Mandibular coronoid fractures, how rare?

BACKGROUND: To study the rarity of mandibular coronoid process fractures and treatment strategies based on the displacement of these fractures. MATERIALS AND METHODS: A retrospective study of 11 cases of coronoid process fractures among 307 treated cases from 2008 to 2013 was conducted. Six patients were treated conservatively and 5 underwent ORIF with associated fractures. A statistical analysis of the data obtained after subjective and objective evaluation was done. RESULTS: The incidence of coronoid process fractures was 3.58% of all mandibular fractures analyzed. There was no statistically significant difference found between two treatment modalities, but differences in maximum interincisal opening (MIO) and pain in the postoperative period were significant. CONCLUSION: We recommend that linear coronoid fractures with minimal displacement can be managed with conservative treatment. For patients with significant displacement of coronoid process, limited mouth opening or concomitant mid-face or lower-face fractures, rigid internal fixation is recommended.

Open cap splint with circummandibular wiring for management of pediatric mandibular parasymphysis/symphysis fracture as a definitive treatment modality; a case series.

Management of pediatric maxillofacial injuries is mainly governed by their psychological, physiological, developmental, and anatomical characteristics. Pediatric mandibular fractures can have variable etiologies but have similar manifestations as those in adult patients. There are various treatment modalities to treat mandibular parasymphysis/symphysis fractures in children, which have their own limitations and complications. We currently describe our experience with open cap splint as a treatment modality which involves fewer risks in treating 10 pediatric parasymphysis/symphysis mandibular fractures.

Mandibular ramus fractures: a rarity.

AIM: To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. MATERIALS AND METHODS: Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. RESULTS: Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. CONCLUSION: Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. CLINICAL SIGNIFICANCE: This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article: Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42. Source of support: Nil Conflict of interest: None declared.

A comparative study of closed versus open reduction and internal fixation (using retromandibular approach) in the management of subcondylar fracture.

OBJECTIVE: The aim of this study was to evaluate the clinical and radiologic outcomes of open reduction and internal fixation compared with closed reduction approach for fractures occurring at the subcondylar level. STUDY DESIGN: Twenty-two patients with subcondylar fractures were included in the study; 12 patients were treated by closed reduction and 10 patients underent open reduction and rigid internal fixation, with follow-up at 3 and 6 months. Selection of patients for open and closed procedures was done on a random basis. RESULTS AND CONCLUSIONS: The results showed that open reduction and internal fixation of displaced subcondylar fractures showed better results clinically as well as radiographically compared with similar fractures treated by closed reduction.

Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla: Report of five cases.

Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech.

Necrotizing cervical fasciitis: a case report and review of literature.

Necrotizing cervical fasciitis is a rare, fulminating infection causing extensive necrosis of the subcutaneous tissue and fascial planes with resultant skin gangrene. To reduce the morbitity and mortality from this condition, it requires early recognition and aggressive surgical debridment with appropriate antibiotic therapy. The origin is generally odontogenic and presents more often in immunocompromised patients. This article presents a case with typical clinical features and appropriate management of this condition. An review of literature was carried out for microbiology, pathogenesis, clinical features, diagnosis, management and prognosis of this condition.

Healing assessment of osseous defects of periapical lesions with use of freeze dried bone allograft.

OBJECTIVES: The aim of this study was to save endodontically failed teeth with periapical pathosis by surgery. Elimination of the periapical pathology and to evaluate the clinical and radiological efficiency of freeze dried bone allograft in bony defects. MATERIALS AND METHODS: Ten patients were included in this study with established periapical pathology with the need for periapical surgery after failed endodontic therapy. Surgery was decided after the cessation of acute symptoms. Patients on regular medications for known medical complications were excluded from the study. A full thickness flap or modified Leubke-ochsecnbein was raised depending upon the size and location of the lesion. Thorough periapical curettage was performed to remove the pathological tissue surrounding the apices and the root of the tooth. The graft material was mixed with patient's venous blood drawn earlier from a peripheral vein to make it more cohesive. The graft material mixed with blood was then carefully packed with light pressure into the defect. The flap was replaced. All the patients received broad spectrum antibiotics one day before and five days after surgery. The cases were followed up with clinical and radiological examination and were recalled at intervals of 1 month, 3 months and 5 months postoperatively to assess the condition of the periapical area. RESULTS: In all the ten cases at the end of 1st month postoperatively a well defined border separating the host bone from the graft material indicating simultaneous resorption of the graft. This resorption continued at 3 months follow up indicating continued graft resorption and also increasing radioopacity, haziness indicating bone regeneration. Eight of the ten patients could be evaluated at the end of fifth month and radiographs showed increase in radioopacity and reduction in size of periapical radiolucency as well as normal trabecular pattern of the bone. CONCLUSION: The results demonstrate successful use of FDBA in the treatment of osseous defects of periapical lesions associated with failed endodontically treated teeth.