The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This ...minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy.
A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months.
This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found.
This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.
This retrospective study aimed to examine the course and prognosis of medication-related osteonecrosis of the jaw (MRONJ) initially treated conservatively and the effects of various factors affecting ...treatment outcomes. We evaluated 129 patients with MRONJ between January 2008 and December 2018 at a university hospital. The factors examined included sex, age, stage of MRONJ (1–3), type of bone modifying agents (bisphosphonate or denosumab), primary disease (osteoporosis or malignant tumor), medical history (diabetes and rheumatoid arthritis), use of corticosteroids, the trigger of MRONJ (teeth extraction or others), and separation of sequestrum, using logistic regression analysis. Patients with MRONJ were treated conservatively as the initial treatment in accordance with the position paper of the American Association of Oral and Maxillofacial Surgeons. Of the 129 patients, 59 (45.7%) were cured, and the condition of 70 (54.3%) remained unchanged or worsened. The overall cure rates at 12, 36, and 60 months were 25.8%, 50.8%, and 72.4% respectively. The cure rate of stage 1 was lower than that of stages 2 and 3 at 80 months. In multivariate analysis, it was found that 37 (64.9%) of 57 patients with osteoporosis as a primary disease were cured (odds ratio OR, 7.7; 95% confidence interval CI, 2.4–24.4). In addition, 40 (69.0%) of 58 patients with separation of sequestrum were cured (OR, 8.9; 95% CI, 3.4–23.5). The cure rate was significantly higher in patients with osteoporosis than in those with cancer when the treatment outcomes of primary disease were compared using the Kaplan-Meier method (p < 0.01). It was also significantly higher in patients who had separation of sequestrum than in those who did not (p < 0.05). Our results suggest that primary disease and separation of sequestrum were associated with favorable outcomes in patients with MRONJ initially treated conservatively. MRONJ had a poor prognosis with conventional treatment carried according to the stage of the disease. This was especially prominent when conservative treatment was employed for mild cases.
•Of the 129 patients with MRONJ, 59 (45.7%) were cured, and the condition of 70 (54.3%) remained unchanged or worsened.•The cure rate of stage 1 was lower than that of stages 2 and 3 at 80 months.•Primary disease and separation of sequestrum were associated with outcomes in MRONJ initially treated conservatively.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A 74-year-old man presented with hemorrhage from the mandible after an injury caused by a 5 × 3 × 3-cm metal square column flying from a 45-ton press machine that struck the right side of his face. ...He is a known atrial fibrillation patient and is on rivaroxaban, a direct oral anticoagulant. An approximately 8-cm Y-shaped wound with persistent hemorrhage was observed in the right mandible, and the mandible was displaced between the right mandibular canine and first premolar. Although the patient showed no dyspnea, the sublingual region showed a slight dark purple swelling; fiberoptic nasal intubation was performed. Computed tomography at 3.5 hours after the injury revealed a comminuted fracture of the right mandibular body, edema at the floor of the mouth, nasal cavity, upper pharynx to hypopharynx, and the pharyngeal airway around the endotracheal tube. Open reduction and internal fixation were performed. Rivaroxaban was started again 3 days after surgery.
Study Design
Case Report
Objective:
A severe condylar resorption following internal fixation of the mandibular condylar fracture is rarely reported.
Methods
A 35-year-old female caused bilateral ...condylar base fracture due to fall. She had no connective tissue autoimmune disease, no temporomandibular joint (TMJ) problems, and no history of the orthodontic treatment. Each fractures of condyles were fixed by 2 none-locking titanium miniplates on ideal lines of the osteosynthesis.
Results:
6 months after surgery, although patient showed no malocclusion and no TMJ pain, panoramic X-ray showed left side condylar head resorption. Twelve months after surgery, bilateral plate removal was performed. Twenty-six months after internal fixation, panoramic X-ray showed bone formation at the left side of the condylar head. Magnetic resonance imaging of the TMJ showed left TMJ disc displacement without reduction and severe deformity of the left condylar head.
Conclusions
The condylar resorption might be caused by increasing functional loading due to new position of the condyle following osteosynthesis. Possible contributors for condylar resorption following osteosynthesis were: (1) internal fixation in bilateral condylar fracture, (2) disc displacement without reduction, and (3) female patient (hormonally-mediated theory, eg estrogen). However, the mechanize of condylar resorption was unclear and the further studies were necessary.
Refracture of the mandible following stable internal fixation would be rare. A 28-years-old male patient was transferred to our emergency center due to fall caused by epilepsy seizure. Computed ...tomography (CT) showed left condylar base fracture with medial displacement and dislocation, and symphysis fracture. The fracture of condyle and symphysis were performed osteosynthesis with 2 mini-plates on ideal lines of osteosynthesis. The proximal segment of the condyle was placed totally three 7-mm-screws and 2 mini-plates. Six days after surgery, the patient transferred to our emergency center again due to fall by epileptic seizure. The patient drunk a lot of alcohol on the day before. CT indicated that left side fracture of condylar neck with medial displacement above the fixation plates, and no fracture of symphysis. The fracture line run on upper screw of posterior plate. The proximal segment of condyle could not be repositioned in the secondary surgery. The epilepsy patient following mandibular fracture might cause further epilepsy seizures. The risk factors of recurrence seizures should be evaluated including alcohol intake, less sleep and a history of noncompliance to anti-epileptic drugs.
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