1/47. Reconstruction of the horizontal rami of the mandible following avulsion in childhood.A 7-year-old boy was involved in a road traffic accident in October 1971, and apparently had been dragged along face downwards with resultant avulsion of the entire horizontal mandibular rami, and most of the mandibular alveolar soft tissue and teeth. Repair by metal implants was attempted but these proved unsatisfactory, and soft tissue replacement for the missing alveolus was carried out by flap raised from arm. Rib grafting was carried out on three occasions at almost yearly intervals, but each time, probably owing to vascular insufficiency, non-union (or more correctly non-replacement) occurred in the left canine region. To "import" a new blood supply, and free some of the scar tissue, a compound muscle/bone/skin flap bearing the clavicle and sternomastoid muscle was transposed to the mandibular bed. This form of grafting was used extensively in world war i to repair facial gunshot wounds, and the transposed blood supply enabled success in the pre-antibiotic period. Bony union is now satisfactory 5 years after injuries and dentures have been recently fitted; speech is normal, the child's facial contours acceptable, and mastication has been satisfactory during this period.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/47. Bilateral reflex fracture of the coronoid process of the mandible. A case report.Bilateral fractures of the coronoid process of the mandible occurred following a blow to the left temporal region in an assault. There was no evidence of direct trauma and the zygoma and other facial bones were intact. The probable cause was acute reflex contraction of the temporalis muscles leading to bilateral stress coronoid fractures. Conservative management was followed by complete resolution of symptoms.- - - - - - - - - - ranking = 0.13287407620904keywords = process (Clic here for more details about this article) |
3/47. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.- - - - - - - - - - ranking = 0.026574815241809keywords = process (Clic here for more details about this article) |
4/47. Failed closed reduction of a bifocal mandibular fracture because of dislocation of the mandibular ramus behind the styloid: case report.We present an unusual dislocation of the mandibular ramus after a low condylar fracture associated with a fracture of the opposite body of mandible. As closed reduction failed, both fracture sites were exposed. The mandibular ramus was dislocated behind the styloid process, which was not shown on the preoperative radiographs. The intermediate fragment was freed and the fractures treated by miniplate osteosynthesis. The patient made an uneventful recovery with no residual deformity.- - - - - - - - - - ranking = 0.026574815241809keywords = process (Clic here for more details about this article) |
5/47. Early treatment of angle Class II, division 2 in combination with functional therapy of TMJ fracture.Children who have sustained condylar fractures are treated with functional appliances because surgical repositioning of the condyle is more resource-intensive without producing better results. In cases with additional malocclusions it is practicable to combine the functional therapy of the fracture with skeletal Class II therapy. A 10-year-old boy suffering from a left condylar fracture and showing Class II, Division 2 malocclusion was treated with a skeletal functional appliance in combination with a utility arch for uprighting of the incisors. A modified transpalatal bar was then used to retain the incisor position. The remodeling process of the mandibular condyle following its fracture with dislocation signifies a high adaptability of the affected tissues. This reaction can be used simultaneously for effective sagittal repositioning of the mandible in certain cases of Class II malocclusion.- - - - - - - - - - ranking = 0.026574815241809keywords = process (Clic here for more details about this article) |
6/47. An unusual case of sub-condylar bilateral fracture and bilateral post-traumatic temporomandibular ankylosis.A case of bilateral sub-condylar fracture with wide stump dislocation associated with a central facial trauma, fracture-intrusion of the rhino-orbital-maxillary complex and a parasymphyseal mandibular fracture, is reported. After surgery and inter-maxillary fixation an unusual temporo-mandibular ankylosis developed. Maximum mouth opening, lateral and protrusive movements were severely limited. Surgical treatment of ankylosis was requested and performed. The originality of this case lies in the atypical lateral dislocation of condylar neck fractured stumps to the zygomatic arches and in the later appearance of ankylosis between the glenoid fossa, zygomatic arch, condylar neck stump, and the condylar process displaced anteromedially. The ankylosed blocks were resected, displaced condyles were also removed due to the strong adhesion with the ankylotic tissue and the lack of any anatomical continuity or connection with the glenoid fossa. Functional therapy allowed the resolution of the functional limitation.- - - - - - - - - - ranking = 0.026574815241809keywords = process (Clic here for more details about this article) |
7/47. Fracture of the coronoid process: report of a case.A case of a fracture of the coronoid process associated with a depressed zygomatic fracture is described. Clinical signs, radiology (3D-CT scan), treatment and follow-up are presented.- - - - - - - - - - ranking = 0.13287407620904keywords = process (Clic here for more details about this article) |
8/47. Treatment of mandibular-condylar fractures.Particularly with true dislocation fractures, nonoperative treatment with maxillomandibular fixation followed by physiotherapeutic exercises leads to poor results, as was proved with axiography and clinical examinations. The main reason for this is the shortening and scarring of the condyloid process and the lack of function of the lateral pterygoid muscle. The condyle with its insertion of the muscle is usually displaced medially and anterially and nearly in touch with the origin on the pterygoid process so that protrusion by the muscle is no longer possible. The physiologic relationship of the lateral pterygoid muscle is restored after reduction of the condyle and osteosynthesis of the condylar neck fracture and the original distance between origin and insertion of the muscle is re-established and is a fundamental necessity for regaining function (Fig. 40). The anchor screw osteosynthesis is a most effective technique with low limitations for its indication. A comparison with plates shows this technique to be very economic because one anchor screw has the effect of at least one five-hole plate with five plating screws. That means a reduction of osteosynthesis implants of up to 80%, which saves a lot of money. On the other hand, the sophisticated technique of an anchor screw osteosynthesis needs some training on the part of the surgeon to get the best results possible. In general, we could realize that the anchor screw osteosynthesis gives a perfect adaptation of the fracture ends with compression also on the inner cortical layer, which with plates is only possible in rare cases. After an osteosynthesis of mandibular condyle neck fractures with an axial anchor-screw there are a few cases with an absorptive process in the fracture interface where the screw migrates in an axial direction with loosening of the osteosynthesis. This effect can be compared with the effect of a dynamic hip screw, which leads to compression of the callus, which speeds up bony union at the expense of shortening the bone. When the same absorption happens using a plate, the fracture ends cannot become sintered and the plate is in danger of fracturing as a result of metal fatigue. Ceipek evaluated 136 patients with mandibular condylar neck fractures treated with axial anchor screw osteosynthesis. Thirty-six of these screws showed signs of migration, but only 3.7% for more than 4 mm. For the migration process there are some important risk factors: difficult repositioning of the proximal fragment, dorsal luxation fracture, indirect method of anchor screw osteosynthesis, narrow condyle neck, no intercuspation in the molar region, no compliance, and disturbance of bone healing. Another stable technique of osteosynthesis should be used if patients show more risk than one risk factor.- - - - - - - - - - ranking = 0.10629926096724keywords = process (Clic here for more details about this article) |
9/47. Intracranial dislocation of the mandibular condyle: report of two cases and review of the literature.Fractures of the mandibular condylar process are common and account for up to 40% of all mandibular fractures. Penetration of the condylar head into the middle cranial fossa is, however, rare. We have found reports of only 43 cases since 1834. The diagnosis of intracranial condylar dislocation is difficult, there are usually no particular symptoms or neurological signs. As a result, detailed radiological studies are necessary. In the absence of clear radiographic images of the condylar structures, computed tomography (CT) is essential to locate the fragments and to investigate and monitor intracranial lesions. This paper describes the diagnostic and surgical procedures used in two cases of condylar dislocation and discusses them with reference to previous cases. The use of a titanium screw, which was positioned intracranially in the first case, has not, to our knowledge, been described previously.- - - - - - - - - - ranking = 0.026574815241809keywords = process (Clic here for more details about this article) |
10/47. TMJ remodeling after condylar fracture and functional jaw orthopedics a case report.BACKGROUND: Condylar fractures in childhood are generally treated in a conservative-functional manner. As a rule, very good healing results are achieved by functional orthodontic treatment alone or, after immobilization, by splinting. history AND TREATMENT: Here we report on a patient who suffered a deep condylar dislocation fracture as a result of trauma at the age of 5. After initial immobilization with Schuchardt splints she underwent functional jaw orthopedics with activators. Subsequent orthodontic treatment with removable and fixed appliances enabled her to be followed up form functional and radiographic aspects over a period of 13 years. The remodeling process of the condylar head and neck could be clearly seen in the panoramic control radiographs. RESULT: Although the traumatized right TMJ was completely pain-free and fully functional after only a short time, the remodeling of the head and neck of the originally traumatized TMJ took 13 years to correspond fully to the healthy TMJ on the opposing side.- - - - - - - - - - ranking = 0.026574815241809keywords = process (Clic here for more details about this article) |
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