Extraoral approach to a bilateral unfavourable mandibular fracture under local anaesthesia: A case report.

OBJECTIVE: To present a feasible treatment method for fractures of severely atrophic mandibles in high-risk patients undergoing general anaesthesia (GA). CASE REPORT: A 77-year-old man presented with bilateral unfavourable fractures in an atrophic mandible. Pre-anaesthetic consultation revealed that the patient was at high risk for GA due to significant medical comorbid conditions of the patient, such as advanced age, chronic obstructive respiratory disease, diabetes mellitus and atherosclerosis. Thus, a modified treatment, consisting of open reduction and internal fixation using a combination of reconstruction plates and miniplates via an extraoral approach, was planned under local anaesthesia. The patient tolerated the surgical procedure well, without the need for sedation, and uneventful healing was achieved during postoperative period. CONCLUSION: Local anaesthesia may be considered as the anaesthetic technique of choice when managing atrophic mandible fractures to reduce the risk of complications and shorten the time needed for recovery, especially in elders with significant medical comorbidities.

Quantified diagnostic work-up casts: applications for interdisciplinary treatment planning.

Diagnostic casts that accurately replicate a patient's occlusion are essential for planning comprehensive care and interdisciplinary treatment. These casts can reveal the actual problem in the spatial relationship between the maxilla and the mandible, which may not be apparent on intraoral examination. Duplicate casts can be altered and measured to quantify the extent of the correction necessary for a predictable result. Treatment planning for interdisciplinary cases requires thorough evaluation of the entire problem and solution set as well as coordination of all procedures. Severe problems and invasive treatments require precise treatment planning. This case report illustrates these principles through multiple applications of quantified diagnostic work-up casts for a patient requiring orthognathic surgery, orthodontics, and occlusal adjustment after a mandibular subcondylar fracture.

Histomorphometrical and radiological comparison of low-level laser therapy effects on distraction osteogenesis: experimental study.

Distraction osteogenesis (DO) is the application of traction to the callus formed between bone segments and stimulation of bone formation by creating stress on the callus with this traction. Shorten the duration of DO and increasing the capacity of bone formation is important to prevent the possible complications of DO. For this reason, it was considered that low-level laser therapy (LLLT) may affect positively DO and it can decrease the complication range by shortening the period. Unilateral mandibular distractors were applied on 16 female white New Zealand rabbit to prove this hypothesis with micro CT, plain radiograph and histomorphometric analyses. Eight rabbits were applied LLLT with GaAlAs laser on the distraction area during the distraction period. On the post-distraction 28th day, four rabbits from study group and four rabbits from control groups were sacrificed. The rest of the rabbits were sacrificed on post-distraction 56th day. As a result of this study, significant positive effects of LLLT on post-distraction 28th day were revealed with all analyses. In histomorphometrical analyses, new bone formation was significantly higher in short-term laser applied group comparing to that of short-term control group (p = 0.029). In both microCT and plain radiograph, the highest radioopacity values were observed in short-term laser group when compared with that of the controls (p = 0.043 and p = 0.025, respectively). Even though LLLT increased the healing capacity on short-term, it was not sufficient on long-term (post-distraction 56th day) healing. LLLT application on distraction period, activate healing on bone so it may decrease DO period. The result of this study should be supported with clinical studies and the most effective laser source, dose and application time should be revealed with experimental and clinical studies.

[Treatment of patients of elderly and sinile age with fractures of the mandibula].

In the above study, the comparison of efficiency of complex treatment of elderly and senile patients with fractures of mandibula has been carried out. After osteosynthesis of mandibula with mini-plates, frequency of development of traumatic osteomyelitis in these patients was lower than that after osteosynthesis by means of bone suture, especially in the group of patients who were admitted with signs of inflammation of osteal wound, where traumatic osteomyelitis developed 3 times less often than after osteosynthesis with bone suture. At bilateral fractures of mandibula, osteosynthesis with bone suture is not prescribed to the elderly patients who are admitted with signs of inflammation of osteal wound. Application of mini-plates for osteosynthesis at fractures of mandibula in the elderly patients enabled to restore mandibula motion and chewing function within much earlier terms.

Effect of pulsed electromagnetic field on healing of mandibular fracture: a preliminary clinical study.

PURPOSE: The aim of the present study was to evaluate the effect of a pulsed electromagnetic field on the healing of mandibular fractures. Pulsed electromagnetic fields have been shown to accelerate healing of fractures of the long bones. PATIENTS AND METHODS: A total of 12 patients with mandibular fractures were selected for the present study. Each patient was treated by closed reduction using maxillomandibular fixation (MMF) and was assigned into 1 of 2 equal groups. The fracture sites of group A only were exposed to pulsed electromagnetic fields (PEMF) 2 hours daily for 12 days, after 2 weeks postoperatively the MMF was removed. For group B (control group), the MMF was removed at 4 weeks postoperatively. The effectiveness of the 2 treatment modalities was evaluated clinically and radiographically using computerized densitometry. The data were statistically analyzed. RESULTS: After releasing the MMF, a bimanual mobility test of the fractured segments showed stability of the segments in all cases. An insignificant difference was found between the mean bone density values of the 2 groups at all study intervals. In contrast, the percentage of changes in bone density of the 2 groups revealed that group A had insignificant decreases at the 15th postoperative day and a significant increase 30 days postoperatively compared with group B. CONCLUSIONS: From the present limited series of patients, PEMF stimulation might have a beneficial effect on the healing of mandibular fractures treated with closed reduction. However, additional research, using randomized controlled trials, should be conducted to ascertain its effectiveness compared with other treatment modalities.

[External respiration peculiarities in inhabitants of European North in cases of mandible fracture].

There were studied external respiration and lung gaseous metabolism in inhabitants of European North in cases of mandible fracture. There were determined respiration disturbances of the obstruction type and changes of lung gaseous metabolism. In patients of the control group which received traditional medical and physical methods of treatment the external respiration indices were normalized to proper values to the moment of fragments union (in 34-38 days). Relation of CO2 excretion to O2 consumption at this term corresponded to mean value of human respiratory coefficient (0.83-0.87). In the group of patients with optimization of comprehensive treatment by ozone therapy use the function of external respiration and lung gaseous metabolism recovered earlier that positively told upon the terms of fragments union and recovery of capacity for work.

Decreased thalamic metabolism without thalamic magnetic resonance imaging abnormalities following shearing injury to the substantia nigra.

A 36-year-old man had fallen about 8 metres. Radiographs showed a mandibular fracture, indicating rotatory force applied to the head. Fluid-attenuated inversion recovery (FLAIR) imaging showed hyperintensity in both medial temporal lobes, left medial midbrain, right midbrain including cerebral peduncle, left pulvinar, left external capsule, fornix, splenium of corpus callosum, and deep white matter of both frontal lobes. Quantitative [(18)F]fluorodeoxyglucose (FDG)-positron emission tomography (PET) indicated markedly suppressed glucose metabolism in the left thalamus but not markedly in the striatum. At that time the neurologic examination demonstrated complete left hemiparesis, severe rigidity of the right upper extremity, and inability to move the right hand and fingers. Levodopa at 300-600 mg/day improved movement of the fingers, decreased the rigidity in the extremity, and lessened the metabolic abnormality. Diminished metabolism in the left thalamus may have contributed to symptoms. The case illustrates the usefulness of PET in disclosing symptom causing abnormalities not detected by magnetic resonance imaging.

A study of sports-related mandibular angle fracture: relation to the position of the third molars.

Mandibular angle fractures have been considered attributable to the presence of unerupted third molars. We examined the relationship between the incidence of sports-related mandibular angle fractures and the presence of a mandibular third molar with emphasis on the position of the third molar. The incidence of angle fracture was significantly higher in the sports-related injury group than in the group with fracture due to other causes (P < 0.05). The incidence of angle fracture in the athletes with higher impaction scores was significantly higher than that in the subjects with higher scores who did not have sports-related fractures (P < 0.05). The percentage of rugby athletes with third molars was significantly higher than that of those without third molars (P < 0.001), and a high proportion of young athletes (89.5%) was considered to belong to a potential high-risk group for angle fractures. Our findings suggest that mandibular angle fractures are influenced by the presence and characteristics of the third molar in sports-related injuries.

[Miniplate osteosynthesis of mandibular fracture in local anesthesia--indications and outcome in 316 patients]. / Miniplattenosteosynthese der Unterkieferfraktur in Lokalanästhesie--Indikation und Ergebnisse bei 316 Patienten.

In an retrospective analysis of 316 patients with mandibular fractures treated between 1984 and 1993 at the maxillo-facial surgery of university of Cologne could be shown that the application of miniplate in local anesthesia causes no more complication than in general anesthesia. We would therefore recommend this technique for not to complicated cases of isolated or double fractures of the mandible. In cases of obstacles to general anesthesia it may be favoured even in severe cases.

[Radiologic and skeletal-anatomical study of mummies at the Tourin Egyptian Museum]. / Indagine radiologica e anatomo-scheletrica su mummie del Museo Egizio di Torino.

The authors present a study performed on three Egyptian mummies, coming from the same inviolate grave belonging to the Necropolis of Gebelin. The grave bore no indications on the occupiers' identity and for that reason Schiaparelli identified it as "Tomb of the Unknown". The mummies and their funerary furniture are now exposed at the Egyptian Museum of Turin. Standard radiographies of the mummies have been taken in situ by means of a portable radiological equipment. It has also been possible to examine directly the anatomic aspect of one unbandaged skeletal mummy. The procedure was simple, reliable, not expensive and did not expose the mummies to damages due to an eventual transfer. Reliable data on the findings have been taken in that way: the three burials, one of them is likely a reburial, belong to three grown-up subjects, whose sex was male for two and probably female for the third. No bone pathology has been found. One of the cadavers seems to be dead due to a serious cranic injury, probably the effect of a heavy bladed weapon.

Mandibular actinomycosis: report of case.

A case of mandibular actinomycosis, secondary to a compound fracture in an alcoholic patient, is described. The factors that apparently enhance the development of this disease are discussed.