Transverse lag screw fixation in midline mandibulotomy. A case series.

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.

Augmented fixation of mandibular fractures with a threaded Kirschner wire.

The maxillofacial surgeon uses a variety of techniques when treating mandibular fractures. The aim of treatment is to restore structure and function while minimizing morbidity. This requires adequate anatomic reduction and immobilization. The surgeon's choice of techniques should be safe, simple, economic, and effective. In this article, we discuss a previously described, yet little known, technique that fulfilled these criteria. The technique of augmented fixation of mandibular fractures using a threaded basal Kirschner wire was successfully used in seven patients. It offered the distinct advantage of rigid basal fixation that augmented interosseous and maxillomandibular fixation techniques. It was especially effective in stabilizing and promoting bone healing in unfavorable comminuted parasymphyseal fractures. Its ease and rapidity of application from readily available materials made it an effective alternate to elaborate techniques such as compression-plating systems.

Thrombophlebitis of the internal jugular vein secondary to pharyngitis.

A case of septic thrombophlebitis of the internal jugular vein after pharyngitis is reported. Because of the common use and effectiveness of antibiotics against throat infections, this complication is now rarely seen. This condition has characteristic signs and symptoms, and a diagnosis can be obtained when the physician is aware of these characteristics. Radionuclide scan and Doppler effect flow studies of the internal jugular vein are useful diagnostic adjuncts. If recognized early and treated promptly with antibiotics, resolution is the rule. The literature has been reviewed.