Clinical Outcome of Conservative Treatment of Displaced Mandibular Fracture in Adults

Lipa Bodner, Sigal Amitay, Ben Zion Joshua

Department of Oral and Maxillofacial Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Otolaryngology Head and Neck Surgery, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

DOI: 10.4236/ss.2013.411097                

Abstract

The article evaluates 12 cases of conservative treatment of displaced mandibular fractures in adults. Twelve cases of displaced mandibular fractures treated surgically, either by closed reduction (IMF) or open reduction internal fixation (ORIF) served as controls. Occlusion, maximal mouth opening, lateral jaw movements, neurological dysfunction (=sensory deficit), and bone remodeling were evaluated and scored in both groups, and results were compared. No significant differences were found between the two groups in all the evaluated parameters. It is concluded that in certain cases, with displacement of 2 - 4 mm, where a surgical approach is not feasible, reasonable spontaneous reduction and bone remodeling can occur. Meticulous follow-up is mandatory.

Keywords

Mandible; Jaw Bone; Trauma; Displaced Fracture; Conservative Management

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	H. D. Barber, S. C. Woodbury, K. E. Silverstein and R. J. Fonseca, “Mandibular Fractures,” In: R. J. Fonseca and R. V. Walker, Eds., Oral and Maxillofacial Trauma, 2nd Edition, W.B. Saunders, Philadelphia, 1997, pp. 473-522.
[2]	T. Imazawa, Y. Komuro, M. Inoue and A. Yanai, “Mandibular Fractures Treated with Maxillomandibular Fixation Screws (MMFS Method),” Journal of Craniofacial Surgery, Vol. 2, 2006, pp. 544-549. http://dx.doi.org/10.1097/00001665-200605000-00026
[3]	D. P. Colleti, A. Salama and J. J. Caccamese Jr, “Application of Intermaxillary Fixation Screws in Maxillofacial Trauma,” Journal of Oral & Maxillofacial Surgery, Vol. 65, No. 9, 2007, pp. 1746-1750. http://dx.doi.org/10.1016/j.joms.2007.04.022
[4]	T. Iizuka and C. Lindqvist, “Rigid Internal Fixation of Mandibular Fractures. An Analysis of 270 Fractures Treated Using the AO/ASIF Method,” Journal of Oral & Maxillofacial Surgery, Vol. 21, No. 2, 1992, pp. 65-69. http://dx.doi.org/10.1016/S0901-5027(05)80533-8
[5]	E. Ellis 3rd, “Treatment Methods for Fractures of the Mandibular Angle,” Journal of Oral & Maxillofacial Surgery, Vol. 28, No. 4, 1999, pp. 243-252. http://dx.doi.org/10.1016/S0901-5027(99)80152-0
[6]	L. A. Assael, “Open versus Closed Reduction of Adult Mandibular Condyl Fractures: An Alternative Interpretation of the Evidence,” Journal of Oral & Maxillofacial Surgery, Vol. 61, No. 11, 2003, pp. 1333-1339. http://dx.doi.org/10.1016/S0278-2391(03)00736-5
[7]	C. O. Hazelrigg and J. E. Jones, “Conservative Management of a Fractured Mandible in a Ten Month Old Child,” Journal of Oral Pathology & Medicine, Vol. 40, No. 3, 1985, pp. 112-114.
[8]	J. Lustmann and I. Milhem, “Mandibular Fractures in Infants: Review of the Literature and Report of Seven Cases,” Journal of Oral & Maxillofacial Surgery, Vol. 52, No. 3, 1994, pp. 240-245. http://dx.doi.org/10.1016/0278-2391(94)90291-7
[9]	S. T. Crean, V. Sivarajasingam and M. J. Fardy, “Conservative Approach in the Management of Mandibular Fractures in the Early Dentition Phase. A Case Report and Review of the Literature,” International Journal of Paediatric Dentistry, Vol. 10, No. 3, 2000, pp. 229-233. http://dx.doi.org/10.1046/j.1365-263x.2000.00196.x
[10]	R. Scariot, I. A. de Oliveira, L. A. Passeri, N. L. Rebellato and P. R. Muller, “Maxillofacial Injuries in a Group of Brazilian Subjects under 18 Years of Age,” Journal of Applied Oral Science, Vol. 17, No. 3, 2009, pp. 195-198. http://dx.doi.org/10.1590/S1678-77572009000300012
[11]	M. Glazer, B. Z. Joshua, Y. Woldenberg and L. Bodner, “Mandibular Fracture in Children—Analysis of 61 Cases and Review of the Literature,” International Journal of Pediatric Otorhinolaryngology, Vol. 75, No. 1, 2011, pp. 62-64. http://dx.doi.org/10.1016/j.ijporl.2010.10.008
[12]	H. Kerem, A. Usluer and L. Yoleri, “Remodeling of a Non Treated Displaced Parasymphyeal Fracture of a Child,” Journal of Craniofacial Surgery, Vol. 22, No. 4, 2011, pp. 1358-1360. http://dx.doi.org/ 10.1097/SCS.0b013e31821c947f
[13]	M. R. Cope, “Spontaneous Fracture of an Atrophic Mandible Treated without Fixation,” British Journal of Oral Surgery, Vol. 20, No. 1, 1982, pp. 22-30. http://dx.doi.org/10.1016/0007-117X(82)90003-8
[14]	K. Frame, “Conservative Management of a Patient with a Fractured Atrophic Mandible,” British Dental Journal, Vol. 162, 1987, pp. 27-28. http://dx.doi.org/10.1038/sj.bdj.4806014
[15]	H. D. Barber, “Conservative Management of the Fractured Atrophic Edentulous Mandible,” Journal of Oral & Maxillofacial Surgery, Vol. 59, No. 7, 2001, pp. 789-791. http://dx.doi.org/10.1053/joms. 2001.24734
[16]	V. A. Petrenko, S. V. Nudelman, E. A. Vainshtein and N. A. Golibkov, “Conservative Treatment of Mandibular Fractures,” Voenno-Meditsinky Zhurnal, Vol. 4, 1988, p. 59.
[17]	E. Reinhart, J. Reuther, C. Michel, N. Kubler, H. Pistner, J. Bill and E. Kunkel, “Treatment Outcome and Complications of Surgical and Conservative Management of Mandibular Fracture,” Fortschritte der Kieferund Gesichtschirgie, Vol. 41, 1996, pp. 64-67.
[18]	M. Z. Martini, A. Takahashi, H. G. de Oliveira Neto, J. P. de Carvalho Jr, R. Curcio and E. H. Shinohara, “Epidemiology of Mandibular Fractures Treated in a Brazilian Level I Trauma Public Hospital in the City of Sao Paulo, Brazil,” Brazilian Dental Journal, Vol. 17, No. 3, 2006, pp. 243-248. http://dx.doi.org/10.1590/S0103-64402006000300013
[19]	M. Helkimo, “Studies on Function and Dysfunction of the Masticatory System. II. Index for Anamnestic and Clinical Dysfunction and Occlusal State,” Swedish Dental Journal, Vol. 67, No. 2, 1974, pp. 101-121.
[20]	A. E. Athanasiou, B. Melsen, D. Mavreas and F. P. Kimmel, “Stomatognatic Function of Patients Who Seek Orthognatic Surgery to Correct Dentofacial Deformities,” International Journal of Adult Orthodontics and Orthognathic Surgery, Vol. 4, No. 4, 1989, pp. 239-254.
[21]	L. A. Passeri, E. Ellis 3rd and D. P. Sinn, “Complication of Non Rigid Fixation of Mandibular Angle Fractures,” Journal of Oral & Maxillofacial Surgery, Vol. 51, No. 4, 1993, pp. 382-384. http://dx.doi.org/10.1016/S0278-2391(10)80350-7
[22]	D. B. Lois, “Complications of Mandibular Fractures: A Comparison between Maxillomandibular versus Rigid Fixation,” Journal of Oral & Maxillofacial Surgery, Vol. 50, Suppl. 1, 2001, p. 94.
[23]	B. Alpert, M. Engelstad and G. M. Kushner, “Invited Review: Small versus Large Plate Fixation of Mandibular Fractures,” Journal of Cranio-Maxillofacial Trauma, Vol. 5, No. 3, 1999, pp. 33-39.
[24]	E. Ellis 3rd, K. F. Moos and A. El-Attar, “Ten Years of Mandibular Fractures: An Analysis of 2137 Cases,” Oral Surgery, Oral Medicine, Oral Pathology, Vol. 59, No. 2, 1985, pp. 120-129. http://dx.doi.org/10.1016/0030-4220(85)90002-7
[25]	G. Ghazal, C. Jaquiery and B. Hammer, “Non-Surgical Treatment of Mandibular Fratures—Survey of 28 Patients,” International Journal of Oral & Maxillofacial Surgery, Vol. 33, No. 2, 2004, pp. 141-145. http://dx.doi.org/10.1054/ijom.2003.0458
[26]	O. A. Van der Meijden, T. R. Gaskill and P. J. Millet, “Treatment of Clavicle Fractures: Current Concepts Review,” Journal of Shoulder and Elbow Surgery, Vol. 21, No. 3, 2012, pp. 423-442. http://dx.doi.org/10.1016/j.jse.2011.08.053