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[Clinical study of mandibular condyle injury].

Mandibular condyle fractures develop frequently and show the variable type of injury and complication. New opinions have emerged from recent investigation into condylar fractures. The author investigated 246 patients with condylar fractures who visited SNUDH from January 1980 to August, 1988, 8. with regard to clinical and treatment aspects, area and displacement of fractures, associated teeth injury and other body injury, complications. At last I have got the following results. 1. The incidence to condylar fractures in a series of 765 mandibular fractures may be as high as 32.2%. 2. The male patients are 3 times more than female patients. The highest frequency was recorded in the group 21-30 years of age. (34.1%). 3. Falls caused the greatest number of condylar fractures (45.2%) and next was in assult (25.6%), traffic accidents (22.4%). 4. Unilateral condylar fractures were present in 74.8%, giving a left: right ratio of 1.2:1. In cases of unilateral fracture, subcondylar fractures were by far the commonest (32.9%) but in cases of bilateral fracture, condylar neck fractures were by far the commonest. In children under 15 years of age, condylar neck fractures were more common but in patients over 16 years of age, subcondylar fractures were common. 5. Anteromedial fracture dislocations were by far the commonest (20.3%). In children under 15 years of age, fracture deviations were common but in patients over 16 years of age, fracture displacements were common. 6. 44.7% of patients with condylar fractures sustained the teeth injuries. Teeth fractures were by far the commonest. 7. Single condylar fractures showed a frequency of 30.5%. Of the concomitant fractures elsewhere in the mandible, symphysis fractures were by far the commonest (54.1%). 8. Associated other body injuries showed a frequency of 28.0%. Of them, head injuries were by far the commonest. 9. The mean interval from injury to treatment was 14.3 days. Of the treatment of condylar fractures, open reduction was by far the commonest (70.3%). Closed reduction comprised 19.9% and functional therapy comprised 8.5%. 10. In 67 patients with possible follow up period, the following complications were developed, two ankylosis, anterior open bite, mouth opening limitation, mouth opening deviation.

Adolescent

Pneumomediastinum and cervical emphysema subsequent to mandibular injury associated with a flare pistol shot.

Pneumomediastinum in patients with war injuries to the maxillofacial region can be a life-threatening condition. A case is presented of a flare-pistol-shot wound to the mandible which subsequently resulted in cervical emphysema, mediastinal emphysema, and pneumomediastinum, causing a critical condition. Maxillofacial surgeons should be alert to this problem when treating blast or multiple-shell injuries to the maxillofacial region.

Adult

Electrophysiologic investigation of mandibular nerve injury.

Isolated lesions of the mandibular branch of the trigeminal nerve have only rarely been reported. We report the occurrence of an isolated lesion of the mandibular nerve associated with a unilateral mandibular fracture, and its substantiation electrophysiologically. A 65-year-old man was involved in a motor vehicle accident resulting in multiple fractures, including a unilateral mandibular fracture and temporomandibular joint dislocation. No evidence of intracranial pathology by CT scan was noted and the neurologic examination was nonfocal except for dysfunction of the mandibular nerve ipsilateral to the fracture site. Bilateral facial nerve latency and blink reflexes were normal. EMG evaluation of the muscles of facial expression and mastication demonstrated denervation confined to the muscles innervated by the mandibular branch of the trigeminal nerve. In patients complaining of facial sensory dysfunction, malocclusion, or weakness of muscles of mastication after mandibular fracture, an electrophysiologic examination can assist in evaluating cranial nerve integrity.

Aged

Prevention of tongue prolapse by immediate stabilization in severely avulsed mandibular war injuries.

A significantly successful procedure for tongue stabilization, used in six cases of severe war injuries to the mandible, which prevents the serious complications of tongue prolapse, is here presented. The procedure consists of a the insertion of horseshoe-shaped Kirschner wire, the ends of which are fixed to the posterior mandibular segments, thus acting as a scaffolding for the lacerated soft tissues of the anterior two-thirds of the tongue, floor of the mouth and the submandibular region. This technique provides an acceptable appearance and assists feeding, reduces dribbling and dryness of the tongue, limits the likelihood of infection of the soft tissues of the floor of the mouth with subsequent contracture, affords scaffolding for the soft tissues, foundation for bone grafts, and permits greater freedom in augmenting the vermilion of the lower lip.

Bone Wires

Bone tissue response to irradiation and treatment model of mandibular irradiation injury. An experimental and clinical study.

The present study was conducted on bone tissue responses to irradiation towards a treatment model of mandibular irradiation injury by comparing the results of experimental observations of irradiation effects on rabbit hind legs and rat mandibular bones (paper I, II and III) with clinical observations of irradiation effects on the human mandible (paper IV, V and VI). The main results of the study were as follows: Bone marrow haemorrhage, eosinophilia and incipient edema were encountered in the rabbit leg one day after a single irradiation dose. Edema and fibrosis were the salient features after five weeks, while both regenerative and fibrotic changes predominated eleven weeks after irradiation. The changes were the more extensive the greater the irradiation dose was. Empty lacunae as a sign of cell damage in cortical bone already appeared on the first day after irradiation; this effect reached its maximum when the dose was 20 Gy or more. Bone marrow and subcutaneous tissue pO2 and pCO2 were measured by means of implanted Silastic tonometers in irradiated and nonirradiated rabbit hind legs. Single dose irradiation was followed by a rapid, dose dependent decrease of marrow pO2. The corresponding effect on pCO2 was weaker and appeared later. The response to hyperoxia in the bone marrow became weaker when the irradiation dose increased. Less significant was the response of CO2 tension to hyperoxia. O2 and CO2 tensions were recovered after single dose irradiation both in subcutaneous tissue and in bone marrow, but the reduction was less in bone marrow. During the twelve weeks observation period clearly better recovery in tissue gas tensions was observed in subcutaneous tissue than in bone marrow. Nonirradiated periosteal grafts on irradiated bone cavities in the rabbit tibia induced more rapid and intense mature bone formation than irradiated periosteal grafts. The irradiated periosteum, even after a single dose of 20 Gy, had some osteogenetic capacity. The alkaline phosphatase content was lowered eight weeks after surgery in irradiated legs but clearly exceeded control values twelve weeks after surgery indicating new bone formation. Lysosomal enzyme DAP II contents were increased in all irradiated specimens as a sign of disturbed bone formation. The tissue concentrations of acid phosphatase, cytochrome oxidase, lactate dehydrogenase, isocitrate dehydrogenase, glucose-6-phosphate dehydrogenase and succinate dehydrogenase in the immediate postirradiation period showed a greater increase in activity in the cut lines of the irradiated rat mandibles than in those of the nonirradiated mandibles.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult

Incidence of inferior alveolar nerve injury in mandibular third molar surgery.

This paper documents the incidence of inferior alveolar nerve injury and resultant sensory disturbance encountered in the removal of 100 consecutive impacted mandibular third molars. Five cases of anesthesia and/or paresthesia resulted and all but one of these resolved within six months. The lack of direct correlation between surgical exposure of the neurovascular bundle intraoperatively and the proximity of radiographic images of tooth root and mandibular canal, with the occurrence of sensory deficit, is noted. Our findings support the 1979 Recommendations of NIHCDCRTM*, upon which the policy of informed consent regarding nerve injury was based.

Adolescent

[A case of greater auricular nerve autologous nerve grafting for inferior alveolar nerve injury by mandibular fracture].

The results of peripheral nerve repair have been greatly improved in the last few years following the introduction of micro-surgery and increased application of free autologous nerve transplants. In the field of oral surgery, a rich experience has been made in plastic and reconstructive repair. The inferior alveolar nerve is endangered by a series of mandibular fractures, with fracture lines running along the nerve canal. For plastic repair of the inferior alveolar nerve, we interpose an autologous transplant from the greater auricular nerve.

Adult

Inter-rami intraoral fixation of severely comminuted mandibular war injuries.

A new technique is presented for the reduction, stabilization and immobilization of an avulsed maxilla and severe comminuted body and symphysis injuries of the mandible sustained by Iraqi soldiers in combat. The technique consists of the use of intraoral inter-rami horseshoeshaped Kirschner wire as a scaffolding for multiple circumferential wires tied around bone fragments. The technique is simple, short, effective and allows function of the lower jaw.

Bone Wires

Fractures of the mandible: role of the general dentist.

Mandibular fractures are the second most common facial fracture, the majority being the result of interpersonal violence, road traffic accidents, or sports injuries. Although most of these patients attend a hospital, it is not uncommon for patients with these injuries to present first to the general dentist, perhaps complaining of a loose tooth or abnormal bite. A careful history should be taken from the patient in order to identify the possibility of other injuries. Mandibular fractures are rarely life-threatening, although airway difficulties can arise. A systematic approach to diagnosis is essential if fractures are not to be missed, including radiological assessment in two planes at right angles. The initial treatment consists of airway management, control of fracture segments, and pharmacologic management. Most fractures have been traditionally managed by the use of intermaxillary fixation; however, increasing use is being made of open reduction and internal fixation techniques. Occasionally, general dentists are involved in the post-operative care of the patient following definitive management.

General Practice, Dental