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dc.contributor.authorNasser, Mona
dc.contributor.authorPandis, N
dc.contributor.authorFleming, PS
dc.contributor.authorFedorowicz, Z
dc.contributor.authorEllis, E
dc.contributor.authorAli, Kamran
dc.date.accessioned2017-06-29T09:54:38Z
dc.date.available2017-06-29T09:54:38Z
dc.date.issued2013
dc.identifier.issn1469-493X
dc.identifier.issn1465-1858
dc.identifier.otherARTN CD006087
dc.identifier.urihttp://hdl.handle.net/10026.1/9565
dc.description.abstract

BACKGROUND: Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. OBJECTIVES: The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (non-surgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication. SELECTION CRITERIA: Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated to include both clinical and methodological factors. MAIN RESULTS: Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of post-operative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I(2) = 0%). Similarly, no difference in post-operative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I(2) = 27%). The included studies involved a small number of participants with a low number of events. AUTHORS' CONCLUSIONS: This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.

dc.format.extentCD006087-
dc.format.mediumElectronic
dc.languageen
dc.language.isoeng
dc.publisherWiley
dc.subjectAtrophy
dc.subjectFracture Fixation [methods]
dc.subjectMandible [pathology]
dc.subjectMandibular Fractures [therapy]
dc.subjectMouth, Edentulous [complications]
dc.subjectAged
dc.subjectHumans
dc.subjectMiddle Aged
dc.titleInterventions for the management of mandibular fractures
dc.typejournal-article
dc.typeJournal Article
dc.typeMeta-Analysis
dc.typeResearch Support, Non-U.S. Gov't
dc.typeReview
dc.typeSystematic Review
plymouth.author-urlhttps://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000322568100041&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008
plymouth.issue7
plymouth.volume2013
plymouth.publication-statusPublished online
plymouth.journalCochrane Database of Systematic Reviews
dc.identifier.doi10.1002/14651858.cd006087.pub3
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Admin Group - REF
plymouth.organisational-group/Plymouth/Admin Group - REF/REF Admin Group - FoH
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Dental School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy
plymouth.organisational-group/Plymouth/Research Groups
plymouth.organisational-group/Plymouth/Research Groups/Institute of Health and Community
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group/Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.publisher.placeEngland
dc.identifier.eissn1465-1858
dc.rights.embargoperiod12 months
rioxxterms.versionofrecord10.1002/14651858.cd006087.pub3
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/under-embargo-all-rights-reserved
rioxxterms.typeJournal Article/Review
plymouth.oa-locationhttp://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006087.pub3/epdf


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