylar fracture along with avulsion of 11 and 21. Intermaxillary fixation was done with Erich arch bars and elastics for the management of mandibular fracture, and rehabilitation of edentulous space was done using the avulsed teeth as pontics which were bonded to the adjacent abutment teeth using fiber-reinforced composite.

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

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.