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At least 199 records · Page 11Linked to original sources

Inferior alveolar nerve injury related to mandibular third molar surgery: an unusual case presentation.

Perforation of the lower third molar roots by the inferior alveolar nerve is uncommon and can be difficult to determine by conventional radiographic methods. Presented is a case of perforation that was treated by coronectomy, and showed an unusual complication in that the retained root erupted, moving the canal with it. The radiographic assessment of root perforation and the imaging modalities used to assess such cases are discussed.

Adult↗

Reflex jaw motions and jaw stiffness pertaining to whiplash injury of the neck.

Because a so-called mandibular whiplash injury requires the absence of short-latency jaw-closing reflexes in order to explain the postulated mechanism of injury (excessive jaw opening); the authors studied the presence and absence and more importantly, the kinematics (duration, displacement, velocity, acceleration) of monosynaptic and possibly, polysynaptic myotatic (stretch) reflexes in the jaw elevator muscles. In six healthy adults jaw jerk maneuvers were elicited through a brisk tap on the chin, and surface electromyography identified elevator reflexes while translational electrognathography identified the kinematics of the reflexes. The maneuvers were done while maintaining the rest position (3% MVC) and moderate clenching of the teeth (30% MVC). Electromyography was also used to identify phasic elevator excitations during a passive brisk neck extension maneuver. A sudden and unexpected elongation of the jaw elevators released autogenic reflex responses that, in conjunction with augmented tissue elasticity (stiffness), elevated the mandible into centric occlusion within approximately 150 milliseconds. In 86% of trials, the responses occurred regardless of the prevailing resting and clenching contractile activities. There was no evidence of a depressor force that consistently would and could anchor the mandible in a position of extreme or moderate depression, the theoretical linchpin of the mandibular whiplash injury. It was concluded that the mandibular locomotor system is very efficient in maintaining the rest and intercuspal positions of the mandible. This study found no evidence corroborating the mechanism claimed to release a so-called mandibular whiplash injury.

Acceleration↗

An evaluation of clinical and electrophysiologic tests in nerve injury diagnosis after mandibular sagittal split osteotomy.

The yield of clinical sensory tests and electrophysiologic tests in the diagnostics of inferior alveolar nerve (IAN) damage after bilateral sagittal split osteotomy (BSSO) was studied. The diagnostic value of these tests was evaluated by comparing the test results to the degree of nerve damage at the end of the operation as documented by means of the intraoperative nerve conduction recording of the IAN. Twenty patients undergoing BSSO were analysed preoperatively and 2 weeks postoperatively. The frequency of the IAN disturbance ranged from 10% to 94% depending on the test method and the test site used. Of the clinical sensory tests, the touch detection threshold (TD) test was the most sensitive and clinically useful test. It also correlated best with the electrophysiologically verified intraoperative nerve damage (R = -0.603, P = 0.017 on the right, R = -0.626, P = 0.01 on the left). The blink reflex and quantitative cold detection threshold tests were almost as often abnormal as the TD-test, but nerve conduction study (NCS) was the most sensitive (88%) of all clinical and electrophysiologic tests. The frequency of abnormal findings in the electrophysiologic tests indicating IAN injury, 75% on the right side and 90% on the left side, corresponded exactly with the figures of subjective sensory alteration. Almost all electrophysiologic tests showed obvious associations with the objectively verified IAN damage. All tests, except the NCS, showed only moderate sensitivity. Specificity of the tests was generally high, the only exceptions being the TD test and the NCS. To increase the diagnostic accuracy of the testing and to detect different types of damage in different nerve fibre populations, a combination of different sensory and electrophysiologic tests is recommended.

Action Potentials↗

[Fracture injuries of the mandibular arch. A repair technic].

The authors describe a technique for reduction of external lateral displacement of the posterior portions of the mandibular arch following unifocal or multifocal fractures. To achieve reduction they use a basilar wire transfixing the floor of the mouth and stretched between two horizontal branches, most often combined with a symphyseal osteosynthesis. This study of ten cases demonstrates the good functional and cosmetic results obtained with this method.

Adult↗

Dental injuries in association with mandibular condyle fractures.

A total of 356 patients with mandibular condyle fractures were studied regarding associated dental injuries. One third of the patients had injured teeth, on average, 3.7 teeth had been injured per accident. Dental traumas were distributed equally between the anterior (incisors and canines) and posterior teeth (premolars and molars) in both jaws. In unilateral condylar fracture cases maxillary dental injuries involved more often premolars and/or molars of the fracture side than those of the nonfracture side. The mean number of dental traumas in the mandible was higher in cases of simultaneous mandibular body fracture than without, whereas the presence of mandibular body fracture did not affect number of associated dental injuries in the maxilla. The dental injuries were mostly to hard tissue (78%), which were commonest in men, 20 to 29 years of age, and in victims of violence or fall accidents. Severe dental injuries in association with mandibular condyle fractures were more common in accidents due to traffic and miscellaneous causes than in those due to violence. Severe dental injuries were more often encountered when simultaneous mandibular body fracture was present than when it was not and more so in bilateral than unilateral condylar fracture cases. The most important factor correlating with the severity of dental injuries was the presence of bilateral condylar fracture.

Accidental Falls↗