Evaluation des intraoperativen Einsatzes standardisierter Hypnose mit State-Trait-Angst-Inventar (STAI)

Background

Surgical treatment under local anesthesia is commonly restricted by limited compliance of patients. Hypnosis may represent an alternative to sedation or general anesthesia. As the procedure demonstrated promising prospects during 1-year experience, the observed hypnosis-induced effects are now being evaluated in clinical studies.

Patients and method

The prospective study included 50 patients scheduled for dental surgery. All procedures were performed under standardized surgical conditions. The experimental group (n=25) received supplementary standardized tape hypnosis, whereas the control group received standard treatment (only local anesthesia). Individual and situative anxiety levels were determined by the State-Trait Anxiety Inventory (STAI).

Results

After simultaneous increase of preoperative state anxiety, anxiety levels in the hypnosis group showed a significant intraoperative reduction to baseline level, whereas intraoperative anxiety of the control group (n=25) remained unchanged.

Conclusions

Hypnosis reduces intraoperative anxiety of oral and maxillofacial patients significantly. Further clinical studies on the use of hypnosis are considered useful.     

Veränderung der Nasalanz nach Le Fort-I Osteotomie

Background

Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy.

Patients and methods

A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: ?Ein Kindergeburtstag“, the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest.

Results

All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of ?ma ma ma“ and ?na na na“ (p?=?0,003, respectively p?=?0,033). Intonation of the vowel /a/ also revealed significant changes regarding the pre- and postoperative values (p?=?0,006). However, the obtained values had no significant impact on the nasality characteristics of speech.

Conclusion

This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.     

Efficacy of Temporomandibular Joint Arthrocentesis on Mouth Opening and Pain in the Treatment of Internal Derangement of TMJ—A Clinical Study

Purpose

This study was designed to investigate the efficacy of arthrocentesis on mouth opening and pain in the treatment of temporomandibular joint (TMJ) internal derangement patients.

Materials and Methods

Fifteen males and 25 females aged between 18 and 37 years comprised the study material in the department of oral and maxillofacial surgery at Govt Dental College Srinagar (India). The patients’ complaints were limited mouth opening and TMJ pain. Arthrocentesis was performed under aseptic conditions. Clinical evaluation of the patients was done before the procedure, and 1 week and 4 months post-operatively. Intensity of TMJ pain and maximal mouth opening were recorded at each follow-up visit.

Results

There was significant improvement in mouth opening and reduction in pain scores in the post-operative period.

Conclusions

Arthrocentesis is a simple and safe procedure for patients of internal derangement with closed lock for improving mouth opening and decreasing pain.     

Überlebensverbesserung eines unizentrischen Gesamtkollektivs aus 20 Jahren

Purpose

The development of overall survival of a DÖSAK (German-Austrian-Swiss Cooperative Group on tumours of the maxillofacial region) clinic’s overall population comprising a time period of more than 20 years (1983–2004) should be assessed. At a cutoff date (January 1st, 1997), a change from a primarily surgically based to a consequent multi-modality treatment regimen was implemented. The periods of time before and after that change should be compared.

Methods and patients

The data of the DÖSAK registry entries on 1038 patients suffering from primary untreated oral and oropharyngeal carcinomas were updated with respect to follow-up and mortality data to achieve a 100% quality of follow-up. The end point (death) was reached in 67% of the overall population. Statistical analysis was carried out by the Trium Analysis Online corporation, Munich.

Results

The portion of female and older tumor patients increased, more than half of all tumor patients were clearly in stage IV of the disease at first referral. The portion of patients operated on persisted approximately (80%), the portion of additional treatment modalities could be increased considerably. The fact of a bony infiltration by the tumor and the operability remained highly significantly relevant for survival in multivariate analysis, despite of multi-modality treatment. The survival rate of the patients remained significantly dependent on the clinical stage of the disease in multivariate analysis but could be improved by 10% in the clinical stages II and III and in the patients who could not be operated on. All in all, the cutoff date was statistically relevant for survival in multivariate analysis, i.?e. the change in the treatment regimen had a verifiable positive effect on the survival of a unicentric overall population.

Conclusion

Survival improvement in an overall population via change in treatment strategy is possible in relatively short time; the clinical stages II and III and the non-operable patients have the greatest benefit from a multi-modality treatment.     

Identifikation eines rezidivierenden, oralen Plattenepithelkarzinoms mittels Bürstenzytologie

Background

Large oral lesions comprise the risk that an incisional biopsy does not reveal the most aggressive site in spite of carefully selecting the place of biopsy.

Case report

The first incisional biopsy of a large, clinically suspect, oral lesion could not identify the subepidermal spread of a recurrent oral squamous cell carcinoma. Atypical cells obtained by a simultaneous brush biopsy prompted a renewed, incisional biopsy which finally established the diagnosis of a recurrent, oral squamous cell carcinoma.

Conclusions

The presented case emphasizes the value of brush biopsy in the follow-up of oral squamous cell carcinoma, especially in examination of oral lesions covering a large area.     

Sekundäre Mittelgesichtsrekonstruktion mittels verschiedener Operationsverfahren unter Nutzung der computergestützten Chirurgie

Aim

Aim of this retrospective study was to assess the outcome after secondary midfacial reconstruction using different operation techniques and computer assisted surgery. Functional and aesthetic aspects as well as experiences are reported.

Patients and methods

18 patients were assessed for enophthalmos, diplopia, and aesthetics during a follow-up period of up to 2.5 years.

Results

In 40% of the patients several techniques for soft and hard tissue reconstruction were used. In 5 of the 9 patients diplopia was improved; in 4 patients there was no change. A significant enophthalmos was corrected in 8 out of 12 patients. After additional surgery 6 patients had a good aesthetic result, 7 a satisfactory and 5 a poor.

Conclusion

For secondary midfacial reconstruction often a combination of different surgical techniques is neccessary. Bony asymmetries and enophthalmos were successfully corrected, however, functional and aesthetic impairment due to bad soft tissue condition are difficult to correct. Computer assisted surgery is helpful for dissection within the orbit, for graft placement, and for positioning of osteotomized segments.     

Foudroyanter Verlauf einer therapierefraktären Wegener Granulomatose bei negativen c-ANCA

Background

Wegener's Granulomatosis is a rare systemic disease characterized by the triad of necrotizing granulomas of blood vessels, upper respiratory tract, and kidneys. Diagnosis depends on clinical symptoms (ACR-criteria), detection of serum circulating antineutrophil cytoplasmic antibodies (c-ANCA) and bioptical histopathology.

Case-report

A 34-year-old patient presented with intraoral ulcerating, necrotizing inflammations of the palate and the gingiva. Chest radiograph (nodules, infiltrates), urin analysis (red blood cell casts) being inconspicuous Wegener's granulomatosis was diagnosed by histopathology of an intraoral incisional biopsy. Conventional therapy with corticosteroids and cyclophosphamide relapsed while the disease was taking a progressive course (pulmonary infiltrates, necrotizing vasculitides all over the common integument). The patient died of cardiac decompensation three months after diagnosis. c-ANCAs were not present at any time of disease.

Conclusions

1. Symptoms of the head and neck are manifest in up to 95% of Wegener's granulomatosis. So knowledge of the disease is important for dentists and oral and maxillofacial surgeons in spite of its low prevalence.
2. c-ANCA-titers do not reflect disease activity. Negative c-ANCAs do not exclude Wegener's granulomatosis.
3. Wegener's granulomatosis can take a progressive, therapy resistent course.

     

Die präoperative Radio-Chemo-Therapie beim fortgeschrittenen Mundhöhlenkarzinom

Background

According the guidelines of the German-Austrian-Swiss Council for maxillary and facial tumours (DÖSAK), patients with advanced oral cavity tumours underwent preoperative radiochemotherapy followed by radical surgery. The results were to be evaluated with regard to curability and quality of life and compared with the current literature.

Patients and methods

Between 1993 and 1998, 52 patients were treated. Radiotherapy up to a total dose of 36?Gy was combined with one cycle of cisplatin (12.5?mg/m², days 1–5) chemotherapy. Besides clinical data concerning radiogenic toxicity and surgical complications, quality of life after therapy was of special interest.

Results

Three years after therapy 33 of 52 patients (63.5%) were alive, and after 5 years 19 of 33 patients (57.6%) were still alive. Seven patients (14.6%) had a local recurrence. Side effects of radiotherapy according RTOG scoring were minor; only one patient (1.9%) had grade 3 toxicity. Of 48 patients, 9 (18.7%) had no surgical complications. Quality of life was good in only 14 patients (29.2%); all the other patients (70.8%) suffered from impaired quality of life.

Conclusions

Preoperative radiochemotherapy in advanced oralcavity carcinomas with subsequent radical surgery is an effective treatment regarding long-term survival. The treatment is burdened by lasting impaired quality of life. High scientific priority should hence be directed to a steady improvement of quality of life in these patients.     

Effects of music intervention on anxiety and pain reduction in ambulatory maxillofacial and otorhinolaryngology surgery: a descriptive survey of 27 cases

Purpose

The aim of this study is to determine patients’ opinion regarding listening to music before an ambulatory maxillofacial surgery and effects on anxiety and pain reduction.

Methods

This study was conducted on outpatients having a maxillofacial surgery between December 2015 and April 2016 at Poissy/Saint-Germain-en-Laye hospital (France). Patients listened with headphones to an easy-listening music in the operation theater before the first ambulation. A questionnaire including a visual analog scale (VAS) for pain and anxiety was given to participants. The primary endpoint was to determine patients’ opinion regarding listening to music before surgery. Secondary endpoints were to determine VAS pain mean, VAS anxiety mean before surgery, VAS anxiety mean after surgery, and if patients wanted to listen to their own playlist. We decided to compare VAS anxiety and pain mean between patients who accepted to listen to music (ALM) and who refused to listen to music (RLM).

Results

Nineteen patients ALM and 8 patients RLM to music. 78.9% of patients considered that listening to music before surgery decreased their anxiety. In patients who ALM, the mean (standard deviation, SD) of VAS pain after surgery was 3.42 (1.95), the mean (SD) of VAS anxiety before surgery was 3.1 (2.3), and the mean (SD) of VAS anxiety was 1.21 (0.85). There was a statistically significantly difference of the VAS anxiety mean (SD) before surgery between patients who ALM 3.10 (2.30) and who RLM 6.12 (1.88) (p = 0.005). There was a statistically significantly difference of the VAS anxiety mean (SD) after surgery between patients who ALM 1.21 (0.85) and who RLM 2.62 (1.30) (p = 0.009). Fifty percent of the patients wanted to choose their own music.

Conclusion

Music seems to reduce anxiety before maxillofacial surgery. An interventional randomized study is needed to demonstrate the positive impact of music on anxiety before maxillofacial surgery.

     

Auswirkung der Strahlentherapie auf die Lebensqualität

Purpose

The therapy of patients with oral cancer often requires a combination of surgery and radiotherapy. This leads to trauma of healthy tissue. The impact of this side effect on quality of life was investigated. Additionally the impairment of 19 factors was determined (comprehension of speech for unknown others, comprehension of speech for familiar others, eating/swallowing, mobility of the tongue, opening range of the mouth, mobility of lower jaw, mobility of neck, mobility of arms and shoulders, sense of taste, sense of smell, appearance, strength, appetite, respiration, pain, swelling, xerostomia, halitosis).

Methods

This retrospective multicenter study was conducted under the auspices of DOESAK (a German, Austrian and Swiss cooperative group on tumors of the maxillofacial region). The Bochum Questionnaire on Rehabilitation was used to determine 147 items. 3894 questionnaires where sent to 43 clinics in Germany, Austria and Switzerland. 1761 questionnaires where returned, while 1411 of them included all of the answers necessary for this study.

Results

686 of 1411 patients where irradiated. Before the beginning of therapy the impairment of the 19 factors was not significantly higher in the group that later received radiotherapy. After therapy there is a significantly higher impairment of the irradiated patients. The factors that are especially worse are xerostomia, swallowing and understanding of speech. The quality of life was not significantly lower.

Conclusions

Although radiotherapy leads to trauma of healthy tissue this method is indicated as it has no significant impact on quality of life. During the rehabilitation physiotherapists should relieve the impairment of speech, eating and swallowing.     

Der zentral gestielte myomucosale Zungenlappen zur Rekonstruktion des anterioren Mundbodens

Background

There are several techniques described for the reconstruction of the anterior floor of mouth after tumour surgery. Here, we point out the advantages of the central island tongue flap for this indication.

Patients and methods

We report on 20 patients with medium sized defect in the anterior floor of mouth, which was reconstructed with the central island tongue flap. Besides this surgical technique, we discuss the results of oral rehabilitation after a follow-up period of at least 3 months.

Results

There was now flap necrosis or loss, and the median time for flap formation was less than 45?min. In the follow-up we found successful oral rehabilitation in speech and swallowing.     

Immunhistochemische Untersuchung des Kollagen-Typ-I-Gehalts der Gingiva bei Dysostosis cleidocranialis

Background

Patients with cleidocranial dysplasia (CCD) present a thickend and fibrotic gingiva.

Purpose

To the best of our knowledge it was analysed for the first time, whether this is correlated with an increased rate of collagen I in oral mucosa.

Patients and methods

27 soft tissue biopsies of six CCD-patients and 17 tissue samples of 12 healthy persons were labled with a monoclonal antibody against collagen I and the bound antibodies were detected with alkaline phosphatase-anti-alkaline phophatase-kit. The histological slices were analysed by a digital image recognition software under a fully automated microscope and the rate of collagen I was converted into amounts of grey tones.

Results

The amount of grey tones reached from 11.909 to 15.319 in the CCD-group, and from 2752 to 12.556 in the control group. The U-Test of Mann, Whitney and Wilcoxon for two independent samples generated a rank sum of 91,50 for CCD-patients, and of 79,50 for the control group. The Z-value was 3,246, the p-value 0,005. “Fisher`s exact test” identified a p-value of 0,0003.

Conclusions

The rate of collagen I in the oral mucosa seems to be increased significantly in CCD. This could explain the typical thick and fibrotic consistency of the gingiva and could be one reason for the delayed or missing dentition.     

Die Arthrozentese als hochwirksame Akuttherapie der Kiefergelenkarthralgie

Purpose

This clinical study deals with the efficiency of arthrocentesis in acute arthropathy of the temporomandibular joint (TMJ).

Patients and methods

In total 142?patients (41.5?years average) were included in the examination. Inclusion criteria were a restriction of mouth opening <?40?mm and/or TMJ pain >?3 on a visual analog scale (VAS). The first examination took place the day before surgery; follow-up was performed 1?day and 4?weeks after arthrocentesis. Study parameters were active mouth opening, TMJ pain on preauricular or intra-auricular palpation, myalgia of the temporalis or masseter muscle, and a deviation clicking or crepitation during mouth opening. Arthrocentesis was performed in all patients under general anesthesia by a double puncture, continuous rinsing technique in an inferolateral approach as recommended by Murakami. The upper temporomandibular joint space was rinsed with 250?ml of a physiological sterile saline solution and a pressure of 200?mmHg.

Results

Arthrocentesis resulted in a highly significant increase of mouth opening and a highly significant reduction of TMJ pain on palpation (p<?0.001).

Conclusion

It can be postulated that TMJ arthrocentesis represents a highly efficient therapy of acute TMJ arthropathy. Whether the results have to be judged as a palliative short-time therapy or if even long-term results can be achieved has to be proved by long-term follow-up studies.     

Hyperbare Sauerstofftherapie bei Unterkiefer-Osteomyelitis

Background

Chronic osteomyelitis of the jaw is a relapsing disease with multiple treatment strategies described in the literature. Hyperbaric oxygen therapy is one of them. The purpose of this study was to evaluate the clinical outcome of hyperbaric oxygen therapy in these patients.

Method

All patients with a chronic osteomyelitis of the mandible who received in our department hyperbaric oxygen therapy between 2000 and 2004 were included in this study. The clinical outcome (lack of symptoms e.g. pain, swelling, etc.) was the pivotal evaluation parameter. All patients were divided in three groups according to their medical history. Group 1: All patients with osteomyelitis of the mandible, who received no treatment before. Group 2: All patients with one local relapse, who received only antimicrobial treatment. Group 3: Patients with at least one local relapse after antimicrobial and surgical treatment.

Results

27 patients were evaluated in this study. Seven out of 13 patients in group 1 were relapse free after performing 40 hyperbaric oxygen therapies. However, only 4 of 9 patients in group 3 were relapse free after treatment. In group 2 the hyperbaric oxygen therapy was successful particularly in the younger patients (3 of 4).

Conclusion

Adjuvant hyperbaric oxygen therapy was successful in the treatment of patients with chronic recurrent osteomyelitis of the mandible. Therefore, it is an treatment option which can avoid ablative surgery in some cases.     

Quest for an Ideal Route of Intubation for Oral and Maxillofacial Surgical Manoeuvres

Purpose

The optimal route of intubation that may be planned for different oral and maxillofacial surgical manoeuvres.

Materials and Methods

A study was performed on patients who underwent nasal, oral or submental route of intubation for elective oral and maxillofacial surgery under general anaesthesia. The study variables were the anaesthetic and surgeon factors that should be taken into consideration before intubation and during surgery, and also algorithms for uneventful surgical procedures. The outcome variables were influence of the ‘route of intubation’ on ‘surgical technique’ and vice versa. Overall results were compiled, tabulated and analysed using SPSS version 14.0.

Results

The study sample comprised of 634 patients. It was found that 35 % (204) nasal, 7.5 % (4) oral and 0 % submental route of intubation had statistically significant influence on oral and maxillofacial surgical procedures and vice versa (p < 0.001).

Conclusion

This present study concluded that the surgical access and visibility was immensely improved by following the anaesthetic and surgeon factors in conjunction with algorithms described for uneventful oral and maxillofacial surgical procedures. Further, this has also substantially minimized the influence of the ‘route of intubation’ on ‘surgical technique’ and vice versa.

     

Neuropathy of Trigeminal Nerve Branches After Oral and Maxillofacial Treatment

Objective

To report the incidence of trigeminal neuropathy seen among new patients in a referral center within a period of 1 year (2013). The cause of damage, method of management and treatment outcome was assessed after 1-year follow-up.

Materials and Methods

The records of all new patients visiting the oral and maxillofacial unit of the University hospital of Leuven in 2013 were screened for a history of damage to branches of the trigeminal nerve. The selected records were examined and the duration of nerve damage, received treatment as well as the outcome of the neuropathy after treatment was noted after 1-year follow-up.

Results

56 patients (21 males, 35 females) from 7602 new patients had symptoms of damage to the trigeminal nerve branch. These symptoms persist in more than one-third of the patients [21/56 (37.5 %)] after 1-year follow-up. The least recovery is seen from oral surgery, implant placement, orthognathic surgery and tooth extraction. After 1 year 85 % (12/14) of neuropathic pain cases still have their symptoms as compared to 19 % (5/26) of patients with hypoesthesia.

Conclusion

This study shows a low incidence of nerve damage among the new patients presenting in oral and maxillofacial surgery clinic (<1 %); however, one-third of patients who sustain nerve damage never recover fully. Early diagnosis of the cause of neuropathy is essential. There is a need to objectively assess all patients with symptoms of trigeminal nerve damage before, during and after treatment.

     

Demographic Study of Prevalence of Systemic Diseases in Oral Maxillofacial Surgery Patients of Central India

Summary

An evaluation and consideration of health status of patient prior to any surgical treatment forms an essential part of comprehensive health care. Apparently well but in fact medically compromised patients usually present with unacceptable possibility of complications; whereas adequate pretreatment utilization of many techniques available to diagnose and treat underlying systemic disease significantly decreases morbidity and mortality associated with it.

Aims and Objectives

Purpose of this study was to evaluate, prospectively, prevalence of various systemic diseases in oral surgery patients.

Materials and Methods

For analyzing prevalence of systemic diseases in oral surgery patients, the patients reporting to oral surgery department for various treatments were prospectively evaluated for a period of 6 months and were grouped according to a system involved and findings analyzed to get prevalence in central India.

Result

Of the 12,487 patients who reported to the department 506 (4.055 %) were medically compromised with a highest prevalence of cardiovascular diseases (35.57 %), and least prevalence of infectious diseases (3.55 %). These results are statistically significant (by Chi-square test) at p < 0.01 (χ² = 342.752).

Conclusion

The aim of study was to evaluate prevalence of systemic disease in oral surgery patients of central India which is 4.055 % with highest population showing involvement of cardiovascular disease and minimum population undergoing oral surgical procedures are compromised by various infectious diseases.     

Solitary Extramedullary Plasmacytoma of the Maxillary Sinus,Progressing to Smoldering Multiple Myeloma with Multifocal Skeletal Involvement,which Resolved Completely Following Chemotherapy Alone

Background

The world wide pattern of oral and maxillofacial surgical conditions has rarely been reported despite its significance in ensuring quality of care. A large number of patients are managed surgically in Oral and Maxillofacial Surgery department of Dhaka Dental College Hospital but there has been no surgical audit to identify the potential problems in patient care.

Objectives

The aim of this study was to identify the pattern of oral and maxillofacial conditions in patients of maxillofacial surgery of Dhaka Dental College Hospital, which would provide valuable information to build up the focus of attention, to develop a future strategy plan, to improve its clinical care and extend the academic and research field.

Patients and Methods

A retrospective survey of oral and maxillofacial surgical cases managed at the inpatient Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital. All admitted patients from 1st January, 2012 to 31st December, 2012 were included in this study. The patients’ data were retrieved from the wards registers and patient records. The data were recorded as age, sex, occupation, geographic distribution, diagnosis, treatment done and operation name. These were studied to assess the prevalence of age, sex, diseases and the name of the treatment offered. Analysis of major groups of diagnosis on the basis of age and sex was also studied. Mortality was also recorded.

Results

Between 1st January, 2012 and 31st December, 2012 a total of 768 patients were treated. Among them 494 patients were male while 274 were female, male female ratio was 1.80:1. The majority of the patients were from Dhaka division. The mean age of the patients was 33.20 years; peak age group was 15–30 years. The most common diagnosis was maxillofacial injuries (35 %), followed by oral squamous cell carcinoma (22 %) and odontogenic tumours and hamartomas (11 %). Maxillo-mandibular fixation or wiring was the main modality of treatment. The mortality rate was 0.26 % of total patients.

Conclusions

The department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital is a busy centre for specialized maxillofacial services in Bangladesh. A good number of patients with a wide range of oral and maxillofacial surgical conditions are managed here. Maxillofacial injury and oral cancer are the two most common conditions encountered here.

     

Effekte der Hyperbaren Sauerstofftherapie (HBO) bei der Behandlung infizierter freier Knochentransplantate

Background

Hyperbaric oxygen therapy (HBO) leads to a significant increase of oxygen supply in poorly perfused tissue. Several physiological mechanisms of this treatment modality are suitable for having a positive effect on infected large autologous free bone transplants.

Case report

In a 49-year-old male with a metastasized squamous cell carcinoma of the floor of the mouth radical tumour surgery with subsequent radiation was performed. Nine years later an infected osteoradionecrosis of the mandible emerged which required a continuity-resection with simultaneously performed reconstruction of the mandible using an autologous free transplanted iliac bone graft. Four days post surgery wide intraoral dehiscence with complete denuding of the bone graft occured. For this reason initiation of an adjuvant hyperbaric oxygen therapy in addition to high dose antibiotic therapy and local wound care. Combined therapy led to granulation tissue on the surface of the transplanted bone with subsequent epithelization. Complete incorporation and conversion of the bone transplant with full rehabilitation concerning function and aesthetics was noted.

Discussion

Without HBO treatment the large volume infected autologous free bone transplant would have been lost. Beside other capabilities of HBO the induction of rapid neovascularisation and increasing oxygen diffusion radius are the reasons that the infected transplant was saved. Only under these conditions it was possible to erradicate the bacterial infection effectively with antibiotics.     

Ursachen, Therapie und Komplikationen bei der Frakturversorgung des Unterkiefers – eine retrospektive Analyse von 10 Jahren

Background

Fractures of the mandible are a common form of facial injury. The aetiological factors associated with mandibular fractures and the trends in these factors over a 10-year period are reported.

Methods

A retrospective survey was carried out of 724 patients presenting with a fracture of the mandible over the 10-year-period 1994–2003. Patients` records were reviewed and analyzed according to age, sex, cause of injury, anatomic site of fracture, treatment and postoperative complications.

Results

Over the 10-year-period the rate of mandibular fractures remained constant (mean 40,7%). There were no changes in the age group (mean 33,3 years) or in the higher prevalence in male (male-female-ratio 2,3?:?1). The major causes of fractures were assaults (38,6%) and accidental fall (27,3%). The most common fracture site was the condylar region (47,0%) followed by the angle (29,4%). Most fractures were treated by closed reduction until 2002, thereafter surgical treatment increased noticeable. The complication rate was 8,9% and the most common complications were hardware exposure and infection.

Conclusion

Fractures of the mandible are a prevalent form of facial injury. Aetiological factors show no significant change over the 10-year-period. Complication-rate is low and will support the tendency towards surgical treatment.