Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department

BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular fractures.METHODS: A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging(facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures.RESULTS: A total of 98 patients were identified, of whom 31.6% had maxillary fractures and9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.CONCLUSION: The clinical decision tool is potentially useful to rule out mandibular fractures,thus preventing unnecessary radiation exposure.

Comparison of lag screws and double Y-shaped miniplates in the fixation of anterior mandibular fractures

BACKGROUNDMandibular fractures constitute about 80.79% of maxillofacial injuries inAlexandria University, either as isolated mandibular fractures or as a part ofpanfacial fractures. The combination of symphyseal and parasymphyseal fracturesrepresent 47.09% of the total mandibular fractures.AIMTo compare the effectiveness of lag screws vs double Y-shaped miniplates in thefixation of anterior mandibular fractures.METHODSThis study is a prospective randomized controlled clinical trial, performed onsixteen patients with anterior mandibular fractures. Patients were divided equallyinto two groups, each consisting of eight patients. Group 1: Underwent openreduction and internal fixation using two lag screws. Group 2: Underwent openreduction and internal fixation using double Y-shaped plates. The followingparameters were assessed: operating time in minutes, pain using a visual analogscale, edema, surgical wound healing for signs and symptoms of infection,occlusion status and stability, maximal mouth opening, and sensory nervefunction. Cone beam computed tomography was performed at 3 and 6 mo tomeasure bone density and assess the progression of fracture healing.RESULTSThe study included 13 males (81.3%) and 3 females (18.8%) aged 26 to 45 years(mean age was 35.69 ± 6.01 years). The cause of trauma was road traffic accidentsin 10 patients (62.5%), interpersonal violence in 3 patients (18.8%) and othercauses in 3 patients (18.8%). The fractures comprised 10 parasymphyseal fractures(62.5%) and 6 symphyseal fractures (37.5%). The values of all parameters were comparable in both groups with no statistically significant difference except forthe mean bone density at 3 mo postoperatively which was 946.38 ± 66.29 in group 1 and 830.36 ± 95.53 in group 2 (P = 0.015).CONCLUSIONBoth lag screws and double Y-shaped miniplates provide favorable means offixation for mandibular fractures in the anterior region. Fractures fixed with lagscrews show greater mean bone density at 3 mo post-operation, indicative ofhigher primary stability and faster early bone healing. Further studies with largersample sizes are required to verify these conclusions.

An experimental study of a novel external fixator based on universal joints for the rapid initial stabilization of mandibular comminuted fractures

Purpose:Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge,especially in emergency circumstance.We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures.This study aims to confirm the efficacy of this novel external fixator through biomechanical tests in vitro and animal experiments.Methods:In vitro biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures.Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates.All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side.The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve.In animal experiments,9 beagles with comminuted mandibular fractures were divided into 3 groups,which were treated with the novel external fixation,reconstruction plate,and dental arch bar,respectively.The general observation,the changes in animals’weight,and the surgical duration were recorded and compared among 3 groups.The CT scans were performed at various intervals of 0 day(immediately after the surgery),3 days,7 days,14 days,21 days,and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days.The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test,enabling multiple comparisons for all tests using GraphPad Prism10.1.0(GraphPad Inc,USA).Results:The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement(p=0.496,0.079)and the slope of load displacement curves(p=0.374,0.349)under 2 load modes between the external and internal fixation groups.The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference,while the arch bar group demonstrated inferior stability.The CT analysis revealed that the best fracture healing happened in the internal fixation group,followed by the external fixation and arch baring at 28 days after fixation.The external fixation group had the shortest fixation duration(25.67±3.79)min compared to internal fixation((70.67±4.51)min,p<0.001)and arch baring((42.00±3.00)min,p=0.046).Conclusion:The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly,offering a viable option for the initial stabilization of comminuted mandibular fractures in the setting of emergency rescue.

A Study of the Mechanical Characteristics of a Mandibular Parasymphyseal Fracture with Internal Fixation Device Subject to Variable Bite Forces: Finite Element Analysis

In recent times, research into mandibular fracture has gained momentum from advances in scanning techniques, software/algorithm developments and improvements, and numerical structural modeling using the finite-element method (FEM). In this work, the FEM is used to model a mandibular fracture (using an inhomogeneous and orthotropic jaw model) simulating the effect of different bite tasks/forces on the stability of the fixated fracture. Specifically, bilateral and unilateral clenches (using muscle data) were studied using a low-profile 3D 4 × 2 hole mini-plate deployed for fracture fixation. Here, the mandible bone was treated as orthotropic and spatially inhomogeneous. Although the results of stress and displacement analyses, for this fixation hardware, indicate sufficient fixation under normal biting conditions, the results show that the unilateral and ipsilateral bites develop, in general, the highest stresses or displacements. Such results can guide post-surgery recommendation on bite behavior.

Key points in surgical management of mandibular condylar fractures

Mandibular condylar fractures are among the most common facial fractures and some of the most difficult to manage.Opinions about the management of mandibular condylar fractures differ among surgeons.With the implementation of new technology,an increased understanding of fracture man-agement,and better functional and morphological outcomes reported in the literature,open reduction and internal fixation is becoming many surgeons preferred choice for the treatment of condylar fractures.Because surgical treatment of such fractures is complex,certain factors must be considered to achieve satisfactory outcomes.In this article,we summarise six key points in the management of mandibular condylar fractures:virtual evaluation of condylar fracture,a suitable surgical approach,good reduction,stable internal fixation,repair of the articular disc,and restoration of the mandibular arch width.We believe that these points will help to improve the prognosis of mandibular condyle fractures.

Epidemiology of Maxillofacial Trauma in Pediatric and Adolescent Population: An Institutional Experience of 6 Years

Introduction: Facial fractures are uncommon injuries in children. Pediatric maxillofacial fractures constitute 1% to 15% of all facial fractures, but show different clinical features when compared with adult patients. Worldwide, the major causes of fractures in children are accidents, falls, violence, and sports- related accidents. Facial trauma in children may result in injury to the facial growth centers, leading to subsequent developmental abnormalities in the injured area. Patients & Methods: Data of pediatric and adolescent patients (0 - 17 years), with a history of trauma, has been compiled over a period of 6 years. History, clinical and radiographic data records were analyzed. Compilation was done in the following categories;age and sex distribution, etiology, site of trauma and associated soft tissue injuries were recorded. The treatment rendered has also been mentioned. Results: A total of 340 patient records were assessed. Demographic data, etiology, type of fracture, associated injury and treatment rendered were recorded. It was found that males (54.7%) were more frequently affected than females (45.3%). Incidence of trauma was more in children belonging to the pre-school age group (38.5%) and the most common etiology was sports-related injuries (43.8%). Dentoalveolar fractures were the most common type (58.5%) of fractures seen in the patients. Most of the patients were managed by conservative treatment (35%) or closed reduction (48%), while a few required open reduction (7.9%). Conclusion: It is felt that this data will be useful in determining the pattern and etiology of maxillofacial trauma in pediatric patients in an Indian setting. Additionally, an outline of the treatment plan in different types of fractures is also summarized.

Effects of recombinant human basic fibroblast growth factor on cell proliferation during mandibular fracture healing in rabbits

Objective:: To investigate the effects of recombinant human basic fibroblast growth factor (rhbFGF) on the cell proliferation during mandibular fracture healing in rabbits. Methods: The complex of rhbFGF and bovine type I collagen was implanted into the mandibular fracture site under periosteum of the animal. The whole mandible was harvested at 7, 14, 28, 56 and 84 days respectively after operation. The expression of proliferating cell nuclear antigen (PCNA) in callus was examined with immunohistochemical staining. Results: PCNA-positive cells in callus in the rhbFGF-treated group on days 7 and 14 were more than that in the control group (P< 0.01 ). Conclusions: It indicates that rhbFGF can stimulate cell proliferation during mandibular fracture healing in rabbits.