Effects of the geniohyoid muscle impairment in tongue injury with mandibular fracture.
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An army mechanic sustained a penetrating mandibular injury, associated with right atlantooccipital dislocation, when the inner tube of a military truck tyre burst. It is thought that he had used a sledgehammer, having wielded it lengthwise with the free end of its hollow cylindrical handle held uppermost, to reposition the locking ring of the fully inflated tyre. In all probability, the sudden release of highly pressurised air disloged the locking ring and forced the circular end of the handle into his right lower jaw, thereby fracturing the mandible and causing an acute hyperextension injury of the cervical spine, with resultant profound spinal shock and instantaneous death.
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The anatomy of the cervical and marginal mandibular branches of the facial nerve is reviewed. In the senior author's practice, "pseudoparalysis of the marginal mandibular nerve" due to cervical branch injury occurred in 34 of 2002 superficial musculoaponeurotic system-platysma face lifts (1.7 percent) and was associated with a full recovery in 100 percent of cases within a time period ranging from 3 weeks to 6 months. Cervical branch injury can be distinguished from marginal mandibular nerve injury by the fact that the patient will be able to evert the lower lip because of a functioning mentalis muscle.
OBJECTIVES: Our goal was to review and identify risk factors for complications from treatment of mandible fractures due to gunshot wounds. Study design and setting We conducted a retrospective review of treatment outcomes in 90 patients with gunshot wounds to the mandible treated over a 10-year period at 2 tertiary care centers. RESULTS: Our series of 90 patients with mandibular injuries due to gunshot wounds included 68 patients who underwent surgical procedures on the mandible. There were 14 complications in this group. Complications were more common in patients whose mandibles were rigidly fixated; however, these patients' injuries were more severe. Complications were significantly increased in patients who lost a segment of mandible in the injury. CONCLUSIONS: Complications were related to severity of injury and independent of treatment modality. SIGNIFICANCE: The complication rate for patients with gunshot injuries can be very high, particularly if bone is missing. Stabilization of remaining mandibular segments with potentially multiple subsequent reconstructive procedures is often required to restore mandibular continuity in these patients.
Chin trauma, mandibular fracture, and cervical spine injury are often progressive components of a single injury pattern. Knowledge of a commonly occurring sequence of damage in patients who have sustained minor head trauma helps to minimize diagnostic omissions and provides a rational basis for deciding how extensive the patient's evaluation should be. Chin laceration associated with underlying skeletal damage has been described previously, but its diagnostic significance seldom has been appreciated. This report describes representative patients with fractures of the cervical spine and of the mandible secondary to chin trauma and suggests a protocol for efficient diagnosis.
Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed: feather light touch, pinprick, sharp/dull discrimination, warm, cold, point location, brush stroke direction, 2-point discrimination and pain perception. Gustation was tested for recognition of sweet, salt, sour and bitter. Mandibular block analgesia causes lingual nerve injury more frequently than inferior alveolar nerve injury. All grades of loss of neurosensory and gustatory functions were found, and a range of persisting neurogenic malfunctions was reported. Subjective complaints and neurosensory function tests indicate that lingual nerve lesions are more incapacitating than inferior alveolar nerve lesions. Unlike most mechanical injuries after surgery, injection injuries were not followed by a course of spontaneous improvement of neurosensory and/or gustatory function. This may indicate neurotoxicity as a central aetiological factor. Fifty-four percent of the nerve injuries were associated with Articaine 4%, and a substantial increase in the number of injection injuries followed its introduction to the Danish market.
Iatrogenic injury to the marginal mandibular branch is an important reason for medicolegal actions. The aim of this study was to determine the distance of the marginal mandibular branch to the inferior border of the mandible as well as variation of nerve position in relation to this border. The marginal mandibular branch was dissected carefully in a number of 36 facial halves. Three points were identified on the inferior border of the mandibular ramus: Point A at the angle of the mandible, Point B just anterior to the facial artery, and Point C, 2 cm anterior to Point B. A metric and geometric morphometric analysis, including thin-plate spline and relative warp analysis was done to determine the variation of nerve position in relation to these three bony landmarks. The metric study indicated a median distance from Point A to the nerve 2.3 mm inferior to Point A, 2.4 mm superior to Point B, and 10.7 mm superior to Point C. The shape analysis indicated that variation in the position of the nerve occurs most commonly at Points A and B. We conclude that these mandibular landmarks may assist surgeons in minimizing marginal mandibular branch injury and patient discomfort.