Results of Using Arthrocentesis in the Treatment of Temporomandibular Disorders Associated with Fractures of the Mandibular Condylar Process

The purpose of the work was to study the effectiveness of arthrocentesis in the complex treatment of post-traumatic temporomandibular disorders. Materials and methods. The clinical part of the study included 24 patients, who had a history of fractures of the mandibular articular process. Patients underwent radiological examination – orthopantomography, computer tomography, ultrasound and magnetic resonance. Patients with titanium mini-plates after osteosynthesis were subjected to ultrasound, and since the reposition and fixation of fragments was performed using intermaxillary fixation they were subjected to magnetic resonance imaging. Pain assessment was performed according to visual analogue scale. Temporomandibular joint arthrocentesis was performed according to a modified method of D. Nitzan (1991) under local anesthesia. Results and discussion. All patients complained of the temporomandibular joint pain, which was rated from 1 to 6 points. All patients noted pain on palpation of the temporomandibular joint. Limited mouth opening ranging from 30 to 38 mm was found in 11 patients. Lower jaw deviation was observed in 18 patients. All patients had articulatory noises – clicking, and 11 had blocked movement of the joint head. Orthopantomograms or computer tomography revealed satisfactory restoration of the anatomical shape of the mandible after fractures and complete consolidation of the fracture. Ultrasound and magnetic resonance revealed signs of unabsorbed hematoma as consequences of hemarthrosis; in 18 patients – deformity of the capsule, in 17 – a slight thickening of the posterior edge of the articular disc, in 18 patients – disc adhesion, in 13 people – forward disc displacement with reduction, in 11 patients – disc protrusion without reduction. According to clinical and radiological signs after traumatic temporomandibular disorders, patients were divided into two groups according to Wilkes classification: 13 patients with stage II (early-middle) and 11 – with stage III (middle). We also found that after surgical treatment – osteosynthesis, the number of patients with stage III according to Wilkes makes up 58.33% (7 people), while those after splinting – 33.33% (4 people). The control ultrasound and MRI carried out 3-6 months after arthrocentesis showed no signs of hemarthrosis in 11 (84.61%) patients with intra-articular disorders of the second degree, and in 8 (72.72%) patients with internal disorders of the third degree, the position and function of the articular disc were restored. Conclusion. Arthrocentesis with temporomandibular joint lavage is a minimally invasive surgical manipulation that has proven itself in temporomandibular disorders of traumatic origin, in particular after fractures of the articular process of the mandible. Arthrocentesis is recommended to be used after ineffective conservative treatment, as well as to prevent post-traumatic intra-articular disorders in the early post-treatment fractures (intermaxillary fixation or osteosynthesis) with the attenuation of acute post-traumatic events, which is our goal of further work

Treatment of Gunshot-Related Mandibular Fracture with Splint-Guided Reduction: Case Report

Summary Background/Aim: Gunshot injury-related mandibular fractures often have a complex pattern, characterized by comminution, bone loss, and soft-tissue avulsion. The management is difficult and varies between individual cases. Case Report: A 41-year-old male patient presented with marked swelling and ecchymosis in the left mandibular region. Intraorally, he had a deviated open bite on the left side. A unilateral comminuted mandibular fracture was diagnosed by panoramic radiograph and computed tomography. An acrylic dental splint-guided open reduction and internal fixation, including intermaxillary fixation through brackets and intermaxillary elastics, was planned. No complications were observed throughout the healing period, and healing at the fracture site was satisfactory. The occlusion returned to the preinjury position and was stable. Conclusions: This case report shows that successful functional and esthetic results can be achieved with a strict patient-specific treatment protocol for a comminuted mandibular fracture due to gunshot injury.

1110 The Cost of Fixing a Fractured Mandible: A Waste Reduction Project

Introduction Fractured mandibles are a frequent injury seen in the hospital and are commonly caused by interpersonal violence and accidental injury. The need to reduce expenditure in the NHS and redirect funds to where it is most needed is an important topic in recent times. The cost of open reduction internal fixation (ORIF) of mandible fractures can vary by the choice of equipment and technique used. Therefore, this waste reduction project aimed to identify any variation in treatment and minimise this. Method A data collection exercise was performed of isolated mandibular fractures which required surgical intervention. Operation notes were examined from April 2018 to March 2019, with 99 cases found. Information was collected about the number and type of drill bits, plates and screws that were used in the surgery. The expected cost for plating different mandibular fractures including simple, comminuted and multiple fractures was calculated which was compared to the actual average cost by type of injury and operating surgeon. Results The most common injury seen was Parasymphysis fractures, with the average ORIF cost across all surgeons being £239.07. The expected cost to fix this fracture was calculated at £237.95, or £325.31 if intra-operative intermaxillary fixation is used. It was demonstrated that the cost across all injuries was within the expected range and therefore no improvement could be made. Conclusions By limiting the available equipment, stocking the most cost-effective options, and teaching surgeons standardised treatments we are able to reduce the cost and waste in the hospital.

A Comparative Analysis of Outcome of Open Reduction and Internal Fixation of Mandibular Fracture With or Without Intermaxillary Fixation

Aim: To evaluate the difference and functional outcome between open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) in mandibular fractures. Study Design: Retrospective study. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Faryal Dental College, Sheikhupura, Lahore from 1st February 2019 to 31st January 2021. Methodology: One hundred and fifty seven patients treated for fractures of mandible and reviewed their prognosis based on use of intermaxillary fixation after reduction of fracture. The patients were divided into two groups; Manual reduction group without the intermaxillary fixation and the intermaxillary fixation group. Results: Good results have been obtained in most patients after mandible fracture reduction. However, complications occurred in 19 (27.5%) patients in group 2 after surgery. 6 patients had an infection, 4 patients had a wound dehiscence, and 4 patients had osteomyelitis. No loosening of the mounting bolts and/or crack of the mounting plates was observed. Correct occlusion was achieved using posterior arch wires and elastic rings in 2 malocclusion patients. Occlusion failed in two patients in Group 1 due to osteomyelitis, and the second operation was performed under general anaesthesia. The mean complication severity scores for Group 1 and Group 2 were 1.37 and 1.38, respectively, with no significant difference. Conclusion: Among the patients treated with manual reduction, 2 patients had malocclusion and 1 patient required a new surgery. Such a simple mandible fracture can give good results even with manual reduction without intermaxillary fixation. For a simple mandible fracture, only manual reduction without intermaxillary fixation or intermaxillary fixation was recommended for a short time. Key words: Complication, Fracture, Internal fixation, Mandible

TO COMPARE THE EFFECTIVENESS OF INTERMAXILLARY FIXATION USING ERICH ARCH BAR AND SCREWS IN MANDIBULAR FRACTURES – A RANDOMIZED CLINICAL STUDY.

Purpose: Intermaxillary xation (IMF) is an essential principle in the management of mandibular fractures; but with the recent advent of open reduction and internal xation (ORIF), the use of IMF is almost limited to intraoperative procedure only. This study aims to investigate and compare the effectiveness of Erich arch bar & intermaxillary xation (IMF) screws for the management of mandibular fractures. Materials And Method: A randomized prospective study was conducted on 20 patients with mandibular fracture, who were randomly allotted to two groups. Group A patients received intermaxillary xation using Erich arch bar and group B patients received IMF screws. The parameters assessed were time taken for application and removal of appliance, stability of occlusion, glove perforation, and pre-and post-operative plaque accumulation. Results: The mean time for placement of the Erich arch bar was 43.10 minutes as compared to 18.60 minutes with intermaxillary xation screws. Better occlusal stability was shown with an arch bar over IMF screws, and was statistically signicant. More glove tears or penetrations occurred during application in group A than Group B (p<0.01). Also, The Plaque Index assessment on removal of appliance showed a statistically signicant difference between the two groups; higher in the arch bar group. Conclusion: This study indicates that with acceptable occlusal stability, IMF screws technique is an effective and favourable alternative to Erich arch bars for temporary intermaxillary xation in mandibular fractures.