Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial.

INTRODUCTION: A mandibular condyle fracture can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation (ORIF). Many IMF-modalities can be chosen, including IMF-screws (IMFS). This prospective multi-centre randomised clinical trial compared the use of IMFS with the use of arch bars in the treatment of mandibular condyle fractures. RESULTS: The study population consisted of 50 patients (mean age: 31.8 years). Twenty-four (48%) patients were allocated in the IMFS group. Twenty-six (52%) patients were assigned to the arch bars group. In total 188 IMF-screws were used (5-12 screws per patient, mean 7.83 screws per patient). All pain scores were lower in the IMFS group. Three patients developed a malocclusion (IFMS-group: one patient, arch bars-group: two patients). Mean surgical time was significantly shorter in the IMFS group (59 vs. 126 min; p<0.001). There were no needlestick injuries (0%) in the IMFS group and eight (30.7%) in the arch bars group (p=0.003). One IMF-screw fractured on insertion (0.53%), one (0.53%) screw was inserted into a root. Six (3.2%) screws loosened spontaneously in four patients. Mucosal disturbances were seen in 22 patients, equally divided over both groups. CONCLUSION: Considering the advantages and the disadvantages of IMFS, and observing the results of this study, the authors conclude that IMFS provide a superior method for IMF. IMFS are safer for the patients and surgeons.

The combined use of two endosteal implants and iliac crest onlay grafts in the severely atrophic mandible by a modified surgical approach.

Seventeen patients, who received an iliac crest onlay bone graft augmentation to their severely atrophic mandible with simultaneous placement of two endosteal implants by a modified surgical approach, were studied retrospectively. Follow-up ranged from 0.5 to 7.9 years after implant loading with an average follow-up of 4.3 years. Frequency of wound dehiscences and other postoperative complications, the extend of resorption of the initial graft, and the implant success rate were assessed. Two patients, who had a previous history of preprosthetic and implantological procedures at the surgical site, developed a serious wound dehiscence with loss of two implants in one patient and need for antibiotic treatment and sequestrectomy in the other patient. One implant was lost in two other patients with a negative surgical history, resulting in an implant success rate of 88.2%. The average resorption at the last follow up visit was 15% of the initial graft. Damage of the mental nerve was seen in 14.7% of nerves. Our preliminary data indicate that the procedure presented provides a reliable and predictable method for the construction of an implant-bearing overdenture in patients with a severely atrophic mandible. This one-step procedure can not be recommended for patients with a history of surgery in the anterior mandible.

The Utrecht Diabetes Project: telemedicine support improves GP care in Type 2 diabetes.

UNLABELLED: The Utrecht Diabetes Project (UDP) is a shared-care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist. AIMS: To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs' motives for enrolling them. METHODS: Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs. RESULTS: Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out-patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out-patient clinics had more patients with diabetes > 10 years or with complications. UDP patients' records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin. CONCLUSIONS: Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care. Diabet. Med. 18, 459-463 (2001)

Ameloblastic fibroma of the mandible.

A case of an ameloblastic fibroma in the mandible is presented. The ameloblastic fibroma is a benign neoplasm belonging to the group of mixed odontogenic tumours. Enucleation is the treatment of choice. Recurrence of the tumour is very rare, but follow up is necessary. Fewer than 75 cases are described in the literature. An additional case is presented with radiographic signs of calcification which could not be identified on histopathological examination.

Protracted dislocation of the temporomandibular joint.

A review of the literature concerning 37 cases of long-standing dislocation of the temporomandibular joint is presented. 3 new cases are added. A wide variety of methods of treatment has been used in the past. A survey of these methods will be given and a scheme of recommendation for managing the different clinical situations will be discussed.

Posterior dislocation of the temporomandibular disc.

In the literature, posterior dislocation of the disc of the temporomandibular joint is seldom mentioned. Although this dislocation occurs rarely, it is important to differentiate this clinical entity from other joint disturbances. After a review of the literature, 3 patients are presented. Repositioning of the disc is succeeded in all 3 cases by manipulation. There were no signs of osteoarthrotic changes on follow-up.

Unilateral condylar hyperplasia combined with synovial chondromatosis of the temporomandibular joint. Report of a case.

A case of unilateral condylar hyperplasia combined with synovial chondromatosis of the temporomandibular joint (TMJ) is presented. Clinical and radiographic findings were consistent with an active unilateral hyperplasia. A high condylectomy was performed. During the operation numerous cartilaginous particles discharged from the TMJ and so it became clear that the patient was also suffering from chondromatosis. Both conditions were confirmed by histological examination.

Synovial chondromatosis of the temporo-mandibular joint. Report of three cases and a review of the literature.

Synovial chondromatosis of the temporo-mandibular joint is a rare affection, characterized by the formation of cartilage particles in the synovial membrane. These particles can break through and enter the joint compartments. The diagnosis must be considered for patients who complain of slowly progressive swelling, pain, and crepitus in the region of the temporo-mandibular joint. When the changes are not visible on plain X-rays due to absence of ossification, important diagnostic information can be obtained by a technetium 99m (99m Tc) bone scan and a computerized tomography (CT) sialogram. The diagnosis can be established only by histopathologic examination of surgically removed particles or resected synovial membrane. Discussed are 25 cases of histopathologically verified chondromatosis of the temporo-mandibular joint reported in the literature, as well as 3 new cases seen and treated at the University Hospital Groningen since 1970. A good clinical result can be obtained by removal of all particles and synovectomy. Condylectomy is seldom required.