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Fracture Patterns Associated With the Presence of Mandibular Third Molars
Poster Session areas of the body. Specific collar design features have been identified that should be incorporated into future ballistic neck protection for UK soldiers which will reduce mortality and morbidity from combat neck injury. References: 1. Breeze J, Allanson-Bailey LS, Hunt NC, Hepper AE, Clasper JC: Mortality and morbidity from combat neck injury. J Trauma 2012; 72: 969-74. 2. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB: Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 2008; 64(2): 295-9.
POSTER 101 Fracture Patterns Associated With the Presence of Mandibular Third Molars J. S. Luria: The University at Buffalo, J. H. Campbell Purpose: The mandible is the most commonly fractured bone in the facial skeleton. Studies have shown that 50% of fractures of the mandible occur in dentate regions. As mandibular third molars are located near the angle of the mandible, they have been suggested to contribute to an increased risk of mandibular fracture at this site due to the presence of a tooth (rather than bone) at a relatively thin area in the jaw. Additionally, it has been suggested that the absence of a mandibular third molar may predispose to fracture at other sites, particularly the subcondylar region. The aim of this study was to assess any correlation between mandibular fracture patterns, specifically in the region of the angle or condyle/subcondyle, and the presence or absence of mandibular third molars. Methods: This study was an IRB-approved retrospective analysis of all patients who were evaluated for mandible fractures by the Oral and Maxillofacial Surgery Service at the Erie County Medical Center (ECMC) for the years 2010 through 2012. The presence and location of third molar teeth, including degree of any impaction, were recorded. The location of all mandibular fractures and their degree of complexity were then documented upon review of available radiographs. The relationship between fracture patterns and the presence or absence of third molar teeth was then evaluated. Odds ratios were calculated to determine relative risk of angle and condylar/subcondylar fractures in the presence or absence of third molar teeth on the same side of the mandible. Results: Two hundred thirty-four patient records were reviewed from the three-year time period, with 468 mandibular halves available for analysis. Ninetythree mandibular angle fractures had third molars present, 30 had no third molar, 206 had a third molar without fracture, and 139 had neither a third molar nor a fracture. If a third molar was present, the risk of mandibular angle fracture was two times greater than if no third molar was present (odds ratio 2.09; 95% confidence interval, 1.31 to 3.35). There were 39 condylar/ e-100
subcondylar fractures in the presence of a third molar, 42 fractures without a third molar present, 255 areas with a third molar but no fracture, and 132 sites with neither a third molar nor a fracture. A condylar/subcondylar fracture was twice as likely to be avoided if a third molar was present on the same side (odds ratio 2.08; 95% confidence interval, 1.30 to 3.32). Conclusions: We conclude that there is a twofold increase in the likelihood of mandibular angle fracture in the presence of a retained third molar tooth. Conversely, there is a twofold decrease in the risk of condylar/subcondylar fracture if a third molar is present on the same side, suggesting that retained third molars may serve a ‘‘protective’’ function against condylar and condylar neck fractures. We do not believe these findings should promote retention of third molar teeth in the presence of other indications for removal since condylar and subcondylar fracture management is often less complex than mandibular angle fracture management.
POSTER 102 Functional Evaluation of the Use of Total TMJ Custom Prothesis in the Treatment of Fracture of the Middle Cranial Fossa by Condylar Impaction G. Hayashi: Federal University of Rio de Janeiro - UFRJ, E. Chiappetta Fracture of the middle cranial fossa by dislocation of mandibular condyle is a rare type of trauma, and only a few cases are reported in literature. This injury is more common among children and young adults than among the elderly. Most of these fracture have been treated in a open reduction, and variable outcomes have been reported, primarily the functional recovery of these patients. The aim of this paper is to present a follow-up of 2 years of a fracture of the cranial fossa by impaction of mandibular condyle treated with TMJ custom prothesis, where we perform the functional assessment preoperative and postoperative, analyzing the maximum incisal opening (MIO), protrusive (P), lateral excursive movements right and left (LR/LL) and deviation (D). Measurements of mandibular movements were made by the same professional using a caliper, the evaluation of the facial asymmetry and occlusion was performed by clinical and radiographic evaluation and pain assessment was performed using a specific questionnaire. The data were subjected to direct analysis of data and measures of central tendency. The patient evaluated had 19 yearold, female, victim of a motorcycle accident. The patient presented with pain, limited jaw movements, facial asymmetry and malocclusion. We did not observe neurological and ENT injuries. Evolved in right subcondilar fracture and middle cranial fossa by dislocation of the left condyle. Surgery was performed through open reduction with IRF AAOMS 2013
POSTER 101 Fracture Patterns Associated With the Presence of Mandibular Third Molars J. S. Luria: The University at Buffalo, J. H. Campbell Purpose: The mandible is the most commonly fractured bone in the facial skeleton. Studies have shown that 50% of fractures of the mandible occur in dentate regions. As mandibular third molars are located near the angle of the mandible, they have been suggested to contribute to an increased risk of mandibular fracture at this site due to the presence of a tooth (rather than bone) at a relatively thin area in the jaw. Additionally, it has been suggested that the absence of a mandibular third molar may predispose to fracture at other sites, particularly the subcondylar region. The aim of this study was to assess any correlation between mandibular fracture patterns, specifically in the region of the angle or condyle/subcondyle, and the presence or absence of mandibular third molars. Methods: This study was an IRB-approved retrospective analysis of all patients who were evaluated for mandible fractures by the Oral and Maxillofacial Surgery Service at the Erie County Medical Center (ECMC) for the years 2010 through 2012. The presence and location of third molar teeth, including degree of any impaction, were recorded. The location of all mandibular fractures and their degree of complexity were then documented upon review of available radiographs. The relationship between fracture patterns and the presence or absence of third molar teeth was then evaluated. Odds ratios were calculated to determine relative risk of angle and condylar/subcondylar fractures in the presence or absence of third molar teeth on the same side of the mandible. Results: Two hundred thirty-four patient records were reviewed from the three-year time period, with 468 mandibular halves available for analysis. Ninetythree mandibular angle fractures had third molars present, 30 had no third molar, 206 had a third molar without fracture, and 139 had neither a third molar nor a fracture. If a third molar was present, the risk of mandibular angle fracture was two times greater than if no third molar was present (odds ratio 2.09; 95% confidence interval, 1.31 to 3.35). There were 39 condylar/ e-100
subcondylar fractures in the presence of a third molar, 42 fractures without a third molar present, 255 areas with a third molar but no fracture, and 132 sites with neither a third molar nor a fracture. A condylar/subcondylar fracture was twice as likely to be avoided if a third molar was present on the same side (odds ratio 2.08; 95% confidence interval, 1.30 to 3.32). Conclusions: We conclude that there is a twofold increase in the likelihood of mandibular angle fracture in the presence of a retained third molar tooth. Conversely, there is a twofold decrease in the risk of condylar/subcondylar fracture if a third molar is present on the same side, suggesting that retained third molars may serve a ‘‘protective’’ function against condylar and condylar neck fractures. We do not believe these findings should promote retention of third molar teeth in the presence of other indications for removal since condylar and subcondylar fracture management is often less complex than mandibular angle fracture management.
POSTER 102 Functional Evaluation of the Use of Total TMJ Custom Prothesis in the Treatment of Fracture of the Middle Cranial Fossa by Condylar Impaction G. Hayashi: Federal University of Rio de Janeiro - UFRJ, E. Chiappetta Fracture of the middle cranial fossa by dislocation of mandibular condyle is a rare type of trauma, and only a few cases are reported in literature. This injury is more common among children and young adults than among the elderly. Most of these fracture have been treated in a open reduction, and variable outcomes have been reported, primarily the functional recovery of these patients. The aim of this paper is to present a follow-up of 2 years of a fracture of the cranial fossa by impaction of mandibular condyle treated with TMJ custom prothesis, where we perform the functional assessment preoperative and postoperative, analyzing the maximum incisal opening (MIO), protrusive (P), lateral excursive movements right and left (LR/LL) and deviation (D). Measurements of mandibular movements were made by the same professional using a caliper, the evaluation of the facial asymmetry and occlusion was performed by clinical and radiographic evaluation and pain assessment was performed using a specific questionnaire. The data were subjected to direct analysis of data and measures of central tendency. The patient evaluated had 19 yearold, female, victim of a motorcycle accident. The patient presented with pain, limited jaw movements, facial asymmetry and malocclusion. We did not observe neurological and ENT injuries. Evolved in right subcondilar fracture and middle cranial fossa by dislocation of the left condyle. Surgery was performed through open reduction with IRF AAOMS 2013