Postoperative malocclusion after maxillofacial fracture management: a retrospective case study

Abstract

PurposeVarious complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture.Materials and methodsIn this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors’ department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery.ResultsOne patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration.ConclusionsConsidering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.Electronic supplementary materialThe online version of this article (10.1186/s40902-018-0167-z) contains supplementary material, which is available to authorized users.

The role of prosthetic, orthodontic and implant-supported rehabilitation in the management of secondary malocclusion to maxillofacial trauma- A systematic review

“…Thus, three out of four domains were inadequate. Kim et al 2018 Tool for evaluating the methodological quality of case reports and case series Moderate Details of all the reported cases were insufficient and the follow-up intervals were unclear. Therefore, two out of four domains were inadequate.…”

“…Kim et al study included 9 patients, of which 7 had mandibular fractures such as body, ramus, and condyle factures ( Kim et al, 2018 ). The patients’ age ranged from 18 to 56 years, and the male-to-female ratio was 1.25:1.…”

“…Treatments of head and face injuries are categorized into surgical and non-surgical methods. Many common treatment approaches are extraction of teeth, occlusal adjustments, functional therapy, or a combination of these ( Becking et al, 1998 , Kim et al, 2018 ). An appropriate treatment plan should typically involve orthodontic treatment because it can prevent multi-segment upper jaw operations and stabilize the arches by coordinating and aligning them.…”

Osteotomy and iliac bone graft for the treatment of malunion caused by failed mandibular fracture reduction

“…Malocclusion is the most common sign of malunion [ 1 ]. If malunion is found early, the fractured segments should be re-reduced and fixed, or the maxillomandibular fixation should be loosened so that occlusion can be restored [ 2 ]. In a case of failed miniplate fixation for an atrophic mandibular fracture, Santos used a load-bearing reconstruction plate combined with an autogenous bone graft from the iliac crest [ 3 ].…”

Temporomandibular Dysfunction After Surgery of Mandibular Fractures Not Involving the Mandibular Condyle: A Prospective Follow-Up Study

“…Depending on the magnitude and direction of the impact, trauma may also cause inflammation of the adjacent muscles 10 . Malocclusion may disturb the balance of the TMJ and therefore cause TMD 11,12 . Cross-bite and TMJ displacement are proven risk factors in TMD development 11 .…”