Third molars in the line of mandibular angle fractures: An 8-year retrospective
analysis
Stylianos ZANAKIS, Fotini IOANNIDOU, Christos DENDRINOS
Hippokration General Hospital of Athens, Department of Oral and Maxillofacial Surgery (Head: Stylianos Zanakis)
Hellenic Archives of Oral & Maxillofacial Surgery (2015) 3, 129-136
SUMMARY: Introduction: Is the prophylactic extraction of 3rd molars involved in mandibular angle fractures necessary or not? This question has not been conclusively answered to date. As recent data indicates, healing problems that had previously been associated with the presence of teeth in the fracture line are primarily related to the limited use of antimicrobial factors, delayed medical care and fixation methods. Materials and Methods: This study was designed to determine the correlation between the presence/absence of 3rd molars in the fracture line and its impact on the healing process. It involved 133 patients with 145 mandibular angle fractures. These patients were treated using mini osteosynthesis plates and intermaxillary fixation with light elastics for 15 days, between 2006 and 2013. Their gender, age, fracture aetiology and postoperative course were recorded. The findings were analyzed and statistically assessed. Results-Conclusions: There was no correlation between the presence of 3rd molars in the fracture line and any postoperative healing complications. Light intermaxillary fixation with elastics helps reduce the risk of postoperative complications.
KEY WORDS: mandibular angle fractures, 3rd molar, fracture healing in the maxillofacial skeleton, complications.
REFERENCES
Arangio P, VelloneV, Torre U, Calafati V, Capriotti M, Cascone P: Maxillofacial fractures in the province of latina, Lazio Italy: review of 400 injuries and 83 cases J Craniomaxillofac Surg. 42(5): 583-587, 2014
Attanasov DT, Vuvakis VM: Mandibular fracture complications associated with the third molar lying in the fracture line. Folia Med (Plovdiv) 42(1): 41-46, 2000 Bradley RL: Treatment of fractured mandible. Am Surg 31:289-290, 1965
Bui P, Demian N, Beetar P: Infection rate in mandibular angle fractures treated with a 2.0-mm 8-hole curved strut plate. J Oral Maxillofac Surg 67(4):804-808, 2009
Burch RJ: Treatment of displaced fractures of the endentulous mandibular angle. Oral Surg Oral Med Oral Pathol 4(9):1101- 1107, 1951
Chrcanovic BR: Teeth in the line of mandibular fractures. Oral Maxillofac Surg 18(1): 7-24, 2014a
Chrcanovic BR: Factors influencing the incidence of maxillofacial fractures. Oral Mallofac Surg 16(1):3-17, 2012b
Chuong R, Donoff RB, Guralnick WC: A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg 41(5):305-309, 1983
De Amaratunga NA: The effect of teeth in the line of mandibular fractures on healing. J Oral Maxillofac Surg 45(4): 312-314, 1987
Dimitroulis G, Eyre J: A 7-year review of maxillofacial trauma in a central London hospital, Br Dent J 20;170(8):300-302,1991
Ellis III E: Outcomes of patients with teeth in the line of mandibular angle fractures treated with stable internal fixation. J. Oral Maxillofac Surg 60(8):863-865, 2002
Gerbino G, Tarello F, Fasolis M, De Gioanni P: Rigid fixation with teeth in the line of mandibular fractures. Int. J. Oral Maxillofac. Surg 26:182-186, 1997
Halazonetis JA: The “weak” regions of the mandible. Br J Oral Surg 6(1):37-48, 1968
atrou I, Theologie-Lygidakis Ν, Tzermpos F, Kamperos G: Internal fixation of mandibular angle fractures using one miniplate in Greek children: A 5-year retrospective study. J. Oral Maxillofac Surg 43, 52-56, 2015
James RB, Fredrickson C, Kent JN: Prospective study of mandibular fractures. J Oral Surg. 39(4):275-278, 1981
Kamboozia AH, Punnia-Moorthy A: The fate of teeth in mandibular fracture lines. A clinical and radiographic follow-up study. Int J Oral Maxillofac Surg 22(2):97-101, 1993
Kyzas PA: Use of antibiotics in the treatment of mandible fractures: a systematic review. J Oral Maxillofac Surg 69(4):1129-1145, 2011
Lee KH: Epidemiology of mandibular fractures in a tertiary trauma centre. Emerg Med J 25 (9):565-568, 2008
Malanchuk VO, Kopchak AV: Risk factors for development of infection in patients with mandibular fractures in the tooth-bearing area. J Craniomaxillofac Surg 35(1): 57-62, 2008
Natu SS, Pradham H, Gupta H, Alam S, Pradham R, Mohammad S, Kohli M, Sinha VP, Shankar R, Agarwal A: An epidemiological study on pattern and incidence of mandibular fractures. Plast Surg Int 2012: 834-864, 2012
Rai S, Pradham R: Tooth in the line of fracture: its prognosis and its effects on healing. Indian J Dent Res 22(3): 495-496, 2001
Ramakrisham J, Shingleton A, Reeves D, Key JM, Vural E: The effects of molar tooth involvement in mandibular angle fractures treated with rigid fixation. Otolaryngol Head Neck Surg 140(6):845-848, 2009
Van Beek GJ, Merkx CA: Changes in the pattern of fractures of the maxillofacial skeleton. Indian J Oral Maxillofac Surg 28(6): 424- 428, 1999
Zachariades N, Papademetriou I: Complications of treatment of mandibular fractures with compression plates. Oral Surg Oral Med Oral Path Oral Radiol Endod 79(2): 150-153, 1995
Hippokration General Hospital of Athens, Department of Oral and Maxillofacial Surgery (Head: Stylianos Zanakis)
Hellenic Archives of Oral & Maxillofacial Surgery (2015) 3, 129-136
SUMMARY: Introduction: Is the prophylactic extraction of 3rd molars involved in mandibular angle fractures necessary or not? This question has not been conclusively answered to date. As recent data indicates, healing problems that had previously been associated with the presence of teeth in the fracture line are primarily related to the limited use of antimicrobial factors, delayed medical care and fixation methods. Materials and Methods: This study was designed to determine the correlation between the presence/absence of 3rd molars in the fracture line and its impact on the healing process. It involved 133 patients with 145 mandibular angle fractures. These patients were treated using mini osteosynthesis plates and intermaxillary fixation with light elastics for 15 days, between 2006 and 2013. Their gender, age, fracture aetiology and postoperative course were recorded. The findings were analyzed and statistically assessed. Results-Conclusions: There was no correlation between the presence of 3rd molars in the fracture line and any postoperative healing complications. Light intermaxillary fixation with elastics helps reduce the risk of postoperative complications.
KEY WORDS: mandibular angle fractures, 3rd molar, fracture healing in the maxillofacial skeleton, complications.
REFERENCES
Arangio P, VelloneV, Torre U, Calafati V, Capriotti M, Cascone P: Maxillofacial fractures in the province of latina, Lazio Italy: review of 400 injuries and 83 cases J Craniomaxillofac Surg. 42(5): 583-587, 2014
Attanasov DT, Vuvakis VM: Mandibular fracture complications associated with the third molar lying in the fracture line. Folia Med (Plovdiv) 42(1): 41-46, 2000 Bradley RL: Treatment of fractured mandible. Am Surg 31:289-290, 1965
Bui P, Demian N, Beetar P: Infection rate in mandibular angle fractures treated with a 2.0-mm 8-hole curved strut plate. J Oral Maxillofac Surg 67(4):804-808, 2009
Burch RJ: Treatment of displaced fractures of the endentulous mandibular angle. Oral Surg Oral Med Oral Pathol 4(9):1101- 1107, 1951
Chrcanovic BR: Teeth in the line of mandibular fractures. Oral Maxillofac Surg 18(1): 7-24, 2014a
Chrcanovic BR: Factors influencing the incidence of maxillofacial fractures. Oral Mallofac Surg 16(1):3-17, 2012b
Chuong R, Donoff RB, Guralnick WC: A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg 41(5):305-309, 1983
De Amaratunga NA: The effect of teeth in the line of mandibular fractures on healing. J Oral Maxillofac Surg 45(4): 312-314, 1987
Dimitroulis G, Eyre J: A 7-year review of maxillofacial trauma in a central London hospital, Br Dent J 20;170(8):300-302,1991
Ellis III E: Outcomes of patients with teeth in the line of mandibular angle fractures treated with stable internal fixation. J. Oral Maxillofac Surg 60(8):863-865, 2002
Gerbino G, Tarello F, Fasolis M, De Gioanni P: Rigid fixation with teeth in the line of mandibular fractures. Int. J. Oral Maxillofac. Surg 26:182-186, 1997
Halazonetis JA: The “weak” regions of the mandible. Br J Oral Surg 6(1):37-48, 1968
atrou I, Theologie-Lygidakis Ν, Tzermpos F, Kamperos G: Internal fixation of mandibular angle fractures using one miniplate in Greek children: A 5-year retrospective study. J. Oral Maxillofac Surg 43, 52-56, 2015
James RB, Fredrickson C, Kent JN: Prospective study of mandibular fractures. J Oral Surg. 39(4):275-278, 1981
Kamboozia AH, Punnia-Moorthy A: The fate of teeth in mandibular fracture lines. A clinical and radiographic follow-up study. Int J Oral Maxillofac Surg 22(2):97-101, 1993
Kyzas PA: Use of antibiotics in the treatment of mandible fractures: a systematic review. J Oral Maxillofac Surg 69(4):1129-1145, 2011
Lee KH: Epidemiology of mandibular fractures in a tertiary trauma centre. Emerg Med J 25 (9):565-568, 2008
Malanchuk VO, Kopchak AV: Risk factors for development of infection in patients with mandibular fractures in the tooth-bearing area. J Craniomaxillofac Surg 35(1): 57-62, 2008
Natu SS, Pradham H, Gupta H, Alam S, Pradham R, Mohammad S, Kohli M, Sinha VP, Shankar R, Agarwal A: An epidemiological study on pattern and incidence of mandibular fractures. Plast Surg Int 2012: 834-864, 2012
Rai S, Pradham R: Tooth in the line of fracture: its prognosis and its effects on healing. Indian J Dent Res 22(3): 495-496, 2001
Ramakrisham J, Shingleton A, Reeves D, Key JM, Vural E: The effects of molar tooth involvement in mandibular angle fractures treated with rigid fixation. Otolaryngol Head Neck Surg 140(6):845-848, 2009
Van Beek GJ, Merkx CA: Changes in the pattern of fractures of the maxillofacial skeleton. Indian J Oral Maxillofac Surg 28(6): 424- 428, 1999
Zachariades N, Papademetriou I: Complications of treatment of mandibular fractures with compression plates. Oral Surg Oral Med Oral Path Oral Radiol Endod 79(2): 150-153, 1995
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