Tateyuki Iizuka

Infection after rigid internal fixation of mandibular fractures : a clinical and radiologic study

Of 214 patients with mandibular fractures treated following the AO/ASIF principle of rigid fixation, 13 patients (6.1%) developed postoperative infection. The yearly percentage decreased remarkably during the study period. When rigid fixation became a routine method, the infection rate was as low as the corresponding figure for cases treated with nonstable techniques and maxillomandibular fixation (MMF). All but one of the infected fractures were in the angular region of the mandible. Teeth had been extracted from the fracture line in 9 of the 10 dentulous patients. It was concluded that erroneous techniques had been used in almost all infected cases, because compression could not be achieved when there was an irregular fracture line, an atrophic edentulous mandible, or inadequate stability due to removal of a tooth in the line of fracture. In five patients, successful reoperation was performed using a reconstruction plate. Detailed radiologic examination was useful in assessment of infection and in follow-up.

Rigid internal fixation of mandibular fractures: An analysis of 270 fractures treated using the AO/ASIF method

The results are reported on 214 patients treated for 270 mandibular fractures, using rigid internal fixation. Of these, 172 fractures (63.7%) in 131 patients had been re-evaluated at final follow-up in connection with plate and screw removal, on average 15.2 months, postoperatively. Although one-third of the patients had a history of alcohol abuse, and 86% were treated with a delay of more than 24 h (mean 3.2 days), good primary bone healing was observed in 93.9% of the patients. Infections, seen in 6.1% of the patients, were related exclusively to inadequate stability of the fracture. Malocclusion, observed in 18.2% of 159 dentate patients, was caused by incorrect plate bending and insufficient fracture reduction. Immediate postoperative dysfunction of the inferior alveolar nerve in 58.1% of the cases, and of the mandibular branch of the facial nerve in 12.7%, was followed by almost total recovery 1 year after operation. It is concluded that rigid internal fixation is a reliable method of treatment, especially indicated for patients with reduced healing capacity and poor co-operation.

Different patterns of condylar fractures: an analysis of 382 patients in a 3-year period

Three hundred eighty-two patients with 443 condylar fractures, accounting for 52.4% of all mandibular fractures, were given diagnoses and treated in our department between 1987 and 1989. A high proportion of the fractures (44%) were caused by interpersonal violence, followed in incidence by falls (29%) and road traffic accidents (21%). The type of condylar fracture seems to be influenced directly by its cause. Severe fractures in which the condyle was dislocated out of the glenoid fossa resulted more often from falls (22%) and road traffic accidents (26%) than from violence (8%). Fractures caused by violence showed a uniform type characterized by a subcondylar location and nondisplacement or deviation at the fracture line. A relatively large number of patients (56, 15%) were considered to have an indication for open reduction of the fracture.

Osteoporosis and bisphosphonates-related osteonecrosis of the jaw: Not just a sporadic coincidence – a multi-centre study

INTRODUCTION Bisphosphonates (BPs) are powerful drugs that inhibit bone metabolism. Adverse side effects are rare but potentially severe such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). To date, research has primarily focused on the development and progression of BRONJ in cancer patients with bone metastasis, who have received high dosages of BPs intravenously. However, a potential dilemma may arise from a far larger cohort, namely the millions of osteoporosis patients on long-term oral BP therapy. PATIENTS AND METHODS This current study assessed 470 cases of BRONJ diagnosed between 2004 and 2008 at eleven different European clinical centres and has resulted in the identification of a considerable cohort of osteoporosis patients suffering from BRONJ. Each patient was clinically examined and a detailed medical history was raised. RESULTS In total, 37/470 cases (7.8%) were associated with oral BP therapy due to osteoporosis. The majority (57%) of affected individuals did not have any risk factors for BRONJ as defined by the American Association of Oral and Maxillofacial Surgery. The average duration of BP intake of patients without risk factors was longer and the respective patients were older compared to patients with risk factors, but no statistical significant difference was found. In 78% of patients the duration of oral BP therapy exceeded 3 years prior to BRONJ diagnosis. DISCUSSION The results from this study suggest that the relative frequency of osteoporosis patients on oral BPs suffering from BRONJ is higher than previously reported. There is an urgent need to substantiate epidemiological characteristics of BRONJ in large cohorts of individuals.

Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures: A clinical and radiologic study of thirteen patients

Thirteen cases of high condylar fracture treated by open reduction and fixation with miniplates were monitored for an average of 18 months postoperatively. Satisfactory functional results were achieved clinically in all but one patient. Radiologically, however, signs of condylar resorption and osteoarthrosis were diagnosed in all patients. In four patients with associated multiple fractures of the facial bones, rapid complete resorption of the condyle was observed. These changes were markedly more severe than those observed in our previous study, in which osteosynthesis was performed by transosseous wiring and subsequent intermaxillary fixation for 3 to 7 weeks. Indications for rigid and nonrigid fixation in the surgical treatment of condylar fractures are discussed.

Analysis of possible factors leading to problems after nonsurgical treatment of condylar fractures.

PURPOSE An attempt was made to identify types of condylar fractures that, despite active nonsurgical treatment, lead to unsatisfactory clinical results. PATIENTS AND METHODS Ninety-two dentate adult patients with unilateral condylar fractures were studied clinically and radiologically. On the basis of the information collected, problematic cases were identified. These consisted of patients with persistent occlusal change and/or marked deviation of the mandible on mouth opening after removal of maxillomandibular fixation or during follow-up. Radiologic analyses were performed using panoramic and Townes views, and the results of problematic and nonproblematic cases were compared. RESULTS Using clinical parameters, two problem groups were found. In patients with persistent malocclusion, ramus height was significantly reduced, irrespective of degree or direction of angulation between the fragments. Deviation of the jaw on mouth opening, but no occlusal disturbances, occurred in those with dislocated condyles. CONCLUSION Problematic condylar fractures can often be identified preoperatively by means of simple radiographic measurements and these cases should probably be treated surgically.

Sensory disturbances associated with rigid internal fixation of mandibular fractures

Sensory status of the inferior alveolar nerve was monitored in 133 patients with 150 fractures in the region of the mandibular canal treated with rigid internal fixation preoperatively and 6 weeks postoperatively. Eighty-five of the patients were reevaluated on final follow-up at an average of 15.9 months. Preoperative sensory disturbance (58.5%) correlated significantly only with the presence of fracture displacement. The occurrence of postoperative paresthesia (76.0% at 6.2 weeks, 46.6% at 15.9 months) correlated significantly with the degree of mandibular edentulousness. Patients with edentulous mandibles, especially when a compression plate was used, suffered significantly more often from nerve injury than fully dentate patients. The results indicated that the sensory disturbance was caused by the surgical procedure. In contrast to previous assumptions, displacement of the fracture and preoperative sensory status did not correlate with postoperative occurrence of paresthesia.

Different patterns of mandibular fractures in children. An analysis of 220 fractures in 157 patients

157 paediatric patients with a total of 220 mandibular fractures were evaluated retrospectively. All patients had been examined with the aid of orthopantomography. 72% of the children had fractures in the condylar region. The patients were divided into four age groups according to the development of the dentition (group A: 0-5 years, B: 6-9 years, C: 10-12 years, and D: 13-15 years). Bicycle accidents and falls were the two main causes of the fractures in all age groups. However, there were significant differences in the causes and location of the fractures between groups A+B and C+D. The proportion of condylar fractures decreased and the proportion of body and angle fractures increased with increasing age; fractures in the horizontal part of the mandible were mainly observed in groups C and D. Both aetiological factors and fracture patterns in the patients older than 10 years of age resembled those of adults. The differences observed should be taken into consideration in studies concerning mandibular fractures in paediatric patients. In this respect the age limit between the adult and child should probably be lowered significantly.

An epidemiological study of patterns of condylar fractures in children

OBJECTIVE To find out how the site and type of condylar fracture are affected by its aetiology and the age and sex of the patient. DESIGN Retrospective study. SETTING Tertiary referral centre, Finland. MATERIAL Radiographs of 101 children (aged 15 years or less) with 119 condylar fractures. MAIN OUTCOME MEASURES Site of fracture and degree of displacement. RESULTS A total of 26 of the 119 fractures were intracapsular (22%) and 93 (78%) extracapsular. Only among patients less than 6 years of age was there a preponderance of intracapsular fractures (7/12 fractures in 10 patients, 58%). In the older children 78% (83/107) were in the condylar neck. There were few subcondylar fractures (5/119, 4%). Only 6 fractures were displaced (5%). Dislocation of the condyle from the glenoid fossa was common in all age groups. CONCLUSION The site of condylar fracture is age related, but not associated with sex or aetiology.

Rigid internal fixation of fractures in the angular region of the mandible: an analysis of factors contributing to different complications.

Data relating to 113 patients with 121 mandibular angle fractures treated according to the principles of rigid internal fixation were analyzed to determine which clinical factors are associated with different complications. Certain clinical characteristics were found to be associated with major complications. The use of compression plates seemed to entail disadvantages resulting in some complications. Because of the relatively small cross section of bone surface and particular anatomic features of the angular region, well-adjusted interfrag-mentary compression is often not possible. A neutral reconstruction plate is considered optimal for rigid osteosynthesis. If a molar tooth in the fracture line has to be extracted, this should be done after fracture stabilization. In most cases, an extraoral approach could not be avoided, but complications associated with this approach were infrequent and well tolerated by patients.