Cases reported "Mandibular Fractures"

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1/11. Unusual dental injuries following facial fractures: report of three cases.

    We report 3 cases of unusual dental injuries following facial fractures. The first patient sustained intrusion of a maxillary incisor into the nasal cavity following a mandibular fracture. The tooth dislocated into the pharynx and was found lodged in the piriform fossa during surgery. The second patient sustained intrusion of molars into the maxillary sinus following maxillary and mandibular fractures. His treatment was delayed due to life-threatening hemorrhage. The third case involved ingestion of multiple avulsed teeth into the alimentary tract following severe maxillofacial fractures. Although the diagnosis was made more than a week after the injury, the patient did not suffer any complications as a result of the dental avulsion. The aim of this report is to emphasize the possibility of associated dental injuries in patients with facial fractures. The trauma surgeon should be cognizant of the importance of carrying out a thorough intraoral examination during the initial evaluation. Any missing tooth should be considered as possibly displaced into other tissue compartments, and must be routinely searched for with x-rays of the skull, cervical spine, chest, and abdomen. If full intrusion injury is suspected, further diagnostic investigation with facial computed tomography scanning may be worth while.
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2/11. Non-surgical treatment of mandibular fractures--survey of 28 patients.

    Between January 1996 and January 2001 28 patients (nine females, nineteen males) with 35 fractures were treated by observation and soft diet only. patients with isolated high condylar neck fractures were not included. The mean age at time of trauma was 35.6 years (5/80). Only patients with normal occlusion and radiologically undisplaced fractures were included. The follow-up time was 15 weeks on average (8/33). The patients did not undergo any active treatment. They just received the instruction to reduce mouth opening and to take a soft diet for 4 weeks. During the first 2 weeks after the trauma the patients were seen twice a week. Follow-up x-rays were performed after 4 and after 8 to 12 weeks. As a preemptive therapy antibiotics (amoxicillin plus clavulanic acid 2 x 1g/day) were given for 5 days. Spontaneous healing of all fractures was observed. In two patients a tooth had to be removed out of the fracture line. One patient complained about an occlusal problem after 1 week. In his case intermaxillary fixation was installed for 2 weeks. For forensic reasons the patients have to be fully informed about possible complications before indicating this type of management. patient selection is crucial and requires a highly experienced surgeon. Patient inconvenience due to frequent consultations must be taken into consideration. This type of treatment can be recommended only in selected cases.
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3/11. Postoperative fractures of the lingual plate after bilateral sagittal split osteotomies.

    We encountered the unusual complication of postoperative fracture of the lingual plate in four patients after bilateral sagittal split osteotomy. We then did a retrospective review to identify possible risk factors. Over a 1-year period we did 52 bilateral split osteotomies. The patients' casenotes were examined and a number of variables were recorded, including surgical technique, and the patient's sex, age, presence or absence of third molars, and the height of the mandible in the region of the osteotomy. Significant risk factors were a vertical mandibular height of 2 cm or less distal to the last molar tooth (p=0.02), and a depth of 0.6 cm or less from the apex of last molar root or impacted third molar to the lower border (p=0.005).
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4/11. Langerhans cell disease associated with pathological fracture of the mandible.

    A 27-year-old male suffered a fractured mandible following extraction of a tooth. It was subsequently found that the fracture occurred in an area pathologically weakened by a localized lesion of Langerhans cell disease. Since lesions of the jaws may be seen either as the first manifestation or as a complication of widespread Langerhans cell disease, the dentist has a major role in the diagnosis and management of such cases.
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5/11. Management and subsequent 13-year progress of a mandibular fracture with malocclusion in a child--case report.

    Under acute conditions, maxillofacial injuries may be treated without the opportunity for an assessment of occlusal irregularities, even when there are mandibular fractures, because life-threatening injuries have priority over occlusion. Consequently, mandibular fractures may result in post-trauma malocclusion and facial deformity. The case history reported is of a male patient who had been involved in a traffic accident in childhood and suffered mandibular fractures. The initial incomplete management resulted in persistent deformation of the mandible, disturbance of dental occlusion and difficulty in mastication. These irregularities were corrected during childhood by non-operative orthodontic treatment. When the patient reached adulthood, some permanent teeth were malformed because the fractures had damaged some tooth germs. However, the permanent dentition in general was almost normal as a result of the corrected primary dentition. Although the alveolar deformity due to the injury remained, the mandibular base was satisfactorily remodelled. The case reported supports the view that early restoration of normal dental occlusion before the eruption of permanent teeth contributes to the establishment of good functional dental occlusion of the permanent teeth.
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6/11. Endodontic therapy averting major surgery and avoiding keloid formation.

    Keloids and mandibular unfavorable fractures are reviewed. A case report of a patient with keloid diathesis, who had a mandibular unfavorable fracture, is presented. A grossly carious, abscessed first molar was in the line of fracture. This tooth was the only erupted tooth present in the proximal fragment. Endodontic therapy and restoration of normal contour enabled the surgeons to treat the fractured mandible by means of simple closed reduction. The endodontic treatment pre-empted a major surgical procedure under general anesthesia and also averted a skin incision which would have subsequently formed a disfiguring keloid.
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7/11. Developmental arrest of tooth bud after correction of mandibular fracture.

    A case of multiple fractures of the mandible following a car accident in a five-year-old patient is reported. The fracture line passed distal to the first molar tooth bud. The fracture was treated by wire osteosynthesis and skeletal fixation. During the ensuing 18 months, a gradual arrest of the development of the first molar tooth bud was radiologically observed. The eruption process had not been disturbed, and the tooth erupted at the age of 6 1/2 years. Since the distal root had completely failed to develop and the mesial roots showed a diminished size, the tooth was extracted. Histopathological examination revealed disturbed dentin apposition, there was almost complete obliteration of the pulp chamber by globular dentin, and evidence of root resorption.
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8/11. A case of osteoporosis with bilateral defects in the mandibular processes.

    We carried out a detailed total body examination of a 62-year-old woman with osteoporosis who had bilateral defects in the mandibular processes. It was inferred that the defects in both articular heads were caused by resorption of small bone fragments following fracture. The quantity of bone salt was determined by microdensitometry, and a diagnosis of osteoporosis was then established. An improved bite was obtained by treatment consisting of tooth extraction and the preparation of partial dentures.
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9/11. An infected mandibular fracture. Case report.

    A case of an infected mandibular fracture is presented. A submandibular abscess appeared to arise from chronic pericoronal infection associated with a third molar tooth in the line of fracture. Treatment of the case is described followed by a short discussion on the aetiology and management of infected mandibular fractures. The importance of adequate first aid and prompt referral is stressed.
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10/11. Cervicofacial actinomycosis in man.

    Two cases of advanced jaw destruction due to actinomyces is reported; one with diabetic diathesis and a history of tooth extraction the other had a trauma of the mandible with the fracture; good results were obtained with penicillin therapy.
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