Geriatric_Maxillofacial_Trauma_Illustrated_PPT.pptx

maxillofacial trauma in geriatric population : choice of implant in mandibular fractures

1. Maxillofacial Trauma in the Geriatric Population Focus: Choice of Implant in Geriatric Mandibular Fractures Prepared using multicenter studies and Fonseca 4th Edition

2. Introduction Challenges: anatomical changes, comorbidities, delayed healing. Increasing incidence with aging population. Reference: Brucoli et al., 2020【22】

3. Definition Geriatric facial trauma: fractures in patients ≥70 years. Mandibular fractures common, especially in atrophic jaws. Reference: Fonseca, 2013【25】

4. Etiology & Prevalence Falls are leading cause (86.9% in >75 yrs). Other: MVAs, assaults, but much less frequent. Reference: Shumate et al., 2018【23】; Liu et al., 2019【24】

5. Epidemiology Mean age ~79.3 yrs (range 70–100). More females than males affected. Reference: Brucoli et al., 2020【22】

6. Common Fracture Sites MZO fractures most common. Mandibular fractures frequent, esp. in atrophic edentulous jaws. Reference: Brucoli et al., 2020【22】

7. Concomitant Injuries Orthopedic, intracranial, thoracic, ocular. Significant impact on treatment timing. Reference: Brucoli et al., 2020【22】

8. Clinical Features Pain, mobility, ecchymosis (extraoral & intraoral). Difficulty in mastication. Reference: Fonseca, 2013【25】

9. Diagnostic Imaging OPG, CT, 3D reconstruction are gold standard. Essential for planning implant placement. Reference: Fonseca, 2013【25】

10. General Considerations Frailty, comorbidities, anesthesia risk. Multidisciplinary care essential. Reference: Brucoli et al., 2020【22】

11. Non-surgical Management Observation, soft diet for high-risk anesthesia patients. Risk: malunion, nonunion. Reference: Fonseca, 2013【25】

12. Closed Reduction Gunning splints, modified dentures. Often poor alignment, complications common. Reference: Fonseca, 2013【25】

13. ORIF Principles AO principles: anatomic reduction + immediate function. Load-bearing osteosynthesis preferred. Reference: Fonseca, 2013【25】

14. External Fixation Temporary stabilization in selected cases. High complication rate (malunion, nonunion). Reference: Fonseca, 2013【25】

15. Atrophic Mandible Challenges Loss of bone height (≤7mm). High fracture risk even with minor trauma. Reference: Fonseca, 2013【25】

16. Surgical Approaches Transcutaneous: easier visualization. Submandibular, transoral: possible but challenging. Reference: Fonseca, 2013【25】

17. Biomechanics Load-sharing plates insufficient in atrophic mandible. Need for load-bearing fixation. Reference: Fonseca, 2013【25】

18. Implant Choice: General Principles Use load-bearing fixation. 2.4 mm locking reconstruction plate = gold standard. Reference: Fonseca, 2013【25】

19. 2.4 mm Locking Plate Angle-to-angle span recommended. ≥3 screws each side of fracture. Reference: Fonseca, 2013【25】

20. Alternatives: 2.0 Locking System For non-atrophic edentulous mandibles (>20 mm height). Reference: Fonseca, 2013【25】

21. Templating & Bending Templates used to pre-shape plate. Perfect adaptation not always needed with locking plates. Reference: Fonseca, 2013【25】

22. Pitfalls Avoid small plates → risk of fracture & displacement. Smaller the jaw, larger the plate. Reference: Fonseca, 2013【25】

23. Bone Grafting Autogenous grafts (iliac crest/tibia). Bone marrow aspirate, BMP may help. Reference: Fonseca, 2013【25】

24. Post-operative Care Diet: liquid/semi-liquid as tolerated. Oral hygiene: chlorhexidine rinses, follow-up imaging. Reference: Fonseca, 2013【25】

25. Complications Malunion, nonunion, infection. Higher risk due to comorbidities & poor bone quality. Reference: Brucoli et al., 2020【22】

26. Multicenter Outcomes Half of patients had surgery delayed >72 hrs. Delay linked to concomitant injuries. Reference: Brucoli et al., 2020【22】

27. Take Home Message Elderly need individualized management. 2.4 mm locking reconstruction plate = standard. Balance function, comorbidities, quality of life. Reference: Brucoli et al., 2020【22】; Shumate et al., 2018【23】; Liu et al., 2019【24】; Fonseca, 2013【25】