Exclusive Functional Treatment for Mandibular Condylar Fractures.

PURPOSE: Despite the frequency of condylar fractures, no consensus has been reached regarding treatment alternatives (ie, operative vs nonoperative). The purpose of the present study was to describe functional treatment without intermaxillary fixation of condylar fractures and summarize the treatment outcomes. PATIENTS AND METHODS: We designed a retrospective case series and enrolled patients with condylar fractures with malocclusion. The primary outcome was treatment success, assessed at the end of 6 weeks. We recorded 5 parameters to assess treatment success, including a stable return to the initial occlusion, lateral excursion of more than 7 mm, centered protrusion of more than 4 mm, centered mouth opening of more than 35 mm, and painless mandibular mobilization. If all 5 parameters were met, treatment was deemed a success. Treatment failure was defined as meeting less than all 5 parameters. We used numbers and percentages for these nominal qualitative variables (healing criterion absent or present). Two prognostic variables (ie, fracture type and age range), stratified by treatment success, were compared using the Fisher exact test for patients presenting with all healing criteria. RESULTS: We included 30 patients with a median age of 33 years. Of the 30 patients (34 fractures), 15 had low subcondylar fractures (44.1%), 12 had high subcondylar fractures (35.3%), and 7 had head condylar fractures (20.5%). At the last consultation, 21 patients (70%) had exhibited all the criteria defining treatment success. A significant difference was found in the success rate when stratified by age (P = .002) in favor of the younger patients. Also, high subcondylar and head fractures were associated with a better success rate. CONCLUSIONS: Exclusive functional treatment showed promising results and should be considered for cooperative patients, avoiding the risks of surgery and the discomfort with intermaxillary fixation.

Are virtual planning and guided surgery for head and neck reconstruction economically viable?

PURPOSE: Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved. MATERIALS AND METHODS: All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded. RESULTS: During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate. CONCLUSIONS: Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable.

Isolated bilateral zygomatic arch fracture: an unusual pattern.

Isolated fractures of the zygomatic arch represent 5% to 14% of all zygomatic complex fractures. Bilateral isolated zygomatic arch fractures, which are defined as fractures of both zygomatic arches without any other facial fracture, are extremely rare. In this case report, we present a rare case of this facial fracture pattern.

Facial Pain Associated with CPAP Use: Intra-Sinusal Third Molar.

Objective. This paper describes a patient with left hemifacial pain elicited by the use of a CPAP mask. Case Report. A 74-year-old man was referred with a history of pain in the left maxillary sinus related to the use of his CPAP interface, thereby prohibiting the use of the latter. Computed tomography revealed an intra-sinusal ectopic third molar in the left maxillary sinus floor corresponding to the painful area. After removal of the ectopic tooth under local anesthesia by a Caldwell-Luc approach, the patient was relieved of his symptoms. Conclusion. Although an ectopic tooth in the maxillary sinus is rare, this case points out the importance of actively looking for a regional problem if patients cannot tolerate the CPAP interface since this can lead to issues of incompliance and medical complications due to the untreated obstructive sleep apnoea syndrome.