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PubMed1980

[Treatment of maxillary fractures in children and adolescents (author's transl)].

Facial and mandibular fractures in 139 children and adolescents were treated in the maxillofacial surgery department of the University Hospital in Cologne (RFA) between 1st January 1974 and 30th June 1979. A critical analysis of this group of patients demonstrates the manner in which therapeutic directives in the Cologne department are partially modified. Conservative treatment is the rule in children up to 12 years of age. In the older group, aged 13 and 17 years, preference is now given to osteosynthesis by miniaturized screw plates combined with conventional treatment.

Adolescent↗
PubMedDate not supplied

Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.

Maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the United States seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the Philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, Otolaryngology-Head & Neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)

Accidents, Traffic↗
PubMed1995

Rigid fixation of facial fractures in children.

This article presents a retrospective analysis of a selective use of rigid fixation among 62 children with facial fractures, treated at a Level I trauma center over a 5-year period (1986-1991). There were 21 mandible fractures, 11 orbital fractures, 11 zygomaticomalar complex fractures, 7 nasal fractures, 5 maxillary fractures, 3 pan-facial fractures, 2 nasal-orbital-ethmoidal complex fractures, and 2 frontal sinus fractures. Only 18 children had rigid fixation of their injuries. Complications of Le Fort upper facial fractures repaired with rigid fixation involved perioperative sinusitis; one case required oral antibiotics, the other ethmoidectomy and maxillary antrostomy. One child with a Le Fort fracture had delayed exposure of a zygomaticomalar buttress plate, which required surgical removal. Permanent enophthalmos occurred in two children with Le Fort fractures. The authors conclude that traditional conservative management is appropriate in most cases. However, in children aged 13 and older with mandible fractures and children with complex mid- and upper facial fractures, a judicious use of rigid fixation has advantages over the traditional techniques.

Adolescent↗
PubMed1998

Treatment of maxillary molars with vertical fractures.

To date, there has been no reliable method for treating bucco-palatal fractured maxillary molar teeth. We have developed a simple repositioning method to fix teeth fractured in this way using wire. The effectiveness of this new approach was evaluated in both in vitro experimental research and clinical studies.

Calcium Hydroxide↗
PubMed1998

Production of platelet-derived growth factor in aseptic loosening of total hip replacement.

Aseptic loosening is the predominant cause of total hip implant failure. It has been assumed that a layer or membrane, containing macrophages, fibroblasts and vascular endothelial cells, of synovial-like tissue develops at the implant-to-bone interface almost invariably and, with time, somehow leads to loosening of the components from the surrounding bone. These cells produce a variety of cytokines and proteolytic enzymes which stimulate bone resorption. Platelet derived growth factor (PDGF) may be one of the cytokines which stimulate bone resorption and contribute to aseptic loosening in total hip replacement (THR). Synovial-like membrane from the implant or cement-to-bone interface (n = 10) and pseudocapsule (n = 10) were obtained from ten patients operated on for aseptic loosening of THR. As a control, nine samples of connective tissues were obtained from patients who had mandibular or maxillary fractures fixed with bone implant. The avidin-biotin-peroxidase complex (ABC) method with polyclonal rabbit anti-human IgG against the A-chain and B-chain of PDGF was used for staining. ABC-alkaline phosphatase-anti-alkaline-phosphatase double staining with monoclonal mouse anti-human fibroblast IgG1 and CD68 antibodies was used to ascertain the cellular origin of PDGF. Results of the PDGF staining were quantitated by a semi-automatic VIDAS image analysis system. The PDGF-A and PDGF-B chain containing cells were found in all periprosthetic tissues, in particular in macrophages with phagocytosed particulate debris, but to some extent also in fibroblasts and in endothelial cells. The numbers of PDGF-A and PDGF-B chain positive cells per mm 2 in synovial-like interface membrane (1881 +/- 486 and 1877 +/- 214) and pseudocapsule (1786 +/- 236 and 1676 +/- 152) were higher (P < 0.01) around loose THR than in control tissue (821 +/- 112 and 467 +/- 150), respectively. The results of the present study suggest that PDGF is preferably expressed by macrophages, which to an increased extent produce it in the synovial-like interface membrane and pseudocapsular synovial-like membrane. Because of its role in bone resorption, it may well play a role in periprosthetic bone loss and aseptic loosening and deserves more detailed study as a mediator and potential target in the modulation or prevention of loosening of THR.

Adolescent↗
PubMed1976

Facial and cervical injuries.

It is not commonly appreciated that mandibular and maxillary fractures are occasionally associated with fractures of cervical vertebrae. An incidence of 1-6% in a three-year survey at the Royal Brisbane Hospital is reported and the implications are discussed.

Australia↗
PubMed1990

Le Fort fractures without mobility.

The Le Fort fracture without maxillary mobility constitutes 9 percent of maxillary fractures observed over a 3-year period. A high Le Fort (level II or III) injury exists as a one- or two-piece incomplete fracture. The degree of fracture is insufficient to permit mobility of the maxillary alveolus. Frequently, an obvious unilateral zygomatic fracture is present. Physical findings consist of bilateral eyelid ecchymosis and malocclusion. The occlusal disturbance may consist of either crossbite, open bite, maxillary rotation, or lack of proper dental intercuspation. On CT scan, fractures are best demonstrated in the posterior and medial maxillary walls at the Le Fort I level; they are most obvious unilaterally with contralateral fractures that may be subtle. Bilateral maxillary sinus fluid is consistently present on CT. Treatment usually consists of observation and traction elastics but may require mobilization of the fragments followed by open reduction and rigid fixation.

Humans↗
PubMed2005

Oral fractures in dogs of Brazil--a retrospective study.

A retrospective study was performed in 100 dogs with 121 mandibular and 21 maxillary fractures. Dog fight (43.0%) and automobile (12.0%) trauma were the most common etiologies for fracture. The cause of fracture was unknown in 23.0% of the cases, while pathologic fractures occurred in 13.0% of cases. Young dogs (< 1-year-old) and dogs > 8-years of age were most affected. Mandibular fractures occurred in 90 dogs (90.0%), with two dogs (2.2%) having concurrent maxillary fractures. Maxillary fractures only were diagnosed in 10 dogs (10.0%). The molar region (47.1%) was the most commonly affected location for mandibular fracture, followed by fractures of the symphysis and parasymphysis (30.6%), premolar region (17.4%), angular process (4.1%) and vertical ramus (0.8%). In fractures of the mandibular region, the mandibular first molar tooth was often (85.9%) involved while the canine teeth were involved in 67.5% of symphyseal and parasymphyseal fractures. The most common fracture of the maxilla was the maxillary bone (52.4%), followed by the incisive (33.3%), palatine (9.5%), and nasal (4.8%) bones.

Accidents, Traffic↗
PubMed1987

Le Fort fractures (I). A study of frequency, etiology and treatment.

The cause and frequency of maxillary fractures as well as type of treatment performed has been reviewed in this study. During the time period between 1969 and 1982, a total of 301 maxillary fractures have been treated at our Department of Oral and Maxillofacial Surgery in Gothenburg. The period has been subdivided in 3 parts to evaluate whether differences in the amount of severe fractures could be observed. Since a law was instituted in Sweden in 1975 calling for a mandatory use of front seat belts, the frequency of fractures related to the time periods before and after 1975 could be of interest. We found a surprisingly equal number of fracture incidents during the different periods of time, but a decreasing number of maxillary fractures of type le Fort I, II and III; partial maxillary fractures on the other hand, had increased in number.

Accidents, Traffic↗
PubMed2004

Implication of differences in the incidence of orbital emphysema in ethmoidal and maxillary sinus fractures.

This study investigated the incidence of orbital emphysema in patients with fractures of the ethmoidal cells or maxillary sinus. We noted that mucosal destruction is essential for orbital emphysema to occur. Computed tomographic examination and intraoperative studies of 58 patients with orbital bone fracture were performed with the patients divided into 2 groups according to the location of the fracture lines. The incidences of orbital emphysema and of intrasinus hematoma were significantly higher in the group with medial orbital bone fracture of ethmoidal cells than in the group with maxillary sinus fracture, which indicates mucosal tear was significantly higher in the former group. Fractured lamina papyracea and intrasinus hematoma were observed in all cases with ethmoidal sinus fracture. On the other hand, intrasinus hematoma was not found in some cases with maxillary sinus fracture, blowout fracture of the orbital floor, or zygomatic bone fracture, while all cases with orbital emphysema were included in the cases with intrasinus hematoma. This suggests that the incidence of orbital emphysema depends on the occurrence of tearing of the mucosa of the paranasal sinus.

Emphysema↗
PubMed1987

Orbital floor fractures: the maxillary approach.

The repair of orbital floor fractures is complicated not only by the technical aspects of the procedure, but by the decision-making process one must initiate to determine when and if the fracture should be repaired. This article examines the indications for repairing orbital floor fractures through the maxillary approach and describes the technical aspects and results that can be achieved with this technique.

Humans↗