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Facial trauma: epidemiology, demographics and fracture patterns
234 able to compare treatment outcomes from different centres. An algorithm is presented to facilitate this. http://dx.doi.org/10.1016/j.ijom.2017.02.789 Infections and cancers mimicking temporomandibular disorders N. Ogi ∗ , Y. Katayama, M. Izumi, Y. Ariji, E. Ariji, K. Kurita Aichi Gakuin University, Nagoya, Japan Background: Jaw pain and trismus are common clinical symptoms among temporomandibular disorders (TMD) patients. These symptoms by a reason other than TMD may puzzle clinicians. Chronic dental infection can provoke the symptoms. Cancer is a rare cause but serious scenario. This report analysed 4 cases presenting TMD-like symptoms: two with chronic dental infections and two with malignancies. Objectives: This report stresses the importance of differential diagnoses of TMD with imaging diagnostics. Methods: The four patients were initially diagnosed with TMD and referred to TMJ clinic. Chronic dental infections: Case 1 and Case 2 with jaw pain and trismus without response to TMD treatment. Malignancies: Case 3 and Case 4 with progressive symptoms in spite of TMD treatment. Findings: Chronic dental infections — computed tomography (CT) scan revealed infection of dental origin into the infratemporal space in Case 1, and postsurgical infection of infra-masseteric space secondary to maxillary dental extraction in Case 2. Surgical drainage and antibiotics successfully resolved the symptoms in both cases. Malignancies — magnetic resonance imaging and/or CT scan disclosed a destructive mass in the condyle in Case 3, and in Case 4 a large cancer mass occupied the sinus and spreading into the adjacent structures. Pathologic examination confirmed lung metastatic adenocarcinoma in Case 3 and squamous cell carcinoma in Case 4. Both patients underwent chemoradiation, but passed away after four and six months, respectively. Conclusion: It is indispensable that oral surgeons be on the alert to symptoms mimicking TMD. Once any underlying disease is suspected, advanced imaging diagnostics should be considered immediately. http://dx.doi.org/10.1016/j.ijom.2017.02.790 Long-term unilateral temporomandibular joint dislocation — a case report R. Parumo ∗ , B.C. Ma, M. Akbar Ali, N.A. Zainal Oral and Maxillofacial Department, Hospital Sultanah Aminah, Johor, Malaysia Background: Chronic long-term temporomandibular joint (TMJ) dislocation is rare. It occurs when a case of acute dislocation is left untreated or is inadequately treated. This long-term anterior positioning of the condyle will caused fibrosis of soft tissue and spasm of the muscle. Therefore the management is complex and controversial.
Objectives: To present the experience in managing this particular long-term unilateral TMJ dislocation and to review the literature related to the management of this rare condition. Methods: A 28-year-old male patient complained of being unable to close his mouth, chew food and speak properly for one month. He was unable to close his mouth after yawning and did not seek treatment immediately. Clinical examination showed an open bite with right side deviation of mandible, excessive salivation and palpable condyle with depression in the left preauricular area. Imaging investigation confirmed of left TMJ dislocation. Manual manipulation was attempted, followed by acrylic blocks with elastic traction placed on arch bars but were unsuccessful. Finally, open reduction technique was carried out under general anaesthesia using wire traction at the angle of mandible to reposition the left condyle back to glenoid fossa. Findings: The left dislocated condyle was successfully disengaged inferiorly and positioned into it glenoid fossa after few attempts. Intraoperative maxillomandibular fixation with wires was done and patient was extubated. Conclusion: Conservative treatments should be the first line approaches before utilising the more invasive surgical methods when managing a long-term unilateral TMJ dislocation. http://dx.doi.org/10.1016/j.ijom.2017.02.791 Facial trauma: epidemiology, demographics and fracture patterns M. Qiu ∗ , A. Barberi, K. Lee Western Health, Australia Background: Trauma of the maxillofacial region has a variety of causal mechanisms and can be seen across a wide variety of patient demographics. There is a variation in the aetiology and fracture patterns within different patient populations within published literature. Objectives: To examine the aetiology, incidence, anatomical patterns, demographics and treatment types associated with patients admitted with facial fractures. Methods: The Victoria Admitted Episodes Dataset of all facial trauma in Victoria between 2004 to 2014 was requested from Turning Point Drug and Alcohol Centre. The dataset was deidentified. Factors relating to aetiology, anatomical distribution, admission funding, patient demographics and regions within the Australian state of Victoria were analysed. Descriptive statistics and regression analysis were performed to identify factors relating to admission. Findings: Over the 10-year period analysed, there were 54,730 patient admissions for facial trauma. Within this patient cohort there were 73,797 facial fractures. Causes for facial fractures were identified and categorised, with facial trauma from falls (29.5%), interpersonal violence (23.7%) and transport accidents (14.9%) being the three main causes for facial trauma within our patient population. Facial fracture pattern types varied depending on the patient demographic, including sex and age of the patient. Various factors were found to be associated with an increase in length of stay for facial trauma admission as well as operative as opposed non-operative management of fractures. Facial fractures were noted to have distinct peaks in the third and eighth decades of life.
235 Conclusion: This retrospective population study demonstrates an insight into the demographics and fracture patterns in facial trauma patients. http://dx.doi.org/10.1016/j.ijom.2017.02.792 Mandibular distraction osteogenesis preceding interpositional arthoplasty — a novel protocol in management of temporomandibular joint ankylosis M.J. Raghani ∗ , B. Pappachan All India Institute of Medical Sciences (AIIMS), Raipur, India Background: Temporomandibular joint (TMJ) ankylosis leads to a significant amount of facial deformity in the affected individuals, more so in adult patients with long-standing bony union. Correction of facial deformity by distraction osteogenesis has now become a mainstay for the treatment of craniofacial syndromes with mandibular hypoplasia including TMJ ankylosis. There is an increased risk of reankylosis when the facial deformity due to TMJ ankylosis is attempted to be corrected by the distraction osteogenesis after release of ankylotic mass. To overcome this potential problem we have attempted the correction of facial deformity by distraction prior to release of ankylosis. Objectives of this study: To evaluate the benefits of distraction osteogenesis prior to release of TMJ ankylosis. Methods: 50 patients of TMJ ankylosis were treated using our protocol i.e. distraction first and then ankylosis release subsequently. Patients included in this study were aged between 5 and 50 years. Both extraoral and intraoral distractors were used depending on the requirement and socioeconomic status of the patient. Minimum follow-up period was 6 months. Findings and Conclusion: The combination of correction of facial deformity as the primary procedure and ankylosis release as secondary procedure provides good functional and aesthetic results in patients with facial deformity due to TMJ ankylosis. http://dx.doi.org/10.1016/j.ijom.2017.02.793 Effectiveness of vitamin b complex in reducing chronic temporomandibular joint disorder pain — double blind randomised clinical trial J.R. Rajaran ∗ , W.S. Choi The University of Hong Kong, Hong Kong Background: Chronic temporomandibular joint disorder (TMD) pain management has always been challenging and usually requires long-term analgesics. Commonly used analgesics have a potential for adverse effects in long-term usage, thus there is a need to look for a safer alternative analgesic option. Objectives: To evaluate efficacy of vitamin B complex (VBC) [B1, B6, B12] in reducing chronic TMD pain. Methods: 26 patients with chronic TMD pain secondary to arthralgia, osteoarthritis and disc displacement were included. The patients were allocated randomly into two groups and received either VBC tablet (B1: 242.5 mg, B6: 250 mg, B12: 1 mg) or placebo once per day for six weeks. Clinical measurements were recorded at week 0 and week 2, week 4, and week 6 to evaluate the efficacy of the treatment. Pain intensity was measured by visual analogue score (VAS) and mandibular range of movement
was measured by maximal comfortable mandibular opening and lateral excursion. Adverse effects and compliance rate towards treatment were also assessed. Findings: In this 6-week clinical trial, both groups showed significant VAS pain reduction (VBC 2.49 ± 1.71; placebo 1.41 ± 1.53; P < 0.05). The amount of VAS pain reduction in the VBC group was significantly higher than in the Placebo group at week 2 (1.19 ± 1.28 versus 0.23 ± 0.90) and week 4 (2.32 ± 1.42 versus 1.25 ± 0.75; P < 0.05). No statistically significant difference was noted in mouth opening improvement. Both VBC and placebo medications were well tolerated with minimal adverse effects. Conclusion: In this study a dose of VBC (B1: 242.5 mg, B6: 250 mg, B12: 1 mg) was significantly better than placebo in reducing chronic TMD pain at week two and week four. http://dx.doi.org/10.1016/j.ijom.2017.02.794 Frequency and morbidity of temporomandibular joint involvement in adult patients with a history of juvenile idiopathic arthritis C. Resnick ∗ , R. Dang, L. Henderson, D. Zander, K. Daniels, P. Nigrovic, L. Kaban Boston Children’s Hospital, Boston, MA, United States Background: The majority of patients with juvenile idiopathic arthritis (JIA) have involvement of the temporomandibular joints (TMJs), but little is known about the natural history of TMJ disease as these children enter into adulthood. Objective: To evaluate adults with a history of JIA in order to document the frequency and severity of TMJ abnormalities and TMJ-related morbidity. Methods: This is a cross-sectional study including adult patients with JIA who were managed at Boston Children’s Hospital as children and at Brigham and Women’s Hospital as adults. Subjects completed a study questionnaire, physical examination and maxillofacial cone-beam CT (CBCT). Additional data was obtained from medical records. We examined the associations between our primary outcome variable: TMJ abnormality on CBCT, and components of the arthritis history, arthritis severity, dental/orthodontic history, TMJ pain, maximal incisal opening (MIO), facial asymmetry, physical examination findings and cephalometric analysis. Findings: 21 subjects (42 TMJs) with mean age 26.06.1 years and a mean duration of care for JIA in our institution of 13.76.5 years were enrolled. 62% had TMJ pain, 43% had functional limitation, and 76% had lower facial asymmetry. TMJ abnormalities were found on 55% of CBCTs, with 79% bilateral. 81% had one cephalometric measurement relating to mandibular size or position >1 standard deviation from normal. Conclusion: TMJ abnormalities and related morbidity are common in adult patients with a history of JIA. Therefore, an early screening protocol for TMJ involvement may be sensible and long-term follow-up in to adulthood is necessary. http://dx.doi.org/10.1016/j.ijom.2017.02.795
Objectives: To present the experience in managing this particular long-term unilateral TMJ dislocation and to review the literature related to the management of this rare condition. Methods: A 28-year-old male patient complained of being unable to close his mouth, chew food and speak properly for one month. He was unable to close his mouth after yawning and did not seek treatment immediately. Clinical examination showed an open bite with right side deviation of mandible, excessive salivation and palpable condyle with depression in the left preauricular area. Imaging investigation confirmed of left TMJ dislocation. Manual manipulation was attempted, followed by acrylic blocks with elastic traction placed on arch bars but were unsuccessful. Finally, open reduction technique was carried out under general anaesthesia using wire traction at the angle of mandible to reposition the left condyle back to glenoid fossa. Findings: The left dislocated condyle was successfully disengaged inferiorly and positioned into it glenoid fossa after few attempts. Intraoperative maxillomandibular fixation with wires was done and patient was extubated. Conclusion: Conservative treatments should be the first line approaches before utilising the more invasive surgical methods when managing a long-term unilateral TMJ dislocation. http://dx.doi.org/10.1016/j.ijom.2017.02.791 Facial trauma: epidemiology, demographics and fracture patterns M. Qiu ∗ , A. Barberi, K. Lee Western Health, Australia Background: Trauma of the maxillofacial region has a variety of causal mechanisms and can be seen across a wide variety of patient demographics. There is a variation in the aetiology and fracture patterns within different patient populations within published literature. Objectives: To examine the aetiology, incidence, anatomical patterns, demographics and treatment types associated with patients admitted with facial fractures. Methods: The Victoria Admitted Episodes Dataset of all facial trauma in Victoria between 2004 to 2014 was requested from Turning Point Drug and Alcohol Centre. The dataset was deidentified. Factors relating to aetiology, anatomical distribution, admission funding, patient demographics and regions within the Australian state of Victoria were analysed. Descriptive statistics and regression analysis were performed to identify factors relating to admission. Findings: Over the 10-year period analysed, there were 54,730 patient admissions for facial trauma. Within this patient cohort there were 73,797 facial fractures. Causes for facial fractures were identified and categorised, with facial trauma from falls (29.5%), interpersonal violence (23.7%) and transport accidents (14.9%) being the three main causes for facial trauma within our patient population. Facial fracture pattern types varied depending on the patient demographic, including sex and age of the patient. Various factors were found to be associated with an increase in length of stay for facial trauma admission as well as operative as opposed non-operative management of fractures. Facial fractures were noted to have distinct peaks in the third and eighth decades of life.
235 Conclusion: This retrospective population study demonstrates an insight into the demographics and fracture patterns in facial trauma patients. http://dx.doi.org/10.1016/j.ijom.2017.02.792 Mandibular distraction osteogenesis preceding interpositional arthoplasty — a novel protocol in management of temporomandibular joint ankylosis M.J. Raghani ∗ , B. Pappachan All India Institute of Medical Sciences (AIIMS), Raipur, India Background: Temporomandibular joint (TMJ) ankylosis leads to a significant amount of facial deformity in the affected individuals, more so in adult patients with long-standing bony union. Correction of facial deformity by distraction osteogenesis has now become a mainstay for the treatment of craniofacial syndromes with mandibular hypoplasia including TMJ ankylosis. There is an increased risk of reankylosis when the facial deformity due to TMJ ankylosis is attempted to be corrected by the distraction osteogenesis after release of ankylotic mass. To overcome this potential problem we have attempted the correction of facial deformity by distraction prior to release of ankylosis. Objectives of this study: To evaluate the benefits of distraction osteogenesis prior to release of TMJ ankylosis. Methods: 50 patients of TMJ ankylosis were treated using our protocol i.e. distraction first and then ankylosis release subsequently. Patients included in this study were aged between 5 and 50 years. Both extraoral and intraoral distractors were used depending on the requirement and socioeconomic status of the patient. Minimum follow-up period was 6 months. Findings and Conclusion: The combination of correction of facial deformity as the primary procedure and ankylosis release as secondary procedure provides good functional and aesthetic results in patients with facial deformity due to TMJ ankylosis. http://dx.doi.org/10.1016/j.ijom.2017.02.793 Effectiveness of vitamin b complex in reducing chronic temporomandibular joint disorder pain — double blind randomised clinical trial J.R. Rajaran ∗ , W.S. Choi The University of Hong Kong, Hong Kong Background: Chronic temporomandibular joint disorder (TMD) pain management has always been challenging and usually requires long-term analgesics. Commonly used analgesics have a potential for adverse effects in long-term usage, thus there is a need to look for a safer alternative analgesic option. Objectives: To evaluate efficacy of vitamin B complex (VBC) [B1, B6, B12] in reducing chronic TMD pain. Methods: 26 patients with chronic TMD pain secondary to arthralgia, osteoarthritis and disc displacement were included. The patients were allocated randomly into two groups and received either VBC tablet (B1: 242.5 mg, B6: 250 mg, B12: 1 mg) or placebo once per day for six weeks. Clinical measurements were recorded at week 0 and week 2, week 4, and week 6 to evaluate the efficacy of the treatment. Pain intensity was measured by visual analogue score (VAS) and mandibular range of movement
was measured by maximal comfortable mandibular opening and lateral excursion. Adverse effects and compliance rate towards treatment were also assessed. Findings: In this 6-week clinical trial, both groups showed significant VAS pain reduction (VBC 2.49 ± 1.71; placebo 1.41 ± 1.53; P < 0.05). The amount of VAS pain reduction in the VBC group was significantly higher than in the Placebo group at week 2 (1.19 ± 1.28 versus 0.23 ± 0.90) and week 4 (2.32 ± 1.42 versus 1.25 ± 0.75; P < 0.05). No statistically significant difference was noted in mouth opening improvement. Both VBC and placebo medications were well tolerated with minimal adverse effects. Conclusion: In this study a dose of VBC (B1: 242.5 mg, B6: 250 mg, B12: 1 mg) was significantly better than placebo in reducing chronic TMD pain at week two and week four. http://dx.doi.org/10.1016/j.ijom.2017.02.794 Frequency and morbidity of temporomandibular joint involvement in adult patients with a history of juvenile idiopathic arthritis C. Resnick ∗ , R. Dang, L. Henderson, D. Zander, K. Daniels, P. Nigrovic, L. Kaban Boston Children’s Hospital, Boston, MA, United States Background: The majority of patients with juvenile idiopathic arthritis (JIA) have involvement of the temporomandibular joints (TMJs), but little is known about the natural history of TMJ disease as these children enter into adulthood. Objective: To evaluate adults with a history of JIA in order to document the frequency and severity of TMJ abnormalities and TMJ-related morbidity. Methods: This is a cross-sectional study including adult patients with JIA who were managed at Boston Children’s Hospital as children and at Brigham and Women’s Hospital as adults. Subjects completed a study questionnaire, physical examination and maxillofacial cone-beam CT (CBCT). Additional data was obtained from medical records. We examined the associations between our primary outcome variable: TMJ abnormality on CBCT, and components of the arthritis history, arthritis severity, dental/orthodontic history, TMJ pain, maximal incisal opening (MIO), facial asymmetry, physical examination findings and cephalometric analysis. Findings: 21 subjects (42 TMJs) with mean age 26.06.1 years and a mean duration of care for JIA in our institution of 13.76.5 years were enrolled. 62% had TMJ pain, 43% had functional limitation, and 76% had lower facial asymmetry. TMJ abnormalities were found on 55% of CBCTs, with 79% bilateral. 81% had one cephalometric measurement relating to mandibular size or position >1 standard deviation from normal. Conclusion: TMJ abnormalities and related morbidity are common in adult patients with a history of JIA. Therefore, an early screening protocol for TMJ involvement may be sensible and long-term follow-up in to adulthood is necessary. http://dx.doi.org/10.1016/j.ijom.2017.02.795