1/13. Tomographic evaluation of 100 patients with temporomandibular joint symptoms.In this study the temporomandibular joints of 100 patients were examined radiographically. While the results leave many unanswered questions, studies of this type do contribute to an increase in the knowledge of this complex structure. It is anticipated that polycycloidal tomography will provide even greater knowledge of the bony components of the TMJ. More accurate, objective radiographic evidence will unquestionably allow us to approach subjective clinical evidence with greater confidence in relating these factors to diagnosis. dentistry must recognize that the newer and more sophisticated methods must be utilized to evaluate pathologic changes or disease entities, such as temporomandibular joint dysfunction. A health profession must be provided with maximum information for total diagnosis.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
2/13. Sevoflurane mask anesthesia for urgent tracheostomy in an uncooperative trauma patient with a difficult airway.PURPOSE: Proper care of the trauma patient often includes tracheal intubation to insure adequate ventilation and oxygenation, protect the airway from aspiration, and facilitate surgery. airway management can be particularly complex when there are facial bone fractures, head injury and cervical spine instability. CLINICAL FEATURES: A 29-yr-old intoxicated woman suffered a motor vehicle accident. Injuries consisted of multiple abrasions to her head, forehead, and face, right temporal lobe hemorrhage, and complex mandibular fractures with displacement. mouth opening was <10 mm. blood pressure was 106/71 mm Hg, pulse 109, respirations 18, temperature 37.3 degrees C, SpO2 100%. Chest and pelvic radiographs were normal and the there was increased anterior angulation of C4-C5 on the cervical spine film. Drug screen was positive for cocaine and alcohol. The initial plan was to perform awake tracheostomy with local anesthesia. However, the patient was uncooperative despite sedation and infiltration of local anesthesia. Sevoflurane, 1%, inspired in oxygen 100%, was administered via face mask. The concentration of sevoflurane was gradually increased to 4%, and loss of consciousness occurred within one minute. The patient breathed spontaneously and required gentle chin lift and jaw thrust. A cuffed tracheostomy tube was surgically inserted without complication. Blood gas showed pH 7.40, PCO2 35 mm Hg, PO2 396 mm Hg, hematocrit 33.6%. Diagnostic peritoneal lavage was negative. Pulmonary aspiration did not occur. Oxygenation and ventilation were maintained throughout the procedure. CONCLUSION: Continuous mask ventilation with sevoflurane is an appropriate technique when confronted with an uncooperative trauma patient with a difficult airway.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
3/13. 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 = 1keywords = complex (Clic here for more details about this article) |
4/13. Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures.Midface fractures, especially if related to traffic accidents, represent a remarkable problem from a surgical, psychological, and social standpoint. In trauma dynamics, the pattern of the fractures can extend to all bony fragments and is often associated with soft tissue injuries and loss of bony structures. This can lead to posttraumatic deformities that greatly influence the patient psychologically and limit his social rehabilitation, sometimes permanently. Panfacial trauma includes midface fractures associated with fractures of other areas (i.e., mandible, frontal bone). Orbits and the nasoethmoidal area are often involved with loss of soft tissue and, in severe cases, loss of orbital contents. We report an unusual complex clinical case representative of this kind of pathological profile in which the guidelines described in the literature were followed in the reconstructive procedure.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
5/13. Chronic osteomyelitis: 20 years after mandible fracture.Chronic osteomyelitis is a persistent abscess of the bone that is characterized by the usual complex of inflammatory processes, including necrosis of mineralized and marrow tissues, suppuration, resorption, sclerosis, and hyperplasia. The purpose of this paper is to report a case of chronic osteomyelitis seen 20 years after mandible fracture.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
6/13. The use of freeze-dried rib and hydroxylapatite in the treatment of a fracture occurring in a patient with familial facial osteodystrophy.The treatment of repeated pathologic fractures of the mandible has long taxed the ingenuity of surgeons. The complexity of the problem increases with the recognition of a metabolic defect that renders the facial bones hypoplastic. In the case presented, a tentative diagnosis of familial facial osteodystrophy was made at the National Institutes of health. Since that time, the patient has undergone autogenous onlay grafting, which has completely resorbed. Because of continuous resorption, a number of pathologic fractures have occurred. The most recent fracture was treated by means of a freeze-dried rib, which acted as a floor and as a splint to the fracture site. Hydroxylapatite and a marrow mixture were placed on the floor to gain height, strength, and durability. Subsequently, hydroxylapatite augmentation was performed to gain a more anatomic alveolar ridge. The patient's 12-month follow-up has shown the mandible to be intact with no noticeable change in either vertical or horizontal dimensions.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
7/13. Mandibular trauma: secondary problems in reconstruction.Cosmetic and functional restoration of the fractured mandible in the great majority of cases is the sine qua non of therapeutic success. Not only must an acceptable low complication rate be obtained, but when present, their complex nature must be understood from the onset. Successful treatment of complications is a multifaceted problem requiring planned, interdisciplinary, often times staged reconstruction. The radiologist and dental prosthodontist make valuable contributions towards the surgeon's ultimate rehabilitation of the patient. A three year experience of 111 mandibular fractures treated on the UCSD otolaryngology Service is characterized. Sixteen complications nine of which were seen after initial treatment elsewhere provide the focus of this report. Special emphasis is given to the pre-treatment planning and surgical techniques necessary to correct malunion and nonunion. Particular advantages achieved by the use of osteogenic autogenous marrow, cellulose acetate filters and vitallium (chrome cobalt) trays are detailed.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
8/13. The role of primary bone grafting in complex craniomaxillofacial trauma.The role of craniofacial surgical techniques and immediate bone grafting in the management of complex craniofacial trauma has been reviewed. Four hundred and one patients with complex facial injuries have been treated. Two hundred and forty-one primary bone and cartilage grafts have been performed in 66 patients. Complex facial injuries should be managed by direct exposure, reduction, and fixation of all fractures utilizing interfragmentary wiring. Very comminuted or absent bone is replaced by immediate bone grafting, producing a stable skeleton without the need for external fixation devices. Associated mandibular fractures are managed with rigid internal fixation utilizing A-O technique. Results of immediate bone grafting have been excellent, and complications are rare. All deformities should be corrected, whenever possible, during the initial operation. This one-stage reconstruction of even the most complex facial injuries will prevent severe postoperative traumatic deformity and disability that may be extremely difficult or impossible to correct secondarily.- - - - - - - - - - ranking = 7keywords = complex (Clic here for more details about this article) |
9/13. External stabilization of the mandible with the Mini-H-Fixator.The use of an adjustable Mini-H-Fixator is described for providing external mandibular stability in complex fractures and segmental resections. It appears that this apparatus offers some definite advantages in providing stability in difficult cases of mandibular discontinuity.- - - - - - - - - - ranking = 1keywords = complex (Clic here for more details about this article) |
10/13. Computed tomography in maxillofacial trauma.Computed tomography (CT) has become the key diagnostic modality in the evaluation of head trauma. Experience with CT in the operative assessment of maxillofacial injuries is limited, however. Plain films and multidirectional tomography have been used until now to define fractures in the facial region. We examined 27 patients sustaining maxillofacial trauma with CT scans. Ten patients were studied in the coronal plane, 12 in the axial plane, and the remaining 5 in both the axial and coronal planes. Polycycloidal tomography in the coronal and/or sagittal plane was obtained in 18 patients for comparison with the CT scan. Fracture lines, bony fragments, and associated skeletal deformities were clearly identified by CT scan in all 27 patients permitting the diagnosis of zygomatic, orbital floor, nasoethmoidal complex, LeFort, temporal bone, frontal sinus, and mandible fractures. More importantly, concomitant intracranial injuries including epidural and intracerebral hematomas, traumatic encephalocoele, and pneumocephalus were readily seen. In addition, facial and orbital soft tissue structures including the globe, optic nerve, orbital fat, and extraocular muscles were easily examined by adjusting the CT level and window settings. overall, CT yielded additional information not available from polytomography in 15 of 18 cases when both modalities were used. Multidirectional tomography is currently superior to CT scanning if fine, intrinsic bone detail is required. However, we have found that complex fractures with fragmentation are more easily identified on CT scans than conventional tomography because of superior contrast resolution of computed tomography. With improved spatial resolution, CT scanning may totally supplant multidirectional tomography in the evaluation of maxillofacial trauma.- - - - - - - - - - ranking = 2keywords = complex (Clic here for more details about this article) |
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