Search

Objective The aim: To establish the possibilities and advantages of cone-beam tomography in the primary diagnostic of mandibular fractures within the dental row compared with traditional methods of radiation diagnosis. Patients and methods Materials and methods: The research was performed involving of 28 patients who had traumatic injuries of the maxillofacial area. The age of the victims was 18-56 years. The injured people were selected who were examinated by traditional radiological methods of diagnosis in the first hours after injury, and for final diagnostic in hospital were used cone-beam tomography of the mandible. The comparison of the results obtained with the help of traditional X-ray examinations with the data of cone-beam tomography allowed to conduct a comparative analysis of the diagnostic capabilities of these methods and to determine the advantage of the last one. Results Results: A comparative analysis of the results of the examination of injured people, which were obtained by using of traditional methods and cone-beam tomography of the mandible, shows the diagnostic advantages of the last one, which allows to determine the extent of traumatic injuries of the mandible and identify hidden fractures that were not determined by traditional X-ray methods. Conclusion Conclusions: For the primary diagnostics of traumatic mandibular injuries, traditional X-ray examinations may be informative, but for complex, combined injuries, as well as fractures that raise doubts,it is advisable to use cone-beam computed tomography. The use of cone-beam computed tomography in mandibular fractures makes it possible to better assess the degree of damage and determine the displacement of fragments.

Condylar fracture and soft tissue injuries to the temporomandibular joint (TMJ) is one of the commonly encountered mandibular injury. These injuries are usually overlooked and least diagnosed. Fracture of the condyle may be caused by direct or indirect trauma to the TMJ apparatus. Soft tissue injuries to the joint apparatus should also be evaluated for arriving at an appropriate diagnosis and to prevent resultant complications that may include disturbed jaw function, internal derangement of the joint, ankylosis and mandibular growth disturbance leading to hypoplasia. All patients with trauma to the temporomandibular joint should be evaluated periodically and followed up closely for any preceding joint derangements. This chapter highlights the clinically valid classifications, diagnostic methods and treatment guidelines for the management of the temporomandibular joint trauma.

Mandibular injuries in the growing patient are not uncommon, and the mature patient with permanent dentition can often be treated similarly to the adult patient. However, pediatric patients with primary dentition and mixed dentition can often be treated much more conservatively due to their healing capacity. It is imperative that the surgeon understand proper application of Risdon cables/wires to facilitate conservative treatment in the pediatric patient. Additionally, some fracture patterns are concerning for growth disturbance and require monitoring over ensuing years to ensure that no further intervention is necessary.

Osteoradionecrosis (ORN) is a major side-effect of radiation therapy in oropharyngeal cancer (OPC) patients. In this study, we demonstrate that early prediction of ORN is possible by analyzing the temporal evolution of mandibular subvolumes receiving radiation. For our analysis, we use computed tomography (CT) scans from 21 OPC patients treated with Intensity Modulated Radiation Therapy (IMRT) with subsequent radiographically-proven ≥ grade II ORN, at three different time points: pre-IMRT, 2-months, and 6-months post-IMRT. For each patient, radiomic features were extracted from a mandibular subvolume that developed ORN and a control subvolume that received the same dose but did not develop ORN. We used a Multivariate Functional Principal Component Analysis (MFPCA) approach to characterize the temporal trajectories of these features. The proposed MFPCA model performs the best at classifying ORN vs Control subvolumes with an area under curve (AUC) = 0.74 (95% confidence interval (C.I.): 0.61-0.90), significantly outperforming existing approaches such as a pre-IMRT features model or a delta model based on changes at intermediate time points, i.e. at 2- and 6-month follow-up. This suggests that temporal trajectories of radiomics features derived from sequential pre- and post-RT CT scans can provide markers that are correlates of RT-induced mandibular injury, and consequently aid in earlier management of ORN.

Objectives Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites. Materials and methods This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05. Results Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035). Conclusion We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

The purpose of this study was to clarify the frequency of missed mandibular fractures and to identify possible predictive factors for missed diagnosis. This was a retrospective study that included patients

There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits. Inpatients were assessed for day surgery using medical, social, and surgical criteria. Each patient’s suitability for discharge was assessed two, three, and five hours postoperatively. A financial feasibility study was made retrospectively on a larger sample of patients with mandibular fractures. The discharge criteria from the day-care unit were fully met by 26/40 patients at five hours postoperatively, mean (range) duration of operation was 145 (40–285) minutes, and mean (SD) Mandibular Injury Severity Score was 13 (3), range 7–20. When all the criteria were combined (n = 100), 12 of the patients were suitable for day care. With 24 bed-day savings/100 patients, potential earnings would increase to around £80 000/year at this hospital. In conclusion, we have identified a group of patients who were suitable for management of mandibular fractures in the day-care unit. Considerable cost savings are anticipated.

Tissue engineering is a promising alternative that may facilitate bony regeneration in small defects in compromised host tissue as well as large mandibular defects. This scoping systematic review was therefore designed to assess in vivo research on its use in the reconstruction of mandibular defects in animal models. A total of 4524 articles were initially retrieved using the search algorithm. After screening of the titles and abstracts, 269 full texts were retrieved, and a total of 72 studies included. Just two of the included studies employed osteonecrosis as the model of mandibular injury. All the rest involved the creation of a critical defect. Calcium phosphates, especially tricalcium phosphate and hydroxyapatite, were the scaffolds most widely used. All the studies that used a scaffold reported increased formation of bone when compared with negative controls. When combined with scaffolds, mesenchymal stem cells (MSC) increased the formation of new bone and improved healing. Various growth factors have been studied for their potential use in the regeneration of the maxillofacial complex. Bone morphogenic proteins (BMP) were the most popular, and all subtypes promoted significant formation of bone compared with controls. Whilst the studies published to date suggest a promising future, our review has shown that several shortfalls must be addressed before the findings can be translated into clinical practice. A greater understanding of the underlying cellular and molecular mechanisms is required to identify the optimal combination of components that are needed for predictable and feasible reconstruction or regeneration of mandibular bone. In particular, a greater understanding of the biological aspects of the regenerative triad is needed before we can to work towards widespread translation into clinical practice.

Resumo Um dos maiores desafios no tratamento de fraturas cominutivas da mandibula e restaurar o contorno anatomico das areas fraturadas, pois, a maioria dos casos apresenta deslocamento osseo severo e perda ossea que diminuem a previsibilidade da reducao dos fragmentos. Nesse contexto o tratamento deste tipo de fraturas mandibulares ainda permanece um desafio para a cirurgia maxilofacial no que se refere a tecnica de reducao. Nesse sentido, a reducao aberta com fixacao interna rigida se apresenta como uma boa opcao de tratamento, por encurtar o tempo de reabilitacao orofuncional e diminuir as chances de infeccao. O presente trabalho tem como objetivo apresentar o caso clinico de um paciente do sexo masculino vitima de acidente com animal cursando com multiplas fraturas de face. A abordagem cirurgica eleita para o tratamento da fratura mandibular cominutiva foi a reducao aberta e instalacao de placa de reconstrucao e parafusos de titânio. A abordagem aberta evitou o bloqueio maxilo-mandibular pos-operatorio em um paciente jovem. Esta tecnica permitiu a reducao precisa dos fragmentos devolvendo a funcao mastigatoria de maneira precoce. Palavras-chave: Fraturas maxilomandibulares, traumatismos mandibulares, reducao aberta, fixacao de fratura. Abstract One of the biggest challenges in treating comminuted jaw fractures is restoring the anatomical contour of the fractured areas. Most cases have severe bone dislocation and bone loss that decreases reduction predictability. In this context, the treatment of this type of mandibular fractures still remains a challenge for maxillofacial surgery regarding the reduction technique. In this sense, open reduction with rigid internal fixation is a good treatment option because it decreases orofunctional rehabilitation time and reduces the chances of infection. The present work aims to present the clinical case of a male patient victim of animal accident with multiple facial fractures. The chosen surgical approach for the treatment of comminuted mandibular fracture was open reduction and installation of reconstruction plate and titanium screws. The open approach favored not performing postoperative maxillomandibular block in a young patient. This technique allowed the precise reduction of fragments and the early masticatory function. Key-words: Jaw fractures, mandibular injuries, open fracture reduction, fracture fixation.

Conventional radiography includes simple projectional X-ray imaging along with panoramic radiography. All except panoramic radiography are obsolete, although the reverse Towne’s view may still be used for suspected mandibular trauma, and cephalograms, although not specifically TMJ radiography, are also used in assessment of some TMJ disorders. The three-dimensional morphology of the bony components of the TMJ does not facilitate conventional radiography. Panoramic radiography can only provide a crude representation of the condyle and temporal component of the TMJ and provides no information about their interrelationships. Its role is as an initial assessment tool before deciding on cross-sectional imaging (CBCT, CT or MR) and to investigate patients with symptoms which might be explicable as dental in origin but which are not localised or specific enough to be assessed using intraoral radiography. Specific criteria can help to determine whether there is any value in using panoramic radiography, and routine screening is not supported by evidence.

The radiological signs that might be identified on conventional radiographs are mainly shape changes due to remodelling and degenerative disease. The most prevalent TMJ disorders produce few or no changes on conventional radiographs.

As fraturas condilares são as fraturas maxilofaciais com maior controvérsia na literatura a respeito das formas de tratamento, uma vez que, no procedimento de escolha, envolve questões relacionadas à idade, localização e tipo de fratura, grau de deslocamento do segmento fraturado, presença de outras fraturas faciais associadas, ausência de dentes, o restabelecimento da oclusão dentária e o tempo decorrido do trauma, fatores estes que direcionam a escolha do tipo de abordagem terapêutica (cirúrgica ou conservadora, estática ou funcional). Este estudo teve como objetivo principal realizar uma revisão integrativa da literatura atual sobre o tratamento das fraturas condilares, destacando suas indicações, limitações, vantagens e desvantagens. A metodologia utilizada foi uma revisão integrativa da literatura por meio de pesquisa bibliográfica, por meio de uma busca de artigos científicos na base de dados eletrônica PubMed e Medline, utilizando os descritores mandibular condyle, mandibular fractures, mandibular injuries, indexados no período de 2015 a 2020, que tratavam de estudos transversais, ensaios clínicos e randomizados. Após os critérios de elegibilidade, foram analisados 27 artigos integralmente publicados em língua inglesa. Os estudos demonstraram qual conduta de tratamento traz mais segurança para a intervenção, apresentando alta confiabilidade, permitindo uma evidência científica previsível e rápida, além de proporcionar um tratamento com menor custo e tempo de internação.

Rationale and Objectives Surgeons aim to restore occlusion and jaw function to baseline status for patients with mandibular fractures using either closed treatment or reduction and fixation. Materials and Methods Occlusion is defined as the relationship between the maxillary and mandibular teeth as they approach each other. Results Radiologists should be familiar with the goals of repair to help identify which treatment is adequate as well as to diagnose potential complications. Some of the more common complications encountered are infection, nonunion or malunion, and malocclusion. Conclusion We provide a comprehensive review of both the desired and untoward CT findings after surgical repair of traumatic mandibular injuries.

Objective The spectrum of etiologies of mandibular fractures is diverse; also, factors such as geography, seasons, means of livelihood, and the psychological make-up and living standards of individuals influence its pattern and incidence. Of significance is the understanding of the pattern and mechanism of mandibular injury that would appear to facilitate choosing the most ideal treatment plan. Method A systematic retrospective review of 483 cases treated between June 2001 and June 2012 was carried out to determine mandibular trauma pattern and distribution in Central Karnataka. Results In our analysis, there were 57 females and 426 males; the male-to-female ratio was 7.5:1 [age range = 5–87 years (mean = 31.19 years)]. RTA (predominantly two-wheeler) was commonest cause of mandibular trauma; age group affected was 20–29 years. While March witnessed a peak in casualty incidence, Sunday recorded the maximum frequency. The mandibular parasymphysis was the commonest site of fracture in this region of Karnataka. Extremity injury was the predominant form of associated injury. In all, 1018 fractures were documented; 887 affected the mandible. Fifty-nine cases had concomitant mid face injury (131 fractures). The left side of the mandible was (marginally) more susceptible to trauma, regardless of gender or etiology. Modes of treatment were ‘open’ or ‘closed’ – 800 fractures were treated by ORIF; the complication rate observed was 48.46%. Conclusion However, further advances in diagnostic imaging and implant-fixation device technology not only aim at reducing the rate of complications in a given setting but also facilitate early return to function and improved quality of life.

Mandibulo-maxillary fixation (MMF) is indispensable for mandibular fracture treatment. Various means for MMF have been proposed, of which arch bars are widely considered to be the mainstay. However, disadvantages to this method have initiated a quest for an alternative, leading to the introduction of MMF screws. MMF screws have frequently been criticized for poor stability of fracture sites, root damage, hardware failure, and nerve damage. We retrospectively evaluate the FAMI (Fixation and Adaptation in Mandibular Injuries) screw in mandibular fracture treatment by scanning for clinically and radiologically visible complications. In total, 534 FAMI screws were used in the successful treatment of 96 males and 34 females. Condylar fractures were most commonly encountered, representing 120 of 241 fracture sites. 15 general fracture-related complications occurred, with the most common being nerve function impairment (3.8%) and postoperative malocclusion (4.6%). In nine cases (7%), clinically visible FAMI-screw-related complications occurred, with the most prevalent being screw loosening (2.3%) and mucosal signs of inflammation (3.1%). Duration of FAMI screws was associated with the occurrence of clinically visible complications (p = 0.042). Radiologically, clinically invisible dental hard tissue damage was noted in 21 individuals (16%). Therefore, FAMI screws seem to be a reliable and safe method for mandibulo-maxillary fixation.

Effectiveness of bone engineering by cell sheet technology to repair canine mandibular injuries was investigated. Cell sheets were produced from canine stem cells cultured by density gradient centrifugation and osteoblast induction. A scaffold surface of polylactic-co-glycolic acid (PLGA) copolymer was wrapped with cell sheets. Mandibular injuries were created in 12 healthy dogs followed by implantation of PLGA with (experimental group; n, 6) and without (control group; n, 6) cell sheets. The progression of the implants was examined at 3, 9, and 12 weeks postoperative. At postoperative 12 weeks, the graft mostly replaced the new bone in the experimental group, compact similar to normal bone was formed at lingual position and the broken end of the bone was normally healed. The bone mass in the control group was 2.5, which was significantly lower than the 4.5 in the experimental group. The optical density of the new bone in the experimental group was significantly higher than that in the control group. The experimental group had more haversian canal and red bone marrow and contained a larger number of lamellar bone than the control group. Overall, satisfactory bone engineering containing lamellar bone can be established by cell sheet technology, which is an ideal method to repair mandibular injuries.

The purpose of this study was to investigate the difference in mandibular trauma caused by two mechanisms for the delivery of missile injuries: firearms and improvised explosive devices (IEDs). The data investigated included sex, age, mechanism of injury, and other clinical and radiographic manifestations. Seventy consecutive patients, predominantly male, with a mean age of 28.6±14 years (range 2-60 years) were enrolled: 38 patients (54.3%) sustained mandibular fractures caused by bullet injuries and 32 patients (45.7%) had mandibular fractures caused by IED explosion injuries. The study revealed that the differences in most of the investigated variables were not statistically significant; the only significant differences were the incidence of trauma to other body regions and the presence of retained foreign bodies. The effect on the mandible of IED explosion resembles that of bullets. Bullet injuries are associated with a relatively higher number of mandibular sites involved and more bilateral fractures, in addition to more extensive bone loss. IEDs, on the other hand, cause more multisystem injuries and result in more retained foreign bodies.

Facial fractures can be potentially fatal in polytraumatized patients due to retropositioning tissues to upper airway obstruction. In the first aids, this situation can be reversed using a tracheostomy procedure to break out the airways. However, fractures leading to airway obstruction are rare and according to Richards Classification can be classified into 5 types. The purpose of this article is to report a clinical patient with a bilateral condylar and mandibular symphysis fractures that resulted in airway obstruction and severe mandibular rear projection.

Introduction: Among the facial injury, the mandibular fractures represent a substantial portion of surgical case load to trauma centers. Management of this common injury varies greatly and is still driven by expert opinion or empirical data. Scientific study of mandible fractures and their treatment has been hampered by the lack of an injury cataloging system that allows a disciplined, systematic aggregation of collective clinical experiences. Materials and Methods: A prospective study was conducted in the Department of Dentistry, Mysore Medical College and Research Institute, Karnataka, Mysore, India. Subjects selected were above 16 years of age with isolated mandibular fractures who were eligible to undergo treatment. A total of 50 patients were divided into two groups, closed and open reduction, each having 25 subjects. Each individual case was evaluated for FLOSID components separately. Mandibular Injury Severity Score (MISS) was assigned based on summated results of FLOSID components. Obtained complication scores and MISS were correlated statistically using Spearman’s correlation coefficient among the different groups. Results: On comparison between the two groups, open reduction and internal fixation (ORIF) and maxillomandibular fixation (MMF), statistical analysis using Mann–Whitney U test showed mean and median values for the ORIF group as 6.52 and 5 (3–11), respectively whereas mean (SD) and median values in the MMF group as 5.52 (3.31) and 5 (3–3.5), respectively. There was proportional increase in both MISS and complication score. The aforementioned analysis indicates that MISS is a predictable parameter in assessing postoperative complications of mandibular fracture and also in predicting the complication outcomes in clinical situation. Conclusion: This study concludes that the higher the MISS, the higher the rate of complications in groups treated with ORIF. MISS however did not correlate much with groups treated using closed method. FLOSID taxonomy predicted the exact details of cases and helped arriving at MISSs, of individual cases with complication score to help the clinician to arrive and predict postoperative events, and to adopt proper treatment plan for individual cases, to minimize the complication score as low as possible, for the benefit patients with Maxillofacial trauma.

Objective In an attempt to explore new tools for constructing a model of blast injuries to the human mandible, a finite element method was used. This model allowed us to perform dynamic simulations and analyse the injury processes and severity of trauma to the human mandible from an explosion striking at the middle mandibular angle. Methods A 3D finite element model of the human mandible was created using digitally visualised CT scanning data of the human mandible. It was used to dynamically simulate the complete injury process of a blast event to a human mandible (at the middle mandibular angle) under the injury conditions of a 600 mg TNT explosion. The model was also used to elucidate the subsequent mandibular damage and the dynamic distribution of several biomechanical indices (e.g., stress, and strain). The resulting data were subjected to a comparative analysis. Results Simulation was successfully conducted for injury events in which 600 mg of TNT exploded at 3 cm, 5 cm and 10 cm from the middle mandibular angle of a human mandible; specifically, the simulation included the dynamic injury processes and the distribution of stress and strain in various parts of the damaged mandible. A comparison of the simulation data revealed that different blast distances resulted in considerable variation in the severity and biological indices of the mandibular injury. Conclusion The finite element model was able to dynamically simulate the blast-initiated trauma processes to a human mandible, which allowed for investigation of the severity of damage to the mandible under different injury conditions. This model and the simulation method are conducive for applications in basic studies and clinical investigations of blast-initiated injury mechanisms of bone tissues.

The critical size defect (CSD) of bone can provide a standard for evaluating the usefulness of bone repair materials or methods. The present study aimed to determine the CSDs of the minipig mandible with and without the periosteum. Ten 18 month-old female minipigs were used. First, the premolars and the first molar in the right mandible of each minipig were extracted. Two months later, the animals were randomly divided into two groups, with six animals in group A and four in group B. In group A, bone segments of 4, 5 and 6 cm were removed from the right mandible and the neighbouring periosteum was preserved. In group B, bone segments of 1 and 2 cm were removed from the right mandible and the periosteum was removed. The defects were retained with two reconstructive titanium plates. The mandibles underwent X-ray examinations at 4, 8 and 12 weeks after the operation. The animals were sacrificed at 12 weeks after the operation, and specimens were evaluated by gross and histological examinations. For defects retained by two reconstructive plates, the CSDs in the minipig mandible models with and without periosteum were determined as 6 and 2 cm, respectively. Copyright © 2009 John Wiley & Sons, Ltd.

Treatment of bilateral parasymphysis fracture often requires special attention due to airway considerations and difficulty in achieving precise anatomic reduction. The central fracture fragment is often displaced posteriorly and inferiorly due to muscle pull, and this adds to difficulty in reduction and stabilization of the central fracture fragment during plate fixation. With this article, we advocate a technique using stainless steel screw and self-holding screwdriver to manipulate the central fragment and achieve an anatomic reduction. We have used this technique in 12 patients with bilateral parasymphysis fracture without any complications and have found it very effective.

Introduction Le kyste osseux anevrysmal (KOA) est une pseudo-tumeur benigne qui realise une cavitation osseuse uni ou multiloculaire a contenu hematique. Observation Nous rapportons un cas de kyste osseux anevrysmal (KOA) du condyle mandibulaire gauche decouvert chez un enfant de 10 ans avec notion de traumatisme mandibulaire survenu un an auparavant. Il a beneficie d’une exerese tumorale suivie de reconstruction immediate par greffon chondro-costal. Les suites ont ete marquees par la survenue d’une hyperplasie cartilagineuse. Discussion La pathogenie du KOA repose sur trois theories, traumatique, vasculaire et tumorale primaire. Plusieurs examens complementaires font evoquer le diagnostic de KOA. L’examen anatomopathologique, peu aise et presentant des ecueils, reste le seul examen de certitude. Le traitement de choix est la resection avec exerese large suivie de la reconstruction immediate.

Background. Vascularized osteoseptocutaneous radial flap is commonly used in the reconstruction of composite bony and soft tissue defects of the lower third of the face due to the outstanding quality of its cutaneous component. The aim was to evaluate the primary and overall success in the reconstruction of mandibular defects, following war injuries, with vascularized osteoseptocutaneous radial flap. Methods. At the Department of Maxillofacial Surgery of the Military Medical Academy Belgrade, there were eight patients with this kind of defect following war injury, and the mandible was reconstructed with a vascularized osteoseptocutaneous radial flap. Bony compartment of the graft was harvested as up to 11 cm long segment of radial circumference. Results. The localization and structure of the defect, features of a harvested compound graft, the procedure of the reestablishment of the mandibular continuity was presented as well as immediate and late complications during the consolidation period, and the primary successful reconstruction in 87.5% of the patients. Conclusion. The primary and overall success in the mandibular defects reconstruction with a vascularized osteoseptocutaneous radial flap was equal or even better than those presented in the literature on the reconstruction of the similar defects after tumor resections.

A 19-year-old mentally retarded male's cachexia, of five months duration, was attributed to a previously undetected anterior dislocation of the mandible. After reduction of the mandible he improved markedly, with better appetite and rapid weight-gain.

Thirty three patients with 0.5 to 4.5 cm gunshot defects of the mandible were treated. The ends of the fragments of the bone were initially compressed, then distracted with the help of a compression-distraction device. The immature callus was distracted at a rate of 0.25 mm four times a day. During the process of distraction the defects of bone and soft tissues are replaced. Lack of soft tissue, which make insertion of a free bone graft impossible, is the main indication for an osteoplasty by local tissues.

South Africa has a high level of violence, as more people are killed by gunfire each year than in motor vehicle accidents, and the numbers are increasing. Regrettably, children are affected most by this epidemic. During 1997, a total of 142 children aged less than 14 years died from gunshot injuries while many more were injured. Here we present the case of an 11-year-old male street child who sustained a gunshot to the face, and illustrate the magnitude of the problem. The escalating epidemic of firearm-related injuries and deaths among children and adolescents in Cape Town, like in many other parts of the world, calls for concern. Further research is needed to understand firearm-related injuries among children and adolescents in South Africa, and to develop policies and programmes for effective prevention of situations such as this.

The replacement of missing anatomic structures may become more demanding when the etiology is trauma. Patients with traumatic injuries will likely have increased forces placed upon their prostheses because of the altered support from the loss of normal anatomy. Successful treatment for these patients may include preprosthetic surgery using osseointegrated implants to augment prosthesis support and stability.

Facial injuries are common and must be radiologically evaluated to detect fractures, to determine their morphology and topography, and to assess adjacent soft-tissue damage. Spiral multislice computed tomography is progressively replacing conventional films for mandible traumatic lesions because it reveals the multiplicity of fragments, the degree of dislocation and rotation, and the extent of skull base involvement. Computed tomography is also very useful in the evaluation of condylar fractures, to determine the best choice for surgical treatment, open or close. 3-dimensional (3D) computed tomography images can display condylar fractures, but also all mandibular fractures, accurately and directly, and are very useful for surgeons to select treating methods of condylar fractures. The demonstration by imaging of the involvement of key anatomic structures is essential to classify correctly the trauma and to select the best management.

[No abstract available]

Case Description—A 6-year-old German Shorthaired Pointer was evaluated for possible reconstruction of a mandibular defect resulting from gunshot trauma. Clinical Findings—A 5-cm defect of the right mandibular body was evident. A segment of the mandibular body was removed 9 weeks earlier because of severe contamination and comminution associated with gunshot trauma. Subsequent right-sided mandibular drift resulted in malocclusion in which the left mandibular canine tooth caused trauma to mucosa of the hard palate medial to the left maxillary canine tooth. The right maxillary canine tooth caused trauma to gingiva lingual to the right mandibular canine tooth. Treatment and Outcome—The right mandible was stabilized with a 2.0-mm maxillofacial miniplate positioned along the lateral alveolar margin and a 2.4-mm locking mandibular reconstruction plate placed along the ventrolateral mandible. An absorbable compressionresistant matrix containing collagen, hydroxyapatite, and tricalcium phosphate was soaked in recombinant human bone morphogenetic protein-2 (rhBMP-2; 7.2 mL of a 0.5 mg/mL solution for a dose of 3.6 mg) and placed in the defect. By 4 weeks after surgery, an exuberant callus was evident at the site of the defect. By 7 months after surgery, the callus had remodeled, resulting in normal appearance, normal occlusion, and excellent function of the jaw. Clinical Relevance—Mandibular defects resulting from gunshot trauma can be treated by removal of contaminated tissue and comminuted bone fragments, followed by staged reconstruction. The combination of rhBMP-2 and compression-resistant matrix was effective in a staged mandibular reconstruction in a dog with a severe traumatic mandibular defect.

The mandible is a bone that is particularly vulnerable to injury because it projects outwards from the facial skeleton. Mandibular injuries generate a lot of interests because of the cosmetic and functional deformities that affected individuals may suffer. Early identification and appropriate treatment of these injuries is required in order to achieve a good outcome. The management experience in a semi-urban tertiary hospital in Nigeria is presented with three illustrative cases. The three cases had fracture of the body of the mandible by three different modes of transportation. The diagnosis, investigations, treatment options and possible outcome are also discussed. Keywords : Fractures, Mandible, Radiology, Treatment Nigerian Journal of Orthopaedics and Trauma Vol. 7 (1) 2008 pp. 26-28

A retrospective 4-year study of 225 patients who collectively suffered 356 midfacial fractures is presented. Distribution of fractures, cause of injury, associated injuries, monthly patterns, and age, race, and sex of the patients are reported.

Sporting injuries are increasing in frequency with the increase in leisure time. This report describes a case of degloving of the mental protuberance. Ideally this injury should be treated as soon as possible by repositioning the displaced tissue and closure. Immediate assistance was not sought until superimposed infection caused pain and swelling. Because the wound was infected, treatment was aimed at obtaining healing by secondary intention.

Background Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. Methods A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. Results All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1–2 months. Conclusions The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.