Effect of early or delayed treatment upon healing of mandibular fractures: a systematic literature review.
ABSTRACT The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies identified confounding factors such as alcohol, drug abuse and/or non-compliance, factors which have been shown strongly to influence the likelihood of complications. A significant problem in this analysis was that rather few patients were actually treated on an acute basis (i.e. within 12 or 24 hours after injury), a fact which together with the lack of control of confounding factors made this analysis problematic. In conclusion, there is presently no strong evidence for either acute or delayed treatment of mandibular fractures in order to minimize healing complications; new studies including a substantial number of cases treated on an acute basis are very much needed.
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ABSTRACT: The ideal timing for treatment of facial fractures has not been well established. The objective of this systematic review was to examine the effects of treatment delay on outcome in the management of facial fractures. The PubMed database was used to search for relevant English-language articles published between 1979 and 2013. Cross-referencing identified additional studies. There were no selection restrictions for study type. The first author, using pre-defined data fields, extracted information independently. Studies were assessed by study type, evidence level, sample size, data collected, outcome variables, control of confounding variables, and findings. Thirty studies were identified. Inconsistency was identified with data collected, outcome variables, and findings. Of the 30 studies identified, 28 were case series, thereby providing a low level of evidence overall. The majority of case series were retrospective and sample sizes were predominantly small. Control of confounding variables was poor. Eighteen studies found no statistically significant relationship between treatment delay and treatment outcome. Nine studies found a statistically significant relationship between treatment delay and worse treatment outcomes. There were three studies with conflicting results. With the current body of evidence, definitive conclusions cannot be drawn on the timing of treatment for facial fractures.International Journal of Oral and Maxillofacial Surgery 08/2014; · 1.36 Impact Factor
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ABSTRACT: In this study ten patients with delayed facial fractures presented to our clinic, three of them were in the Research institute of ophthalmology clinic, dental and maxillofacial unit and the other seven were in AL Haram hospital clinic, maxillofacial unit. The patients were in a range of age 25-45 years old, two females and eight males (table.1). All of the patients had non-union fibrous healing and most of them had facial scars at different sites of the face. Others had a chief complaint of pain or numbness of different areas of the face. All of them underwent physical, clinical and radiographic investigations using computed tomograph. Reduction of bone fragments using bone holder was done. The infraorbital nerve was evaluated and decompressed when necessary. Following alignment of the fractures, fixation was maintained by a titanium miniplate and in some cases microplates and screws, after adaptation of the plates to the area. Postoperative care included antibiotics (Clindamycin 300mg.) for a total of 7 days, ice compresses intermittently for 24h., Voltaren 75mg. I.M. every12 h.. Simvastatin (zocor 20 mg. tab.) daily dose was prescribed only to five patients for 3 months (group1) while the other five patients received only the ordinary postoperative prescription (group 2). The aim of this study is to evaluate the effect of oral administration of simvastatin drug on accelerating delayed non –union fractured bone healing. Results: Follow up of the cases revealed slight edema, swelling and hematoma in the first2 weeks; however, it was less in simvastatin group patients, while no infection was noticed in all the patients. Clinical examination of the patients revealed good stability of the bones immediately postoperative. Three months postoperative CT. and/ or three dimensional (3D) facial bone CT scans for all patients revealed that the displaced bone was reduced to its normal anatomy. . It was noticed that patients on the regimen of simvastatin (zocor tablets) (group1) had ameliorated recovery without any complications than in (group2), as the inflammatory reaction was more severe in this group. Bone healing seemed to be accelerated as seen in the CT. radiograph in (group1). At 6-month follow-up, all patients complained of no particular discomfort in everyday life activities and were satisfied with their external appearance. Conclusion:-From this study it could concluded that oral administration of simvastatin 20mg.tablets (zocor) could be prescribed as a regimen postoperatively for all patients with fractures specially in delayed cases for acceleration of bone and soft tissue healing and enhancement of postoperative inflammatory reactions.
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ABSTRACT: Background This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. Methods Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. Results The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. Conclusion Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.Journal of Cranio-Maxillofacial Surgery 10/2014; · 2.60 Impact Factor