Management of the fractured edentulous atrophic mandible

  • Review
  • Intervention

Authors


Abstract

Background

Fractures of the atrophic and edentulous (toothless) mandible (lower jaw) are fairly common in elderly people. Atrophy and weakening tend to occur as a result of reduced vascularity and decreased blood flow. Treatment options for reduction and fixation include closed and open techniques, with the degree of atrophy having a significant influence on the type of treatment. Many methods have been proposed for treating fractures of the atrophic mandible but there is still some uncertainty as to which method has the most successful outcomes.

Objectives

The objective of this review was to provide reliable evidence regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured edentulous atrophic mandibles.

Search methods

We searched the Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE from 1966 and EMBASE from 1980, both to 30th January 2006. Last search was done in January 2006.

Selection criteria

Randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were to be included.

Data collection and analysis

Screening of eligible studies was conducted in duplicate and independently by two review authors. 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 including both clinical and methodological factors.

Main results

No eligible randomised controlled trials were identified.

Authors' conclusions

This review illustrates that there is currently inadequate evidence for the effectiveness of a single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that until high level evidence is available treatment decisions should continue to be based on clinician's prior experience.
This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.

摘要

背景

處理無牙且萎縮的下顎骨骨折

萎縮且無牙的下顎骨骨折相當常見於老年人。常因血流供應減少而造成下顎骨萎縮以及脆弱。治療有封閉和開放式復位及固定術,萎縮程度對治療方式有顯著的影響。有提出許多方法治療萎縮的下顎骨骨折,但是對於何種方法有最佳結果仍然有某些不確定性。

目標

這篇文獻回顧的目的是提供任何關於無牙萎縮下開放式或封閉式顎骨骨折的處理方式,是否有效的可靠證據。

搜尋策略

我們搜尋了Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE from 1966 and EMBASE from 1980,兩者都到2006年一月三十日。最後的搜尋於2006年一月完成。

選擇標準

隨機對照試驗,包括超過55歲的患者,其萎縮無牙下顎骨因外傷、種植植體或病理性骨折造成於骨聯合、骨聯合旁、骨體、骨角、骨枝、髁突及喙突之骨折。包括比較任何處理方法(開放式或封閉式復位或固定術)的研究。

資料收集與分析

審查是否合格由兩位文獻回顧作者重複且獨立進行。結果以隨機效果模式表示,且連續變項使用平均差,二元變項採RR以及其95% CI。研究臨床及方法因子產生的異質性。

主要結論

沒有發現符合條件的隨機對照試驗

作者結論

本回顧顯示目前沒有足夠證據證明單一方式(開放式或封閉式)對無牙且萎縮的下顎骨骨折的療效。在有高度證據前,治療方式應根據醫師的經驗。沒有相關證據可能是部份代表對議題沒有清晰定義,或是對標準評估成功結果變項的定義差異很大且缺少可靠度

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

萎縮且無牙的下顎骨骨折相當常見於老年人。治療有封閉和開放式復位及固定術,但是對於何種方法有最佳結果仍然有某些不確定性。 結果:回顧作者對兩項治療都只找到不足夠的療效證據,可能部分因為缺乏對開放性或封閉性及保守和積極治療的定義缺乏共識,此外,對什麼結果變項最為適當也有不同

Plain language summary

Management of the fractured edentulous atrophic mandible

Fractures of the toothless, brittle and weakened lower jaw are fairly common in elderly people. Options for treatment include closed and open surgical techniques but there is still uncertainty as to which method has the most successful outcomes.
The review authors found insufficient evidence for the effectiveness of either approach, which may be partly attributable to a lack of agreement in what is open or closed and conservative and invasive treatment, in addition to some variability in what are the most appropriate measures of successful results.

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