Vertical-split fracture of mandibular condyle and its sequelae.
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A case of vertical-split fracture of the right mandibular condyle and its sequelae is presented. The patient was a 16-year-old female being assessed for orthodontic treatment. Orthopantomograph and plain joint view radiographs showed a remodelled condyle which had suffered trauma 10 years previously. This type of fracture is unusual in nature but has not led to any secondary lack of growth, restriction of movement or facial asymmetry. (+info)
The epidemiology of mandibular fractures treated at the Toronto general hospital: A review of 246 cases.
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BACKGROUND: Mandibular fractures constitute a substantial proportion of cases of maxillofacial trauma. This study investigated the incidence, causes and treatment of mandibular fractures at a hospital in Toronto. METHODS: The medical records and radiographs for 246 patients treated for mandibular fracture at the Toronto General Hospital over a 51 2-year period (from 1995 to 2000) were reviewed. Data on the patients age, sex, smoking status, alcohol and drug use, mechanism of injury, treatment modality, and post-operative complications were recorded and assessed. RESULTS: Men 21 to 30 years of age sustained the most mandibular fractures. The ratio of males to females was 5:1. Most fractures were caused by violent assault (53.5%), followed by falls (21.5%) and sports activities (12.2%). Alcohol was a contributing factor at the time of injury in 20.6% of fractures for which this information was available. Nearly half of all cases were treated by open reduction (49.1%). Complications occurred in 5.3% of patients. CONCLUSION: The incidence and causes of mandibular fracture reflect trauma patterns within the community and, as such, can provide a guide to the design of programs geared toward prevention and treatment. (+info)
Management of traumatic dislocation of the mandibular condyle into the middle cranial fossa.
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Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of facial trauma that can have neurological and life-threatening implications. This article discusses the anatomic features that predispose patients to this type of injury, as well as the clinical features and mechanism of injury for this rare type of condylar deformity, to help practitioners recognize this easily overlooked injury and avoid disastrous complications. The article summarizes previously published case reports of this rare complication of condylar trauma and presents a case for which initial diagnosis and a management protocol are described. (+info)
Principle and stability of locking plates.
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A new internal Mini-Locking-System was tested compared with conventional 2.0 mm Miniplates. Standardised osteotomies in the angular region of 16 human cadaver mandibles were fixed with a 6-hole-plate at the oblique line. Osteosynthesis and stability of fixation was proofed in a three-dimensional in-vitro-model in which functional load was simulated. Comparison of the different osteosynthesis techniques showed that in the case of Miniplate fixation torsion and gapping of the bone fragments occurred following plate application and screw tightening when the plates were pressed onto the bone, so last incongruences between bone surface and plate were transferred to the mobile bone fragments resulting in more extended gaps and torsion. This was only observed to a much lesser extent with the Mini-Locking-System due to the fixation principle avoiding pressure to the bone. During functional loading the Mini-Locking-System showed also a significant higher stability in comparison to conventional Miniplates. Due to the fixation method imitating the principles of a fixateur the screws form together with the plate and the cortical bone a frame construction. Loading forces are transmitted without the need of plate friction directly from bone over the screws to the plate resulting in higher stability. (+info)
New innovations in craniomaxillofacial fixation: the 2.0 lock system.
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Rigid internal fixation with plates and screws is now standard for the treatment of fractures, osteotomies and reconstruction of the craniomaxillofacial skeleton. The latest innovations are self-drilling, self-tapping screws and locking miniplates. These screws offer the prospect of less instrumentation and faster application. Preclinical testing has shown them to be substantially more retentive in cancellous bone, a significant advance in cancellous block bone grafting. Locking 2.0 miniplates utilize double threaded screws which both lock to the bone and the plate creating a mini-internal fixator. This results in a more rigid construct with less distortion of the fracture or osteotomy, screws which do not loosen and less interference with bone circulation since the plate is not pressed tightly against the bone. Locking miniplates are designed for midface application in the repair of fractures, osteotomies and defects. Three configurations in a variety of shapes and lengths are available for mandibular surgery. The thinner and medium varieties are useful in transoral plating of fractures utilizing the Champy technique. The heavier, longer variety are used in unilateral edentulous fractures in the symphysis and parasymphysis as well as an aid to tumor resection and reconstruction with both free and vascularized grafts. They are not designed to replace the heavier 2.4 locking reconstruction plates designed for complex fractures or extensive reconstructions. (+info)
Spontaneous mandibular fracture in a partially edentulous patient: case report.
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This article describes the case of a 78-year-old patient whose mandibular fracture was treated with miniplate osteosynthesis. After initial treatment, panoramic radiography revealed a fracture of the miniplate, and at follow-up, a loosening of the replacement plate. For the dental practitioner, this clinical case highlights the importance of panoramic radiography and occlusal analysis and stabilization for diagnosis of mandibular fracture, evaluation of miniplate fracture and treatment, especially in the absence of trauma. (+info)
Spontaneous bone regeneration of the mandible in an elderly patient: a case report and review of the literature.
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Spontaneous bone regeneration is an unexpected phenomenon that may take place in large mandibular defects secondary to trauma and tumor resection. One explanation for this unusual healing course is that it may be derived from the mechanism of fracture healing. A review of the literature presents several factors that may influence this process, such as the presence of periosteum and bony fragments, mandibular stabilization, soft tissue protection, the presence of infection, and a young age. Previous reports of spontaneous mandibular regeneration have all taken place in relatively young patients (5-35 years old). This paper reports a case of spontaneous bone regeneration in a 58-year-old woman who sustained an injury to her mandible from an explosive blast, and presents some explanations on how such an event could take place. (+info)
MR imaging of traumatic lesions of the inferior alveolar nerve in patients with fractures of the mandible.
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BACKGROUND AND PURPOSE: The objective of this study was to assess whether MR imaging can image the neurovascular bundle in patients with fractures of the mandible. In addition, an attempt was made to evaluate whether MR images provide information regarding the continuity of the inferior alveolar nerve before surgery and regarding signal intensity changes after trauma. METHODS: We analyzed preoperative MR images of 23 patients with mandibular fractures. Object-oriented sagittal view proton density- and T1-weighted sequences (before and after the administration of contrast agent) were used not only in an attempt to obtain purely qualitative information regarding nerve continuity in the neurovascular bundle (inferior alveolar nerve, artery, vein) but also to perform quantitative region-of-interest measurements of signal intensities at four defined measurement sites. The measurements were compared with those obtained for a patient population with healthy mandibles. RESULTS: It was possible to interpret MR images in 21 cases. MR imaging findings showed that the neurovascular bundle had been cut in two patients and was intact in the remaining 19 patients. These MR imaging findings were confirmed intraoperatively in all cases. Although we found no significant signal intensity differences between patients with intact nerves and patients with cut nerves, we found significant differences between patients with mandibular fractures and patients with unremarkable mandibles. CONCLUSION: It is possible to diagnose the interruption of nerve continuity by using MR imaging. Signal intensity measurements in the neurovascular bundle provide no information regarding nerve continuity. (+info)