Kora Ramya Reddy

Abstract

Introduction: Maxillofacial fractures not only cause a change in the skeletal architecture (anatomical) but also lead to changes in the masticatory apparatus (functional). Masticatory function refers to the ability to chew without any interference or pain. The major determinants of this is the range of mandibular motion, maximum occlusal forces, and the activity of the masticatory muscles. This function is affected in maxillofacial trauma and also pathological injuries to the jaws. Bite force measurements are an excellent criteria for the assessment of masticatory efficiency. The purpose of this study was to assess the effect of maxillofacial fractures on the bite forces of patients treated for such fractures. Materials and Methods: 65 patients divided into 7 groups based on the kind of maxillofacial fracture. All the cases underwent ORIF. Bite force were measured on the immediate post-operative period, 1st , 4th and 12th post-operative week. The bite force instrument (transducer) was positioned between the antagonizing cusps in the region of Left First Molar and Right First Molar. Results: At the end of the 3rd post-operative week, all the groups showed a statistically significant increase in the bite force measurement as compared to the immediate post-operative bite force recording. Conclusion: Thus we conclude by saying that our study provides a basis for similar studies with a longer follow up period and larger sample size in order to assess the different kinds of maxillofacial trauma and its effect on bite force. Keywords: Bite force, Bite force device, Occlusal load, Maxillofacial trauma, Lefort fractures, Restoration of bite force.

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Abstract

Aim: The aim of this study is to assess whether the third molar in the line of mandibular angle fracture predisposes to post-operative infection, which further may lead to implant retrieval. Materials and Methods: Surgically rehabilitated cases of mandibular angle fracture at our center Sanjay Gandhi institute of trauma and orthopedics from 2016 to 2019 were considered in the study. During this period 49 cases were followed up for over a period of 6 months at 3 moths and 6months interval. All the cases were operated by the same surgeon using universal aseptic precautions using semi- rigid fixation. Results: Out of 49 cases, 20 cases the third molar was removed and in 29 cases the third molar was retained. The mean age group of the population of the study was 33.67 (18 to 60 years), out of which majority of the cases 93.9%(46) were male patients and 6.3%(3) were female patients. The main etiology of the cases were attributed to RTA. 96.3%. At the end of the 6 months follow up it was noted that 4 plates in case of retained group and 2 plates in removed group. In the 3 month follow up in 4 cases of the retained third molar was extracted due to signs of infection. When the tooth in question was removed, infection did not occur. At the 3rd to 6 month follow another 4 retained third molars were extracted along with implant retrieval. Statistically the relationship between the two groups were analyzed using Chi-square test bivariate statistics. A P ? 0.05 was taken as significant. Conclusion: In our study we could not provide any concrete evidence to form a protocol for the management for the third molar in the line of mandibular angle. Retaining the third molar in the line of fracture has an increased chance of post-operative infection. We would like to conclude that partially impacted tooth are best to be removed during the procedure for better outcomes provided the fractured segments stability is maintained. Until an algorithm is set for the management of the third molar in the line of fracture, the dilemma of retaining or removing still stays and varies from case to case and on the surgeon’s experience. Keywords: Mandibular angle, Third molar, Tooth in line of fracture.

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