Articles: mandibular-fractures.
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Review Case Reports
Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature.
We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We believe that increased knowledge of this association will facilitate early recognition and hence prevention of a devastating outcome. ⋯ Carotid artery dissection is a rare but life-threatening condition that can develop after trauma to the head and neck. There should be a high index of suspicion in patients with a mechanism of injury that places the internal carotid artery at risk because blunt vascular injury may show delayed onset with no initial symptoms of vascular damage. By implementing an algorithm for early detection and treatment of these injuries, serious brain damage may be avoided.
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Review Case Reports
Intracranial Dislocation of the Mandibular Condyle: A Case Report and Literature Review.
Intracranial dislocation of the mandibular condyle is an infrequent injury that can follow traumatic upward force at the chin. A limited number of cases have been reported, and an individualized approach for patients is often recommended. Nevertheless, several consistent strategies for reduction have emerged. ⋯ Appropriate surgical and nonsurgical approaches for addressing mandibular dislocation have emerged during the past several decades. When deciding on an optimal strategy, variables including patient age, time-to-diagnosis, accompanying injuries, prior failed maneuvers, and risk of resubluxation should be considered. Coordinated care between neurosurgery and otolaryngology teams can minimize complications and achieve successful reductions.
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JAMA Facial Plast Surg · Nov 2015
ReviewReporting of Postoperative Pain Management Protocols in Randomized Clinical Trials of Mandibular Fracture Repair: A Systematic Review.
The control of pain associated with mandibular fractures is an important treatment outcome that affects function, adherence to treatment regimens, and patient comfort and satisfaction. ⋯ Pain management is a neglected outcome in randomized clinical trials of mandibular trauma; most studies did not describe the specific analgesics used. Many randomized clinical trials (13 [34%]) assessed pain levels among patients without providing information about the agents prescribed. The incorporation of validated pain measures and quality-of-life scores in future studies of mandibular trauma would focus attention on this key outcome measure.
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Cochrane Db Syst Rev · Jul 2013
Review Meta AnalysisInterventions for the management of mandibular fractures.
Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. ⋯ This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.
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Oral Maxillofac Surg · Jun 2013
Review Comparative StudyOpen versus closed reduction: comminuted mandibular fractures.
The purpose of the study was to review the literature regarding the evolution of current thoughts on management of comminuted mandibular fractures (CMFs). ⋯ Open reduction and internal fixation (ORIF) in cases of CMFs are indicated in (a) severe injuries with significant displacement to allow restoration of pretraumatic anatomic relationships, (b) in the edentulous and semi-dentate patient, who may benefit from ORIF of CMFs when stable occlusal relationships are absent, and (c) in cases with multiple fractures of the midface, in which the mandible has to serve as a guide to reposition the midfacial bones. However, there is still a place for closed reduction/conservative treatment (CTR). ORIF in CMFs is not indicated in cases of minimally displaced comminuted fractures that could easily and adequately be treated with CTR. If the surgical team is not well versed in the nuances of rigid internal fixation, or the necessary equipment is not available, it is far better to do simple CTR. However, it would be more reasonable to refer the patient to a hospital that can provide means of ORIF in cases of clear indication of its use in CMFs. In cases where ORIF is indicated, stabilization by compression or any other form of load-sharing osteosynthesis is obviously contraindicated because small fragments cannot be compressed and are not capable of sharing loads. Thus, the ORIF of CMFs is best performed using load-bearing osteosynthesis; most experience has been gained with 2.7-mm reconstruction plates. External pin fixation could be used in cases when there is so much comminution, soft tissue disruption (mostly gunshot wounds), and there are inadequate teeth on either side of the comminuted fracture to control the spatial relationship of the remaining mandibular fragments with maxillomandibular fixation (MMF).