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PubMed1976

Complicated mandibular fractures.

In many mandibular fractures, proper alignment of the fragments is only a portion of the management program. Consideration must be given to the possibility of numerous other complications, and the patient should be carefully evaluated for injuries of the cervical spine, skull, head, and chest. The medical background, age, and other factors, such as the patient's ability to cooperate and follow the physician's instructions, may determine the method of applied treatment.

Adolescent↗
PubMed1999

[Analysis of 413 cases of mandibular fractures].

OBJECTIVE: To investigate the characteristics of mandibular fracture. METHODS: 413 patients with mandibular fracture were chosen from patients who received treatment at the department of oral and maxillofacial surgery, College of Stomatology, West China University of Medical Sciences from 1986 to 1995, and a retrospective study was carried out. Chi-square test, t-test and linear regression were used to analyzed age, sex, causes, anatomic site, complicated injury, and treatment of jaw fracture. RESULTS: Fracture of Mandible occurred mainly in male, and during 20 to 29 years old. Mental fracture was common in mandibular fracture, and fracture of central craniofacial bone and craniocerebral injury were often complicated with jaw fracture. CONCLUSION: Mandibular fractures are caused mainly by traffic ever since 1990, and rigid intrafixation is a satisfactory treatment which has been accepted by surgeons.

Accidents, Traffic↗
PubMed2001

Minimally invasive approaches to mandibular fractures.

Excellence in mandibular fracture repair requires anatomic restoration of the displaced bone segments, maintenance of the reduction until bone union has been confirmed, and minimization of surgical stigmata. Repairs should ideally be cost-effective, reproducible, adaptable, and expeditiously executed. Fractures of two subregions of the mandible, the condylar neck and the symphysis, can benefit from minimally invasive surgical techniques. The use of these techniques in the mandible is reviewed.

Endoscopy↗
PubMed2000

Case reports: the use of intermaxillary screws to achieve intermaxillary fixation in the treatment of mandibular fractures.

INTRODUCTION: Treatment of mandibular fractures commonly involves the use of arch bars in temporary maxillo-mandibular fixation (also called intermaxillary fixation) to aid bone plating, for the postoperative application of light elastic traction to correct minor occlusal discrepancies and intermaxillary fixation for post reduction immobilisation. The purpose of this paper is to describe a quick and simple alternative for intermaxillary fixation. CLINICAL PICTURE: Three cases of mandibular fractures are presented to demonstrate the use of intermaxillary screws instead of conventional arch-bar wiring. TREATMENT: Two cases were treated with closed reduction methods while the other case was treated with open reduction. OUTCOME: Subsequent fracture healing was not compromised using this technique. CONCLUSIONS: With careful case selection, successful treatment outcome may be achieved using this time-saving and technically simple procedure. Some of the advantages and disadvantages of the intermaxillary screws are discussed.

Adult↗
PubMed1987

Nasal spine suspension for reduction and immobilization of mandibular fractures.

Successful treatment of mandibular fractures involves proper fracture reduction and immobilization for an adequate length of time. A simple wire fixation technique that can be used in many situations involves suspension wiring from the base of the anterior nasal spine to a pair of circummandibular wires. The technique may be used alone or adjunctively with other methods of fixation. It offers several advantages over other methods, particularly in the treatment of pediatric mandibular fractures.

Bone Wires↗
PubMed1998

Complications of mandibular fractures.

Timely repair of mandibular fractures remains an effective means to reduce pain, restore function, and prevent complications. This study addresses the effect of the time interval between injury and treatment on the overall complication rate, the complication rate between various treatment modalities (mandibular-maxillary fixation [MMF] alone, MMF with intraosseous wire bone fixation, and MMF with rigid internal fixation), and the relationship of inpatient vs. outpatient management. Cost was also examined with respect to choice of management. We report a retrospective series of 308 consecutive patients managed at the University of Miami/Jackson Memorial Hospital. Patients who received treatment 3 to 10 days following injury were found to have a lower complication rate than earlier or later repair. We postulate that most patients with mandibular fractures may be managed on an outpatient basis, which represents a considerable savings in cost.

Adolescent↗
PubMed1979

Inferential therapy to promote union of mandibular fractures.

Non-union of mandibular fractures is uncommon, but when it does occur it requires protracted treatment including further surgery. Nine patients with factors known to predispose to non-union out of 150 consecutive mandibular fractures received interferential therapy (I.T.) during the fixation period; all fractures united satisfactorily. In a retrospective study of 150 consecutive mandibular fractures previously treated by the same surgeons without I.T., three fractures resulted in non-union requiring grafting. Thus the incidence of non-union was 0% when I.T. was used and 2% in the control group.

Electric Stimulation Therapy↗
PubMed2007

Complicated late mandibular fracture following third molar removal.

Mandibular fractures are a rare complication after third molar removal. Symptoms show a wide variance. Treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. This article describes a patient who presented a late mandibular fracture following third molar removal. The fracture was not detectable in radiographs at the time of fracture. Six weeks after the reported cracking noise, the patient presented a mandibular fracture with associated osteomyelitis. Treatment by open reduction and internal fixation and autologous iliac crest graft was performed via a submandibular approach. The delayed diagnosis of this pathologic fracture demonstrates the necessity of repeated radiologic controls to prevent osteomyelitis when a fracture is suspected.

Bone Plates↗
PubMed1992

Emergency repair followed by complete-coronal restoration of a fractured mandibular incisor.

Severely fractured anterior teeth often require immediate repair, while long-term restoration is delayed until a healing period is completed. This paper details a technique of immediate emergency repair of a fractured mandibular incisor followed by placement of a bonded composite resin complete-coronal restoration months later. Careful diagnosis, gentle handling of the freshly traumatized tooth and surrounding tissues, and ideal selection and use of the respective bonding materials are necessary to ensure eventual replication of form, function, and tooth shade when the long-term restoration is placed.

Child↗
PubMed1994

The relationship between fracture severity and complication rate in miniplate osteosynthesis of mandibular fractures.

There are many factors influencing the outcome of mandibular fracture management; however, the relationship between fracture severity and complication rate has only been recognised intuitively due to the absence of an accepted system of classification of the severity of these fractures. In 1989 Cooter and David described the alpha numeric system of computer based coding for craniofacial fractures. Using this system, a prospective sample of 324 patients with mandibular fractures presenting to the Royal Adelaide Hospital was coded for fracture severity and their progress followed with respect to complication rate. A strong correlation between complication rate and fracture severity was established.

Bacterial Infections↗
PubMed1981

Prospective study of mandibular fractures.

A one-year prospective study of mandibular fractures that included 253 consecutive patients with 422 mandibular fractures was completed at Charity Hospital, New Orleans. Nine major categories were studied. Patients with multiple mandibular fractures seemed to have a fracture pattern. Complications associated with mandibular fractures are influenced more by location of the fracture or fractures and the cause than by a few days' delay in treatment, the specific technique in treatment, or extraction of teeth associated with the fracture. Thorough knowledge of occlusion and the masticatory apparatus is paramount in successful treatment.

Adolescent↗
PubMed1998

Population-based analysis of 10,766 hospitalizations for mandibular fractures in California, 1991 to 1993.

BACKGROUND: This study describes mandibular fracture incidence, causes, and consequences in a large population. METHODS: California hospital discharge data from 1991 to 1993 were examined to describe causes, lengths of stay, and hospital charges for patients hospitalized for mandibular fractures. Rates were calculated per 100,000 population. RESULTS: There were 10,766 discharges with mandibular fracture as principal diagnosis or as diagnoses two through five on the discharge record (rate=11.5). Of these, 2,694 had mandibular fracture as the only diagnosis (principal diagnosis). For all 10,766 cases, assaults were responsible for more than half (54.0%) of all admissions for mandibular fracture. The highest rates were found among males (18.7), blacks (43.0), and adults aged 16 to 20 (26.5). Charges for the initial hospitalization (excluding physician's fees) for the 2,694 cases with only a diagnosis of mandibular fracture were used to estimate mean charges ($8,740). The total extrapolated 1993 inflation-adjusted hospital charges for mandibular fractures were $34 million per year. Most patients' bills were submitted to government payers, such as Medicaid. CONCLUSION: Treatment of mandibular fractures represents a considerable cost to public-supported programs as well as to patients.

Adolescent↗
PubMed2000

Mandibular fracture after third molar removal.

PURPOSE: Mandibular fracture after impacted lower third molar removal is a rare, but major, complication. The factors leading to a mandibular fracture secondary to third molar removal are analyzed retrospectively. PATIENTS AND METHODS: Six patients who suffered from a mandibular fracture as a complication after third molar removal were examined clinically and radiographically. RESULTS: All fractures occurred an average of 14 days postoperatively. The patients were 42 to 50 years old and were all fully dentulous. All grades of tooth impaction were included. CONCLUSIONS: The major risk factor for this complication seems to be advanced age in combination with a full dentition. The degree of tooth impaction is less important. Preexisting bone lesions weaken the mandible and further predispose to a fracture.

Adult↗
PubMed1992

Changing concepts and controversies in the management of mandibular fractures.

The successful treatment of mandibular fractures and the avoidance of complications ultimately depends on sound surgical judgment. Judgments are influenced by an array of variables. Location, degree of complexity or displacement of the fracture, state of dentition, patient cooperativeness, presence of other maxillofacial trauma, and the surgeon's experience and expertise are some of these factors. We have attempted to outline the basic tenets of mandibular fracture management, recognizing that some areas remain controversial. It is hoped that as technology continues to improve, we will have the luxury of being more dogmatic about our approaches to these problems.

Bone Plates↗
PubMed1993

Rigid fixation of comminuted mandibular fractures.

Treatment of comminuted mandibular fractures has traditionally involved closed reduction with external fixation in an effort to avoid stripping periosteum from the bony segments. The purpose of this study was to evaluate retrospectively the success rate of rigid fixation used to treat 16 consecutive comminuted fractures of the mandible in 15 patients. The comminuted fractures were as follows: symphysis and body, 10; angle, 3; and ramus, 3. In 13 cases, AO stainless steel reconstruction plates were applied, with a minimum of three 2.7-mm tapped bone screws in each of the two stable segments. In most cases additional screws were placed into the comminuted fragments to stabilize them. In two patients, the mandibular ramus was comminuted (one case bilaterally), which made it impossible to place a large plate. These fractures were stabilized with multiple titanium miniplates (2.0 mm, tapped). All patients' fractures healed to a bony union without bone grafting. The mean maximum incisal opening at longest follow-up was 40 mm (range, 20 to 50 mm). All patients had a satisfactory facial form and none required further surgery for facial recontouring or malocclusion. Complications were observed in three patients. Two patients (13%) developed infections. Both infections were caused by loose hardware and responded to removal of the hardware and did not require any other treatment. One mandible refractured during manipulation after coronoidectomy to treat mandibular hypomobility, a sequellae of a gunshot wound that traversed both mandibular rami. This fracture healed after plate removal and a course of maxillomandibular fixation without bone grafting. This study suggests that rigid fixation of comminuted mandibular fractures is a viable treatment that satisfies the necessity for reestablishment of form and function with minimal morbidity.

Adult↗
PubMed2003

[Chemical synthesis of biodegradable poly-para-dioxanone and its application for mandibular fracture fixation].

OBJECTIVE: To observe mandibular fracture healing after synthesized bioabsorable poly-para-dioxanone (PDS) ligature fixation. METHODS: Para-dioxanone monomer was prepared by chemical reactions of metallic sodium, ethylene glycol and other raw materials. PDS was synthesized by polymerizing the purified para-dioxanone in the presence of catalyst under the conditions of negative pressure and certain temperature. PDS ligature was obtained by processing the polymer into small granules, drying and melt-extruding through a spinnerette. Eighteen adult male New Zealand rabbits were assigned randomly into two groups. After mandibular fracture models were created, reductions of the artificial fractures were accomplished by means of transosseous PDS ligatures on each of 12 rabbits in experimental group. While the other six rabbits without any internal fixation were set as control. Schedules for killing were arranged to give postoperative samples at two-week interval till 12th week. RESULTS: Radiographical and histological examinations demonstrated that all fractures fixed with PDS ligatures healed without any complication. Periosteal and cartilaginous osteogenesis was observed in newly formed external callus. In contrast, bone fragment migration and the consequent nonunion occurred in the control group. PDS ligature degraded and absorbed without interference with osseous union and healing. The tensile strength reduction of PDS ligature was prior to its absorption in vivo. CONCLUSION: The synthesized PDS is a colorless, flexible, themoplastic and monofilament fiber, which can be sterilized by ethylene oxide embalmment without serious loss of tensile strength. It seems that the application of this macromolecular material in internal fixation is of great worth for further study.

Absorbable Implants↗