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Introduction: Open reduction and fixation are the standard of care for treating mandibular fractures and usually lead to successful healing. However, complications such as delayed healing, non-union, and infection can compromise patient outcomes and increase healthcare costs. The initial inflammatory response, particularly the response involving specific CD8+ T cell subpopulations, is thought to play a critical role in healing long bone fractures. In this study, we investigated the role of these immune cell profiles in patients with impaired healing of mandibular fractures. Materials and methods: In this prospective study, we included patients with mandibular fractures surgically treated at Charité – Universitätsmedizin Berlin, Germany, between September 2020 and December 2022. We used follow-up imaging and clinical assessment to evaluate bone healing. In addition, we analyzed immune cell profiles using flow cytometry and quantified cytokine levels using electrochemiluminescence-based multiplex immunoassays in preoperative blood samples. Results: Out of the 55 patients enrolled, 38 met the inclusion criteria (30 men and 8 women; mean age 32.18 years). Radiographic evaluation revealed 31 cases of normal healing and 7 cases of incomplete consolidation, including 1 case of non-union. Patients with impaired healing exhibited increased levels of terminally differentiated effector memory CD8+ T cells (TEMRA) and a higher TEMRA to regulatory T cell (Treg) ratio, compared with those with normal healing. Conclusions: Our analysis of mandibular fracture cases confirms our initial hypothesis derived from long bone fracture healing: monitoring the TEMRA to Treg ratio in preoperative blood can be an early indicator of patients at risk of impaired bone healing. Radiologic follow-up enabled us to detect healing complications that might not be detected by clinical assessment only. This study highlights the potential of individual immune profiles to predict successful healing and may form the basis for future strategies to manage healing complications. [ABSTRACT FROM AUTHOR]

Background: Restoration of the mandibular region after segmental resection surgery is crucial for masticatory function and facial aesthetics. The precision of three‐dimensional printers has advanced in recent years, enabling the development of fully customized reconstruction plates. In recent years, three‐dimensional printing technology has been applied in the field of dental and oral surgery. Among these, the selective laser melting method has been developed. This case report was aimed at exploring the utility in restoring mandibular morphology. Cases: Patients diagnosed with medication‐related osteonecrosis of the jaw (MRONJ) in Oral and Maxillofacial Surgery at Kanazawa Medical University Hospital who underwent mandibular disarticulation and immediate completely customized reconstruction plate (COSMOFIX) were included. Case 1 involved a female in her 70s with MRONJ on the right side of the mandible. Case 2 involved a female who received bisphosphonates for extensive metastatic breast cancer, resulting in MRONJ affecting the bilateral mandible. Case 3 involved a woman who developed MRONJ on the right side of the mandible during alendronate treatment for osteoporosis. Completely customized reconstruction plates were used for reconstruction after segmental resections. Findings: The three patients adapted to the remaining bone. The reconstructed and preoperative mandibular morphologies were similar. Conclusions: In conclusion, the use of completely customized reconstruction plates obviates the need for bending and other adaptations, reduces surgical time, and improves postoperative aesthetics. Of significance, preparing completely customized reconstruction plate requires about 3 weeks; thus, careful case selection and scheduling are indispensable. [ABSTRACT FROM AUTHOR]

Background: To plan optimal treatment, obtain satisfactory outcomes, and avoid undesirable clinical errors, surgeons need to have efficient tools for providing a complete and prompt diagnosis. The aim of this study was to establish the sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate of the "air sign" (AS) within soft tissues as an indirect radiological indicator of mandibular body and angle fractures. Methods: A retrospective analysis of preoperative computed tomography (CT) and cone beam computed tomography (CBCT) scans was performed on patients with mandibular fractures within a three-year period. Two fracture types were analyzed: open and closed fractures. Results: Forty-three patients with a total of 71 mandibular fractures were included in the study. The mean age of the patients was 35 years, and the majority were male (83.7%). The sensitivity of the AS was 92.2%, specificity = 90.0%, positive predictive value = 95.9%, negative predictive value = 81.8%, false positive rate = 10.0%, and false negative rate = 7.8%. Higher values were observed for open fractures compared to closed fractures. Conclusions: The sensitivity and specificity of AS are lower than those of OPG, CT, and CBCT. However, AS offers an important additional radiological indicator that can effectively reduce the risk of misdiagnosing mandibular body and angle fractures. [ABSTRACT FROM AUTHOR]

Background: Osteomyelitis secondary to mandibular fracture surgery is rare and complete surgical debridement of necrotic infected tissues is an optimal treatment for it. Subsequent reconstruction is required for bone defect caused by operation. Autogenous, allograft and synthetic bone graft substitutes have become widespread in bone defect treatment. Distraction osteogenesis (DO) was also applied in bone defect reconstruction, even it wasn't conventional therapy in jaw. Case presentation: Here we report a case of a 40-year-old aged man who presented with chronic swelling and pain on the right mandibular masseteric region after mandibular angle and Le Fort II fracture surgery. In six weeks after surgery, CBCT images showed that the fracture ends hadn't heal and the fracture gap had widened significantly. The clinical diagnosis of the patient was right mandibular angle osteomyelitis. After controlling the symptoms of pain and infection with local rinses and systemic antibiotic therapy, the patient underwent segmental resection of the infected bone and DO reconstruction for bone defect simultaneously. Encouragingly, well bone healing and normal occlusion restoration was observed finally. Conclusions: DO could be a valuable alternative therapy to bone grafts for bone defect, even in the case of infection. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the relationship between the precise three-dimensional location of the third molar (M3) and mandibular angle fracture (MAF) patterns and to assess the effect of the volume ratio occupied by M3 in the mandibular angle on fracture patterns. The location of M3 was assessed in 218 patients with MAF using computed tomography reconstruction. The bone volume of the mandibular angle and the bone volume occupied by M3 were measured to calculate the volume ratio of M3 to the mandibular angle (M3/MA). MAF patterns were categorized into simple fracture (Type I), displaced fracture (Type II), and comminuted fracture (Type III) based on fracture severity. The results showed that the location of M3 significantly influenced MAF patterns (vertical position: P =.001; horizontal position: P =.002; angulation: P =.027, respectively) and the volume ratio of M3/MA was significantly higher for Type III fracture than Types I and II (P <.001). Regression analysis showed that the horizontal position and angulation of M3 and the volume ratio of M3/MA were the main predictors for comminuted MAF. A larger volume ratio (odds ratio [OR], 1.201; 95% confidence interval [CI], 1.037–1.391; P <.014), Class III position (OR, 7.978; 95% CI, 1.275–49.910; P <.026), and horizontal angulation (OR, 7.212; 95% CI, 1.028–50.581; P <.047) of the M3 were more prone to comminuted MAF than simple fracture. Our findings indicate that the location of M3 significantly affects MAF patterns, and that M3 may weaken the mandibular angle by occupying more bone space, thereby increasing the risk of a comminuted fracture. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to evaluate and compare the efficacy of extra-oral mandibular nerve block (infra-zygomatic approach/lateral approach) vs. intra-oral (Gow-Gates) mandibular nerve block in arch bar fixation for management of mandibular fractures. Methodology: A total of 200 patients reported with maxillofacial fractures. Out of them, 50 patients who required arch bar fixation for management of mandibular fractures were divided into two groups: Group I: Extra-oral and Group II: Intra-oral mandibular nerve blocks. The intra-operative pain, time of onset of anaesthesia, volume of drug administered, depth of needle insertion, repetition of injections and postoperative complications were analysed. Results: In Group I (Extra-oral nerve block), the time of onset of anaesthesia, volume of anaesthesia administered, needle depth, number of repetition of injections and postoperative complications were more as compared to Group II. No significant difference was observed in intra-operative pain score between two groups. Conclusion: Intra-oral approach with Gow-Gates technique seemed to be efficient and easy to operate as compared to extra-oral approach, for arch bar fixation of mandibular fractures in an output door setting, as extra-oral approach is more technique-sensitive and may lead to certain complications which require operation theatre setting with medical attention. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methodology Results Conclusion Road traffic accidents have significantly impacted public health in Vietnam. This study investigated the patterns of midface fractures in Vietnam and their correlation with road traffic accidents in the country.This retrospective cross‐sectional study reviewed 2187 medical records of patients with midface fractures in Ho Chi Minh City. After applying exclusion criteria, the fractures were categorized. Statistical analyses, including chi‐squared and logistic regression, were conducted to identify associations and relationships among the types and causes of fractures.The study found that 89.3% of midface fractures stemmed from road traffic accidents, with 55.2% and 14.4% zygomatic complex fractures and Le Fort type II fractures, respectively. Adults aged 19–39 accounted for 65.1% of patients, with males at 80.5%. Traffic accidents were significantly associated with an 18.7 times higher risk of concomitant mandibular fractures and a 10.5 times higher risk of Le Fort type II fractures, irrespective of age and gender.This study underscores the need for targeted prevention strategies to decrease the incidence of maxillofacial injuries resulting from road traffic accidents in Vietnam, particularly among high‐risk groups such as males and young adults. [ABSTRACT FROM AUTHOR]

Background: This research aims to assess the demographic characteristics, prevalence, outcomes, and complications in chronic kidney disease (CKD) patients following mandible fractures in the United States using a nationally representative database. Methods: We analyzed data from the National Inpatient Sample from 2010 to 2019 in the United States. Patients with mandible fractures were categorized into three groups based on the International Classification of Diseases, Ninth and Tenth Revisions (ICD-9-CM and ICD-10-CM): end-stage renal disease (ESRD), non-ESRD CKD, and healthy kidney function. Chi-squared tests and analysis of variance (ANOVA) were used to compare these groups. Additionally, multivariate regression analysis was performed to determine whether CKD is an independent risk factor for complications in patients with mandible fractures. Results: A total of 38,481 patients in the United States were estimated to have experienced mandible fractures between 2010 and 2019. The incidence rate of non-ESRD CKD in patients with mandible fractures significantly increased over time, while the prevalence of ESRD remained stable during the ten-year period. Compared to the healthy kidney function group, patients with chronic kidney disease exhibited higher hospital costs, longer hospitalization durations, and higher in-hospital mortality rates. Additionally, they had greater odds ratios for most of the investigated complications. Conclusions: This study revealed a steady annual increase in the morbidity rate of non-ESRD CKD among patients with mandible fractures, while ESRD prevalence remained stable over ten years. We observed a close association between chronic kidney disease and the prognosis of patients with mandible fractures. Clinicians should prioritize preventive measures and appropriate management of mandibular fractures in patients with CKD. [ABSTRACT FROM AUTHOR]

Background: Mandibular condyle fractures in pediatric patients can lead to crippling sequelae such as ankylosis, pain and facial deformity if not managed properly. However, there is no consensus on the best approach for treating these fractures in children. Objective: This study aimed to describe the management of mandibular condyle fractures in growing patients across 14 maxillofacial departments worldwide. Methods: A retrospective multicenter study was conducted on children and adolescents aged 0 to 16 who had at least one mandibular condyle fracture. This study included patients who underwent expectant, closed, or open management and were treated over an 11-year period. Results: 180 patients had at least one mandibular condyle fracture, and 37 had a second condylar fracture. One hundred sixteen patients (65%) were males, and 64 (35%) were females (ratio 1.8:1). An expectant strategy was chosen in 51 (28%) patients, a closed treatment—stand-alone maxillomandibular fixation (MMF)—in 47 (26%), and open reduction and internal fixation (ORIF) was performed in 82 (46%) patients. The management varied significantly between the different departments (p < 0.0001). Significant differences were also identified between the fracture type (non-displaced, displaced or comminuted) and the management of the 180 patients with a single condylar fracture. Out of 50 non-displaced fractures, only 3 (6%) had ORIF, 25 (50%) had expectant management, and 22 (44%) had MMF. Out of 129 displaced fractures, 79 (62%) had ORIF, 25 (19%) had a soft diet, and 25 (19%) had MMF. Conclusions: Expectative management, MMF, and ORIF were all effective in treating pediatric mandibular condyle fractures, with a low incidence of complications and asymmetry. [ABSTRACT FROM AUTHOR]

Background/aim: This study evaluates anatomical reduction and rigid internal fixation of mandibular condyle fractures using the preauricular retroparotid approach. It also discusses advantages, deficiencies, and associated complications of the technique. Materials and methods: This retrospective study reviewed the medical records of a total of 52 mandibular condyle fractures from 42 patients who were treated with open surgery using the preauricular retroparotid approach between January 2019 and January 2024. Preoperative and postoperative assessments included measurements of mouth opening (maximum interincisal distance), vertical mandibular movement, and facial paralysis. Moreover, the Vancouver Scar Scale (VSS) was used to evaluate scar quality at the surgical site. Descriptive statistics were used to summarize patient demographics, preoperative findings, and postoperative outcomes. Results: Anterior open bite was the most common finding, detected in 83% of the patients before surgery. The mean mouth opening of the patients increased significantly from 29 ± 4.94 mm to 37.76 ± 2.12 mm. Vertical mandibular movement exceeding 4 cm was a finding in more than half (52.3%) of the patients. The mean VSS score, indicating scar quality, was 1.64 ± 0.70, suggesting overall good cosmetic outcomes. Plate breakage in two patients was noted as a complication during follow-up. Conclusion: Several surgical techniques have been described for mandibular condyle fractures, each with its own benefits and limitations. [ABSTRACT FROM AUTHOR]

Background: Treatment methods for mandibular head fractures are controversial, although effective techniques for open reduction and rigid fixation (ORIF) have been known since the late 1990s. Notably, some forms of posttraumatic comminution of the mandibular head can be reduced or fixed. Methods: This study presents a personalized treatment to cure patients with nonreduced comminuted fractures of the mandibular head: total temporomandibular joint alloplastic replacement (18 patients). The reference group included patients who underwent ORIF (11 patients). Results: Personalized alloplastic joint replacements resulted in a more stable mandibular ramus after three months compared with ORIF. Conclusions: The authors recommend not performing osteosynthesis when the height of the mandibular ramus cannot be stably restored or when periosteal elevation from most of the mandibular head is necessary for ORIF. Personalized TMJ replacement should be considered in such patients. Personalized medicine allows patients to maintain a normal mandibular ramus height for a long period of time. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility's impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this study was to evaluate incidental findings in the mandible after the placement of dental implants using a new cone–beam computed tomography (CBCT) software. Methods: The initial sample consisted of 2872 CBCT scans of patients of both sexes. The parameters evaluated in this study were the location of the implants in the mandible, implant length, anatomical relationship of the implant with the mandibular canal, presence or absence of damage to the adjacent teeth, presence or absence of implant fractures, and presence or absence of bone support. Fisher's exact test was performed to compare the variables. The significance level was set at p = 0.05. Results: Out of 2872 CBCT scans, 214 images of patients with an average age of 44.5 years were included. The most frequent location of the implants was the posterior region (93.5%), with 54% of the implants having a length between 9 and 14 mm. It was found that 92% of the implants were positioned above the mandibular canal. Damage to adjacent teeth was observed, with no correlation with the implant positioning (p = 1.000). In 100% of cases of implants in the anterior region, there was bone support. Fracture was observed in 1.7% of implants with a length between 9 and 14 mm. Conclusions: The installation of implants in the mandible occurs more frequently in the posterior region, with a high presence of bone support and a low incidence of damage to adjacent teeth, anatomical structures, and fractures. [ABSTRACT FROM AUTHOR]

Background: Aim-The aim of study was to evaluate the prevalence of maxillofacial fracture following road traffic accidents, to access the pattern of maxillofacial fracture and to estimate the most common type of facial fracture following road traffic accidents in patient attending a tertiary health care center. Materials and methods: Patient coming to ENT OPD and casualty of Shri Vasantrao Naik government medical college Yavatmal with facial bone fractures following RTA, were evaluated in this study. Results: Total 140 patients were evaluated with facial bone fracture after RTA. The prevalence of facial fracture in RTA patient is 11.2%. Majority of them were in age group of 21 to 40 years. Male preponderance was seen. Most common facial fracture was mandible 48.5%, followed by nasal bone 18.5%, ZMC 17.1%, multiple bone fracture 10.7%. Among all mandible fractures 47.19% had parasymphysis fracture. Two wheeler accidents were majorly seen 47.1%, 33.6% four wheeler, 16.4% pedestrians and 2.9% three wheeler. Among the 2 wheeler drivers, majority 78.8% were not wearing helmets. Majority 60.7% cases needed surgery and 39.3% were treated conservatively. Among surgical cases 12.9% of cases had complication following surgery. Conclusion: On the basis of data which was reproduced after examination of 140 patients, having RTA with facial bone fractures attending tertiary care hospital, it is concluded that most common fracture following RTA is mandible. In mandible, the most common site is parasymphysis. Two wheeler accidents were majorly seen. Majority of patients were under influence of alcohol. Majority of them were not wearing helmets. To avoid RTA, it is important to implement stringent traffic rules, improving the quality of roads, safety regulation rules should be followed. ORIF being the main stay of treatment in present study followed by IMF. [ABSTRACT FROM AUTHOR]

Purpose There have been numerous advancements in the strategies used for treating mandibular fractures in the present times, while open reduction and internal fixation is still accepted as the most preferred treatment option for such fractures despite numerous drawbacks. The aim of the present prospective, randomized controlled study was to evaluate the clinical outcome including neurosensory deficit and pain score variables in mandibular fractures that were treated using rigid internal fixation with three-dimensional (3D) miniplate internal fixation. Materials and Methods For the present study, a total of 20 patients of either sex in an age range of 18 to 55 years with simultaneous angle and contralateral body/parasymphysis fractures of the mandible were included, while the clinical outcome was compared in relation to the two groups wherein different treatment options were used including using rigid internal fixation in one as against 3D miniplate internal fixation in the other. Results Pairwise comparison of pain scores in Group I and Group II patients by the Mann–Whitney U-test at different time zones revealed the results to be statistically significant for all pairs except when the findings were compared between 1 month and 3 months after the procedure in Group II patients. Also, significant recovery was observed in both Group I and II patients during healing when assessed preoperatively to 1 month and then 3 months after the procedure with the results being statistically highly significant in case of the variations observed in relation to the neurosensory deficit observed at different time zones for both Group I and II patients (p = 0.0001). Conclusion Based on the results obtained, it can be concluded that 3D miniplate-led osteosynthesis was found comparable to the osteosynthesis accomplished using reconstruction plates during fixation of unfavorable body/parasymphysis fractures of mandible in study, providing optimal stability, while satisfactorily meeting the biomechanical requirements for occlusal loading, and an early return to normal function. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen therapy (HBOT) is utilized as an adjunctive treatment for human and veterinary patients with compromised tissues. Medical records from two veterinary hospitals with HBOT chambers were searched for small animal veterinary dentistry and oral surgery specialty patients. The HBOT records were combined with the medical records from the referring specialty veterinary dentistry and oral surgery services. Clinical indications for HBOT treatments associated with a positive outcome in this case series included resistant bacterial infections, electrical cord injury, bite wound injuries, osteomyelitis, crush/traumatic injuries including mandibular fractures, oral surgery performed at previously irradiated sites, and osteonecrosis, presumably radiation induced. Conditions within this case series that remained unchanged or were associated with partial improvement included preoperative treatment of stomatitis without steroid usage and delayed HBOT treatment for long-term endodontic health of laterally luxated immature permanent mandibular incisors. Eighty-eight percent of the HBOT sessions were tolerated well by the patients in this case series. The most common adverse event was mild anxiety. One patient required oral anxiolytic medications to complete the course of treatment. One patient experienced transient seizure activity and was able to complete that session as well as subsequent sessions at a lower chamber pressure. Future prospective studies are necessary to further evaluate and characterize the potential benefits of HBOT as well as to clarify optimal treatment protocols for specific conditions in veterinary dentistry and oral surgery. [ABSTRACT FROM AUTHOR]

Facial or maxillofacial trauma occurs as a consequence of physical injury to the face and can include damage to soft tissue and bony structures either in isolation or combination. There is a male predominance with highest incidence in the age group of 20–40 years. The range of injuries include soft tissue damage, bruising, lacerations, burns and fractures of the underlying facial skeleton including the zygomatic complex, mandible, maxilla, orbit and nasoethmoidal complex. The concentration of special senses in the head and neck region means that even seemingly minor injuries can have a significant impact upon the long-term outcome for a patient. Careful assessment of an injured patient must include a full ATLS evaluation to ensure that associated potentially life-threatening injuries are not missed. This article describes the signs, symptoms and treatment of maxillofacial trauma, including management of hard and soft tissue trauma. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective, descriptive observational study. Objective: The need for revision surgery after mandibular fractures is an indicator for severe postoperative complications. This study aimed to characterise this patient cohort, describe solutions to deal with complications and evaluate treatment quality as a risk variable for complications. Methods: Patients with revision surgery with refixation after open reduction and internal fixation (ORIF) of a mandible fracture were included. Patient- and therapy-specific information were assessed together with postoperative complications. The quality of fixation was evaluated individually by 6 specialists. Interobserver agreement was analysed using Fleiss' kappa. Results: Out of 630 patients, inclusion criteria were met by 17 patients (14 male, 3 female) with an average age of 43.3 (±15.5) years. Complications at the mandible body/angle/symphysis led to refixation in all cases. Main indications for refixation were osteomyelitis (52.9%) or pseudarthrosis (41.2%). Risk factors were drug-related immune suppression, local infection or substance abuse (nicotine, alcohol or drugs). Six patients did not present any of these predictors. Of these, treatment of 4 patients was rated as not in accordance to the AO principles. The interrater reliability of treatment quality assessments was.239. Conclusions: Patients with risk factors need to be carefully observed perioperatively after ORIF of mandibular fractures and treatments need to be adapted to these patients. Discrepancies of treatments to common guidelines may also be an independent predictor for treatment failure in patients without risk factors. Current treatment guidelines should be re-evaluated concerning additional treatment strategies for patients with specific risk factors. [ABSTRACT FROM AUTHOR]

Study Design: The purpose of this study was to do a retrospective analysis about patients with mandibular fracture who were treated at the department of Maxillofacial Surgery, Regional University Hospital of Ancona, Italy, between 2011 and 2021. Objective: In this study we evaluated clinical and epidemiological findings of mandible fractures focusing on the association between surgical timing, type of surgical approach and mid- and long-term outcomes. Methods: Patients were evaluated based on various parameters including age, sex, etiology, symptoms, comorbidity, clinical findings, mandible fracture type, other facial fractures, treatment, waiting time before the operation, complications and sequelae. In the period described, we recorded 1023 mandibular fractures. 93% of patients underwent surgery under general anesthesia, almost exclusively patients undergoing an open approach to internal fixation. Results: Of the patients, 684 were male (66.86%) and 339 were female (33.13%). The average age of the patients was 42, 38 years (range, 7-94 years). The leading cause of these fractures was traffic accidents (27.3%) and mandibular parasymphysis fractures were the most frequent (34.1%). The most common clinical signs and symptoms were malocclusion, difficulty in chewing, limitation of the buccal opening, hypoesthesia extending through the territory of the inferior alveolar nerve, difficulty in protrusion movements and mandibular lateralization. Conclusions: The continuous research in epidemiology, etiology, materials, and techniques will further refine the treatments of mandible fractures, which are nowadays more and more customized according to the type of trauma. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P =.06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P =.019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P =.028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to (a) record and evaluate the epidemiological data relevant to the fractures of the atrophic mandible in the Greek population (b) present our experience in the management of these difficult injuries and (c) compare our results to the outcomes of other similar studies and discuss the postoperative complications. Methods: A prospective analysis of all the edentulous patients with fractures of the atrophic mandible treated at the Oral and Maxillofacial Surgery Department of K.A.T General Hospital of Athens in Greece was performed from November 2012 to December 2022. Age, gender and medical history of the patient, etiology and site of the fracture, classification of atrophy, type of surgical approach, type of osteosynthesis and postoperative complication. Results: 34 patients were included in the present study and 48 fractures of the atrophic edentulous mandible were managed surgically. 22 fractures were classified as class II of atrophy, 21 fractures as class III and 5 injuries as class I. In 32 patients we used an extraoral approach and only 2 patients were treated with an intraoral access. 44 fractures were treated with a 2.0 mm locking reconstruction plate and only 4 injuries of class I atrophy were treated with mini plates. Conclusions: Clinical practice has confirmed that for these cases an extraoral approach followed by stable fixation with a 2.0 mm reconstruction locking plate can deliver excellent results. Our findings show that the routine use of primary bone grafts is not necessary and can be reserved for more complex cases. [ABSTRACT FROM AUTHOR]

Introduction: Mandibular fractures, representing 35.54%–44.2% of facial fractures, often affect the mandibular body and subcondylar region. Effective treatment seeks optimal reduction, stable fixation and functional restoration. This study assesses a modified three-dimensional C plate’s efficacy in treating mandibular fractures, emphasising occlusal forces and the mental nerve region. Materials and Methods: A randomised clinical trial (2019–2024) involving 20 patients with mandibular fractures was conducted. Group A (10 patients) received the modified C titanium plate and Group B (10 patients) received conventional miniplates. The clinical parameters – pain, occlusion, mobility, bite force and neurosensory deficits – were evaluated pre- and postoperatively at various intervals. Statistical analysis was performed using the SPSS software. Results: Group A shows superior bite force and functional outcomes, with significant neurosensory recovery by the 10th day. Both groups had no plate fractures, screw loosening or infections. Group A also had better stability, reduced procedural time and improved post-operative comfort. Conclusions: The modified C miniplate provides superior stabilisation, simplifies application, reduces complications and enhances early functional recovery compared to conventional miniplates.

BACKGROUND: The healing of mandibular fractures after rigid internal fixation is influenced by many factors, including the material of the bone plate, fracture site, and bone density of the patient. However, there are relatively few studies on the relationship between the stability of mandibular fracture fixation in different bone qualities and they lack a scientific basis. OBJECTIVE: To analyze the stability of fixation of mandibular fractures with different bone qualities with bioabsorbable plates and miniature titanium plates by finite element analysis. METHODS: Three-dimensional finite element models of class I-IV mandibular fractures were developed according to the bone quality classification method proposed by ZARB and LEKHOLM. The fractures at the median mandibular symphysis, mandibular body, and mandibular angle were simulated under different bone qualities. Bioabsorbable bone grafting plates (or miniature titanium plates) were placed at each fracture site for fixation and to simulate the state of healthy side occlusion. Finite element analysis on the model was used to analyze the relative displacement of the fracture segments and the stress distribution of fixators. RESULTS AND CONCLUSION: (1) The maximum stress value during fixation with titanium plates increased gradually with the increase of bone class, in which the maximum stress value of titanium plates was the highest in the mandibular body class IV bone group, which was 382.74 MPa and 96.11 MPa in the miniature titanium plate and bioabsorbable plate groups. The results for mandibles of the same bone type showed that the maximum stress value of titanium plates was much higher than that of bioabsorbable plates. (2) For fractures of the median middle of the mandible in types III and IV, the displacement of the fracture breaks at the fixation site was large and exceeded the limiting value of bone healing (> 150 μm), regardless of whether the fixation was performed with a miniature titanium plate or a bioabsorbable plate. For type IV mandibular fractures, the fracture end displacement in the bioabsorbable plate group exceeded the healing limit value, and the fracture end displacement in the miniature titanium plate group was close to the healing limit value. Under the same bone quality and fracture site, the fracture displacement of the miniature titanium plate group was smaller than that of the bioabsorbable plate group. (3) The results showed that the strength and stiffness of the two internal fixations were sufficient to support bone healing of fractures at three sites of the types I-IV mandible, and the fixation stability of the bioabsorbable plate was almost the same as that of the miniature titanium plate, which could provide early healing conditions for fractures. Mandibular bone type should be taken into consideration in the treatment of mandibular fracture. The higher the mandibular bone grade, the worse the stability of fracture fixation, and the more likely the complications such as poor bone healing will occur after surgery. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare two different designs of three-dimensional osteosynthesis plates for their suitability in the treatment of mandibular angle fractures in terms of sufficient fracture healing and concomitant complications. Materials and methods: Retrospectively a total of 54 patients with 56 mandibular angle fractures were evaluated. Two different types of three-dimensional plates from the Medartis Trilock system were analyzed: (A) Square design plate (☐-plate) with a thickness of 1.0 mm, and (B) triangular-shaped 3D-plate (△-plate) with a thickness of 1.3 mm. Patient demographics, fracture mechanism and intraoperative details were recorded during an average follow-up period of 1 year. Results: The utilization of △-plates was observed to entail a considerably lengthier surgical time in contrast to ☐-plate systems (P = 0.037). The application of △-plate showed a tendency of higher incidence of major complications than ☐-plate (P = 0.06), as evidenced by the occurrence of non-union in 2 out of 22 cases, resulting in higher surgical revision rate for △-plate (P = 0.027). Conclusion: Sufficient treatment of mandibular angle fractures is feasible by using 1.0 mm thick, square shaped three-dimensional plate systems. The use of thicker three-dimensional osteosynthesis plates seems to significantly increase the operating time and complication rates, whereby the geometry of the plate seems to have an influence. Clinical relevance: The plate design could have an impact on treatment outcomes of mandibular angle fractures. Trial registration number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Patients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases. Methods: Models of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation. Results: When force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures. Conclusions: The reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures. [ABSTRACT FROM AUTHOR]

Background: The goal of treating broken mandibular condyles is to return the affected jaw to its pre-trauma state in terms of masticatory ability, occlusion, symmetry, and function. The two methods can be used to treat the mandibular condylar fracture. These protocols consist of two types: the closed therapy, which employs closed reduction to immobilise the fracture segments, and the open treatment, which involves open reduction of the fracture segments by surgery, followed by internal fixation. Aim: to compare the post-treatment results of closed therapy versus open surgical treatment for mandibular condyle fractures. Methods: 42 individuals were treated with either open reduction with internal fixation or closed reduction utilising IMF in 2 groups (n = 12). The clinical parameters of lateral excursion and protrusion, occlusion, mandibular ramus height, deviation/deflection during jaw opening, and pain evaluation using VAS were measured at 1stand 3rd day and at 1, 3, and 6 weeks. The gathered data were examined statistically. Results: For Group I and Group II, the inter-incisal opening was 8.125±0.3467mm and 6.016±.1528mm, respectively. These values were statistically significant (p ~0.00001). In the surgical groups, it climbed to 17.433±0.3822mm at 3 months and 19.175±0.3696mm at 6 weeks post-operatively. The interincisal opening for the non-surgical group was smaller during the first postoperative week, and subsequently it grew to 9.375±0.2734mm and 12.208±0.1881mm, respectively, at the third and sixth months. Both of these results have statistical significance (p ~<0.00001). At 1, 3, and 6 months recall, the protrusive movement increased in Group I, with means of 0.4667±0.403, 2.275±0.2006mm, and 2.7917±0.0289 mm, respectively. Conclusion: The current study concludes that, in terms of inter-incisal opening, lateral excursion and protrusive mandibular movement range, pain parameters, facial symmetry, occlusion, and ramal height restoration in a 6-week follow-up period, surgical open reduction and internal fixation treatment of the mandibular condylar fracture is superior to non-surgical closed reduction. [ABSTRACT FROM AUTHOR]

Background: We developed a novel interlocking three-dimensional (3D) miniplate design with an adjustable configuration. As this device is new, surgeons must become familiar with its application. This study evaluated the usability and learning curves associated with the novel interlocking 3D miniplate for mandibular fracture fixation. Methods: The study participants, nine plastic surgeons, were asked to apply an interlocking 3D miniplate and a standard miniplate to polyurethane mandible models. The participants had completed the Basic Craniomaxillofacial Osteosynthesis course during residency and had operated on craniomaxillofacial fractures within the past 5 years. They were instructed to place the interlocking 3D miniplate three times and the standard miniplate once. We assessed the time required for implant placement, the comfort level of the surgeons, and the biomechanical stability of the plates. Biomechanical testing was conducted by subjecting the mandible to forces ranging from 10 to 90 N and the displacement was measured. Results: The results indicate increasing comfort with each attempt at placing the interlocking 3D miniplate, with a significant difference between the first and third attempts. Additionally, a reduction in application time was noted with repeated attempts, suggesting improved efficiency. Biomechanical tests showed comparable stability between the tested plates. Conclusion: Multiple attempts at applying the interlocking 3D miniplate resulted in increased comfort and reduced application time. These findings indicate that, despite its novelty, the interlocking 3D miniplate is relatively straightforward to apply and has a short learning curve. However, surgeons must have specific qualifications to ensure proper training and minimize errors during placement. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. Methods: This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. Results: A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients' clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications. [ABSTRACT FROM AUTHOR]

Objectives: The treatment of fractures prioritizes the restoration of functionality through the realignment of fractured segments. Conventional methods, such as titanium plates, have been employed for this purpose; however, certain limitations have been observed, leading to the development of patient-specific plates. Furthermore, recent advancements in digital technology in dentistry enable the creation of virtual models and simulations of surgical procedures. The aim was to assess the clinical effectiveness of patient-specific plates utilizing digital technology in treating mandibular fractures compared to conventional titanium plates. Materials and methods: Twenty patients diagnosed with mandibular fractures were included and randomly assigned to either the study or control groups. The surgical procedure comprised reduction and internal fixation utilizing patient-specific plates generated through virtual surgery planning with digital models for the study group, while the control group underwent the same procedure with conventional titanium plates. Assessment criteria included the presence of malunion, infection, sensory disturbance, subjective occlusal disturbance and occlusal force in functional maximum intercuspation (MICP). Statistical analysis involved using the Chi-square test and one-way repeated measures analysis of variance. Results: All parameters showed no statistically significant differences between the study and control groups, except for the enhancement in occlusal force in functional MICP, where a statistically significant difference was observed (p = 0.000). Conclusion: Using patient-specific plates using digital technology has demonstrated clinical effectiveness in treating mandibular fractures, offering advantages of time efficiency and benefits for less experienced surgeons. Clinical relevance: : Patient-specific plates combined with digital technology can be clinically effective in mandibular fracture treatment. [ABSTRACT FROM AUTHOR]

Background: The Union for International Cancer Control and American Joint Committee on Cancer tumor staging system is used globally for treatment planning. As it may be insufficient for tumor staging of lower gingival carcinomas, we proposed the mandibular canal tumor staging system. In this study, we aimed to compare the two systems for such tumor staging and to identify prognostic markers. Methods: This multicenter, retrospective study included patients with lower gingival squamous cell carcinoma who underwent radical surgery during 2001–2018. We compared survival rates (Kaplan–Meier estimator) and patient stratification according to the two systems. Results: The proposed system yielded more balanced patient stratification than the existing system. Progression in the tumor grade according to the proposed system was associated with a poorer prognosis. The 5-year overall and disease-specific survival rates for the entire cohort were 74.9% and 81.8%, respectively. Independent factors affecting overall survival were tumor stage according to the proposed system, excision margins, and number of positive nodes, whereas those affecting disease-specific survival were excision margins and number of positive nodes. Conclusions: Subsite-specific tumor classification should be used for patients with oral cancer, and our results suggest that mandibular canal tumor classification may be effective for patients with lower gingival carcinoma. [ABSTRACT FROM AUTHOR]

This article discusses various topics related to dental traumatology research. It emphasizes the importance of qualitative research methods in gaining insights into patients' perspectives of traumatic dental injuries. The use of finite element analysis (FEA) in dentistry research is also explored, highlighting its value in understanding the biomechanics of the oral cavity. Other topics covered include the treatment of immature teeth with necrotic pulps, the need for comprehensive dental trauma education, the importance of dental trauma first aid, the impact of the COVID-19 pandemic on traumatic injuries, the correlation between facial fractures and traumatic brain injuries, the demographics and causes of mandibular condylar fractures in pediatric patients, the effectiveness of sports mouthguards in preventing orofacial injuries, and the appropriate use of splinting materials in stabilizing traumatized teeth. [Extracted from the article]

Background/Aim: Results of studies investigating the association between traumatic brain injury (TBI) and maxillofacial fractures (MFs) have varied considerably. The present study aimed to evaluate the correlation between TBIs and MFs, as well as the impact of age, sex, trauma mechanism, and season on TBIs. Materials and Methods: This 12‐year retrospective study of 2841 patients used univariate and multivariate logistic regression to assess the association between MFs and other factors impacting TBIs. Results: Among 2841 patients, 1978 TBIs occurred in 829 (29.2%), with intracranial injuries (n = 828) is the most common. Of 829 patients with TBIs, 688 were male and 141 were female, corresponding to a male‐to‐female ratio of 4.9:1.0. The most common age group was 40–49 years (24.6%). Vehicles (including motor vehicles and electric vehicles) accidents were the primary causes of injuries. Multivariate regression analyses revealed an increased risk for TBIs among males (odds ratio [OR] 0.632, p < 0.001). Patients >40 years of age were at higher risk for TBIs, especially those ≥70 years (OR 3.966, p = 0.001). Vehicle accidents were a high‐risk factor for TBIs (OR 6.894, p < 0.001), and winter was the most prevalent season for such injuries (OR 1.559, p = 0.002). Risk for TBI increased by 136.4% in combined midfacial and mandibular fractures (p = 0.016) and by 101.6% in multiple midfacial fractures (p = 0.045). TBIs were less common in single mandibular fractures, notably in single‐angle fractures, with a risk of only 0.204‐fold. Conclusion: TBIs in MFs were significantly correlated with sex, age, aetiology, season and fracture location. Maxillofacial surgeons and emergency physicians must be aware of the possible association between TBIs and MFs to assess and manage this complicated relationship in a timely manner. [ABSTRACT FROM AUTHOR]

Background/Aims: The COVID‐19 (Coronavirus Disease‐2019) pandemic confronted the global healthcare system with a variety of challenges. The pandemic and the associated lockdowns also had an impact on multiple medical disciplines (i.e. delay of surgery, change of hospital admissions). The aim of this study was to analyze the impact of the COVID‐19 pandemic on mandible fracture patterns/distributions and circumstances in a German cranio‐maxillofacial trauma center. Materials and Methods: This retrospective study compared the mandible fracture patterns of patients in the PreCOVID (PC) era (February 2019–January 2020) with patients in the IntraCOVID (IC) era (February 2020–January 2021). In addition to baseline characteristics, the number/type of mandible fractures, location of the mandible fracture, circumstances leading to mandible fracture, and hospital admissions/treatments were analyzed. Results: A total of 127 patients was included in this study. In the IC period, the absolute frequencies of mandible fractures decreased (PC = 72 vs. IC = 55). There were minor changes in the mandible fracture locations. An increase of concomitant facial soft tissue injuries (IC = 69.1% vs. PC = 58.3%), as well as higher rates of traumatic tooth loss (IC = 32.7% vs. PC = 22.2%), was observed. Regarding the causes/accidents leading to mandible fractures, there were significant increases in falls and significant decreases in sports accidents as well as interpersonal violence during the IC period. A significant increase in accidents at home and domestic violence during the COVID‐19 pandemic, with a simultaneous decrease in weekend and night‐time trauma leading to mandible fractures was observed. Furthermore, a significant increase in days from trauma to surgery was recorded. Conclusion: The COVID‐19 pandemic had a significant impact on mandibular fracture patterns. The locations and types of mandibular fractures changed slightly. However, significant differences in the circumstances leading to mandible fractures (increased falls, decreased interpersonal violence) were recorded. [ABSTRACT FROM AUTHOR]

Background/Aim: Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. Materials and Methods: This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. Results: A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1–3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. Conclusions: The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures. [ABSTRACT FROM AUTHOR]