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The goal of fracture treatment that includes the dentoalveolar process is to obtain the anatomic bone healing and the pre-injury occlusion restoration with functional and aesthetic recovery, avoiding dental or periodontal lesions. Fractures activates, in the damaged tissue, the Regional Acceleratory Phenomenon, a physiological healing process that can also be activated during orthodontic overloads. Orthodontic treatment in the traumatized area could exploit this phenomenon in order to sustain the cellular activity.The aim of this study is to propose a treatment protocol for dentoalveolar fractures based on the use of orthodontics in order to sustain the physiological healing process known as Regional Acceleratory Phenomenon.The authors present 2 cases of an 18 year old woman and 23 year old man affected by dentoalveolar fracture. The operative protocol the authors applied foresaw three steps of treatment: orthodontic brackets application, surgery, orthodontic treatment.The patients showed complete healing at the 3 months follow-up and were treated up to 18 months for further orthodontic treatment.The operative protocol proposed by the Authors appears to be a rational choice since it allows a single orthodontic device to be an "active splinting system", with fast application time, good acceptance by the patient, low complications rate; moreover, it produces any planned dental movements for further orthodontic treatments.

Bioabsorbable plates developed for use in the facial skeleton have become an integral part of the craniomaxillofacial surgeon's reconstructive armamentarium. They avoid the problems associated with the retention of metal plates and can be easily contoured when heated in a thermobath. The technical process of molding and securing these devices, often through small access incisions, to achieve rigid fixation of facial fractures can be difficult. In this article, we describe a simple, novel technique that we have developed, using hot water suction irrigation, to achieve in situ molding of resorbable plates during facial fracture fixation. We used this technique to fix 123 facial fractures in 110 patients over a 4-year period. No complications secondary to the use of hot water suction irrigation were encountered.

These clinical studies reflect the experience of the author in managing 673 patients treated during the last 8 years. All patients were treated in the Maxillofacial Unit, Surgical Specialties Hospital, Medical City, Baghdad, and in the author's private clinic. Included patients were 530 males and 143 females; patients' age ranged between 1 year and 75 years (mean, 38 y). Distribution of injuries was as follows: fracture of the mandible, 287 (42.64%); middle third injuries, 39 (5.79%); orbital injuries, 236 (35.07%; including 12 cases with cranioorbital injuries); injuries in children, 27 (4.0%); fracture of the zygoma, 52 (7.73%); and fracture of the nose, 40 (5.94%).Maxillofacial injuries in this study were classified as follows: (1) craniomaxillofacial with head injuries and cerebrospinal fluid leak; (2) fracture of the middle third including Le Fort I, II, and III and midline split in the face; (3) fracture of the mandible as an isolated injury or as part of a facial skeleton injury; and (4) isolated complex injuries of the zygoma, the orbital skeleton, and the nasoethmoidal region.The technique used for treating middle third injuries was external fixation either by halo frame (with vertical rods and cheek wires) or by box frame (using 4 external pins connected by rods) or internal fixation by suspending the middle third with internal wires (0.5 mm stainless steel) from the zygomatic process of the frontal bone beneath the zygomatic arch down the lower arch bar. Fractures of the mandible were treated by gunning splint with intermaxillary fixation (IMF) or with open reduction and fixation by stainless steel wire with IMF or by IMF screw or by an arch bar and IMF. Other fractures such as fracture of the orbit were treated by bone graft, sialastic, or lyophilized dura with open reduction. Fractures of the zygoma were treated by open reduction and fixation with stainless steel wire and bone graft or by reduction without fixation. Fractures of the nose were treated by reduction with straightening of the septum with a splint (lead splint or polythene) or by external splint with plaster of Paris. With the techniques used, results from managing these cases were satisfactory.

This study evaluates 22 patients with retained foreign bodies in the maxillofacial region that were all caused by penetrating missile injuries. Surgical intervention for the retrieval of the foreign bodies was carried out in 20 patients through the existing wounds and through separate incisions; all patients were followed up for a minimum of 2 months during which all the complications were registered and managed. Preoperative imaging is a prerequisite for the accurate localization of the foreign body and the subsequent successful removal of it. All patients developed complications that were categorized in this study into those that result from the injury itself and those that occur because of the retrieval procedure, the latter category being mostly easily managed. In general, all foreign bodies in the maxillofacial region should be removed; the surgeon involved should weigh the benefits and the perils of the removal, and the patient should be well informed about the possibility of the failure of removal of the foreign body.

Background: A large number of studies and clinical cases show that an ideal prognosis for mouth function cannot be obtained without sufficient and reasonable postsurgical functional exercise after jaw fracture. However, no unifying criteria exist on postsurgical functional exercise with jaw fracture. The study was designed to explore effective methods of postsurgical functional exercise of jaw fracture., Materials and Methods: One hundred seventeen inpatients with jaw fracture between August 2005 and August 2006 were subjects in this study. Sequential function exercise methods were used to recover patients' gape degree, chewing, and so on. Gape degree was recorded, and healing of the jaw was assessed using x-ray., Results: All 117 patients with jaw fracture who underwent surgery were involved in the analysis. After sequential function exercise, gape degree and chewing function improved; good occluding relations were retained. Gape degree was significantly improved at 8 or 12 weeks postsurgery compared with 1 or 4 weeks postsurgery (P < 0.01). However, no significant differences in gape degree were observed between 1 and 4 weeks postsurgery and between 8 and 12 weeks postsurgery (P > 0.05)., Conclusions: Sequential function exercise contributes much to patient recovery of mouth function. This method is effective for postsurgical functional recovery of jaw fracture.

Endoscopic approaches to maxillofacial trauma have included their use in temporomandibular joint arthroscopy, zygomatic arch repair, repair after orbital trauma, repair of frontal sinus fractures, and finally in the repair of subcondylar mandibular fractures. These techniques provide exciting new options for the management of facial fractures. Many of the techniques provide a steep learning curve and require specialized equipment. The approach to an orbital blowout fracture allows the use of a Caldwell-Luc approach and the use of a naturally occurring body space (the maxillary sinus) for the visualization and maneuvering of the endoscope, tools, and implants. The use of the endoscope in the management of fractures for facial structures such as mandibular subcondylar fractures, which do not have a naturally occurring body cavity, may present greater challenges when trying to obtain visualization, reduction, and fixation. When used for the treatment of subcondylar fractures, wide exposure and the use of right-angled drills and screw drivers may significantly help with this procedure. This may be considered by some surgeons as an endoscopically "assisted" procedure that can possibly be accomplished with direct visualization and the use of dental mirrors. It remains to be seen as to whether some of these diverse endoscopic applications will represent the standard of care in the future or remain a specialized technique practiced by a minority of surgeons in a few specialized centers. This article reviews various endoscopic applications to maxillofacial trauma and discusses some of the controversies of these techniques.

Transformation of the surface of metallic titanium with titanium oxides prepared in various ways is a modern procedure. For more than 15 years, the authors have been utilizing fixing elements coated with titanium oxide ceramics, prepared by anodic oxidation and thermal treatment, for purposes of jawbone osteosynthesis. The aim of the authors' work was to assess the extent to which the titanium oxide ceramic coating influences the fate of the plates used for osteosynthesis within the human organism, in regard to the possible need for their removal. During a 5-year period, 108 of 1,396 plates coated with anodic titanium oxide had to be removed for various reasons: plate exposure (47), osteomyelitis (25), palpable swelling and tenderness (21), patient request for psychological reasons (13), or fracture of the plate (2). In none of these 108 cases was metallosis observed, which otherwise is reported relatively frequently in the vicinity of traditional titanium fixing elements, nor was any tissue damage connected with the surface of the plates. The results indicate the favorable properties of the titanium oxide ceramic surface.

Fractures of the palate are frequently associated with the more common and well-described Le Fort fractures. Palatal fractures may present diagnostic and exposure challenges and, if not satisfactorily treated, will result in occlusal problems after surgery. From 1986 through 1998, 116 complex maxillary fractures were treated at the authors' center. Among these, 13 patients were diagnosed with fracture of the palate. Patients with gunshot wounds to the face were excluded from the present study. Open reduction and internal fixation of the palatal fractures were achieved through elevation of the entire palatal mucoperiosteal flap to avoid late hardware exposure. This paper presents a unique approach to visualizing the whole bony palatal surface for accurate reduction and internal fixation of fractures.

Mandibulomaxillary fixation (MMF) is an essential technique for accurate treatment of maxillary and mandibular fractures. Traditional techniques of obtaining MMF (circumdental wires and load-distributing arch bars with or without plastic splints) often work poorly in children and adults with partial or absent dentition, require significant operative time, are at risk for glove puncture, and are painful to patients at time of removal. We have developed two new techniques for the rapid establishment of MMF in all ages and all types of dentition with or without splints. These techniques use four bone anchors--two placed in the pyriform rim of the maxilla and two in the mandibular symphysis. "Microlugs" are anchors constructed from Luhr Witallium mesh and are fixated to bone with 0.8-mm microscrews in primary- and mixed-dentition patients. Mitek MiniGII bone anchors are placed for treatment of secondary-dentition patients. Central skeletal MMF is achieved by linking each maxillary bone anchor to each mandibular bone anchor with suture ligatures and heavy orthodontic elastics. In this study, 112 patients (age range, 15 months-75 years) with maxillary and mandibular fractures underwent central skeletal MMF with one of the two new techniques described. Central skeletal MMF was maintained intraoperatively and for up to 6 weeks postoperatively, according to pathological anatomy. Our techniques succeeded with primary, mixed, and secondary dentition, and with splints and dentures, resulting in functional bone healing in 110 of 112 patients. Malocclusion occurred in 2 patients (1.8%), constituting treatment failure. Microlug central skeletal MMF required 15 to 20 minutes to place, and Mitek anchor central skeletal MMF required 7 to 12 minutes to place. There were no glove punctures noted during the course of treatment. Patient satisfaction has been clearly superior with these two techniques, since MMF amy be released in the office with minimal discomfort, even without topical anesthesia.

A simple intermaxillary fixation technique for the maxillomandibular osteosynthesis is devised using miniscrews and surgical wires. Using this technique, we have treated 13 cases of maxillomandibular fractures and osteotomies. Sufficient intermaxillary fixation was provided at surgery, and satisfactory results were obtained in all patients. This technique is quite simple and easy to use and requires no special instruments. Positive occlusion during surgery is obtained for the osteosynthesis, providing a very useful auxiliary technique for rigid internal fixation. The details of this technique are described.

A patient with severe orbital facial trauma with complete dislocation of the globe into the maxillary antrum is presented. Reconstruction of the defect with autogenous bone restored globe position and maintained the visual and ocular-rotary function of the eye.