Search

Various techniques of rigid internal fixation have evolved to achieve skeletal stability during healing. Although the miniplates and screws currently used have many advantages, their placement and presence may present significant difficulties for clinicians subsequently providing treatment. Problems with both endodontic diagnosis and treatment after miniplate fixation are illustrated with three case reports.

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.

Purpose: Limited data are currently available regarding the nature of craniomaxillofacial fractures in the geriatric population. This retrospective study reviews 109 hospital records dating from 1981 to mid-1993. The goal of this study was to provide details relevant to these types of injuries., Results: Most patients were injured in motor vehicle accidents (MVA) or fall-related episodes. Females sustained 43.9% of the fractures while males sustained 56.1%. In females, falls were the most common cause of fractures, while in males MVAs caused the majority of fractures (P < .01). Most fractures were found in the upper midface region (60.3%) and the mandible (27.5%). MVAs and falls were responsible for 82.7% of all mandibular fractures. The majority of fractures were treated nonsurgically (49.5%); however, 37.6% were treated with open reduction and internal fixation. The in-hospital mortality rate was 11.1%, and there were three postoperative complications., Conclusion: The geriatric craniomaxillofacial trauma patient is readily treatable with both aggressive surgical measures and more conservative approaches. Elderly patients often have an underlying medical condition that may subsequently alter the patient's treatment. The findings of this study also suggest that more preventive measures and methods of minimizing mortality and morbidity need to be implemented.

In the last 20 years, the management of pan-facial injuries has progressed to the point where immediate treatment using open reduction with rigid fixation is now the standard of care. After discussing the historical progression of treatments, the authors present a plan for treatment of craniofacial injuries based on the use of incisions that expose the four areas of the face: the frontal area, upper midface, lower midface and occlusion, and the basal mandibular area. According to the authors, five incisions permit access to the entire anterior craniofacial skeleton: the coronal, lower eyelid, upper and lower gingival-buccal-sulcus, and the preauricular-retromandibular. Through these incisions, the facial buttresses can be accessed to allow reduction and rigid fixation of facial fractures.

Objectives: To compare the changes in postoperative weight and body composition following orthognathic surgery or jaw fractures treated by intermaxillary fixation (IMF) or miniplate osteosynthesis., Design: A 4-month non-randomised prospective pilot study. Body composition was assessed using the 4 site skinfold thickness technique. The fixation method used in each case was dependent on clinical criteria alone., Setting: Oral and maxillofacial surgery units at St James's University Hospital and the General Infirmary at Leeds., Subjects: All patients were eligible for inclusion in the study if they had sustained a jaw fracture or had undergone orthognathic surgery. Patients were excluded if they had sustained polytrauma, if their sole orthognathic surgery procedure was a genioplasty and if the author was not directly involved in their management. The final study group consisted of 22 patients, 18 following surgical correction of jaw fractures and 4 following elective orthognathic surgery. Thirteen patients were managed with intermaxillary fixation and 9 patients were treated with miniplate osteosynthesis., Main Outcome Measures: Weight, lean body mass, total body water, fat and water free lean body mass, 1 week and 6 weeks postoperatively., Results: There was no significant difference in weight loss or body composition changes between the plated and non plated groups at 1 week postoperatively. However, by 6 weeks postoperatively the IMF group had lost significantly more weight (4.5 kg) than the plated group (1.1 kg). In the plated group this weight loss resulted entirely from a loss of lean body mass (77% water), whereas in the other group it resulted from a fat loss of 1.2 kg plus a lean body mass loss of 3.3 kg (73% water). Estimated protein losses were 0.9 kg for the IMF group and 0.3 kg for the plated group., Conclusions: Intermaxillary fixation compromises nutritional status in the early postoperative period leading to loss of water, fat and protein. The results of this pilot study suggest that further investigation of postoperative weight and body composition changes after oral and maxillofacial operations is indicated.

Authors describe the acute treatment and the reconstruction of the face in the severe, multiple combined fracture of the facial bones. After the primary definitive care further reconstructive operations were performed. After one and half year treatment the functional and esthetic results are good.

Postsurgical infection has always been a cause for major concern in ENT surgery. Papers on the topic allowed to identify indications for antibiotic prophylaxis. In ear surgery, in the absence of prior infection (stapes surgery, medium dry ear surgery), studies' results are not in favour of antibiotic prophylaxis. On the other hand, however, when the ear is inflamed or infected, the use of antibiotics is indicated, if possible after having first taken a sample. For nose and sinus surgery, antibiotic prophylaxis seems to be worthless in the absence of a prolonged packing. If a packing has to be maintained or if a transplant is used, an antibiotic administration has to be considered; the most appropriate antibiotic and its mode of use still have to be specified. In case of facial trauma, antibiotic prophylaxis using cefazolin reduces the risk of infection of paraymphysis fractures and angle fractures. The postoperative course after tonsillectomy is simplified by a prolonged antibiotic administration based on ampicillin. In clean cervico-facial surgery, without buccopharyngeal opening, the antibiotic prophylaxis seems to be worthless. In the opposite, antibiotherapy is required in case of buccopharyngeal opening. Indeed the presence of potential pathogenic bacteria in the buccopharyngeal cavity, the difficulties of mucosa closing, the importance of the tumoral extension, the length of the procedure, radiotherapy and use of myocutaneous flaps may all be the cause of a high infection rate (80%) in the absence of antibiotic prophylaxis. Two types of antibiotics seem to be suitable, cefazolin and clindamycin. Antibiotics active against Gram negative bacteria seem to be useless. There is a disagreement concerning the duration of antibiotic administration. The populations studied are too small to obtain significant results. Both points of view (prolonged antibiotic administration or true antibiotic prophylaxis) can be considered. Only large scale prospective studies with an adequate methodology will provide credible data for this debate.

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.

Records of 169 patients referred to Haukeland Hospital, Bergen, Norway, for treatment of maxillofacial fractures during the period 1989-91 were studied with respect to socio-etiologic aspects, frequency and localization of jaw fractures, treatment, and complications. The number of maxillofacial fractures found in the present study was about twice as many as found in a study from the same area during the period 1974-9. Recent trends in the etiology of maxillofacial traumas were confirmed, such as increased number of fractures caused by interpersonal violence, and a reduction of cases related to traffic accidents. Alcohol abuse was a contributing factor in 28% of the patients. Mandibular fractures were 4.8 times more frequent than maxillary fractures. Reduction and fixation with miniplate osteosynthesis was the preferred treatment in most patients.

This article describes a 5-year study of 73 cats that were surgically treated for mandibular fractures or combinations of fractures with luxation of the temporomandibular joint. Surgical technique and results are described in detail.

The purpose of this survey was to evaluate the current trends in the care of facial trauma. Data were obtained through the responses of a survey mailed to all those members and candidates listed in the 1989 American Society of Plastic and Reconstructive Surgeons Directory. A total of 2777 questionnaires were sent, with 1113 (40 percent) returned by means of a self-addressed envelope. Demographic results show that over 70 percent of the treating plastic surgeons fall within the age range 30 to 50 years. Although significant advances have occurred, treatment goals have remained unchanged. These center around the principles of accurate reduction and precise stabilization of fracture segments. The results of this survey reveal that a number of acceptable techniques were employed in the surgical repair of mandibular and zygomatic complex fractures. In the care of Le Fort III fractures, 59 percent of the respondents preferred the use of miniplates and screws for stabilization. Only 26.8 percent believed that facial fracture repair should be performed within the initial 24 hours. With frontal sinus fractures, the vast majority of plastic surgeons (82.1 percent) obtained a neurosurgical consultation. When the posterior wall was involved, 45.6 percent favored removal of the sinus mucosa, 29.7 percent obliterated the frontal sinus with a variety of autogenous materials, while 20.5 percent preferred cranialization. In summary, this survey shows a wide variation in the practice of facial fracture management within the plastic surgical community.

Immobilization of the jaw by wires has remained a common method of treatment over the past 130 years as determined through articles in the medical and dental journals as far back as 1887. A variety of devices and techniques have been invented as an alternative to the wires but have failed to gain popularity because of their complex mechanical design or surgical technique. A wire with a precisely engineered thread and threaded nylon nut are described as an accurate, speedy and simple alternative to the arch bars and wires method of immobilizing the jaw while greatly reducing the chances of trauma to the surgeon.

Complex craniofacial trauma has been traditionally managed in three stages: urgent craniotomy, secondary orbitofacial repair and delayed cranioplasty. Departing from this conventional approach, we employ an early single-stage neuro and plastic-surgical reconstruction for patients presenting open cranial wounds of the frontobasilar region coexisting with orbitofacial fractures. Neurological outcome does not seem to be affected by the additional operating time, nor is the incidence of infection raised, although bone fragments are repositioned, primary bone grafting is employed, and metallic material is used for fixation. Adequate direct exposure followed by reduction and rigid internal fixation results in primary bone healing and permits to avoid the difficult complications related to soft tissue contracture over misaligned bone. Compared with the conventional staged approach, immediate reconstruction appears functionally and aesthetically preferable, as well as technically easier.

Although most surgical procedures of the head are technically easier to perform with the horse under general anesthesia, other factors will influence whether a surgical procedure is performed with the horse standing or recumbent under the influence of general anesthesia. The accessibility of the head lends itself to many standing surgical procedures if the proper combination of analgesia and physical and chemical restraint is used. Traumatic injuries of the head (lacerations, facial bone fractures, and oral fractures) may involve vital structures, and a thorough examination is indicated. Failure to treat a traumatic injury may result in facial deformity, bony sequestra, paranasal sinusitis, salivary-cutaneous fistula, cutaneous fistulas into a nasal passage or paranasal sinus, nasal septal deformities, and ocular dysfunction. Proper management of these injuries typically results in a cosmetic outcome because of the head's abundant blood supply. Other surgical procedures that can be performed in the standing horse include centesis and trephination of the paranasal sinuses, certain dental procedures, alar fold stabilization, and extirpation of epidermal inclusion cysts of the nasal diverticulum.

Most recently there seems to be a general turning away from the use of rectangular osteosynthesis miniplates in the treatment of maxillofacial fractures and in plastic surgery. Meanwhile a novel design based on circular arcs and connecting bars has been successfully employed. Its particular two-dimensional shape allows three-dimensional deformation without damaging the plates or the openings required for screw insertion. Apart from a reduced plate-bearing area and an increased torsional stability during adaptation to the bone surface, this new plate geometry and the complete system excells by its high tissue compatibility. This later characteristic is attributable to the choice of the bioinert material titanium, which has been processed into a special alloy.

Ni-Ti alloy compression mini-plate was developed for rigid bone-fixation in oral surgery. The investigation of the mechanical properties of this plate was performed to obtain basic data for its clinical application. Ni-49.49 Ti (at%) alloy and Ni-49.26 Ti (at%) alloy were used for the specimens. First, transformation temperatures of the alloys were measured to evaluate the effect of heat-treatment temperatures. Secondly, tensile and shape recovery tests were performed on four types of mini-plates, i.e., four-hole regular and long types Ni-49.49 Ti (at%), five-hole regular type Ni-49.49 Ti (at%) and Ni-49.26 Ti (at%). The following results were obtained. 1. Specimens with a heat-treatment at 500 degrees C, for 30 minutes in both compositions showed adequate As points (about 25 degrees C) and Af points (44-50 degrees C) for clinical use. 2. In the tensile and shape recovery tests, the 500 degrees C heat-treated four-hole regular type plate showed better mechanical properties than the 440 degrees C heat-treated one. However, in the four-hole regular type plate without heat-treatment, the shape memory effect was rarely found. 3. The five-hole regular type plate of Ni-49.49 Ti (at%) alloy had the best mechanical properties for clinical application, judging from the amount and the temperature of shape recovery. It is concluded that Ni-Ti shape memory alloy mini-plates should be applied for rigid internal bone-fixation in oral surgery.

The use of miniplate-osteosynthesis in fracture treatment has been evaluated in 47 patients. In 25 of the patients plate fixation of the fracture was used without intermaxillary fixation and in 22 a supplementary IMF was used. Nine of the 47 patients had alcohol or drug addiction problems. The most common cause of fracture was assault and traffic accidents. The rate of complications including sensibility disturbances, occlusal disturbance and infection was evenly distributed among the two groups. The frequency of postoperative sensibility disturbances was however high, fifteen of the patients, although the sensibility returned in seven of these patients. Postoperative infections developed in five patients where the time between trauma and treatment exceeded three days. In no single case did the plate insertion make any damage to adjacent teeth.

In this article the use of Titanium miniplates in the maxillo-facial surgery is being examined. After a literature-study concerning the qualities of Titanium and the advantages, disadvantages aswell as indications of the miniplates, the stability of osteotomies using this system is being traced, aswell as its eventual developments. From this research it becomes clear that the miniplates indeed contribute to greater stability of the skeletal fixation in maxillo-facial surgery.

This paper reviews the clinical use of titanium miniplate osteosynthesis in maxillofacial traumatology and orthognathic surgery. These materials were originally developed for treatment of mandibular fractures, but the application has within recent years been extended to other fractures of the facial skeleton and orthognathic surgery. The osteosynthesis increase stability in many situations, and may reduce or eliminate the need for post-operative intermaxillary fixation, by which morbidity, hospitalization period and period of sick-leave can be reduced. In orthognathic surgery, the stability of the miniplate osteosynthesis increase the demand for precision during surgery as compared to conventional fixation with wire osteosynthesis and intermaxillary fixation. Further refinements of the technique are, however, necessary in the future, as the current techniques does not always allow a sufficient reproduction of the position of the condylar segment.

Osteotomy with reposition of fractured fragments of the facial skeleton is the most effective method of treatment of post-traumatic deformities. In this way it is possible to correct permanently the position of the bones, to restore normal facial features and adequate conditions for the function of the stomatognathic system, respiration and articulation. A condition of success is good early planning of the operation with consideration of the vascularization of bones after osteotomy and effective reposition of bone fragments as well as a narrow slit of the incision for sparing of bone tissue. A condition of healing of the incision is good immobilization of bone fragments.

The Hall surgical miniplating system has been evaluated for use in maxillofacial trauma and orthognathic surgery. The biomechanical characteristics of the plates have been examined and experience gained, using 53 plates, in 25 patients is presented. The feature which distinguishes these plates is the narrow bridge between paired screw platforms. The specially designed screwdriver has a splined head which allows screw transfer to be carried out as a one-handed procedure. The plates show considerable advantages over existing small plate systems in their size, malleability and consequent ease of handling.

Some of the European countries have advocated the use of monocortical screw miniplates for osteosynthesis in the craniofacial areas and there are several advantages over the wired osteosynthesis. The advantages and different applications of the miniplates in maxillofacial surgery are presented.

The removal of foreign bodies in the maxillofacial region is often a tedious and time consuming process. The image intensifier, which is a standard piece of hospital equipment, facilitates and expedites this surgical procedure and minimises disfigurement. In addition the image intensifier can be useful in the surgical treatment of maxillofacial trauma. Some applications of such use are illustrated with clinical examples. The use of the image intensifier is presented highlighting the advantages to both patient and clinician in the reduction of radiation exposure, cost effectiveness and saving of time in maxillofacial surgical work.

Rigid stabilization of sagittal fractures of the palate is described that utilizes plate and screw fixation in the palatal vault. Accurate reduction of facial width is obtained, and stability is significantly enhanced. An existing laceration or a longitudinal incision in the palatal mucoperiosteum provides exposure for maxillary adaption plate application. The transpalatal reduction should be supplemented by fixation at the piriform aperture, the zygomaticomaxillary and nasomaxillary buttresses, and by the use of an arch bar. Since slower bone healing may be observed following palatoalveolar fractures, the occlusion must be observed for deviation throughout a full 16-week period even though early motion and soft diet are permitted. Removal of the plate and screws in the roof of the mouth is sometimes required and utilizes local anesthesia.

Fractures of the mandible and maxilla occur frequently in the dog and cat. Appropriate preoperative, intraoperative, and postoperative management of jaw fractures is imperative for successful results. Various techniques of jaw fracture management, including tape muzzles, circumferential wiring, interarcade wiring, interosseous wiring, interdental wiring, acrylic splints, percutaneous skeletal fixation, intramedullary pinning, bone plating, and partial mandibulectomy, have unique advantages and disadvantages. Selection of the appropriate method of fixation depends on the signalment of the animal, type of fracture, and the veterinarian's experience and expertise with the various types of fixation. Careful postoperative evaluation will result in the early detection of problems and ensure proper postoperative care.

Prescription habits, dose and form of application of analgesics were investigated in a retrospective study of postoperative pain alleviation involving 250 patients. On the basis of clinical and pharmacological criteria, a prescription regime is presented for Paracetamol as used singly and in combination with Codeine. The prescription regime has been tested in a prospective study involving 50 patients and found to be effective.

Fractures and injuries of the face and jaws in children differ from those in adults with regard to common occurrence and seriousness of injury. Injuries occur predominantly at school or during sports, whereas car accidents are not significant. 7% of our children had fractures of the middle face , compared with a much higher incidence in adults. In such cases, it is always necessary to look for a fracture of the skull base. For the transport of the seriously injured child, respiration and circulation must be safeguarded . Intubation and treatment of haemorrhage must, in the case of serious injury, be placed first. It is only then that transport to a specialised clinic can be carried out. Special features of diagnosis and therapy in children are indicated.

11 years of anaesthesiological experience in maxillofacial and reconstructive plastic surgery (1-4-1966/1-4-1977) are reviewed. The problems connected with these operations are examined. On the basis of localizations, types of operation and surgical requirements, the problems of greatest importance in these branches of surgery may be indicated in the following 5 parameters: 1. Control of the respiratory ways with naso-tracheal intubation under direct view or blind (more than a thousand cases), oro-tracheal intubation: their indications and contraindications as alternatives to pre- intra- and postoperative tracheotomy. 2. Local control of bleeding. 3. Arousal and prevention of possible postnarcotic complications. 4. Prevention and treatment of postoperative oedema. 5. Nutrition of the patient undergoing surgery. In the interests of history, the superseded problem of whether to use local anaesthesia and general anaesthesia in maxillofacial surgery is mentioned and the various problems are discussed exhaustively. Personal anaesthesiological conduct is then specified in relation to the parameters examined and results reported. The importance in certain endo- and extraoral operations of prolonged intubation in the immediate postoperative period (10-15-30 hours) with respect to the indication for postoperative tracheostomy is highlighted. Apart from certain special pathological situations, tracheostomy is rather exceptional and is no longer employed on a routine basis as it was 2-3 years ago.

In a case of persistent traumatic epistaxis successful treatment by embolization therapy is reported. The method is described in detail and the advantages of the use of Digital Subtraction Angiography (DSA) are stressed.