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ABSTRACT: Maxillofacial fractures in Japanese children were retrospectively analyzed. The subjects were 287 patients aged 15 years and younger seeking treatment for maxillofacial fractures in the Department of Oral and Maxillofacial Surgery, Nara Medical University. The patients were 186 males and 101 females. Injuries most frequently occurred as a result of traffic accidents in 125 patients, 92 of which were bicycle-related accidents. Injuries by falling from one level to another were found in 49, primarily in younger children. One hundred seventy-nine fractures occurred in the mandible, 100 in the midface, and 8 in both. In the mandible, fractures most frequently occurred in condyle followed by symphysis. In the midface, alveolus was mostly involved. The facial injury severity scale ranged from 1 to 9 with an average of 1.83 and was higher in traffic accidents. Injury to other sites of the body was found in 33 patients, 28 of which occurred in traffic accidents. Observation was most frequently chosen in 84 patients. Intramaxillary fixation was chosen in 79, primarily for alveolar fractures and in younger children. Maxillomandibular fixation was chosen in 62 for mandibular fractures in older children. Open reduction and internal fixation was performed in 40, primarily in older children. The facial injury severity scale was higher in patients treated by open reduction and internal fixation and maxillomandibular fixation. Maxillofacial fractures in Japanese children showed characteristic features primarily depending on their age in terms of etiology, patterns, and treatment modalities.
The Journal of craniofacial surgery 01/2013; 24(1):153-7. · 0.81 Impact Factor
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ABSTRACT: The purpose of the present study was to analyze the trends and characteristic features of maxillofacial fractures in older patients.
The data from 247 patients aged 65 years old or older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University, from October 1981 to March 2010, were retrospectively analyzed.
Of the 247 patients, 127 were men and 120 were women; 50 patients had been treated in the first third of the period, 87 in the second, and 110 in the third. Injury had most frequently occurred because of falling on a level surface (n = 126), followed by a traffic accident (n = 84). Of the fractures, 140 were in the mandible, 90 in the midface, and 17 in both. In the mandible, the fracture lines were most frequently observed at the condyle, followed by the body, exclusively in edentulous patients. In the midface, the zygoma was mostly involved. The facial injury severity scale score ranged from 1 to 10 (average 1.81). Injury at other sites of the body was found in 45 patients. Observation was most frequently chosen (n = 127), primarily for those of older age, followed by open reduction and internal fixation in 46 and maxillomandibular fixation in 41 patients. The facial injury severity scale score was greatest in patients treated by open reduction and internal fixation, followed by those treated by maxillomandibular fixation.
Maxillofacial fractures in older patients have been increasing and showed the characteristic features of etiology, patterns, and treatment modalities.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 06/2011; 69(8):2204-10. · 1.58 Impact Factor
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ABSTRACT: The purpose of this study was to analyze maxillofacial fractures sustained in bicycle accidents by demographics, cause of injury, site and severity of fractures, injuries to other sites of the body, and treatment modalities.
Data on 307 patients treated for maxillofacial fractures sustained in bicycle accidents in the Department of Oral and Maxillofacial Surgery, Nara Medical University from 1981 through 2009 were analyzed retrospectively.
The patients were 166 males and 141 females (average age, 30.9 years). Causes of injury were a fall on a level surface in 169 patients, an automobile accident in 56, fall from 1 level to another in 28, and a motorcycle accident in 24. One hundred seventy-five fractures were observed in the mandible, 117 in the midface, and 15 in the mandible and midface. In the mandible, fracture lines were exclusively observed at the condyle. In the midface, the zygoma was most frequently involved. The Facial Injury Severity Scale ranged from 1 to 7 (average, 1.88). Injuries at other sites of the body were found in 47 patients and were frequently found in automobile and motorcycle accidents. Maxillomandibular fixation was most frequently chosen in 81 patients, followed by observation in 76 and open reduction and internal fixation in 71. The Facial Injury Severity Scale was highest in patients treated by open reduction and internal fixation, followed by those treated by maxillomandibular fixation.
Maxillofacial fractures sustained in a bicycle accident frequently occurred by falling on a level surface and were not so serious in most cases; however, in accidents with motor vehicles, injuries to other sites of the body were observed at a higher rate.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 06/2011; 69(6):e155-60. · 1.58 Impact Factor
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ABSTRACT: A mandibular body fracture related to mouth-opening training in a dialysis patient is reported. A 61-year-old male patient had noticed pain in the right mandibular body and difficulty in mouth opening a week previously. The patient had been performing mouth-opening training for a couple of weeks. The right lower face was slightly swollen with tenderness at the right lower border of the mandible. Hypoesthesia of the right lower lip was also observed. A bone step was palpable on the alveolar ridge of the right mandible, but mobility was not marked. The mandible was atrophic in the body region with only four anterior teeth left. Panoramic X-ray examination revealed a moderately displaced fracture in the right molar region of the mandible. The patient had no severe pain or difficulty in eating using a partial denture. The patient had received dialysis for 17 years and had also been treated by warfarin and aspirin. The patient was followed up under restricted mouth opening. Osteosynthesis with bone remodeling was confirmed after 6 months by X-ray examination. No complication requiring further treatment occurred during the follow-up period. In this patient, a medically compromised condition under long-term dialysis is considered a predisposing factor, which made the atrophic mandible more susceptible to the stress related to mouth-opening training.
Dental Traumatology 04/2011; 27(4):318-20. · 1.20 Impact Factor
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ABSTRACT: One hundred and three patients with maxillofacial fractures due to work-related accidents were analysed. Ninety-nine patients (96.1%) were male and 4 (3.9%) were female. The average age was 46.8 years (range 18-75 years). The injuries were most commonly sustained during construction (42 patients, 40.8%) followed by agriculture and forestry (31 patients, 30.1%) and manufacturing (15 patients, 14.6%). Being struck by an object was the main cause of injury (43 patients, 41.7%) followed by fall from one level to another (31 patients, 30.1%). Fifty-four patients (52.4%) had fractures in the mandible, 41 (39.8%) in the midface, and 8 (7.8%) in both the mandible and the midface. The most common sites for fractures were the condyle and symphysis in the mandible and zygoma in the midface. The facial injury severity scale ranged from 1 to 6 with an average of 1.99±1.18. There was no difference in the nature of the work being undertaken or the cause of the injury. Fractures in other sites were observed in 22 patients (21.4%). Open reduction and fixation was the most frequent treatment for mandibular fractures (25 patients, 40.3%) followed by maxillomandibular fixation (19 patients, 30.6%). Observation was most commonly used for midface fractures (18 patients, 36.7%) followed by open reduction and fixation (15 patients, 30.6%) and transcutaneous reduction (8 patients, 16.3%).
Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 04/2011; 39(3):182-6. · 1.25 Impact Factor
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ABSTRACT: This study investigated the biomechanical behavior of the mandible after marginal resection by tensile test in a human cadaveric mandible and finite element (FE) analysis.
Human cadaveric mandibular models after marginal resection were prepared with residual heights of 5, 10, and 15 mm. The strength in each of these mandibular models was examined by tensile testing. In addition, FE models of the mandible after marginal resection were prepared with residual heights of 5, 7.5, 10, 12.5, and 15 mm. Distribution and magnitude of von Mises stress were analyzed by applying bite forces of 151 N as a point load on the incisal region and 355.2 and 478.1 N on the premolar and molar regions on the nonresected and resected sides, respectively. At the molar region of the resected side, bite forces of 368.5 N and 286.9 N (80% and 60%, respectively, of 478.1 N) were also applied.
On tensile testing, all cadaveric mandibular models were broken at the posterior resection corner. The tensile force was significantly larger in the model with a residual height of 15 mm compared with that of those with a 5- or 10-mm residual height. On FE analysis, von Mises stress was concentrated at the resection corner. The region of maximal von Mises stress concentration in FE models was consistent with that showing destruction on tensile testing. The relationship between the residual height and von Mises stress in the resection area was linear in models of the incisal, premolar, and molar loading on the nonresected side and quadratic in models of the premolar and molar loading on the resected side. The maximal von Mises stress in the resection area was highest during molar loading on the resected side under the present loading condition and exceeded the threshold for the development of pathologic fracture in the model with a residual height of around 10 mm or less. However, the maximal von Mises stress decreased in parallel with the reduction of bite force in the molar region of the resected side.
The residual height and bite force are critical factors for the prevention of pathologic fracture of the mandible after marginal resection. Currently, a residual height of more than 10 mm and reduction of bite force are recommended to reduce the risk of fracture.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 01/2011; 69(6):1798-806. · 1.58 Impact Factor
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ABSTRACT: The fate of developing tooth buds located in relation to mandibular fractures was investigated in three infancy cases. Three infants, 2 girls and a boy, aged from 1 year and 5-months old to 2 years and 6-months old, were treated for dislocated mandibular fracture in the symphyseal region by manual reduction and fixation with a thermoforming splint and circumferential wiring under general anesthesia. Fracture healing was uneventful in all cases. A few years later, no obvious deformity of the jaw or malocclusion was observed; however, malformation of the crown was found in one of the permanent teeth on the fracture line in the first case. In the second case, no abnormality was observed in one of the permanent teeth on the fracture line, but the effect on the other tooth could not be evaluated due to abnormality of the tooth probably not related to the injury. In the third case, root formation was arrested in one of the permanent teeth on the fracture line and the tooth was lost early after eruption. The development of tooth buds on the fracture line is not predictable and therefore, should be monitored by regular follow up.
Dental Traumatology 08/2010; 26(4):353-6. · 1.20 Impact Factor
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ABSTRACT: The purpose of this study was to analyze maxillofacial fractures resulting from falls in terms of the demographics, the circumstance of injury, the site and severity of fracture, and the treatment.
Data of 457 patients treated for fall-related maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara, Japan, from 1981 to 2007 were retrospectively analyzed.
Patients were 163 males and 116 females with an average age of 51.3 years who had fallen on a level surface (simple fall), and 110 males and 68 females with an average age of 31.9 years in falls from a greater height (fall from height), respectively. Fractures of the mandible were more frequently observed than those of the midface. In the mandible, fracture lines were exclusively observed at the condyle, especially in simple falls. In the midface, the zygoma was most frequently involved. Facial Injury Severity Scale ranged from 1 to 6, with an average of 1.78 in simple falls, and from 1 to 9, with an average of 2.04 in falls from height, respectively. These were dependent on the causes and height of the fall. Fractures at the other sites of the body were found in 14 patients (5.0%) with simple falls and 38 (21.3%) with falls from height. Maxillomandibular fixation was most frequently chosen for mandibular fractures and observation for midface fractures. Open reduction and fixation was more frequently chosen in patients with falls from height than those with simple falls and in patients with a higher Facial Injury Severity Scale score.
Maxillofacial fractures resulting from falls showed characteristic features in the demographics, the circumstance of injury, and the site and severity of fracture. Treatment was chosen according to these features.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 04/2010; 68(7):1602-7. · 1.58 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the biomechanical behavior of miniplate osteosynthesis for fracture of the edentulous mandible with various degrees of atrophy by finite element (FE) analysis.
Three-dimensional FE models simulating various atrophic or nonatrophic edentulous mandibles were constructed. The models were divided into 3 groups based on the height: 20 mm, 15 mm, and 10 mm. A model 30-mm high was defined as a nonatrophic mandible. Fracture in the premolar region was simulated. Single or double miniplate osteosynthesis was assumed to fix the fracture. In each case, models of fractures with and without bone contact between bone fragments were prepared. A bite force of 62.8 N was applied in the FE models as a point load on the anterior point.
There were no noticeable differences in compressive stress level in the bone around screws among the single miniplate models or double miniplate models with bone contact. Single miniplate models without bone contact showed markedly greater compressive stress than that of models with bone contact. The use of double miniplates showed a great influence on von Mises stress reduction in the miniplates. Without bone contact, greater interfragmentary displacements occurred; however, interfragmentary displacements were within the limit of not causing a malunion of the fractured bone in all models.
Double miniplate fixation may be a reliable method for treating fracture of the atrophic mandible from a biomechanical viewpoint.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 11/2009; 67(11):2397-403. · 1.58 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the demographics, the type of impact, the site and the treatment of maxillofacial fractures sustained during baseball and softball to develop an effective preventive strategy.
Data of 82 patients treated for baseball- and softball-related maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Nara Medical University between 1982 and 2007 were retrospectively analyzed.
Injuries were found in 64 men in baseball and 16 men and two women in softball with average ages of 19.6 and 30.0 years, respectively. Fractures were caused by being hit by the ball in 61 patients followed by collision in 16 patients. Fractures of the mandible and the mid-face were found in 44 and 38 patients, respectively. The mental and angle region of the mandible and zygoma and alveolar bone of the maxilla were frequently involved. Treatment was mostly conservative. Open reduction and internal fixation were performed only in 15 patients.
Most maxillofacial fractures in these sports were ball-related. Therefore, effective preventive means should be considered to protect against such injuries.
Dental Traumatology 05/2009; 25(2):194-7. · 1.20 Impact Factor
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ABSTRACT: This study analyzed the changes in mandibular movement and occlusal condition after conservative treatment for unilateral condylar fractures by use of a sensitive occlusal pressure sheet (Dental Prescale; Fujifilm, Tokyo, Japan) for the evaluation of occlusal condition.
We compared 18 patients conservatively treated for unilateral condylar fracture with 23 control subjects. Mandibular movement and occlusal condition were evaluated at 3 and 6 months after conservative treatment.
Maximal mouth opening over 40 mm was achieved at 6 months but was not improved to the control level. Recovery of lateral excursion, protrusion, or deviation on mouth opening was also limited at 6 months. Occlusal area, which was reduced at 3 months, had significantly improved at 6 months. The asymmetry index of the occlusal area was significantly improved at 6 months compared with that at 3 months. Mean pressure in the patient group was significantly greater than that in the control group. Total occlusal force, which was reduced at 3 months, was significantly improved at 6 months. The asymmetry index of occlusal force, which was significantly greater than that in the control group, was significantly improved at 6 months.
Mandibular movement was increased at 6 months despite the slight disturbance in lateral excursion to the nonfractured side and the presence of deviation on mouth opening. Occlusal area and occlusal force improved at 6 months, although mean pressure remained slightly higher than that in the control group.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2009; 67(1):83-91. · 1.58 Impact Factor
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ABSTRACT: The purpose of this study is to analyze the characteristics of isolated zygomatic arch fractures and to evaluate the functional and radiological outcomes of the treatment.
Forty patients with isolated zygomatic arch fractures were analyzed clinically.
The patients were 25 males and 15 females with an average age of 42 years. The cause of injury was traffic accident in 26, followed by fall in 8, sports in 3, and assault in 3. The left side was involved in 25 cases. Fractures were classified into 5 types according to the degree of displacement and loss of bone contact. Reduction was performed in 31 patients, 26 treated by the Gillies temporal approach. Conservative treatment was chosen in 9 patients. The reduction status was excellent in 12 cases, good in 17 cases, and fair in 2 cases. There was no difference in the reduction status in terms of the fracture types or the interval between reduction and injury. Interincisal distance (IID) at maximal mouth opening recovered from 33.4 to 43.8 mm by excellent reduction, from 26.2 to 42.2 mm by good reduction, from 27.5 to 40 mm by fair reduction, and from 41 to 46.6 mm by conservative treatment.
Good functional and radiological outcomes were obtained in isolated zygomatic arch fractures. Reduction status was not influenced by either the fracture type or the interval between reduction and injury, and recovery of IID was similarly achieved by excellent, good, and fair reduction.
Journal of Oral and Maxillofacial Surgery 04/2007; 65(3):457-61. · 1.64 Impact Factor
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ABSTRACT: This study investigated factors associated with the onset of methicillin-resistant Staphylococcus aureus (MRSA) infection among patients with head and neck cancer who underwent radical reconstructive surgery. The study group consisted of 103 patients who underwent radical reconstructive surgery between January 1994 to December 2002. They were divided into two groups with respect to the date of surgery: Group I (from January 1994 to December 1997) and Group II (from January 1998 to December 2002). The use of third-generation cephalosporins and imipenem as postoperative antibiotics was restricted after 1998 (Group II). A significantly lower incidence of MRSA was found in Group II than for Group I (p = 0.0069, chi2 test). The following factors were identified as being associated with the onset of MRSA infection: long surgical duration (p < 0.035, Wilcoxon signed-rank test), large hemorrhage (p < 0.049, Wilcoxon signed-rank test), and use of third-generation cephalosporins or imipenem (p < 0.004, chi2 test). MRSA infection was found more often in the surgically reconstructed tongue and floor of the mouth. The use of antibiotics such as vancomycin, wound irrigation, curettage and sequestrectomy were effective in eradicating the infection. MRSA, when it occurred in the maxilla, was mostly limited to colonization.
Special Care in Dentistry 26(5):209-13.
