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INTRODUCTION: Facial bone fractures triggered by low-height falls are rare in toddlers, while severe intracranial injuries resulting from minor trauma are extremely rare. CASE: Herein, we report the case of a 2-year-old girl who fell from a baby chair, striking her chin, who rapidly developed impaired consciousness 3 h later. The patient subsequently presented with a mandibular fracture and acute obstructive hydrocephalus due to a traumatic isolated subarachnoid hemorrhage in the posterior cranial fossa. She was successfully treated with ventricular drainage, which achieved a favorable outcome. CONCLUSION: Maxillofacial trauma and head injuries are closely associated. Even in minor cases of maxillofacial trauma, vigilant monitoring and prompt intervention are crucial to prevent fatal outcomes in toddlers.

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The approach to mandibular fractures remains a contentious topic, with the vestibular and crevicular approaches being prominent incision options, each offering distinct advantages. This review explores the comparative benefits of crevicular incisions over the vestibular approach, focusing on ease of surgical access, better fracture reduction, and enhanced soft tissue healing. Along with a thorough literature review, a case report is also presented to exemplify the successful implementation of crevicular incision in treating a mandibular fracture, emphasizing on its key advantages, which include decreased risk of nerve injury and enhanced patient comfort, underscoring the clinical benefits of this approach. By synthesizing existing literature and case report findings, this review supports the adoption of crevicular incision as a preferred approach for various mandibular fracture cases. This approach offers clinicians a reduced surgical time, good soft tissue adaptation, improved surgical outcomes, and patient well-being.

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Objectives: This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. Methods: This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. Results: A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients' clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications.

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BACKGROUND: Patients presenting with partially impacted lower third molars (M3) have a higher likelihood of experiencing angle fractures while simultaneously decreasing the risk of condylar fractures. However, the specific biomechanical mechanism responsible for this occurrence remains unclear. Moreover, there is an ongoing debate regarding whether the removal of M3s might actually increase the risk of condylar fractures. This study aimed to evaluate how the presence of M3s influences mandibular fractures resulting from blows to the symphysis and lateral mandibular body, and to determine the indication for extracting M3s in such cases. METHODS: Models of the mandible with a partially M3-impacted model (M3I), M3-extracted model (M3E), and M3-absent model (M3A) were generated using a computer. A traumatic blown force of 2000 N was applied to the symphysis and the right body of the mandible. Von Mises and principal stresses were analyzed, and failure indexes were determined. Two cases of mandibular linear fractures were chosen for model verification and interpretation. RESULTS: When force was applied to the symphysis, the condylar region exhibited the highest stress levels, while stress in the mandibular angle region was much less regardless of the M3 state. On applying the force to the right mandibular body, stress in the condylar region decreased while stress in the mandibular body increased, especially in the blown regions. Impacted tooth or cavity formation post-M3 extraction led to uneven stress distribution on the blown side of the mandible, increasing the risk of mandibular angle fractures. In cases where M3 was absent or the extraction socket had healed, stress from lateral traumatic blown force was evenly distributed along both the inner and outer oblique lines of the mandible, thereby reducing the risk of mandibular fractures. CONCLUSIONS: The reduced risk of condylar fractures in patients with partially impacted lower M3s and mandibular angle fractures is mainly due to lateral blows on the mandible, which generate less stress in the condylar region than blows on the mandibular symphysis, rather than being caused by the M3 itself. Extraction of the lower M3 can decrease the risk of mandibular fractures, with a minor influence on condylar fractures.

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Dentigerous cysts, if left untreated, can grow significantly and weaken the mandible, posing risks of pathological or iatrogenic fracture. Treatment options may include decompression, marsupialization, and enucleation, which are available, with the choice being multifactorial and tailored to each case. This article describes the management of two complex dentigerous cysts at risk of fracture, one about an 84-year-old woman and the second about a 41-year-old man. The cysts and associated teeth were surgically removed, and simultaneously custom-made titanium osteosynthesis plates were placed to prevent per- and postoperative fracture risks. This approach appears to be indicated in cases where marsupialization or decompression is impossible and when there is a high risk of iatrogenic fracture.

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PURPOSE: Shaping and assembling contemporary external fixators rapidly for the severe mandibular fractures remains a challenge, especially in emergency circumstance. We designed a novel external fixator that incorporates universal joints to provide the stabilization for mandibular comminuted fractures. This study aims to confirm the efficacy of this novel external fixator through biomechanical tests in vitro and animal experiments. METHODS: In vitro biomechanical tests were conducted using 6 fresh canine with mandibular defect to simulate critical comminuted fractures. Three mandibles were stabilized by the novel external fixator and other mandibles were fixed by 2.5 mm reconstruction plates. All fixed mandibles were subjected to loads of 350 N on the anterior regions of teeth and 550 N on the first molar of the unaffected side. The stability was evaluated based on the maximum displacement and the slope of the load-displacement curve. In animal experiments, 9 beagles with comminuted mandibular fractures were divided into 3 groups, which were treated with the novel external fixation, reconstruction plate, and dental arch bar, respectively. The general observation, the changes in animals' weight, and the surgical duration were recorded and compared among 3 groups. The CT scans were performed at various intervals of 0 day (immediately after the surgery), 3 days, 7 days, 14 days, 21 days, and 28 days to analyze the displacement of feature points on the canine mandible and situation of fracture healing at 28 days. The statistical significance was assessed by the two-way analysis of variance test followed by the Bonferroni test, enabling multiple comparisons for all tests using GraphPad Prism10.1.0 (GraphPad Inc, USA). RESULTS: The outcomes of the biomechanical tests indicated that no statistically significant differences were found in terms of the maximum displacement (p = 0.496, 0.079) and the slope of load displacement curves (p = 0.374, 0.349) under 2 load modes between the external and internal fixation groups. The animal experiment data showed that there were minor displacements of feature points between the external and internal fixation groups without statistic difference, while the arch bar group demonstrated inferior stability. The CT analysis revealed that the best fracture healing happened in the internal fixation group, followed by the external fixation and arch baring at 28 days after fixation. The external fixation group had the shortest fixation duration (25.67 ± 3.79) min compared to internal fixation ((70.67 ± 4.51) min, p < 0.001) and arch baring ((42.00 ± 3.00) min, p = 0.046). CONCLUSION: The conclusion of this study highlighted the efficacy and reliability of this novel external fixator in managing mandibular fractures rapidly, offering a viable option for the initial stabilization of comminuted mandibular fractures in the setting of emergency rescue.

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Introduction Traumatic facial injuries, leading to facial fractures represent a significant subset of traumatic events, with age emerging as a crucial determinant influencing both their etiology and outcomes. Understanding the age-related patterns of traumatic facial fractures is essential for developing targeted prevention and management strategies. In this context, the Appalachian tri-state area stands as an underexplored region concerning this issue, necessitating comprehensive research to elucidate the nuances of age-related traumatic facial fractures within this geographic context. Methods This retrospective study delves into the age-related patterns of traumatic facial fractures within the Appalachian tri-state area, drawing upon patient records from Cabell Huntington Hospital and Saint Mary's Medical Center spanning a five-year period. The study cohort encompasses 623 patients categorized into three age groups: individuals aged <22 years, those aged 22-65 years, and individuals over 65 years. Data analysis involves meticulous examination of mechanisms of injury, injury severity scores (ISSs), hospital length of stay, and the prevalence of surgical interventions across different age cohorts. Results Out of 623 patients, 104 (16.7%) were under 22 years old, 367 (58.9%) were between 22 and 65 years old, and 152 (24.4%) were over 65 years old. The majority were male (70%). Falls were the most common cause of facial fractures in patients over 65 (78%), while assaults were predominant in the 22-65 age group (24%), and motor vehicle collisions (MCVs) in those under 22 (34%). The median ISS and hospital stay durations were similar across age groups. 28% of patients underwent surgery, with significant variation among age groups (p<0.001): 38% for <22 years, 33% for 22-65 years, and 11% for >65 years. Mandibular fractures were more prevalent in younger patients, with rates of 12% for <22 years compared to 5.3% for >65 years. Logistic regression analysis revealed that patients aged 22-65 had 4.10 times higher odds (95% CI=2.38, 7.45, p<0.001) of undergoing surgery, while those under 22 had 5.14 times higher odds (95% CI=2.73, 10.0, p<0.001) compared to those over 65. Significant associations were found for mandibular and bilateral mandibular outcomes in patients aged 22-65 years. Discussion These findings underscore the imperative for tailored prevention strategies and age-specific treatment protocols to optimize patient outcomes. Fall prevention initiatives for the elderly and interventions addressing sports-related injuries for younger individuals are paramount. Moreover, the study highlights the necessity of specialized care protocols for elderly patients to minimize hospital stay durations and manage age-related comorbidities effectively. Moving forward, further research should address limitations, validate findings, and explore the efficacy of specific interventions, thereby paving the way for enhanced preventive measures and management strategies tailored to the diverse age cohorts affected by traumatic facial fractures in the Appalachian region.

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Mandible fractures are one of the most common facial fractures. Within the mandible, the condylar process fractures have the highest frequency of occurrence. This fracture type is associated with cases of assaults and falls. Fractures of the condylar head are frequently missed on clinical examination if the ramus height shortening is absent. These types of fractures have a higher incidence in the pediatric population. Condyles tend to fracture with other anatomical subsites of the mandible. The isolated fracture of a single condylar component is less common. This report highlights the unusual case of an isolated unilateral condylar head fracture in an adult female following a road traffic accident (RTA). This case report attempts to discuss the incidence rate of such types of fractures and the controversies surrounding them.

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INTRODUCTION AND IMPORTANCE: Pathological mandibular fractures, defined as fractures that occur in regions where bone has been weakened by an underlying pathological process, are rare, accounting for fewer than 2 % of all fractures of the mandible. Mandibular pathological fractures can have several aetiologies including osteomyelitis, osteoradionecrosis (ORN), surgical interventions, bisphosphonate-related osteochemonecrosis of the jaw and tumoral lesions. CASE PRESENTATION: We present a case of a 13-year-old male patient following a tooth infection with a right facial swelling and limited mouth opening, multiple purulent cutaneous fistulas and mandibular hypoplasia. Intraoral examination revealed the presence of generalized calculus, dental mobility in quadrants 3 and 4. We carried out an orthopantomography which revealed a mandibular angle fracture and the diagnosis of secondary mandibular osteomyelitis with pathological fracture was retained. Sequestrectomy was carried out followed by an open reduction with mini reconstruction plates. CLINICAL DISCUSSION: At 13 years old, this patient with a secondary mandibular osteomyelitis, to the best of our knowledge is the youngest case reported having a secondary mandibular osteomyelitis as etiology of his pathological fracture. Due to the early onset, the patient presented with a bird's profile clinically. His pathological fracture was due to a vicious cycle limiting bone turnover created by the secondary osteomyelitis. CONCLUSION: Pathological mandibular fractures are complex and challenging to treat because of their different aetiologies and also clinicians often have to deal with individuals with grossly infected bone with the fracture management dependent on the resulting bony defect.

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INTRODUCTION: Surgical therapy is effective for medication-related osteonecrosis of the jaw. However, appropriate conservative treatment options are still important for cases in which surgery is contraindicated. We report a case of medication-related osteonecrosis of the jaw successfully treated conservatively for a pathological mandibular fracture. PRESENTATION OF CASE: An 84-year-old female patient presented to our department with a chief complaint of inadequate healing of an extraction tooth socket. She had been taking minodronic acid hydrate for approximately five years for osteoporosis. The clinical examination revealed erythema, diffuse swelling of the left mandibular angle, erythema of the buccal gingiva adjacent to the left mandibular first molar, and fistula formation. Although surgery was recommended, the patient declined to proceed. Therefore, a conservative treatment was initiated. A pathological fracture of the inferior mandibular margin was observed one month after the initial visit. Mouth opening was restricted for six months using a bandage. Two months after the pathological fracture, the inferior margin of the fracture was aligned. Five months later, the inferior margin continued. One year later, the bony union of the fracture was observed. DISCUSSION: Conservative treatment and restricting mouth opening was effective in our case. Three years and seven months after the pathological fracture, no new sequestrum formation was observed, and the patient was doing well. CONCLUSION: Conservative treatment can be effective for medication-related osteonecrosis of the jaw with severe cases.

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This study aims to assess the outcomes of mandibular fractures treated through surgical stabilization using plates and screws, focusing on factors such as postoperative complications, patient satisfaction, and functional recovery. A total of 42 patients were included in the study. Surgical interventions involved the application of plates and screws at the fracture sites. Postoperative complications, including infection, hardware failure, and malocclusion, were recorded. Surgical stabilization of mandibular fractures using plates and screws demonstrates favorable outcomes in terms of stability, occlusal alignment, and patient satisfaction. The findings of this study contribute valuable insights into the efficacy of this surgical approach, highlighting its role in achieving successful outcomes for mandibular fracture management. Further prospective studies and randomized controlled trials are recommended to strengthen the evidence base and refine treatment protocols.

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Isolated coronoid process fractures are uncommon, and iatrogenic isolated fractures are extremely rare. This case describes a displaced fracture of an isolated coronoid process thought to be due to excessive force applied by a dentist that had been overlooked and left untreated for about a month. The patient was a woman in her late 50's and she had undergone a molar extraction. Her dentist had confused her symptoms of trismus, pain, and facial oedema with the complex tooth extraction procedure. Following a cone-beam computed tomography (CBCT) scan we showed that the mandibular coronoid process on her right side had suffered a longitudinal fracture, and the fractured fragment had rotated upwards and inwards. Following successful surgical elimination of the fragmented coronoid process, the patient received targeted physiotherapy sessions that yielded excellent results. At the five-month follow-up, the ability of the patient to open her mouth had improved enormously, and her facial appearance almost recovered to its original state.

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CASE SERIES SUMMARY: A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively. RELEVANCE AND NOVEL INFORMATION: In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.

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This review examines the prevailing modalities for fractures of the anterior mandible, which represent a significant proportion of the maxillofacial injuries commonly treated by oral and maxillofacial surgeons. The article traces the historical shift from conservative techniques to the dominant management strategies of open reduction and fixation. Encompassing a range of studies, the review, in accordance with PRISMA 2020 recommendations, meticulously examines various fixation methods, assessing their efficacy in achieving stability of fracture, early healing, and mobilisation. The comparison of these methods highlights their unique advantages and limitations, and demonstrates the need for more nuanced and precise approaches. The review emphasises evidence-based methodology in the management of anterior mandibular fractures (AMF), highlighting the benefits offered by innovative techniques such as 3D miniplates. It also acknowledges the advantages provided by older fixation devices such as lag screws. The importance of postoperative outcomes and the need for tailored treatment strategies are recognised, considering the complex nature of these fractures.

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Treatment of edentulous and atrophic mandibular fractures is extremely difficult. Generally, mandibular fractures are repaired and fixed as internal fixation using a reconstruction plate or miniplates with intra- or extraoral approach. Few cases in which external fixation including a transmucosal fixation was performed have also been reported. We report a case of atrophic and edentulous mandibular fracture which was healed by the fixation using dental implants and implant-supported bridge.

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Pediatric maxillofacial fractures, which are not very prevalent, account for around 5% of all face injuries. Children under the age of 13 are more susceptible to craniofacial injuries because they have a larger cerebral mass-to-body ratio than adults. The fracture pattern in children does not resemble that of adults, due to which the treatment of pediatric fractures differs from that of adults and can pose substantial difficulties to the pediatric dentist due to many factors, including the complex anatomy of the developing jaw. In this case report, a 5-year-old male patient presented with an injury to the upper and lower jaw. A case was managed with a conservative approach by using a modified open cap splint. A radiographic investigation, including CT brain and face, was done, which revealed the mandibular symphyseal fracture, bilateral condyle, and right Lefort II fracture. A modified open cap splint was fabricated and fixed with circummandibular and circumzygomatic wiring under general anesthesia. After two months, the fractured site showed good healing on orthopantomography (OPG), and satisfactory occlusion was achieved. The patient was kept on monthly follow-ups for up to five months. Treatment guidelines for pediatric maxillary and mandibular fractures are different from those for adults in that most pediatric cases are managed by a conservative approach. Cap splints are a versatile treatment option for juvenile mandibular fractures because they can be used to restore function and aesthetics with minimal morbidity, do not impede jaw growth or the development of dentition, and can be applied to patients of a wider range of ages.

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A 64-year-old edentulous woman with a mandibular fracture received a subperiosteal implant for fracture fixation and dental rehabilitation. However, the ball abutments were submerged by the soft tissue because they were too short. Therefore, we designed a connector to lengthen the attachment and achieve adequate stability and retention for the overdenture.

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Mandibular fractures are very common in maxillofacial trauma surgery. While previous studies have focused on possible risk factors related to post-operative complications, none have tried to identify pre-existing conditions that may increase the risk of mandibular fractures. We hypothesized, through clinical observation, that anatomical conditions involving poor dental contacts, such as malocclusions, may increase the risk of mandibular fractures. This work was subdivided into two parts. In the first part, Digital Imaging and Communications in Medicine (DICOM) data of four healthy patients characterized by different dentoskeletal occlusions (class I, class II, class III, and anterior open bite) have been used to develop four finite element models (FEMs) that accurately reproduce human bone structure. A vertical and lateral impact have been simulated at increasing speed on each model, analyzing the force distribution within the mandibular bone. Both vertical and lateral impact showed higher level of stress at the impact point and in the condylar area in models characterized by malocclusion. Specifically, the class III and the open bite models, at the same speed of impact, had higher values for a longer period, reaching critical stress levels that are correlated with mandibular fracture, while normal occlusion seems to be a protective condition. In the second part of this study, the engineering results were validated through the comparison with a sample of patients previously treated for mandibular fracture. Data from 223 mandibular fractures, due to low-energy injuries, were retrospectively collected to evaluate a possible correlation between pre-existing malocclusion and fracture patterns, considering grade of displacement, numbers of foci, and associated CFI score. Patients were classified, according to their occlusion, into Class I, Class II, Class III, and anterior open bite or poor occlusal contact (POC). Class I patients showed lower frequencies of fracture than class II, III, and open bite or POC patients. Class I was associated with displaced fractures in 16.1% of cases, class II in 47.1%, class III in 48.8% and open bite/POC in 65.2% of cases (p-value < 0.0001). In class I patients we observed a single non-displaced fracture in 51.6% of cases, compared to 12.9% of Class II, 19.5% of Class III and 22.7% of the open bite/POC group. Our analysis shows that class I appears to better dissipate forces applied on the mandible in low-energy injuries. A higher number of dental contacts showed a lower rate of multifocal and displaced fractures, mitigating the effect of direct forces onto the bone. The correlation between clinical data and virtual simulation on FEM models seems to point out that virtual simulation successfully predicts fracture patterns and risk of association with different type of occlusion. Better knowledge of biomechanics and force dissipation on the human body may lead to the development of more effective safety devices, and help select patients to plan medical, orthodontic/dental, and/or surgical intervention to prevent injuries.

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BACKGROUND: It is very important to detect mandibular fracture region. However, the size of mandibular fracture region is different due to different anatomical positions, different sites and different degrees of force. It is difficult to locate and recognize fracture region accurately. METHODS: To solve these problems, M3YOLOv5 model is proposed in this paper. Three feature enhancement strategies are designed, which improve the ability of model to locate and recognize mandibular fracture region. Firstly, Global-Local Feature Extraction Module (GLFEM) is designed. By effectively combining Convolutional Neural Network (CNN) and Transformer, the problem of insufficient global information extraction ability of CNN is complemented, and the positioning ability of the model to the fracture region is improved. Secondly, in order to improve the interaction ability of context information, Deep-Shallow Feature Interaction Module (DSFIM) is designed. In this module, the spatial information in the shallow feature layer is embedded to the deep feature layer by the spatial attention mechanism, and the semantic information in the deep feature layer is embedded to the shallow feature layer by the channel attention mechanism. The fracture region recognition ability of the model is improved. Finally, Multi-scale Multi receptive-field Feature Mixing Module (MMFMM) is designed. Deep separate convolution chains are used in this modal, which is composed by multiple layers of different scales and different dilation coefficients. This method provides richer receptive field for the model, and the ability to detect fracture region of different scales is improved. RESULTS: The precision rate, mAP value, recall rate and F1 value of M3YOLOv5 model on mandibular fracture CT data set are 97.18%, 96.86%, 94.42% and 95.58% respectively. The experimental results show that there is better performance about M3YOLOv5 model than the mainstream detection models. CONCLUSION: The M3YOLOv5 model can effectively recognize and locate the mandibular fracture region, which is of great significance for doctors' clinical diagnosis.

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Previous research on computer-assisted jawbone reduction for mandibular fracture surgery has only focused on the relationship between fractured sections disregarding proper dental occlusion with the maxilla. To overcome malocclusion caused by overlooking dental articulation, this study aims to provide a model for jawbone reduction based on dental occlusion. After dental landmarks and fracture sectional features are extracted, the maxilla and two mandible segments are aligned first using the extracted dental landmarks. A swarm-based optimization is subsequently performed by simultaneously observing the fracture section fitting and the dental occlusion condition. The proposed method was evaluated using jawbone data of 12 subjects with simulated and real mandibular fractures. Results showed that the optimized model achieved both accurate jawbone reduction and desired dental occlusion, which may not be possible by existing methods.

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