Effect of early or delayed treatment upon healing of mandibular fractures: A systemic literature review

Department of Oral and Maxillofacial Surgery, Hillerød Hospital, Copenhagen, Denmark.
Dental Traumatology (Impact Factor: 1.6). 03/2008; 24(1):22-6. DOI: 10.1111/j.1600-9657.2006.00499.x
Source: PubMed


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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    • "We did not observe any correlation between the day of treatment and complication rate. The effect of treatment delay on healing of fractures has been a subject of discussion (27). Whereas some studies failed to find any effect of treatment delay on fracture healing (28,29), others reported an increasing number of complications in case of delayed treatment (30,31). "
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    ABSTRACT: Purpose: This study evaluated the trends and factors associated with maxillofacial fractures treated from 1997 to 2007 in the Oral and Maxillofacial Surgery Department of the Clermont-Ferrand University Hospital. Methods: This study included 364 patients of which 82% were men and 45%, 20-29-years old. The etiology, anatomical distribution, treatment modality and complications of maxillofacial fractures were examined. Results: Overall, interpersonal violence, traffic accidents and falls were the most common mechanisms of injury. There was a decreasing trend in traffic accidents and increasing one in falls as a cause of fracture over the 11-years period of this study. Young male patients were preferentially victim of interpersonal violence and traffic accidents, while middle-aged ones were of falls and work-related accidents. Middle-aged female patients were preferentially victim of traffic accidents and interpersonal violence, while older ones were of falls. And the number of fractures per patient varied according to the mechanism of injury: low after work-related accidents and high after traffic accidents. About two-third of fractures involved the mandible. Most of these mandibular fractures were treated by osteosynthesis with or without intermaxillary fixation, with the proportion of the latter increasing over time. There were very few postoperative infections and only in mandible. Conclusions: Maxillofacial fractures predominantly occur in young men, due to interpersonal violence. There is nevertheless an increasing trend in falls as a cause of fracture, especially in female patients, consistent with the increasing trend in presentation of older people. Most maxillofacial fractures involve the mandible and there is an increasing trend in treating these fractures by osteosynthesis without intermaxillary fixation. Antibiotic prophylaxis associated with dental hygiene care can be indicated to prevent postoperative infections.
    Full-text · Article · Dec 2013 · Medicina oral, patologia oral y cirugia bucal
    • "The main focus of mandibular fracture treatment is surgical repositioning and internal skeletal fixation. The healing complications to be analyzed are infection in the fracture line and malocclusion.[1] "
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    ABSTRACT: Mandibular fractures are among the most common of facial fractures. Fractures of the mandibular angle are associated with the highest incidence of postsurgical infection of all mandibular fractures. The treatment of facial fractures has traditionally involved reestablishment of a functional dental occlusion with various types of intermaxillary fixation. Treatment modalities range from simple maxillo-mandibular fixation to rigid internal fixation of the bone fragments. The aim of this study was to determine the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle with access via an intraoral route. Cases of unfavorable fractures of the mandibular angle were selected for the study of intraoral surgical management of mandibular angle fractures using a single 2.0-mm noncompression miniplate. An observational study was carried out on treatment of fractures of the angle of the mandible, and the findings were recorded and presented. We studied the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle and found no complications associated with superior border miniplate fixation of mandibular angle fractures.
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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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