An Experimental Anodized and Low-Pressure Oxygen Plasma-Treated Titanium Dental Implant Surface-Preliminary Report.

Chemical composition and physical parameters of the implant surface, such as roughness, regulate the cellular response leading to implant bone osseointegration. Possible implant surface modifications include anodization or the plasma electrolytic oxidation (PEO) treatment process that produces a thick and dense oxide coating superior to normal anodic oxidation. Experimental modifications with Plasma Electrolytic Oxidation (PEO) titanium and titanium alloy Ti6Al4V plates and PEO additionally treated with low-pressure oxygen plasma (PEO-S) were used in this study to evaluate their physical and chemical properties. Cytotoxicity of experimental titanium samples as well as cell adhesion to their surface were assessed using normal human dermal fibroblasts (NHDF) or L929 cell line. Moreover, the surface roughness, fractal dimension analysis, and texture analysis were calculated. Samples after surface treatment have substantially improved properties compared to the reference SLA (sandblasted and acid-etched) surface. The surface roughness (Sa) was 0.59-2.38 µm, and none of the tested surfaces had cytotoxic effect on NHDF and L929 cell lines. A greater cell growth of NHDF was observed on the tested PEO and PEO-S samples compared to reference SLA sample titanium.

Are recent available blended collagen-calcium phosphate better than collagen alone or crystalline calcium phosphate? Radiotextural analysis of a 1-year clinical trial.

OBJECTIVES: The purpose of this study is to compare bone regeneration properties of recently available collagen-calcium phosphate (C-CP) blend as bone substitute (BS) material in oral surgery with calcium phosphate (CP) as well as collagen material (Collagen). Is C-CP better than the classic loose CP, or is it at least equally effective in the jawbone regeneration with the superiority of a coherent consistency? MATERIALS AND METHODS: This study included 102 patients during 12-month follow-up. All patients underwent the following surgical procedures: sinus lift (52patients) and tooth extraction (50patients). Patients were divided into 3 groups which are as follows: experimental group with C-CP, CP and pure Collagen as control groups. Texture analysis was performed in intra-oral radiographs. Analyses were performed in the MaZda 4.6 software. Average 2444-pixel ROIs were established in the image of BS materials and normal trabecular bone for texture comparison to evaluate the jawbone regeneration process. Four features were calculated and investigated. RESULTS: Texture analyses revealed that all 4 features described the healing process well. Reference textural value of feature SumOfSqrs < 102.37 was soft tissue, DifEntr < 1.1 was not the bone, Entr < 2.62 was not a bone and LngREmph > 1.8 was soft tissue. For 12 months, bone regeneration was proved by 3 of 4 investigated features. Only Entr indicated to CP remnants in the ROI (p < 0.05). CONCLUSIONS: This study proves that blended collagen-calcium phosphate as a BS material can bring satisfactory and predictable outcomes in jawbone regeneration. CLINICAL RELEVANCE: Clinicians can choose a satisfactory and predictable material for bone regeneration treatment.

Comparison of compression screws used for mandible head fracture treatment-experimental study.

OBJECTIVES: Compression screws that can fix a fracture of the condylar head of the mandible are available. Although typical titanium lag screws are generally used, a series of headless screws have been designed for this purpose. The "headless" advantage derived from the complete submergence of the screw in the bone after fixation is the lack of irritation of the lateral ligament of the temporo-mandibular joint by the screw head. The aim of this study is to compare the compression force of typically used lag screws with that of newly developed headless compression screws. MATERIALS AND METHODS: This study tested five types of screws with a 14-mm length: 10 2.0-mm lag screws and 40 headless screws (four groups of equal size: 1.5-mm H screws, 1.8-mm H screws, 2.0-mm H screws, and 1.8-mm W screws). Two cuboid blocks of standardized polyurethane foam were fixed by one screw. The maximal compression force (F in N) and torque at maximal compression force (T in Ncm) were tested according to the guidelines of the American Society for Testing and Materials (ASTM F1839-08). RESULTS: The test results were as follows: 2.0-mm lag screw: F = 211.5 ± 20.7 and T = 21.1 ± 1.6; 1.5-mm H screw: F = 47.2 ± 5.6 and T = 18.2 ± 1.1; 1.8-mm H screw: F = 95.5 ± 9.8 and T = 18.2 ± 1.1; 2.0-mm H screw: F = 145.1 ± 18.4 and T = 25.5 ± 1.5; and 1.8-mm W screw: F = 180.5 ± 8.7 and T = 26.4 ± 2.8. Each type of screw significantly differed from one another as far as compression forces (F) were considered (p < 0.05): the best is the lag screw contrary to the thinnest H screw which is the worst one. For all tested screws, the compression force depended on the torque (S curve relationship was revealed, p < 0.05) and screw diameter (a larger diameter yielded greater compression, p < 0.05). CONCLUSIONS: The 8-mm headless screws featured only a small loss of compression ability compared to the titanium lag screws. CLINICAL RELEVANCE: Headless screws are mechanically attractive fixation materials for condylar head fracture treatment.

Classification proposal for fractures of the processus condylaris mandibulae.

OBJECTIVE: The current classification of mandibular condyle fractures as basal, low neck, and high neck as reported by Loukota et al. (Br J Oral Maxillofac Surg 43:72-73, 2005) and Neff et al. (Craniomaxillofac Trauma Reconstr 7:S44-S58, 2014) has a weakness. Nearly no high-neck fractures are reported (they are typically classified as type C head fractures) contrary to basal condylar fractures, which are overestimated (nearly all low-neck fractures are classified as basal). The aim of this study is to present a modified AO/SORG classification of mandibular condyle fractures. MATERIAL AND METHODS: A new arrangement of the reference lines is proposed because the fracture lines are mainly oblique in this region. The proposed classification was validated using a series of 84 cases that were treated surgically. RESULTS: The diagnoses using the proposed new classification system significantly differed from those based on the old system (p < 0.005). All basal fractures in the new classification system were also classified as basal in the old system. The same was true for type C head fractures. The differences were found for low-neck fractures (4 of 84 diagnoses differed between the old and new classifications, i.e., they were previously classified as basal fractures) and high-neck fractures (3 of 84 fractures were diagnosed as low-neck fractures or type C head fractures using the old classification). CONCLUSION: The epidemiology of the condyle injury should be based on a classification, which reveals types of fractures which are represented by factually and frequently observed cases. That is why a relatively common AO/SORG classification can be modified for the benefit of assessing incidences of high-neck and low-neck fractures. CLINICAL RELEVANCE: Considering that the treatment of the high-neck fractures is much technically complicated than the low-neck ones, this will have an influence on the management of trauma to the area.

Effect of Implant-Abutment Connection Type on Bone Around Dental Implants in Long-Term Observation: Internal Cone Versus Internal Hex.

PURPOSE: The purpose of this study was to evaluate the influence of the implant-abutment connection type on the bone level around dental implants in long-term observation and the survival rate for the different types of implant-abutment connections. MATERIALS AND METHODS: Two groups of implants made of titanium grade 23 alloy and with sandblasted and acid-etched (SLA) surface were included in the study: (a) the internal hex implant-abutment connection group (480 SPI dental implants; Alpha-Bio Tec, Petach Tikwa, Israel, 184 patients) and (b) the internal cone implant-abutment connection group (60 C1 dental implants; MIS Implant Technologies, Shlomi, Israel, 34 patients). Certain inclusion and exclusion criteria were applied. Marginal bone loss (MBL) around the dental implants was measured in intraoral radiographs taken with parallel technique with a film holder and by bite recording index. X-rays were performed at the moment of functional loading, and at 12, 24, 36, and 60 months after loading. The digital analysis was conducted using Dental Studio 2.0 computer software. RESULTS: Average MBL was significantly lower in the conical connection compared with internal hex group-0.68 ± 0.59 versus 0.99 ± 0.89 mm (12 months), 0.78 ± 0.80 versus 1.12 ± 1.00 mm (24 months), 0.83 ± 0.87 versus 1.22 ± 1.03 mm (36 months), and 0.96 ± 1.02 versus 1.30 ± 1.15 mm (60 months after loading). Both groups of implants achieved a 100% survival rate. CONCLUSION: The internal cone connection reduced bone resorption compared with the internal hex. Both groups of implants had a 100% survival rate.

Radiological Evaluation Key to Diagnosis of Idiopathic Solitary Cyst.

Idiopathic solitary cysts have a predilection for long bones and the mandible. Although the origin of these cysts is unclear, the prognosis seems to be good, given proper diagnosis and surgical treatment. A 14-year-old female patient with a bone lesion in the right mandibular ramus was referred to the Department of Pediatric Dentistry at the Medical University of Gdansk, Poland. Due to severe headache lasting two days, the patient had previously undergone magnetic resonance imaging (MRI) examination of the head. A unilocular bone cyst in the mandible was discovered incidentally. Comparison with a previous orthopantomogram (OPG) taken two years earlier for routine dental treatment revealed a clearly visible but smaller bone lesion at the same location. Surgery was carried out in order to achieve bone regeneration. This report documents the importance of careful evaluation and assessment of all radiographs taken, as the lesion could have been diagnosed and treated much earlier, thus lowering the risk of complications.

Radio-opaque polyethylene for personalized craniomaxillofacial implants.

OBJECTIVE: This study aimed to present a new possibility to create radio-opaque implant material for craniomaxillofacial reconstruction. MATERIALS AND METHODS: The test disks made of the own compound of polyethylenes with addiction of 2, 4, and 6 % of weight TiO2 was investigated for cytotoxicity [each group 15 disks respectively]. Next, computed tomography of the disks was performed in environment of muscle and fat. Hardness, tensile modulus and strength, and compressive modulus and strength were tested too. RESULTS: Deterioration of mechanical properties of the composites containing titanium dioxide was observed [hardness, tensile modulus and strength, compressive modulus and strength, respectively: 56.7 ± 1.6 shore D, 354 ± 52, 22.5 ± 1.3, 21.8 ± 1.1, and 2995 ± 327 MPa as addiction of 2 % TiO2; 52.0 ± 0.9 shore D, 347 ± 66, 18.0 ± 0.7, 14.2 ± 0.9, and 1396 ± 477 MPa as 4 % TiO2; 51.3 ± 1.3 shore D, 316 ± 9, 17.4 ± 0.2, 13.6 ± 0.6, and 1100 ± 144 MPa as 6 % TiO2 added]. The test disks revealed no cytotoxicity effect on human osteoblasts. The new material presents mild radio-opacity which was enough to observe the implant in relation to fat and muscle, but with no visible effect of beam hardening. CONCLUSION: In view of the performed tests, the polyethylene enriched by titanium dioxide seems to be a proper material to consider manufacturing of craniomaxillofacial implants. CLINICAL RELEVANCE: Maxilloafacial surgery is still looking for new implantologic materials. The proposed one is a new way to manufacture an implant visible in computed tomography which does not interfere with its shape in radiological examination and makes it possible to observe the surrounding soft tissues.

[Skin cancer of the nose - methods and results of surgical treatment].

BACKGROUND: Non-melanoma skin cancer particularly basal cell carcinoma is the most common human malignancy in Caucasians. The majority of these tumours (80-90%) arise on the sun exposed parts of face. Lesions of the nose are the most challenging for the surgeon, because of the aesthetic feature. THE AIM: The aim of the study is to evaluate results of surgical treatment of nose skin cancer. MATERIALS AND METHOD: Authors analysed retrospectively 23 cases of skin cancer of the nose. Demographic data, aesthetic units, surgical methods and complications as well as aesthetic and functional results of treatment were noted. RESULTS: 23 people (9 male and 14 female) with 23 skin lesions were included to the study. The mean age was 72 ± 13 years. Majority of tumours infiltrated more then 1 nose aesthetic subunit. The most common surgical method of reconstruction was bilobed flap. Most of patients presented good aesthetic and functional outcome. CONCLUSIONS: The most important stage of treatment is proper qualification to surgical treatment - selection of reconstruction method, what establish radicalness of resection and good aesthetic and functional results.

Estimation of the use of fibrin and collagen membranes as carriers for platelet-derived growth factor-BB (PDGF-BB) in the presence of amoxicillin.

The effect of homogeneous fibrin (Fb), collagen (Coll) and composite fibrin-heparin (Fb-Hp), fibrin-collagen (Fb-Coll) membranes on in vitro release of platelet-derived growth factor (PDGF-BB) was evaluated in the presence or absence of amoxicillin using of the ELISA immunoassay test. Amoxicillin concentration was determined spectrophotometrically at 272 nm. The process of the PDGF-BB growth factor and amoxicillin release from the studied membranes was of a two-phase nature in the majority of the systems analysed. The PDGF-BB was released in the highest amount from the Coll membrane (M7) without the presence of amoxicillin--546.2 ± 7.47 pg, t0.5 = 0.88 h and 202.5 ± 6.83 pg, t0.5 = 26.65 h during the first phase and second phase, respectively. The lowest PDGF-BB release was observed from composite M4 (Fb-Hp) membrane--5.88 ± 0.81 pg, t0.5 = 1.69 h; and 110.2 ± 6.48 pg, t0.5 = 855.6 h during first and second phase respectively. An optimal release of amoxicillin was observed in the case of the composite M6 (Fb-Coll) membrane--only in the second phase: 64.2 ± 7.8 µg, t0.5 = 83.5 h. The lowest and delayed amoxicillin release was achieved for M4 membrane (approx. 17.1 ± 1.12 µg, t0.5 = 46.5 h). The results of the PDGF-BB release and amoxicillin from membranes indicated a correlation between the level of release and composition of the film. Our results suggested that fibrin and collagen membranes may be beneficial to enhance periodontal bone regeneration.

Efficacy assessment of the drainage with permanent airflow measurement in the treatment of pneumothorax with air leak.

AIM: The aim of this study was to compare the efficacy of the treatment of patients with spontaneous pneumothorax with air leak (AL) using two different chest drainage systems. METHODS: Patients were randomized into two groups: group A included 30 patients (23 males and 7 females, mean age 41.1 ± 16.29 y, range 17-71 y) in which digital drainage system was used, group B with 30 patients (22 males and 8 females, mean age 40.3 ± 15.74 y, range 18-72 y) in which traditional suction drainage system was applied.The following variables were evaluated: intensity of AL, duration of the chest tube drainage, delay in surgery, length of stay, and the overall hospitalization costs. RESULTS: In group A the mean drainage duration was 47.63 hours, the hospitalization time was about 5.10 days, and the cost of hospitalization was €1,495. In group B the mean drainage duration was 84.93 hours, the hospitalization time was 6.97 days, and the hospitalization cost was €1,925. CONCLUSION: The digital drainage system applied in the treatment of AL in patients with pneumothoraces reduced the duration of the drainage, the length of hospital stay, and overall hospitalization costs.

Treatment strategy in Goldenhar syndrome.

Goldenhar syndrome is a rare congenital defect characterized by ocular symptoms including (epibulbar dermoids, microphthalmia, anophthalmia, eyes asymmetry/dysmorphy, cleft eyelid, exophthalmia, strabismus), auricular symptoms (dacryocystitis), preauricular appendages, preauricular fistulas, ear asymmetry, microtia, atresia of the external auditory canal), craniofacial deformities (cleft face, cleft lip, cleft palate, macrostomia, bifid tongue, hypoplasia of the mandible, hypoplasia of the maxilla, asymmetry of the mandible and maxilla, malocclusion, tooth discrepancies, agenesis of third molars and second premolars, supernumerary teeth, enamel and dentin malformations, delay in tooth development), and skeletal abnormalities (cleft spine, microcephaly, dolichocephaly, plagiocephaly, vertebral defects) or abnormalities of internal organs. The degree of abnormalities vary from severe to mild. In this article, we present a long-term observation of a patient with Goldenhar syndrome. During the patient's life, the intensification of anomalies varied. We describe preoperative and postoperative orthodontic treatment and surgical correction procedures of maxillofacial deformation.

Personalized Temporomandibular Joint Total Alloplastic Replacement as a Solution to Help Patients with Non-Osteosynthesizable Comminuted Mandibular Head Fractures.

Background: Treatment methods for mandibular head fractures are controversial, although effective techniques for open reduction and rigid fixation (ORIF) have been known since the late 1990s. Notably, some forms of posttraumatic comminution of the mandibular head can be reduced or fixed. Methods: This study presents a personalized treatment to cure patients with nonreduced comminuted fractures of the mandibular head: total temporomandibular joint alloplastic replacement (18 patients). The reference group included patients who underwent ORIF (11 patients). Results: Personalized alloplastic joint replacements resulted in a more stable mandibular ramus after three months compared with ORIF. Conclusions: The authors recommend not performing osteosynthesis when the height of the mandibular ramus cannot be stably restored or when periosteal elevation from most of the mandibular head is necessary for ORIF. Personalized TMJ replacement should be considered in such patients. Personalized medicine allows patients to maintain a normal mandibular ramus height for a long period of time.

Optimal Plate Choice for High-Neck Mandibular Condyle Fracture: A Mechanistic Analysis of 16 Options.

(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25-45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking high-neck condyle fractures were utilized in this study. Sixteen distinct plate designs, constructed from titanium sheets, were tested. The figures underwent force assessments on a durability testing apparatus, and the relationship between used force and fracture movement was documented. (3) Results: For high-neck breaking, the two straight plates emerged as the most effective, aligning with established osteosynthesis standards. The second-best plate exhibited nearly half the strength of the gold standard. (4) Conclusions: In response to the aim of this study, considering the mechanical aspects, the double plain plate stands out as the optimal choice for osteosynthesis in cases of high-neck fractures of the mandibular condylar process. In addition, the authors propose the Mechanical Excellence Factor (MEF) as a superior metric for appraising a plate's mechanical force, surpassing the conventional Plate Design Factor (PDF).

A Prospective Randomized Control Trial of Lingual Frenuloplasty with Myofunctional Therapy in Patients with Maxillofacial Deformity in a Polish Cohort.

Introduction: There are few publications concerning ankyloglossia in mixed-aged groups utilizing myofunctional therapy and frenuloplasty in patients undergoing orthodontic treatment and maxillofacial surgery. While it is well known that ankyloglossia is mainly diagnosed in babies, research on functional and structural disorders in different age groups is less common. Thus, there is a high need for specific information about the influence and effectiveness of frenuloplasty with myofunctional therapy on the stomatognathic function and final treatment outcome for a wider variety of patients, especially those with maxillofacial deformities. Aim: This paper aims to evaluate the impact of lingual frenuloplasty as an adjunct to myofunctional therapy for the treatment of ankyloglossia in children and adults with maxillofacial deformity. Methods: Prospective randomized control trial with 155 subjects. Methods were based on visual observation and examination of the oral cavity. There were two groups: myofunctional therapy vs. myofunctional therapy and lingual frenuloplasty. Patients were randomized based on order of entry into the study. χ2 test, Kruskal-Wallis, ANOVA, Student's t-test and others were used for statistical analyses. Results: The presented protocol with myofunctional therapy and surgical procedures proved to be significantly more effective in improving tongue mobility and stomatognathic functions such as swallowing, breathing, and oral resting postures as compared to the reference group who underwent myofunctional therapy only. Conclusions: Lingual frenuloplasty with myofunctional therapy is highly effective in restoring the equilibrium of the orofacial muscles and the skeleton, which is often disturbed and may lead to unstable functional effects among patients considering orthodontic and orthognathic treatments for maxillofacial deformities.

Workflow for Maxilla/Mandible Individual [Mai®] Implant by Integra Implants-How Individual Implants Are Manufactured.

The newest technology allows the medical industry to manufacture innovative products such as milled titanium prosthodontic parts in an implant for a screw-retained suprastructure. In the literature, there are some articles on the clinical usage of subperiosteal implants, but none of these publications, either in PubMed or Google Scholar, thoroughly describe the workflow for the design and manufacture of individual implants for maxillofacial surgery with milled threads for a screw-retained prosthodontic bridge. The aim of the article is to present a step-by-step method of producing personalized implants, from the first steps of production to the implantation of the final product. The article includes information on patient qualification for surgery, computational preparation and skull printing, planning of Mai Implants®, meshing, 3D printing and milling, cleaning, rinsing, anodizing, and laser marking, as well as the cleaning and sterilization process in a hospital or dental clinic. A detailed description of implant production allows for the analysis of each step and the development of technology. The production of implants is an expensive procedure, but considering all the advantages of the Mai Implants® treatment and the disadvantages of alternatives, the product is worth the price.

New Radiological Corticalization Index as an Indicator of Implant Success Rate Depending on Prosthetic Restoration-5 Years of Follow-Up.

The new Radiological Corticalization Index (CI) is an indicator that describes bone remodeling near the dental implant's neck at the pixel level and is not visible to the naked eye. The aim of this research was to evaluate the correlation between the CI and bone remodeling using only radiographic (RTG) images. RTG samples were divided into groups depending on prosthetic restoration; the implant neck area around dental implants was examined, and texture features of the RTG images were analyzed. The study also investigated the type of prosthetic restoration and its influence as a factor on bone structure. The statistical analysis included evaluating feature distribution, comparing means (t-test) or medians (W-test), and performing a regression analysis and one-way analysis of variance or the Kruskal-Wallis test, as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Differences or relationships were considered statistically significant at p < 0.05. The research revealed correlations between single crowns, overdenture restoration, bridge restoration, platform switching, prosthetic fracture, CI, and also marginal bone loss where p was lower than 0.05. However, the corticalization phenomenon itself has not yet been fully explored. The findings suggest that, depending on the type of prosthetic restoration, the corticalization index may correlate with marginal bone loss or not. Further research is necessary, as the index is suspected to not be homogeneous.

Bone Metabolism and Dental Implant Insertion as a Correlation Affecting on Marginal Bone Remodeling: Texture Analysis and the New Corticalization Index, Predictor of Marginal Bone Loss-3 Months of Follow-Up.

Background/Objectives: The general condition of implantology patients is crucial when considering the long- and short-term survival of dental implants. The aim of the research was to evaluate the correlation between the new corticalization index (CI) and patients' condition, and its impact on marginal bone loss (MBL) leading to implant failure, using only radiographic (RTG) images on a pixel level. Method: Bone near the dental implant neck was examined, and texture features were analyzed. Statistical analysis includes analysis of simple regression where the correlation coefficient (CC) and R2 were calculated. Detected relationships were assumed to be statistically significant when p < 0.05. Statgraphics Centurion version 18.1.12 (Stat Point Technologies, Warrenton, VA, USA) was used to conduct the statistical analyses. Results: The research revealed a correlation between MBL after 3 months and BMI, PTH, TSH, Ca2+ level in blood serum, phosphates in blood serum, and vitamin D. A correlation was also observed between CI and PTH, Ca2+ level in blood serum, vitamin D, LDL, HDL, and triglycerides on the day of surgery. After 3 months of the observation period, CI was correlated with PTH, TSH, Ca2+ level in blood serum, and triglycerides. Conclusion: The results of the research confirm that the general condition of patients corresponds with CI and MBL. A patient's general condition has an impact on bone metabolism around dental implants. Implant insertion should be considered if the general condition of the patient is not stable. However, CI has not yet been fully investigated. Further studies are necessary to check and categorize the impact of corticalization on marginal bone loss near dental implants.

Maxillofacial Microvascular Free-Flap Reconstructions in Pediatric and Young Adult Patients-Outcomes and Potential Factors Influencing Success Rate.

Background: Maxillofacial microvascular free-flap reconstructions are significant interventions in the management of congenital defects, traumatic injuries, malignancies, and iatrogenic complications in pediatric and young adult patients. Craniofacial disorders within this demographic can result in profound functional, cosmetic, and psychosocial impairments, highlighting the critical need for thorough investigation into factors that may influence procedural success and postoperative quality of life. This retrospective chart review aims to examine the outcomes and potential influencing factors, aiming to offer valuable insights into optimizing the effectiveness of these reconstructions and improving patient outcomes. Methods: A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender, and etiology of defect were determined using the ANOVA test and χ2 test of independence. Results: The results indicate a 90% success rate. No significant relationship was found between the incidence of total flap loss and patient age, etiology, or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular reconstructions (11 vs. 3 cases). Conclusions: Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and young adult patients.

Current Frequency of Mandibular Condylar Process Fractures.

There are significant discrepancies in the reported prevalence of condylar process fractures among all mandibular fractures (16.5-56%) in the available literature. In addition, it seems that the actual number of difficult-to-treat fractures of the mandibular head is unknown. The purpose of this study is to present the current incidence of the different types of mandibular process fractures with a special focus on mandibular head fractures. The medical records of 386 patients with single or multiple mandibular fractures were reviewed. Of the fractures found, 58% were body fractures, 32% were angle fractures, 7% were ramus fractures, 2% were coronoid process fractures, and 45% were condylar process fractures. The most common fracture of the condylar process was a basal fracture (54% of condylar fractures), and the second most common fracture was a fracture of the mandibular head (34% of condylar process fractures). Further, 16% of patients had low-neck fractures, and 16% had high-neck fractures. Of the patients with head fractures, 8% had a type A fracture, 34% had a type B fracture, and 73% had a type C fracture. A total of 89.6% of the patients were surgically treated with ORIF. Mandibular head fractures are not as rare as previously thought. Head fractures occur twice as often in the pediatric population than in adults. A mandibular fracture is most likely related to a mandible head fracture. Such evidence can guide the diagnostic procedure in the future.

Lateral Pterygoid Muscle Alteration in Patients Treated Surgically Due to Mandibular Head Fractures.

The goal of surgical treatment of mandibular head fracture is to restore anatomical relations; however, it also carries other implications. The purpose of this study is to present the alteration in the size of lateral pterygoid muscles after surgical treatment of unilateral mandibular head fractures and the impact of this change on the range of motion of the mandible. Another issue addressed is the persistence of changes in the appearance of the lateral pterygoid muscles after surgical treatment. In this study, 66 patients with unilateral mandibular head fracture were included. An additional 15 patients from this group who were treated only conservatively were separated as an extra reference group to exclude completely the effect of surgery on the appearance of the pterygoid lateral muscle (even on the opposite side to the surgically treated side). The range of mandibular movements was measured at specific time intervals up to 24 months post-operationally. Then, the lengths and widths of the lateral pterygoid muscles on the operated and healthy site were measured in CT images. The results were compared with a control group which consisted of muscles of the intact site (opposite site to the fracture). A significant reduction in the length-to-width ratio of the lateral pterygoid muscle on the operated side by approx. 20% is observed. This suggests that the muscle becomes more spherical, and thus the range of lateral movement to the contralateral side is permanently reduced.