RESUMO
The present study aims to compare three types of internal fixation for fractures of the mandibular angle. Mechanical testing was performed on replicas of polyurethane hemimandibles sectioned at the angle region to simulate a fracture and fixed with three different hardwares. Fixation devices enrolled on this survey included the grid plates with and without an intermediate bar and the method described by Champy and colleagues in 1978 and the sample consisted of 10 hemimandibles for each group. Vertical loadings were applied on each hemimandible and recorded after a vertical displacement of 3 and 5 mm. Statistical analysis was made by means of the variance analysis (ANOVA) and the Duncan test with a significance level of 5%. The Champy technique showed a statistically significant increased resistance when compared to the grid plates after vertical displacements of 3 and 5 mm. The results of this survey suggest that the Champy technique, when compared to the grid plate positioned at the middle of the mandibular bone (placement site selected for this study), is more resistant than the grid plate and that the inclusion or not of an intermediate bar to the grid plates does not improve its resistance after linear vertical loadings.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas Mandibulares/cirurgia , Materiais Biocompatíveis/química , Fenômenos Biomecânicos , Força de Mordida , Parafusos Ósseos , Força Compressiva , Desenho de Equipamento , Humanos , Fraturas Mandibulares/classificação , Modelos Anatômicos , Poliuretanos/química , Estresse Mecânico , Titânio/químicaRESUMO
The purpose of this study was to retrospectively evaluate the complications of 58 patients who underwent surgery for mandibular condylar process fractures. Data were collected from patients during a 10-year period (1999-2009). The data recorded included demographic data, etiology, diagnosis, type of condylar fracture, surgical approaches, and postoperative complications. A total of 58 underwent surgery for reduction of the condylar fractures. There were 22 patients with bilateral condyle fractures and 36 patients with unilateral condyle fractures, accounting for 65 surgeries. In 8 fractures, a preauricular approach was performed to access the fractures condyle, whereas the retromandibular approach was performed in 57 fractures. There were 2 temporary facial palsies, 1 permanent facial palsy, and 1 sialocele. There were no cases of hypertrophic scar, Frey syndrome, or salivary fistula. In conclusion, permanent deformities after surgical complications were unusual, and the results are acceptably safe.
Assuntos
Fixação Interna de Fraturas/métodos , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Complicações Pós-Operatórias , Adolescente , Adulto , Perda Sanguínea Cirúrgica , Placas Ósseas , Parafusos Ósseos , Criança , Paralisia Facial/etiologia , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Fraturas Cominutivas/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Doenças Parotídeas/etiologia , Glândula Parótida/cirurgia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Articulação Temporomandibular/cirurgia , Adulto JovemRESUMO
PURPOSE: The aim of this study was to evaluate the clinical outcome of patients with mandibular angle fractures treated by intraoral access and a rectangular grid miniplate with 4 holes and stabilized with monocortical screws. PATIENTS AND METHODS: This study included 45 patients with mandibular angle fractures from the Department of Oral and Maxillofacial Surgery São Paulo State University, Araraquara, Brazil, and from the Clinic of Oral and Maxillofacial Surgery at the University of Frankfurt, Germany. The 45 fractures of the mandibular angle were treated with a rectangular grid miniplate of a 2.0-mm system by an intraoral approach with monocortical screws. Clinical evaluations were postoperatively performed at 15 and 30 days and 3 and 6 months, and the complications encountered were recorded and treated. RESULTS: The infection rate was 4.44% (2 patients), and in 1 patient it was necessary to replace hardware. This patient also had a fracture of the left mandibular body; 3 patients (6.66%) had minor occlusal changes that have been resolved with small occlusal adjustments. Before surgery, 15 patients (33.33%) presented with hypoesthesia of the inferior alveolar nerve; 4 (8.88%) had this change until the last clinical control, at 6 months. CONCLUSIONS: The rectangular grid miniplate used in this study was stable for the treatment of simple mandibular angle fractures through intraoral access, with low complication rates, easy handling, and easy adjustment, with a low cost. Concomitant mandibular fracture may increase the rate of complications. This plate should be indicated in fractures with sufficient interfragmentary contact.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas Mandibulares/cirurgia , Adolescente , Adulto , Parafusos Ósseos , Remoção de Dispositivo , Desenho de Equipamento , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Hipestesia/etiologia , Masculino , Má Oclusão/etiologia , Mandíbula/cirurgia , Fraturas Mandibulares/classificação , Nervo Mandibular/fisiopatologia , Pessoa de Meia-Idade , Ajuste Oclusal , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Atrophic mandible fracture is common among elderly patients. Such fractures present management difficulties related to anatomic and physiologic alterations in this population. The purpose of this study was to evaluate the results of this type of fracture treatment and to realize a critical review of literature on the subject. PATIENTS AND METHODS: The sample was obtained from records of patients of Restauração Hospital (Recife, Brazil) who underwent surgical treatment of atrophic mandible fracture between 2006 and 2009. Data, such as etiology, location, and degree of displacement of the fractures, as well as access, type of fixation used, and the presence of postoperative complications, were analyzed. RESULTS: Successful bone union was achieved in 100% of cases. Complications were related to those patients treated with reconstruction plates (2.4 mm). CONCLUSIONS: Open reduction and internal fixation with miniplates seem a feasible option for primary treatment of atrophic mandible fractures without comminution or loss of substance. The level of scientific evidence for the treatment of atrophic mandible fractures is low.
Assuntos
Mandíbula/patologia , Fraturas Mandibulares/cirurgia , Acidentes por Quedas , Acidentes de Trânsito , Idoso , Idoso de 80 Anos ou mais , Atrofia , Placas Ósseas , Remoção de Dispositivo , Feminino , Seguimentos , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Humanos , Luxações Articulares/cirurgia , Masculino , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologiaRESUMO
Las fracturas mandibulares se presentan de manera frecuente en pacientes con trauma facial. Pueden ser la única manifestación traumática de o bien combinarse con otros trazos fracturarios del macizo facial. Las fracturas de cóndilo mandibular constituyen entre el 25 y el 35 por ciento de las lesiones del maxilar inferior y son provocadas en la gran mayoría de los casos por un mecanismos traumático indirecto. Los abordajes terapéuticos pordrían resumirse en dos grupos, los denominados tratamientos conservadores cerrados y los tratamientos abiertos, quirúrgicos, con fijación interna estable en alguna de sus formas. El objetivo de este trabajo es exponer las distintas alternativas de tratamiento y evaluar la eficacia de los mismos a corto y mediano plazo. Se realiza, además, una extensa revisión bibliográfica, comparando la evidencia encontrada con la experiencia acumulada en nuestro servicio.
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Côndilo Mandibular/lesões , Fixação Interna de Fraturas/métodos , Fraturas Mandibulares/cirurgia , Fraturas Mandibulares/classificação , Fraturas Mandibulares/terapia , Técnicas de Fixação da Arcada Osseodentária , Fatores Etários , Argentina/epidemiologia , Equipe Hospitalar de Odontologia , Fixação de Fratura/métodos , Fraturas Mandibulares/epidemiologiaRESUMO
OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.
Assuntos
Fraturas Mandibulares/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fios Ortopédicos/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Fixação de Fratura/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Lactente , Técnicas de Fixação da Arcada Osseodentária/estatística & dados numéricos , Masculino , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Turquia/epidemiologia , Violência/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70 percent) males and 162 (30 percent) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65 percent) in young patients and traffic accidents (38 percent) in adults. The most common fracture sites were the symphysis (35 percent) and condyle (36 percent) in young patients, and the symphysis in adults (36 percent). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67 percent) and adult (39 percent) patients, and 43 percent of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However, there were differences regarding age, etiology and fracture site. These findings between young and adult patients are broadly similar to those from other studies. Analysis of small differences may be an important factor in assessing educational and socioeconomic environments.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fraturas Mandibulares/epidemiologia , Fatores Etários , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Fios Ortopédicos/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Fixação de Fratura/estatística & dados numéricos , Técnicas de Fixação da Arcada Osseodentária/estatística & dados numéricos , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Turquia/epidemiologia , Violência/estatística & dados numéricos , Adulto JovemRESUMO
This retrospective study evaluated the epidemiology, treatment and complications of mandibular fracture associated, or not associated, with other facial fractures, when the influence of the surgeon's skill and preference for any rigid internal fixation (RIF) system devices was minimized. The files of 700 patients with facial trauma were available, and 126 files were chosen for review. Data were collected regarding gender, age, race, date of trauma, date of surgery, addictions, etiology, signs and symptoms, fracture area, complications, treatment performed, date of hospital discharge, and medication. 126 patients suffered mandibular fractures associated, or not, with other maxillofacial fractures, and a total of 201 mandibular fractures were found. The incidence of mandibular fractures was more prevalent in males, in Caucasians and during the third decade of life. The most common site was the condyle, followed by the mandibular body. The therapy applied was effective in handling this type of fracture and the success rates were comparable with other published data.
Assuntos
Fraturas Mandibulares/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Criança , Pré-Escolar , Queixo/lesões , Queixo/inervação , Ossos Faciais/lesões , Feminino , Seguimentos , Fixação de Fratura/estatística & dados numéricos , Humanos , Incidência , Estudos Longitudinais , Masculino , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Transtornos de Sensação/epidemiologia , Fatores Sexuais , Fraturas Cranianas/epidemiologia , Fumar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto JovemRESUMO
This article reviews cases of mandibular fractures treated at the Service of Oral and Maxillofacial Surgery of the Hospital Complex of Mandaqui (SUS/SP), which is a reference hospital complex for trauma in the northern area of the city of São Paulo, Brazil. Ninety-eight patients with mandibular fractures were seen at the hospital between January and December, 2001. Out of this total, 91 cases whose files were deemed adequate in terms of data accuracy and completeness were reviewed. The following data were collected for the study: age, gender, etiology, anatomical fracture site, treatment modality, relation to other facial bone fractures, hospitalization time and posttrauma complications. Motorcycle accident was the major cause of mandibular fractures followed by physical aggression and height fall. The mandibular anatomical sites of higher fracture incidence were: body, symphysis and condyle. The most commonly performed treatment modes were conservative approach or open reduction and intraosseous fixation. In conclusion, motorcycle accidents were associated with a larger number of facial fractures and most predominantly affect 21-30 year-old males. On the average, motor vehicle accident victims had more (and more severe) fractures than physical aggression victims. Complications were mostly associated with angle fractures and hospitalization period. Polytraumatized patients presented greater morbidity for complications.
Assuntos
Fraturas Mandibulares/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Ossos Faciais/lesões , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Fraturas Cranianas/epidemiologia , Violência/estatística & dados numéricosRESUMO
This article reviews cases of mandibular fractures treated at the Service of Oral and Maxillofacial Surgery of the Hospital Complex of Mandaqui (SUS/SP), which is a reference hospital complex for trauma in the northern area of the city of São Paulo, Brazil. Ninety-eight patients with mandibular fractures were seen at the hospital between January and December, 2001. Out of this total, 91 cases whose files were deemed adequate in terms of data accuracy and completeness were reviewed. The following data were collected for the study: age, gender, etiology, anatomical fracture site, treatment modality, relation to other facial bone fractures, hospitalization time and posttrauma complications. Motorcycle accident was the major cause of mandibular fractures followed by physical aggression and height fall. The mandibular anatomical sites of higher fracture incidence were: body, symphysis and condyle. The most commonly performed treatment modes were conservative approach or open reduction and intraosseous fixation. In conclusion, motorcycle accidents were associated with a larger number of facial fractures and most predominantly affect 21-30 year-old males. On the average, motor vehicle accident victims had more (and more severe) fractures than physical aggression victims. Complications were mostly associated with angle fractures and hospitalization period. Polytraumatized patients presented greater morbidity for complications.
O artigo tem como objetivo revisar casos de fraturas de mandíbula atendidos no Serviço de Cirurgia Bucomaxilofacial do Conjunto Hospitalar do Mandaqui (SUS/SP), hospital de referência para trauma na região norte de cidade de São Paulo. De janeiro a dezembro de 2001, foram atendidos 98 pacientes com fraturas de mandíbula no hospital. Dentre estes, 91 casos que dispunham de dados suficientes em prontuários foram analisados. Para o estudo foram considerados: idade, gênero, etiologia, local anatômico da fratura, modalidade de tratamento, relação com fraturas de outros ossos faciais, tempo de hospitalização e complicações. Acidente motociclístico foi a principal causa de fraturas mandibulares, seguido de agressão e queda de altura. Os três locais anatômicos de maior incidência foram: corpo, sínfise e côndilo. O modo de tratamento consistiu de abordagem conservadora ou redução aberta e fixação interna. Conclui-se que acidentes motociclísticos estão associados a um maior número de fraturas mandibulares com predominância em homens de 21 a 30 anos. Vítimas de acidentes com veículos apresentaram, em média, mais fraturas do que vítimas de agressões. As complicações mostraram-se associadas ao maior período de hospitalização e fraturas de ângulo mandibular, e tiveram maior incidência em pacientes politraumatizados.