Search

Although excellent results may be achieved in the management of many orbital floor injuries with standard transconjunctival or transcutaneous approaches, visualization of the posterior edge of the orbital floor or medial wall defect may be challenging at times. We describe our experience using endoscopic examination of the orbital floor through maxillary sinus approaches during the repair of selected orbital floor fractures. Owing to the posterosuperior angulation of the orbital floor, these approaches allow better visualization of the posterior edge of fractures involving the posterior portion of the orbital floor than do the standard transconjunctival approaches, and they facilitate confirmation that all orbital soft tissues have been elevated from the fracture site. We have used these techniques successfully in 9 patients with fractures involving either the posterior portion of the orbital floor or the medial wall or both.

The maxillary tuberosity can fracture during extraction of a molar tooth. If a small bony fragment is affected, the extraction of the tooth and tuberosity continues; however, a conservative approach is advised if the bony fragment is large. In a modified blind surgical technique, the tooth is removed without the fractured bone.

The incidence of unfavorable fractures of the maxilla during Le Fort I osteotomy was compared between patients with atrophic, edentulous maxillae and patients with normal dentate maxillae. Unfavorable fractures frequently occurred in atrophic, edentulous maxillae. The most common maxillary fracture involved the junction of the horizontal plate of the palatine bone and posterior part of the maxilla. Prevention strategies and treatment options are discussed.

In order to evaluate the current trends in maxillo-mandibular fractures, hospital records of all patients who had sustained maxillo-mandibular fractures (in Tanzania Mainland) from 1990-1992 were examined. A specially designed questionnaire was dispatched to Regional Dental Officers to be filled after examining the hospital files of patients. Factors considered were age, sex, date fracture and anatomical site of the fracture. Records of 179 patients who had sustained 187 maxillo-mandibular fractures were identified and analysed. Results showed that the greatest number of maxillo-mandibular fractures occurred in patients between the age group 21-30 years, with a male to female ratio of 3:1. Assault was found to have been the leading aetiological factor (29.9%) followed by motor vehicle and motor cycle accidents (27.3%), falls (18.2%), bar fights (9.1%), sports (8.6%), spouse abuse (3.7%) and work injuries constituted 3.2%. Mandibular fractures out-numbered maxillary fractures in a ratio of 4:1. Of the mandibular fractures, fracture of the body of the mandible occurred most followed by fracture at the angle of the mandible, symphysis, condyle, alveolar and ramus.

A review of biomechanical studies that have attempted to measure fracture tolerances of facial bones has been carried out. The particular bones of interest were the mandible, the zygoma, the maxilla and the nasal bones. Numerical values have been given for the peak force and pressure fracture tolerances for these bones. A study of these values illustrates just how variable the bone strength of various individuals is. A review of various methods that have attempted to measure and quantify the physical effects of a blow to the face has also been carried out. Three major types of test procedure exist, namely frangible elements, peak force and pressure sensing elements and deformable elements. Frangible and deformable elements generally replace the face of a standard test dummy, fracturing and deforming at appropriate impact force levels, respectively. These surrogate face forms are used for two different reasons; either they are used to measure the damage to the human face for some impact scenario or they are simply used to better simulate the response of the whole head to impact by simulating the compliance of the face. Peak force and pressure sensing elements take the form of piezoelectric sensors and pressure-sensitive, colour 'Fuji film'. Both these methods are complicated and really only suitable for research purposes only. Finally, it is recommended that a mathematical model approach be used to establish the principal injury mechanism and support further development of an acceptable face form test.

The extensive damage after gunshot injuries needs excellent primary closure, secondary reconstruction and functional rehabilitation. The huge bone defect can best be reconstructed with vascularized iliac bone graft. An additional advantage of vital bone transplant is the possibility of its support with endosseal implants, which leads to a very good chance for longtime restauration of the masticatory function with a low rate of complications.

The aetiological factors associated with maxillofacial fractures, and the trends in these factors over a 13 year period are reported. The First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tokyo Medical and Dental University, managed 695 patients with maxillofacial fractures between 1977 and 1989. The male to female ratio was 3.2:1 and the majority of patients were aged between 10 and 30 years old. Road traffic accidents and accidental falls were the main causes of fractures throughout the 13 year study period. Mandibular fractures occurred in 477 patients (68.6%). A high percentage of patients were treated by closed reduction and maxillo-mandibular fixation, or occlusal splinting.

A retrospective analysis of complications and side effects associated with surgery for 1000 mandibular and 500 maxillary impacted third molars was performed. The analysis included 614 patients with impacted mandibular third molars and 274 with impacted maxillary third molars who were treated in a 5-year timeframe from 1987 to 1992. The incidence of intraoperative complications and side effects of mandibular third molar surgery was 1.1% and 4% for maxillary third molar surgery whereas postoperative complications were 4.3% and 1.2%, respectively.

Three cases of post-traumatic sialocele involving the parotid region and one case of post-traumatic mucocele involving the submandibular region are presented. Computed tomography (CT) with contrast showed enhancing borders after a few weeks. Cases earlier than 2 weeks from occurrence showed no enhancement because of the absence of a well-developed capsule. Patients who had the disease longer showed better enhancement of the periphery with contrast because of capsule development. By CT scanning alone it is difficult to differentiated these lesions from other cystic lesions of the face and neck, although certain characteristics like location and rim enhancement may favor one lesion over the other.

Two cases of internal carotid artery thrombosis associated with a maxillary Le Fort III and mandibular angle fractures after maxillofacial blunt injuries are described. Both patients had delayed neurologic deficit and hemiparesis. The diagnosis was made by carotid angiography after clinical evidence of thromboembolism. Clinical aspects and etiology, with special attention to mechanism of injury, are discussed.

Fracture of the left maxillary tuberosity during surgical extraction of multiple teeth, involving the maxillary sinus and pterigomaxillary fossa in a male patient with classic hemophilia due to factor VIII deficiency, is reported. The subject was treated by a private dentist and afterwards admitted at the Oral and Maxillofacial Surgery unit of the "20 de Noviembre" Hospital, ISSSTE, where extraction was completed and the fracture detected at surgery. The patient was then referred to Hematology and substitute therapy of factor VIII for two weeks was prescribed but, eventually, persistent bleeding led to suturing the external carotid.

A new device for the treatment of maxillary fractures is described. Indications for its application are discussed. Experience gained in the treatment of 6 patients with fractures of the median segment of the face is presented.

In the years 1968 to 1987 a total of 1484 patients were treated for facial bone fractures at the Hospital for Stomatology and Maxillofacial Surgery of Neuruppin. Most of them were aged between 16 and 25 years. In the majority of the cases, the injuries resulted from acts of violence (40%) and road accidents (35.7%), although the number of care accidents is decreasing. The ratio of mandibular to midfacial fractures is 2.2: 1. Multiple injuries were found in 60% of the patients. The use of surgical treatment methods increased to 30%.

The incidence, aetiology and trends in fractures of the facial bones occurring in the years 1965, 1970, 1975 and 1980 in the Grampian Region of Scotland are reported. A 2.7 fold increase in incidence occurred during this period. Males are seen to be most at risk and an increase in assault and sports-related trauma is seen. Offshore oil exploration developed during this period and its effects are discussed. Attention is drawn to the differences in the aetiology of right and left malar fractures.

The cause and frequency of maxillary fractures as well as type of treatment performed has been reviewed in this study. During the time period between 1969 and 1982, a total of 301 maxillary fractures have been treated at our Department of Oral and Maxillofacial Surgery in Gothenburg. The period has been subdivided in 3 parts to evaluate whether differences in the amount of severe fractures could be observed. Since a law was instituted in Sweden in 1975 calling for a mandatory use of front seat belts, the frequency of fractures related to the time periods before and after 1975 could be of interest. We found a surprisingly equal number of fracture incidents during the different periods of time, but a decreasing number of maxillary fractures of type le Fort I, II and III; partial maxillary fractures on the other hand, had increased in number.

The following case report describes a patient who suffered an anterior maxillary alveolar ridge fracture resulting from difficult laryngoscopy and intubation. An unfortunate sequelae of this injury was the loss of two maxillary central incisors due to persistent mobility despite long term dental stabilization. To the authors' knowledge, fractures involving the premaxilla have not been reported as a complication of laryngoscopy and intubation.

The medical records of 368 patients, hospitalized for facial fractures, were analyzed according to sex, age, etiology, etc. To get the long-term results, the patients were given a questionnaire which was answered by 271 patients (73.6%). In the total material there is an overrepresentation for younger males and the main reasons for the fractures are traffic accidents (34.8%) and fights (27.1%). The most common fracture is the zygomaticomaxillary one (202 cases), followed by the fractures of the mandible (121 cases). The results 1 week postoperatively were good from a clinical point of view. The results from the X-ray examination with its exact demands were poorer. This discrepancy is discussed. The questionnaire covers a postoperative period of 6--99 months. Altogether, 40.1% of the patients operated on and 57.1% of those not operated on were satisfied and considered themselves as good as before the lesion. The results improve in the course of time, especially the functional ones. The reactivation of the function in the infraorbital nerve seems to be a more drawn-out process than previously supposed.

All of the cases involving fractures of the mandible and/or maxilla in Greenland were recorded in a 1 1/2 year period beginning 1 July 1981. Further information of aetiological patterns was added from 2 studies of mandibular fractures in Godthåb/Greenland. The incidence of jaw fractures in Greenland (17 to 10,000 per year) was the highest ever reported. In 90% of these cases, the cause of fractures were interpersonal violence. Jaw fractures were encountered in nearly all districts of Greenland, most often in urban areas and the patients were chiefly of Greenlandic descent. The % of patients in the age group of 20-29 years was extremely high (57%) as was the women (36%). 75% of the women were ill-treated by their spouses. In half of the cases, the victims and the assailants were related. Victims unknown to the assailants made up only 20% of the cases. These were trends typical of a small society. Compared to other reports, violence in Greenland was aggravated and involvement of alcohol was seen in 4 out of 5 cases. Regulation and deregulation of alcohol in Greenland had only temporary effects on the occurrence of jaw fractures. Aetiological patterns of jaw fractures changes from one subculture to another depending on social conditions. The figures from Greenland demonstrated this.

Selected facial bone locations were impacted to simulate clinical trauma conditions. Locations selected included the nose, zygoma, mandible, maxilla, and frontal bone. The experiment clearly delineate tolerance bands for the facial bones for both sexes. These data should permit the improved design of injury producing structures.

One hundred cases of facial mass fractures observed in the period April-September 1988 have been assessed using a clinico-anamnestic type investigation. Among trauma patients there is a prevalence of male patients aged between 10 and 30. Fractures located at the middle third and mandible occur in a practically equivalent number. Most traumas are the result of road accidents, following by falls. A good degree of correlation was observed between trauma aetiology and dynamics on the one hand and type and gravity of fractures on the other. Direct fractures, with greatest comminution of fragments prevail in high speed traumas; indirect fractures are most frequent in low speed traumas (cyclists and accidental).

Injury to the face as a result of firearm wounds differs as a function of whether the injury was due to a bullet or lead shot. In the first case treatment is usually that of a mandibular or maxillary comminuted fracture and is principally orthopedic. In the case of hunting guns the damage is considerable and requires reconstitution of soft tissue with the use of a distant flap (purely cutaneous or musculo-cutaneous), bone repair, when necessary, being by costal or iliac grafts.

The material comprised patients from the Stockholm region with jaws fractured during the years 1978-1980. It is the first time a total material is reported from this area. The following data were registered from case sheets and radiographs: age, sex and nationality, time of injury, admittance clinic, time spent in hospital, delay before treatment, aetiology of injury, associated consumption of alcohol or narcotics, localisation and number of fractures, additional injuries, treatment complications and cooperation.

The aim of this study was to compare frequency, etiology and location of jaw fractures in Malmö during the periods 1952-62 and 1975-85. The following statistically differences were found. The number of patients with jaw fractures increased from 1 to 2 per 10,000 inhabitants and year. The proportion of women increased from 18% to 26%. The proportion of fractures caused by violence increased from 26% to 44% while fractures caused by traffic accidents decreased from 41% to 22%. The proportion of maxillary fractures increased from 16% to 25%. The most striking findings in this study were that jaw fractures were twice as common in Malmö during the last decade as during the fifties and that violence replaced traffic accidents as the most common cause.

The present report is an analysis of 93 patients (52 male; 41 female) treated in 1981-1983 for maxillofacial fractures sustained in bicycle accidents. These accidents accounted for 7.1% of all facial bone fractures treated during the same period. Most accidents were single vehicle accidents (88%) and took place during the summer months. Of the patients, 65% had mandibular fractures, 35% had midface fractures and 5% had fractures in both the middle and lower thirds of the face. Condylar fractures were by far the most common of the mandibular fractures (67%)--a result which differs from studies concerning the profile of mandibular fractures in general. The majority of the middle third fractures were zygomatic (65%). Multiple injuries were diagnosed in 38% of the cyclists and other head injuries were the most common associated injury. Mean hospitalization of the in-patients (38%) was 4.1 days and the average sick leave was 14 days. The results of the study indicate that the use of protective helmets should be strongly recommended to cyclists, although most commercially available helmets do not protect the whole facial area and especially not the chin.