Management of maxillofacial fractures within three years ... · Results. Male patients had higher...

$: Management of maxillofacial fractures within three years ... · Results. Male patients had higher fracture ratio (zygomatic and maxillary – 84%, mandibu-lar – 89.72%). Complications$
Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 2 39

Management of maxillofacial fractures within three years of empirical findings

Marijus Leketas*, Evelina Vedlugaitė*, Ričardas Kubilius*

SCIENTIFIC ARTICLES

SUMMaRy

Objectives. To investigate which treatment of maxillofacial fractures is more effective and what type of complications is the most common after observed treatment. The second aim is to explore relationship between treated facial bone fractures and temporomandibular joint (TMJ) pathology.

Material and Methods. Cases with TMJ pathology in Lithuanian University of Health Sci-ences (LUHS) in the Department of Maxillofacial Surgery (MS) during 2012-2014 were analysed to research the occurrence of TMJ disorders after facial bone fracture treatment. Moreover, the clinical data of patients that were treated in LUHS in the Department of MS during 2012-2014 was collected and analysed.

Results. Male patients had higher fracture ratio (zygomatic and maxillary – 84%, mandibu-lar – 89.72%). Complications occurred in 6% of the patients in a zygomatic and maxillary frac-tures group, mainly as an infraorbital nerve injury. Closed reduction and indirect fixation were performed for mandibular patients 49.7%. The ratio of complications for mandibular fractures was 6.1%. There were complications in group with the open reduction and direct fixation (24.2%, mostly osteomyelitis), when in the closed reduction and indirect fixation group (42.4%, mostly bone healing complications). There were no patients with TMJ pathology as a complication after facial bone fracture treatment.

Conclusions. Fractures treatment technique differs in all cases because of individual charac-teristics and treatment variations. In the open reduction and direct fixation group complications occurred in fewer cases than in the closed reduction and indirect fixation group. Well-timed facial bone fracture treatment leads to non-occurrence of TMJ complications.

Key words: fracture fixation, postoperative complications, mandibular fractures, maxillary fractures, zygomatic fractures, temporomandibular joint disorders.

SCIENTIFIC aRTICLESStomatologija, Baltic Dental and Maxillofacial Journal, 18: 39-50, 2016

*Department Maxillofacial Surgery, Lithuanian University of Health Sciences, Lithuania

Address correspondence to Marijus Leketas, Department of Maxillofacial Surgery, Medical Academy, Lithuanian University of Health Sciences, Eivenių g. 2, Kaunas LT-50028, Lithuania.E-mail address: [email protected]

INTRODUCTION

Facial fractures are treated by open reduction and closed reduction techniques. The fracture area is im-mobilized with intermaxillary fixation or other tech-niques, using screws, plates in order to achieve faster bone healing (1). There are various techniques for fracture treatment but there is no clearly established specific treatment best suited in each case. According to scientific publications open reduction and direct fixation has benefits such as quickly restored chewing function, optimal reposition, and faster rehabilitation. Closed reduction and indirect fixation procedure is

less traumatic, more protecting blood vessels and fracture area, less expensive, followed by a shorter hospitalization time of the patient (2). The purpose of this study is to find out which fracture treatment method is more effective.

The main goals of this research are to evaluate the effectiveness of the fracture treatment techniques, find out which technique leads to lower complications ratio, and verify the temporomandibular joint (TMJ) disorders occurrence after applied fracture treatment. Scientific articles are reviewed on this topic, research of mostly applied techniques was done, and complica-tions incidence rate was investigated. As well as the task is to analyze the data of the patients that were treated for facial fractures and for TMJ pathology separately in the Department of Maxillofacial Surgery in Lithuanian University of Health Sciences (LUHS).

40 Stomatologija, Baltic Dental and Maxillofacial Journal, 2016, Vol. 18, No. 2

Analysis of fracture cases data was selected on the aspects of chosen treatment method, the ensuing com-plications, and further treatment of complications. Analysis of clinical cases with temporomandibular joint disorder diagnosis was investigated to verify if they had facial bone fracture in the case history. The results from literature review and clinical data are compared.

MaTERIaL aND METHODS

Clinical data of 192 patients with temporoman-dibular joint disorders (TMD) during 2012-2014 years in LUHS Maxillofacial Surgery Department was collected. Main aspect of anamnesis was trauma in maxillofacial region and its treatment. Furthermore DC-TMJ exam form (3) had to be filled to evaluate clinical symptoms of each case. All patients had TMJ symptoms.

Moreover clinical data about maxillofacial frac-tures in LUHS Maxillofacial Surgery Department during 2012-2014 years was collected, focusing on fracture localisation, treatment, complication type and rate, treatment after complication. Patients were selected if they had facial bone fracture treatment in the Department of Maxillofacial Surgery in Lithu-anian University of Health Sciences from 2012 to 2014. Maxillary and zygomatic fractures appeared to 298 patients, mandibular fractures for 559 patients, multiple fractures – 28 patients. Complication oc-currence type and rate was explored, complications occurrence reliance from fracture localisation, type and intervention was analysed. Interventions analysis after complications was performed too. Data was systematized, quantitative records analysis was done with records statistical analysis program IBM SPSS 19v. Proof of statistical significance was checked with Fisher criterion. Result was considered as statistically significant if p<0.05.

When clinical analysis was fulfilled, literature review was performed through the search of PubMed, Google Scholar databases, with purpose to compare our results of clinical analysis with the results re-ceived from literature review. The keywords used for search were "maxillofacial fractures", "zygomatic fracture", "mandibular fracture", "open reduction”, "closed reduction", "temporomandibular joint”, "temporomandibular disorders”, "craniomandibular disorders". The search was restricted to the published date from 1 January 2008 to 31 December 2014. Through the search 2735 articles were found and analysed if they confirmed the topic about advantages and disadvantages of closed reduction and external fixation, open reduction and internal fixation, or com-

plications occurrence rates, 34 articles were found and included (Figure).

RESULTS

156 patients who complained about TMJ prob-lems were investigated. Mean age value was 25.3 +/-1.2 and 84% of patients were female. Only 2 pa-tients noted the history of facial trauma, especially in mandibular region. One 26 years male patient is professional boxer. He had no history of facial bone fracture but experienced mandibular trauma during boxing once in a while. After mandibular trauma patient experiences the pain in left temporomandibu-lar joint region both at rest and active mandibular movements. When the patient takes nonsteroidal anti-inflammatory drugs, the symptoms disappear till the next mandibular trauma.

Another patient is 22 years female patient with clicking and recurrent pain in temporomandibular joint region on the right. The symptoms started two years ago after mandibular trauma appeared dur-ing traffic accident. The patient complained about contusion in facial area without maxillofacial bone fracture.

From all patients there was no case of maxillofa-cial fracture although trauma in maxillofacial region was the most emphasized aspect in this survey.

Moreover clinical data of 933 patients with maxillofacial bone fracture cases from 2012 to 2014 who were treated in LUHS Maxillofacial Surgery Department was analysed. Maxillary and zygomatic fractures occurred in 298 cases (48 were rejected because of information shortage), mandible fractures in 559 cases (14 were rejected because of informa-tion shortage), and multiple fractures in 28 cases (information was rejected because of wide informa-tion dispersion).

Results showed that maxillary and zygomatic fractures occurence by gender was 84% (210 males) and 16% (40 females). Operative treatment (open reduction only, combination of open reduction and direct fixation) was the most frequent. Conservative methods (closed reduction only or combination of closed reduction and indirect fixation) were used less (Table 1).

In the cases of maxillary or zygomatic bone frac-tures, complications occurred for 6% of the patients. The most frequent complications were infraorbital nerve injuries (Table 2).

The analysis of treatment strategies after com-plication showed that in the cases where infraorbital nerve lesions appear, pharmacological medicament infusion, neurolysis, and physiotherapy or rest re-

M. Leketas, E. Vedlugaitė, R. Kubilius SCIENTIFIC ARTICLES


SCIENTIFIC ARTICLES M. Leketas, E. Vedlugaitė, R. Kubilius

When complications occurrence rate (in the cases where different interventions were performed) of zy-gomaticomaxillary complex was analysed, the results showed that complications occurrence dispersion has no statistical significant results (Fischer test P=0.625).

Statistical analysis of patients with mandibular fractures showed that mandibular fractures appear more frequent for male patients 89.72 % (489 males)

gime is used the most. If the complication was facial nerve injury, pharmacological medicament infusion was used. When the bone regeneration complication occurred, wire, screw or plate removal, physiother-apy, treatment with pharmacological medicament is performed. If the complication was osteomyelitis, antibiotic therapy, incision with drainage, and se-questrectomy was performed.

Fig. Flowchart of systematic review and its stages


than female patients (10.28%, n=56). Mandibular bilateral (40.9%, n=223) and angle (29.4%, n=160) fractures occurred the most frequently (see Table 3). In the cases of bilateral mandible fractures angle and body fractures occurred the most frequently. As well as bilateral body fractures (7.3%) and condylar process and body (9%) fractures occurred quite fre-quently (Table 3).

In most mandibular fracture cases chosen frac-ture treatment method was closed reduction and indirect fixation (n=271, 49.7%), and open reduction and direct fixation (38.2%) (Table 4).

When analysis of complications occurrence fre-quency was performed, the results showed that the cases where closed reduction and indirect fixation were done complications occurrence rate was higher (5.2%) than in the cases where open reduction and direct fixation were performed (3.8%). The results were statistically significant (Fisher test P<0,001) (Table 4).

Complications occurrence rate is 6.1% (n=33) (see Table 5). In most cases complications are bone regeneration complication (n=13, 2.4%) and osteo-myelitis (n=12, 2.2%) (Table 6).

After bone regeneration complication, chosen treatment was open reduction and internal fixation (5 patients), closed reduction and external fixation

(3 patients), pharmacological medicament infusion (3 patients), wire, screw, plate removal (1 patient), condilectomy (1 patient). Chosen treatment after osteomyelitis complication was pharmacological medicament infusion (8 patients), closed reduction and external fixation (2 patients), open reduction and direct fixation (1 patient) and sequestrectomy (1 patient). In the cases of phlegmone pharmacological medicament infusion (2 cases), incision and drainage (2 cases), indirect fixation (1 case) and physiotherapy (1 case) was performed. When the complication was abscess, incision and drainage was performed. In the case of periostitis incision, incision with drain-age, and pharmacological medicament infusion was performed. There was no case of TMJ pathology as a complication.

When analysis of complication occurrence de-pendence of fracture localisation was performed, the results showed that complications occurred mostly in these cases where condylar fractures, mandible body and ramus fractures were seen. The results were sta-tistically significant (Fisher test P=0.006) (Table 5).

Moreover when complications occurrence de-pendency of performed interventions was analysed, complication occurrence between different interven-tions showed statistically significant results. (Fisher test p=0.024) (Table 6).


Table 1. Interventions dispersion in zygomaticomaxillary complex

Intervention Frequency PercentageOpen reduction 140 56.0Open reduction and direct fixation 5 2.0Closed reduction and indirect fixation

55 22.0

Closed reduction 9 3.6Clinical inspection 14 5.6Neurolysis 3 1.2Closed reduction and external fixation

21 8.4

Wire, screw, plate removal 3 1.2All in 250 100.0

Table 2. Complications type dispersion in zygomaticomaxil-lary complex. Complications occurrence dispersion has no statistical significant results (Fischer test P=0.625)

Complication Frequency PercentageInfraorbital nerve injury 10 4.0Facial nerve injury 2 .8Bone regeneration complication 2 .8

Osteomyelitis 1 .4All in 15 6.0

Table 3. Mandible fracture localisation

Intervention Frequency PercentageAngle 160 29.4Bilateral Bilateral angle Angle and condyle Angle and condylar process Angle and body Body and condylar process Angle and ramus Body and ramus Bilateral condylar process Condylar process and body Body and coronoid process Ramus and coronoid process Bilateral body Body and alveolar process

22362783112644921401

40.91.10.41.315.20.20.24.80.79.00.40.27.30.2

Condyle 3 .6Condylar process 53 9.7Symphysis and parasymphysis 21 3.9Body 48 8.8Multiple 15 2.8

Ramus 13 2.4Alveolar process 7 1.3Coronoid process 2 .4All in 545 100.0



In the fracture cases where open reduction and direct fixation was performed, there was no-ticed higher occurrence of osteomyelitis. In cases where closed reduction and indirect fixation was performed, higher oc-currence of bone regen-eration complications was noticed.

Literature review was performed (Table 7); the analysis showed that most articles of this subject are published from India (8 of 34) and China (7 of 34). All in all in our study 34 articles were used. Mostly ar-ticles about mandibular fractures are published, and usual study object is the treatment results of mandibular condyle fractures (15 of 34). The amount of analysed pa-tients varies from 6 to 2986 patients. A total of 11428 patients’ informa-tion was analysed.

In zygomatic frac-tures open reduction and direct fixation (50.6-73.8%) is used more than closed reduction and indi-rect fixation (9.4-27.3%). Conservative treatment is chosen in 1.7-10.3% of cases. In the treatment of mandibular condyle fractures usually open re-duction and direct fixation was chosen (11 of 15 ar-ticles about the treatment of mandibular condyle fractures).

In zygomatic frac-ture cases where open reduction treatment was performed hypoesthesia, diplopia, mouth opening limitation, infection, he-

Table 4. Complication occurrence in dependence on the intervention peformed in mandibular region. The results were statistically significant (Fisher test P<0,001).

Complications TotalNot occurred Occurred

Intervention Open reduction Frequency 37 1 38% 97.4% 2.6% 100.0%

Incision and drainage Frequency 0 7 7% .0% 100.0% 100.0%

Open reduction and direct fixation

Frequency 200 8 208

% 96.2% 3.8% 100.0%Clinical inspection Frequency 8 1 9

% 88.9% 11.1% 100.0%Teeth removal Frequency 7 0 7

% 100.0% .0% 100.0%Wire, screw, plate removal Frequency 3 2 5

% 60.0% 40.0% 100.0%Closed reduction and indi-rect fixation

Frequency 257 14 271

% 94.8% 5.2% 100.0%Total Frequency 512 33 545

% 93.9% 6.1% 100.0%

Table 5. Complication occurrence in dependence on the fracture localisation in mandibular region. The results were statistically significant (Fisher test P=0.006).

Complication occurrence TotalNot occurred Occurred

Angle Frequency 150 10 160% 93,8% 6.3% 100.0%

Bilateral Frequency 214 9 223% 96.0% 4.0% 100.0%

Condyle Frequency 2 1 3% 66.7% 33.3% 100.0%

Condylar process Frequency 52 1 53% 98.1% 1.9% 100.0%

Symphysis and parasymphysis Frequency 21 0 21% 100.0% .0% 100.0%

Body Frequency 38 10 48% 79.2% 20.8% 100.0%

Multiple Frequency 14 1 15% 93.3% 6.7% 100.0%

Ramus Frequency 12 1 13% 92.3% 7.7% 100.0%

Alveolar process Frequency 7 0 7% 100.0% .0% 100.0%

Coronoid process Frequency 2 0 2% 100.0% .0% 100.0%

Total Frequency 512 33 545% 93.9% 6.1% 100.0%



matoma complications occurred the most, occurrence rate was 19.1%.

In the mandibular fracture cases complication oc-currence rates vary from non-occurrence to 28.53%. The most frequent complications in open reduction cases were sensory complications, wound dehiscence, infection.

There are lots of articles (13 of 34) about post-operative TMJ complications after fractures. In most cases TMJ complications, such as TMJ dysfunction, stiffness, functional restrictions (4 articles), TMJ clicking (3 articles), and pain in TMJ area (2 articles) occurred.

DISCUSSION

The results showed that higher tendency of facial bone fractures exists between male patients (84%), and the same high results are in other studies (4, 5). In mandible fracture cases the most frequent fracture localisation is bilateral fracture and angle fracture (6).

In this study complication occurrence rate was low (6%) while after literature review results showed that complications occurrence ratio varies from non-occurrence to 28.53% (7-16). In zygomatic group complications occurrence ratio varies from non-occurrence to 19,1% (9).

The results of our retrospective analysis showed that in zygomatic and maxillary fractures cases the most common complications were infraorbital nerve injuries. In the mandible fractures cases bone regeneration complication and osteomyelitis. After literature review it was clear that in other studies the most common complication was wound - healing disturbancies, nerve trauma, infection and functional impairment (9, 15).

Complications occurrence rate in mandible fracture cases was higher where closed reduction and indirect fixation was performed; the most fre-quent complication was bone fracture regeneration complication. In our research the most frequent

complication in the cases where open reduction and direct fixation was performed was osteomyelitis. In other studies it is stated that more complications occur where open reduction and direct fixation is performed, and the most frequent complication is nerve injuries and infections (2). Mostly in surgically treated fractures the most frequent complications are infection, wound healing disturbancies, nerve inju-ries, osteosynthesis failure, osteomyelitis, occlusal disharmony, TMJ complications (7, 8, 11, 13-15, 18-30). This kind of research causes uncertainty on the superiority of open reduction and direct fixation method. But still there are publications where the most frequent treatment method was closed reduc-tion (59.52%), and postoperative complications, such as infection, irregular occlusion, TMJ dysfunctions and face asymmetry, occurrence rate was 10.31%. When infection appeared, treatment was applied us-ing antibiotic therapy. When irregular disturbances appeared, mostly reoperation or orthodontic treatment was offered. Temporomandibular joint disturbances were treated by physiotherapy. Face asymmetry was left without treatment (31).

In condylar or subcondylar fracture group correct anatomical position of the fragments was achieved more in operative group (32) and in closed reduction group TMJ dysfunction complications are observed (40). But there are publications where despite the surgical treatment poor anatomical reduction is clini-cally seen (33). In condylar or subcondylar fracture group mouth opening complications, occlusion dis-turbancies, TMJ complications such as pain, crepi-tation are observed (19, 20, 22, 26, 29, 30, 32-34). Condylar and subcondylar fractures are often treated endoscopically, and complications after this treatment are infection, fixation failure, temporary facial nerve complication, “Frey” syndrome. In our research com-plications after condylar and subcondylar fractures appeared in 2 of 56 cases, and there are cases when complications did not occur at all or occur just for temporary period (17, 35-37).

Table 6. Complications occurrence dependency of performed intervention in mandibular region. The results were statistically significant (Fisher test p=0.024).

Submandibular abscess

Osteomyelitis Bone regeneration complication

Periostitis Phlegmone Total

Open reduction 0 0 1 0 0 1Incision and drainage 0 4 0 0 3 7Open reduction and direct fixation 0 6 1 0 1 8Clinical inspection 0 0 1 0 0 1Wire, screw, plate removal 0 0 2 0 0 2Closed reduction and indirect fixation 1 2 8 1 2 14Total 1 12 13 1 6 33


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Indi

a10

38 p

atie

nts c

ases

with

max

il-lo

faci

al in

jurie

s wer

e an

alys

edO

RIF

was

per

form

ed in

72.

83%

of c

ases

, and

con

serv

-at

ive

man

agem

ent f

or 2

2.73

%, a

nd 2

.5%

pat

ient

s wer

e tre

ated

by

circ

um-m

andi

bula

r wiri

ng.

Ther

e w

as n

o in

fect

ion,

non

-uni

on, m

al u

nion

, or a

ny fu

nctio

nal d

is-

abili

ty re

porte

d in

the

patie

nts w

ho re

ceiv

ed IM

F fo

r 4-6

wee

ks. M

outh

op

enin

g w

as n

orm

al in

all

patie

nts.

TMJ s

tiffn

ess w

as d

urin

g fir

st w

eek

of a

fter r

elea

sing

IMF.

It c

omes

nor

mal

afte

r a w

eek

with

phy

siot

hera

-py

.J.

Shi,

et

al. 2

014,

(3

3)

Chi

na83

cas

es w

ith 1

59 m

andi

bula

r an

d co

ndyl

ar fr

actu

res s

ites

wer

e in

clud

ed in

the

treat

men

t an

alys

is.

Clos

ed tr

eatm

ent w

as p

erfo

rmed

in 2

2 co

ndyl

ar

proc

ess f

ract

ures

(28.

6%),

open

redu

ctio

n- fo

r 55

cond

ylar

pro

cess

frac

ture

s (71

.4%

).

Func

tiona

l TM

J eva

luat

ion

show

ed th

at o

vera

ll pa

tient

satis

fact

ion

rate

w

as 9

6.4%

. 6 p

atie

nts h

ad d

evia

tion

of m

andi

bula

r mov

emen

t, an

d al

l of

them

had

con

dyla

r fra

ctur

es. C

licki

ng in

the

TMJ w

as n

oted

at 2

si

tes a

nd p

ain

in 3

site

s; h

owev

er, t

here

was

no

sign

ifica

nt d

iffer

ence

be

twee

n th

e co

nser

vativ

e tre

atm

ent a

nd th

e su

rger

y gr

oup.

Tabl

e 7.

Mai

n ch

arac

teris

tics a

nd fi

ndin

gs o

f rev

iew

ed st

udie

s (co

ntin

ued

on n

ext p

age)



Stud

yC

ount

rySa

mpl

eFr

actu

res t

reat

men

tM

ain

findi

ngs.

Com

plic

atio

ns o

ccur

renc

eT.

Esk

itas-

ciog

lu, e

t al

. 201

3,

(7)

Turk

ey75

3 m

andi

bula

r fra

ctur

e pa

tient

s. A

ll ca

ses h

ad a

tota

l of

109

0 fr

actu

res,

the

mos

t co

mm

on w

as th

e pa

rasy

mph

ysis

(2

8.6%

) fra

ctur

e.

For 2

5 (3

.3%

) pat

ient

s with

non

-disp

lace

d fra

ctur

e,

sym

ptom

atic

trea

tmen

t was

app

lied.

Clo

sed

redu

c-tio

n w

as p

erfo

rmed

in 2

80 (3

7.2%

), os

teos

ynth

esis

by O

RIF

for 4

03 (5

3.5%

); fo

r 134

of t

hese

- clo

sed

redu

ctio

n to

o.

61 (8

.1%

) pat

ient

s sh

owed

pos

tope

rativ

e co

mpl

icat

ions

: occ

lusi

on

diso

rder

, pla

te e

xpos

ition

, inf

ectio

n, s

enso

ry c

ompl

icat

ions

, ope

ning

at

the

muc

osal

sut

ures

, and

TM

J dy

sfun

ctio

n. T

here

was

no

com

-pl

icat

ion

for p

atie

nts

who

wer

e tre

ated

con

serv

ativ

ely.

The

low

est

com

plic

atio

n ra

tes

wer

e fo

r pat

ient

s w

ho h

ad c

lose

d re

duct

ion

alon

e (9

/280

) and

the

high

est i

n pa

tient

s w

ho h

ad b

oth

open

and

clo

sed

redu

ctio

n (3

0/13

4).

J.L.

Muñ

ante

-C

árde

nas,

et a

l. 20

10,

(24)

Bra

zil

2986

med

ical

reco

rds f

acia

l tra

uma

The

cons

erva

tive

treat

men

t was

use

d in

51%

of c

ases

, an

d 49

% re

ceiv

ed su

rgic

al tr

eatm

ent.

Post

oper

ativ

e co

mpl

icat

ions

iden

tified

for 5

pat

ient

s. F

rom

55

surg

i-ca

lly tr

eate

d ca

ses,

5 (9

%) h

ad p

osto

pera

tive

com

plic

atio

ns s

uch

as

surg

ical

wou

nd d

ehis

cenc

e (1

), fa

cial

par

esth

esia

(3),

infe

ctio

n du

e to

loss

of m

ater

ial fi

xing

(1).

Com

plic

atio

ns re

late

d to

TM

J an

kylo

sis

and

faci

al a

sym

met

ry w

ere

not i

dent

ified

. Aut

hors

bel

ieve

that

it

was

ach

ieve

d by

ear

ly m

obili

zatio

n of

the

TMJ

and

inte

nsiv

e ph

ysi-

othe

rapy

.T.

Kan

no,

et a

l. 20

14,

(39)

Japa

n12

com

min

uted

man

dibu

lar

frac

ture

s with

a lo

w-p

rofil

e lo

ckin

g m

andi

bula

r rec

onst

ruc-

tion

plat

e

Ana

tom

ical

redu

ctio

n of

the

com

min

uted

segm

ents

re-

esta

blish

ed th

e m

andi

bula

r ske

leto

n in

stab

le o

cclu

sion

with

rigi

d IM

F vi

a ex

traor

al (3

3.3%

), in

traor

al (5

0%),

or c

ombi

ned

(16.

7%) a

ppro

ache

s.

Imm

edia

te fu

nctio

nal r

ecov

ery

was

ach

ieve

d. S

ound

bon

e he

alin

g ac

hiev

ed fo

r all

patie

nts,

no

com

plic

atio

ns w

ith a

mea

n fo

llow

-up

of

16.3

mon

ths.

Pre

oper

ativ

e ne

urol

ogic

al a

sses

smen

t sho

wed

par

es-

thes

ia o

f man

dibu

lar a

lveo

lar-

men

tal n

erve

in 8

cas

es (6

7%),

and

rem

aine

d af

ter s

urge

ry. I

n so

me

patie

nts,

a re

duce

d m

outh

-ope

ning

an

d lim

itatio

ns in

late

ral e

xcur

sion

wer

e no

ted

for 1

mon

th p

osto

p-er

ativ

ely.

¬¬V.

Pr

ade,

et

al. 2

014,

(3

5)

Fran

ce22

pat

ient

s (25

man

dibu

lar

cond

yle

frac

ture

s)Th

e ch

osen

trea

tmen

t was

end

osco

pica

lly a

ssist

ed

surg

ical

trea

tmen

tTh

e co

mpl

icat

ions

wer

e: in

fect

ion

(3),

fixat

ion

failu

re w

ith g

ood

con-

solid

atio

n(1)

; for

com

bine

d ap

proa

ches

: tem

pora

ry fa

cial

pal

sy(2

) and

2

case

s of F

rey

synd

rom

e.

J. S.

Sc

henk

el,

et a

l. 20

14,

(14)

Aus

tria

45 p

atie

nts w

ith c

omm

inut

ed

man

dibu

lar f

ract

ures

ORI

F us

ing

an in

traor

al a

ppro

ach

was

per

form

edEx

celle

nt p

osto

pera

tive

resu

lts w

ere

seen

in 8

4% (3

8 pa

tient

s). P

ost-

oper

ativ

e co

mpl

icat

ions

wer

e se

en in

16%

(n=7

). W

ound

deh

isce

nce

(7%

[n =

3])

, ost

eom

yelit

is (7

% [n

= 3

]), a

bsce

ss (4

% [n

= 2

]), b

one

necr

osis

(2%

[n =

1])

, non

occl

usio

n (2

%[n

= 1]

).V.

Sing

h, e

t al

. 201

3,

(29)

Indi

a40

pat

ient

s with

an

man

dibu

lar

angl

e fr

actu

re

All

patie

nts h

ad a

com

bina

tion

of O

RIF

and

max

il-lo

faci

al fi

xatio

n.

Ther

e w

as n

o si

gnifi

cant

diff

eren

ce b

etw

een

OR

IF o

f dis

plac

ed

frac

ture

s (>2

mm

) via

intra

oral

app

roac

h w

ith a

pplic

atio

n of

a si

ngle

m

onoc

ortic

al m

inip

late

ver

sus a

n ex

traor

al a

ppro

ach

with

app

licat

ion

of a

n in

ferio

r bor

der p

late

with

two

hole

s on

eith

er si

de o

f the

frac

-tu

re li

ne. F

unct

iona

l out

com

es in

clud

ing

pain

(vis

ual a

nalo

gue

scal

e sc

ore)

at t

he 1

-wee

k fo

llow

-up

and

inte

r-inc

isal

mou

th o

peni

ng a

t the

12

-wee

k fo

llow

-up

wer

e be

tter i

n ex

traor

al a

ppro

ach

grou

p. In

intra

oral

ap

proa

ch g

roup

, 25%

of p

atie

nts (

n =

5) h

ad a

pos

t-inj

ury/

pres

urgi

cal

neur

osen

sory

defi

cit,

whi

le in

ext

raor

al g

roup

, 50%

of p

atie

nts (

n =

10)

had

a po

st-in

jury

/pre

surg

ical

neu

rose

nsor

y de

ficit.

E. F

ran-

cios

i, et

al.

2014

, (8)

Arg

en-

tina

18 e

dent

ulou

s pat

ient

s, pr

e-se

nted

a to

tal o

f 35

man

dibu

lar

frac

ture

s

6 co

ndyl

ar fr

actu

res w

ere

treat

ed c

onse

rvat

ivel

y. 2

9 fra

ctur

es w

ere

treat

ed w

ith O

RIF.

Frac

ture

redu

ctio

n w

as c

onsi

dere

d sa

tisfa

ctor

y in

96.

5%, w

ith 2

2.2%

of

com

plic

atio

ns a

nd 1

1.1%

of r

eope

ratio

ns n

eede

d. 1

pat

ient

requ

ired

a re

oper

atio

n du

e to

uns

tabl

e fr

actu

re. C

ompl

icat

ions

: of f

acia

l ner

ve

inju

ries(

2) a

nd se

gmen

ts n

onun

ion

(1).


Tabl

e 7.

Mai

n ch

arac

teris

tics a

nd fi

ndin

gs o

f rev

iew

ed st

udie

s (co

ntin

ued

from

pre

viou

s pag

e/co

ntin

ued

on n

ext p

age)



Stud

yC

ount

rySa

mpl

eFr

actu

res t

reat

men

tM

ain

findi

ngs.

Com

plic

atio

ns o

ccur

renc

eA

. Rah

-pe

yma

, et

al. 2

014,

(2

5)

Iran

25 p

atie

nts (

28 fr

actu

re li

nes)

w

ith m

andi

bula

r fra

ctur

esTr

eatm

ent-t

wo

perp

endi

cula

r min

i-pla

tes v

ia e

xtra

oral

ap

proa

ch. F

ract

ure

line

fixat

ion

was

mad

e by

two

min

i-pla

tes p

erpe

ndic

ular

to e

ach

othe

r. 1-

wee

k IM

F an

d 3

wee

ks o

f sof

t die

t was

per

form

ed.

All

patie

nts w

ere

follo

wed

up

for a

t lea

st 1

yea

r reg

ardi

ng in

fect

ion

and

mal

occl

usio

n. A

mon

g th

e pa

tient

s who

und

erw

ent s

urge

ry, 1

mal

occl

u-si

on a

nd n

o ca

ses o

f inf

ectio

n w

ere

obse

rved

. No

faci

al n

erve

wea

knes

s ca

ses o

r dam

age

wer

e ob

serv

ed in

this

stud

y.S.

Bin

dra,

et

al.

2011

, (1

8)

Indi

a10

pat

ient

s with

dis

plac

ed

unila

tera

l/bila

tera

l con

dyla

r fr

actu

res

Trea

tmen

t – o

pen

redu

ctio

n an

d in

tern

al fi

xatio

n of

co

ndyl

ar fr

actu

res u

sing

retro

man

dibu

lar a

ppro

ach

Disc

repa

ncy

in o

cclu

sion

was

in 5

pat

ient

s (50

%) a

fter 2

4 h

and

1 w

eek

posto

pera

tivel

y, b

ut a

fter 3

mon

ths s

how

ed sa

tisfa

ctor

y ce

ntric

oc-

clus

ion.

Mou

th o

peni

ng a

nd la

tero

trusiv

e m

ovem

ents

incr

ease

d w

ith

time.

Prea

uric

ular

tend

erne

ss w

as in

4 p

atie

nts (

40%

) afte

r 1 w

eek,

in

2 pa

tient

s (20

%) a

t 6 w

eeks

and

non

e of

the

patie

nts h

ad p

reau

ricul

ar

tend

erne

ss a

fter 3

mon

ths.

Out

of 1

0, 2

pat

ient

s (20

%) h

ad c

licki

ng in

the

oper

ated

join

t one

wee

k po

stope

rativ

ely

whi

ch re

solv

ed g

radu

ally

. 4 p

a-tie

nts (

40%

) had

dev

iatio

n on

mou

th o

peni

ng to

war

ds th

e op

erat

ed jo

int

side

afte

r one

wee

k bu

t non

e ha

d an

y de

viat

ion

at 6

wee

ks o

r 3 m

onth

s po

stope

rativ

ely.

N. V

. V.

Red

dy, e

t al

. 201

2,

(26)

Indi

a17

5 co

ndyl

ar fr

actu

res

62.9

% o

f fra

ctur

es re

quire

d O

RIF

and

37.1

% w

ere

man

aged

with

clo

sed

redu

ctio

n.In

OR

IF g

roup

com

plic

atio

ns w

ere

sialo

ceol

e (2

cas

es),

ear d

ischa

rge

(1),

trans

cien

t fac

ial p

alsy

(19)

, occ

lusio

n di

sturb

anci

es (2

), sti

ch a

bsce

ss

(1),

trism

us (2

), pe

riodo

ntiti

s (4)

. In

IMF

grou

p oc

clus

ion

distu

rban

cies

(3

cas

es),

trism

us (4

), pe

riodo

ntiti

s (10

cas

es).

S.T.

Xie

, et

al.

2013

, (2

9)

Chi

na70

pat

ient

s with

con

dyla

r hea

d or

nec

k fr

actu

res

ORI

F w

as p

erfo

rmed

for a

ll th

e pa

tient

s. 38

wer

e tre

ated

with

mic

ropl

ates

and

32

with

min

ipla

tes.

The

max

imal

mou

th o

peni

ng w

as la

rger

in th

e m

icro

plat

e gr

oup

than

in

the

min

ipla

te g

roup

; sco

res f

or b

one

reso

rptio

n an

d co

ndyl

e m

orph

olog

y w

ere

bette

r in

the

mic

ropl

ate

grou

p. P

atie

nts f

rom

min

ipla

te fi

xatio

n ha

d a

signi

fican

tly h

ighe

r inc

iden

ce o

f TM

J clic

k.R

Pra

sad

, et

al.

2013

, (1

3)

Indi

a20

man

dibu

lar f

ract

ures

in 1

8 pa

tient

s Pa

tient

s wer

e tre

ated

by

ORI

F us

ing

3D p

late

s.A

signi

fican

t red

uctio

n in

ling

ual s

play

(72.

2%) a

nd o

cclu

sal s

tabi

lity

(72.

2%) w

as se

en. T

he o

vera

ll co

mpl

icat

ion

rate

was

(16.

6%):

post-

oper

ativ

e pa

resth

esia

of l

ip (2

), in

fect

ion

(3),

mas

ticat

ory

diffi

culty

(2).

No

evid

ence

of n

on-u

nion

, mal

unio

n w

as n

oted

.Z.

Li e

t al.

2013

, (23

)C

hina

13 p

atie

nts w

ith m

andi

bula

r co

ndyl

e di

sloc

atio

ns

Trea

tmen

t: (1

) rel

ief o

f the

disl

ocat

ion

by m

anip

ula-

tion

or o

pen

redu

ctio

n; (2

) red

uctio

n of

the

med

ial

cond

ylar

frag

men

t, fix

atio

n w

ith sc

rew

s, or

(3)re

mov

al

of th

e fra

gmen

t if l

ess t

han

50%

of t

he c

ondy

lar w

idth

.

Post

oper

ativ

ely,

all

patie

nts d

ispl

ayed

une

vent

ful h

ealin

g w

ithou

t com

-pl

icat

ions

such

as p

osto

pera

tive

haem

orrh

age

or in

fect

ion,

but

1 p

atie

nt

was

with

tran

sien

t fac

ial p

aral

ysis

with

reco

very

in 2

mon

ths.

Dur

ing

the

follo

w-u

p pe

riod,

no

patie

nts s

how

ed d

ysfu

nctio

n or

dev

elop

men

t of

ank

ylos

is, p

ain.

S.

Sch

iel ,

et

al.

2013

, (3

6)

Ger

-m

any

6 pa

tient

s with

dis

plac

ed c

on-

dyla

r bas

e an

d ne

ck fr

actu

res

(n =

9)

Ope

n su

rger

y, e

ndos

copi

cally

ass

isted

redu

ctio

n an

d fix

atio

n us

ing

a tra

nsor

al ro

ute.

All

patie

nts h

ad n

orm

al o

cclu

sion

, pa

in-f

ree

unre

stric

ted

TMJ f

unct

ion

at 3

, 6, 1

2, 1

8 m

onth

s pos

tope

rativ

ely.

The

re w

ere

no si

gns o

f inc

om-

plet

e re

mod

elin

g or

def

orm

atio

n.A

. Miji

ti,

et a

l. 20

14,

(11)

Chi

naA

tota

l of 1

350

patie

nts w

ith

max

illof

acia

l fra

ctur

es w

ere

revi

ewed

retro

spec

tivel

y

1860

frac

ture

s, 62

.4%

wer

e tre

ated

usin

g op

en

redu

ctio

n, 2

7.3%

usin

g cl

osed

redu

ctio

n, a

nd 1

0.3%

un

derw

ent o

bser

vatio

n on

ly

97 (7

.2%

) pat

ient

s had

loca

l com

plic

atio

n an

d 86

% o

f the

se w

ere f

ound

in

open

redu

ctio

n an

d ob

serv

atio

n gr

oups

. The

mos

t com

mon

com

plic

atio

n w

as tr

ansie

nt in

traor

al o

r ext

raor

al so

ft tis

sue i

nfec

tion

(64.

8% (6

3/97

) ca

ses)

, dist

urbe

d oc

clus

ion

and

anky

losis

25.

8% (2

5/97

) and

4.1

%(4

/97)

of

the a

ll co

mpl

icat

ions

, oste

omye

litis

(n=5

). A

. A. D

. A

dam

, et a

l. 20

12, (

41)

Chi

na31

0 pa

tient

s tre

ated

for z

ygo-

mat

ic b

one

and

zygo

mat

ic a

rch

frac

ture

s

Patie

nts t

reat

ed b

y O

RIF

with

min

ipla

te a

nd sc

rew

s co

nstit

uted

90.

6%, c

lose

d re

duct

ion-

9.4

%.

Mos

t pat

ient

s with

the

zygo

mat

ic b

one

and

zygo

mat

ic a

rch

had

no

com

plic

atio

n. C

linic

al e

xam

inat

ion

wer

e pe

rfor

med

at 4

, 6 a

nd 2

4 w

eeks

pos

tope

rativ

ely.

Tabl

e 7.

Mai

n ch

arac

teris

tics a

nd fi

ndin

gs o

f rev

iew

ed st

udie

s (co

ntin

ued

from

pre

viou

s pag

e/co

ntin

ued

on n

ext p

age)



Stud

yC

ount

rySa

mpl

eFr

actu

res t

reat

men

tM

ain

findi

ngs.

Com

plic

atio

ns o

ccur

renc

eY.

Lei

ser,

et a

l. 20

13,

(22)

Isra

el37

pat

ient

s had

a fr

actu

re b

elow

th

e si

gmoi

d no

tch

(low

subc

on-

dyla

r)

10 p

atie

nts w

ere

treat

ed u

sing

the

ante

ropa

rotid

tra

nsm

asse

teric

(APT

M) a

ppro

ach,

27

wer

e tre

ated

co

nser

vativ

ely

by m

axilo

man

dibu

lar fi

xatio

n.

In th

e op

en re

duct

ion

grou

p, 2

pat

ient

s (20

%) h

ad li

mite

d m

outh

ope

n-in

g (r

esol

ved

follo

win

g ph

ysio

ther

apy)

; the

clo

sed

redu

ctio

n gr

oup

had

mou

th o

peni

ng li

mita

tion

(bel

ow 3

5 m

m) (

18.5

% o

f cas

es).

No

faci

al

nerv

e da

mag

e w

as n

oted

.T.

For

ou-

zanf

ar, e

t al

.201

3,

(34)

The

Net

her-

land

s

41 p

atie

nts w

ith b

ilate

ral c

ondy

-la

r fra

ctur

esCo

nser

vativ

e tre

atm

ent o

f bila

tera

l con

dyla

r fra

ctur

es

was

per

form

edO

f 41

pat

ient

s, no

pat

ient

had

cros

sbite

, 5 h

ad an

terio

r ope

n bi

te. N

o pa

tient

s with

mal

occl

usio

n ha

d an

y TM

J pai

n du

ring

6 m

onth

s.5 p

atie

nts

had

little

inte

nsity

or d

isabi

lity.

1 pa

tient

had

inte

nse p

ain

but l

ittle

disa

bilit

y,

1 pa

tient

had

mod

erat

ely

limiti

ng b

ut se

rious

ly d

isabl

ing

pain

. No

patie

nts

had

seve

rely

lim

iting

and

serio

usly

disa

blin

g pa

in.

J. H

. Zh

ou ,

et

al.2

013,

(3

0)

Chi

naA

tota

l of 7

8 pa

tient

s (10

0 co

n-dy

lar f

ract

ures

)A

prea

uric

ular

long

-cor

nifo

rm in

cisio

n fo

r ORI

F of

m

andi

bula

r con

dyla

r fra

ctur

es.

The

maj

ority

of p

atie

nts i

n al

l gro

ups h

ad g

ood

occl

usio

n (≥

88.5

%),

no

pain

(≥89

.5%

), an

d an

atom

ical

redu

ctio

n 10

day

s afte

r sur

gery

(≥81

.6%

). Th

ere

wer

e no

cas

es o

f joi

nt ri

gidi

ty, p

late

bre

akag

e, o

r scr

ew lo

osen

ing.

6

mon

ths a

fter s

urge

ry, t

here

wer

e 12

cas

es o

f mild

disp

lace

men

t and

5

case

s of p

oor a

nato

mic

al re

duct

ion.

At 6

mon

ths f

ollo

w-u

p, fr

actu

re

redu

ctio

n w

as id

eal i

n 83

% o

f cas

es.

R S

. Pat

il,

et a

l. 20

11,

(12)

Indi

a10

pat

ient

s with

low

sub-

cond

y-la

r fra

ctur

eTh

ese

patie

nts w

ere

treat

ed b

y op

en re

duct

ion

and

inte

rnal

fixa

tion

thro

ugh

intra

-ora

l app

roac

h.A

ll pa

tient

s fol

low

ed fo

r 6 w

eeks

, max

imum

mou

th o

peni

ng w

as m

ore

than

40

mm

in 7

pat

ient

s (ra

nge

from

40

to 5

0 m

m) a

nd le

ss th

an 4

0 m

m in

3 p

atie

nts.

Occ

lusi

on w

as sa

tisfa

ctor

y in

all

and

none

show

ed

devi

atio

n of

man

dibl

e on

mou

th o

peni

ng.

D. H

e, e

t al

. 200

9,

(20)

Chi

na22

9 pa

tient

s with

312

intra

ca-

psul

ar c

ondy

lar f

ract

ure

wer

e tre

ated

.

Trea

tmen

t pro

toco

l is o

pen

redu

ctio

n fo

r a fr

actu

re in

w

hich

the

supe

rola

tera

lly d

isloc

ated

ram

us st

ump

is ou

t of t

he g

leno

id fo

ssa

or a

ny ty

pe o

f fra

ctur

e w

ith

disp

lace

d or

disl

ocat

ed fr

agm

ents

that

may

cau

se T

MJ

dysf

unct

ion

late

r.

Of t

he jo

ints,

ORI

F w

as d

one f

or17

3; 9

5.6%

had

abso

lute

or n

early

anat

omic

re

duct

ion.

In al

l of t

hem

nor

mal

mou

th o

peni

ng an

d oc

clus

ion

wer

e res

tore

d.

No

or li

ttle d

evia

tion

was

foun

d du

ring

mou

th o

peni

ng. C

ompl

icat

ions

- pa

in in

the j

oint

(n=

1), c

repi

tatio

ns (n

= 2

), fa

cial

ner

ve p

aral

ysis

(n =

1).

2 pa

tient

s had

the p

late

rem

oved

bec

ause

of c

ompl

icat

ions

.G

. Ger

-bi

no, e

t al.

2009

, (19

)

Italy

50 p

atie

nts w

ith a

tota

l of 5

7 tre

ated

con

dyla

r fra

ctur

es w

ere

incl

uded

.

Ope

n re

duct

ion

and

inte

rnal

fixa

tion

Afte

r sur

gery

via

the r

etro

man

dibu

lar a

ppro

ach,

3 p

atie

nts h

ad sa

livar

y fis

tula

s. 1

patie

nt h

ad an

infe

ctio

n af

ter s

urge

ry v

ia th

e sub

man

dibu

lar a

p-pr

oach

. 6 p

atie

nts s

how

ed te

mpo

rary

faci

al n

erve

wea

knes

s (12

%),

but a

ll pa

tient

s rec

over

ed fa

cial

soft

tissu

e sym

met

ry w

ithin

8 w

eeks

. 2 p

atie

nts h

ad

perm

anen

t fac

ial n

erve

pal

sy (4

%).

Plat

e fra

ctur

es w

ere o

bser

ved

in 4

case

s. 3

patie

nts h

ad F

rey's

synd

rom

e, 3

had

mal

occl

usio

n, 4

7- h

abitu

al o

cclu

sion.

R S

chm

-el

zeis

en, e

t al

. 200

9,

(37)

Ger

-m

any

74 p

atie

nts w

ith c

ondy

lar n

eck

frac

ture

sTh

e no

nend

osco

pic

extra

oral

gro

up in

clud

ed 3

4 pa

-tie

nts a

nd th

e en

dosc

opic

ally

ass

isted

ope

n re

duct

ion

grou

p in

clud

ed 4

0 pa

tient

s.

The

patie

nts w

ith b

ilate

ral f

ract

ures

in b

oth

grou

ps sh

owed

dec

reas

ed

func

tion

at th

e fir

st fo

llow

-up

visit

com

pare

d w

ith u

nila

tera

l fra

ctur

es

patie

nts (

P =

.097

and

P =

.079

). Fa

cial

ner

ve d

amag

e w

as a

des

crib

ed

com

plic

atio

n, o

ccur

ring

in 1

5 pa

tient

s in

this

study

.R.

G

onzá

lez-

Gar

cía,

et

al. 2

009,

(9)

Spai

n17

pat

ient

s with

subc

ondy

lar

frac

ture

sTr

anso

ral e

ndos

copi

c-as

siste

d op

en re

duct

ion

and

fixat

ion

with

min

ipla

tes

No

dam

age

to th

e fa

cial

ner

ve w

as o

bser

ved.

No

visib

le sc

ars w

ere

pres

ent.

Tran

sitor

y hy

posth

esia

was

obs

erve

d in

3 c

ases

. 6 m

onth

s afte

r su

rger

y, th

e TM

J fun

ctio

n w

as n

ot im

paire

d. N

one

of th

e pa

tient

s com

-pl

aine

d of

pai

n. N

o co

ndyl

ar re

abso

rtion

was

pre

sent

.K

. Hw

ang,

et

al.

2010

, (1

0)

Kor

ea2,

094

patie

nts w

ith fa

cial

bon

e fr

actu

res

Clos

ed re

duct

ion

was

per

form

ed in

46.

3% o

f the

cas

es

whi

le 3

9.7%

of t

he c

ases

requ

ired

open

redu

ctio

nTh

e co

mpl

icat

ion

rate

was

6.4

% a

nd th

e m

ost c

omm

on c

ompl

icat

ion

was

hyp

oest

hesi

a (6

8.4%

) fol

low

ed b

y di

plop

ia (2

5.6%

). Th

e av

erag

e fo

llow

-up

perio

d fo

r hyp

oest

hesi

a w

as 1

.2 m

onth

s. Th

e av

erag

e fo

llow

-up

per

iod

for d

iplo

pia

was

2 m

onth

s.

Tabl

e 7.

Mai

n ch

arac

teris

tics a

nd fi

ndin

gs o

f rev

iew

ed st

udie

s (co

ntin

ued

from

pre

viou

s pag

e)


Our study about TMD showed that there was no case of maxillofacial fracture when TMD was noted, and there were some articles with the same results too. In condylar or subcondylar fractures cases where endoscopically assisted reduction and fixation was performed, normal pain-free unrestricted function of the TMJ was seen at 3, 6, 12, 18 months postop-eratively, TMJ function problems were not seen in any patient (17, 36). In subcondylar fractures which were treated by open reduction and internal fixation, all patients (n=10) had satisfactory occlusion and no deviation of mandible (12). In the article about trauma it was stated that in cases where early mobilization of TMJ and intensive physiotherapy after conservative or surgical treatment was applied, low postoperative complications rate (9%, n=5) was identified (24).

Although our study about TMD showed that there was no patient with TMJ problem after maxillo-facial fracture, there are studies which show different results. Temporomandibular joint complications such as pain, dysfunction, click or stiffness are observed for some time postoperatively (16, 20, 29, 33, 38), and it resolves gradually with time (18, 39). Long term follow-up period is important for TMJ treatment. For example, TMJ function was followed 6 months after surgery, and 18 months follow-up term for oc-clusion discrepancies and criterion of pain (17, 36). In long term follow-up period most of TMJ compli-cations decrease or disappear without any residual effects. In mandibular fractures where mostly closed reduction and intermaxillary fixation was performed TMJ dysfunction appeared in 30 of 164 cases (40). In mandibular cases where mostly open reduction and internal fixation was performed, postoperative complications rate, including TMJ, was 8.1% (7). In maxillofacial fractures which mostly were managed by open reduction and direct fixation TMJ stiffness appeared during first week after releasing intermax-illary fixation and it became normal after a week of physiotherapy (38). In condylar fracture cases which were treated mostly by open reduction (71.4%), complications such as mandibular movement devia-

tion (6 patients), TMJ clicking (2 cases), and pain (3 patients) was noted (33). In condylar fracture cases where open reduction and internal fixation was per-formed, in 2 of 10 cases TMJ clicking was noted one week postoperatively which disappeared gradually, 3 of 50 cases showed malocclusion, TMJ click was noted more in osteosynthesis miniplates group than in microplates group (P=0014), pain in TMJ area for 1 of 229, and crepitation for 2 of 229 (18-20, 29). In bilateral condylar fractures cases where conservative treatment was performed, no patients with malocclu-sion had any TMJ pain during 6 months, 5 patients had little intensity or disability of TMJ (34). There are different results of the studies about TMJ disorders after maxillofacial fracture.

The results of this research showed that results of mandible fractures are statistically significant, but more studies should be made in wider amplitude of years. The results of complications in the cases of zygomatic and maxillary fractures showed no statis-tical significance; therefore more studies should be done on this object.

CONCLUSIONS

The success of treatment depends on experience and practical skills of the surgeon and individual fracture conditions; therefore it is impossible to state which treatment technique is superior. Complications rate was higher in these cases where fractures were treated by closed reduction and indirect fixation. In the Department of Maxillofacial Surgery in Lithu-anian University of Health Sciences from 2012 to 2014 year complications of facial bones treatment rate was 6%. The most frequent complications were nerve injuries, bone regeneration complications and osteomyelitis. There was any of temporomandibular joint pathology as a complication.

CONFLICT OF INTEREST

None.


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Management of maxillofacial fractures within three years ... · Results. Male patients had higher...

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