Cases reported "Mandibular Fractures"

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1/7. Unilateral mandible fracture with bilateral TMJ dislocation.

    temporomandibular joint (TMJ) dislocation occurs when the condylar head slips forward causing the posterior articulating surface of the condyle to advance ahead of the articular eminence, possibly becoming entrapped. Following dislocation, the ligaments around the joint often stretch, causing severe muscle spasms and joint pain. There is no standard evaluation and treatment method for acute TMJ dislocation, but the most effective course is immediate reduction. This paper presents a 42-year-old woman who sustained a unilateral mandible fracture with bilateral TMJ dislocation in an automobile crash. Although the fracture was apparent on plane film and panorex, the dislocation was not found until six weeks later, when the jaw was unwired. At that time, the dislocation was suspected because of decreased range of motion, but was not verified until an MRI was performed. The result was long-term therapy, eventual bilateral TMJ surgery, and chronic TMJ pain for the patient.
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2/7. Treatment of condyle fracture caused by mandibular angle ostectomy.

    A prominent mandibular angle is considered to be unattractive in Asian countries because it gives the face a square and muscular appearance. Successful correction by angle ostectomy has been reported, but one of the serious complications of angle reduction ostectomy is fracture of the mandibular condyle. If the ostectomy line is misdirected vertically, the condyle may be fractured. The authors experienced two cases of condylar fracture during angle reduction. Case 1 was a pulled-out condylar fracture, where an L-shaped miniplate was then attached by external approach, and intermaxillary fixation (IMF) with arch bar was used on postoperative day 14. With release of the IMF, a systematic approach for a jaw-opening exercise was begun. On postoperative day 21, the elastics were placed to assist in guiding protrusion of the mandible anteriorly 24 hours a day. After postoperative day 28, it was possible to completely abandon daytime elastic fixation. The exercise was modified to lateral movement. Case 2 was green-stick condylar fracture, with the IMF with arch bar applied on postoperative day 10. After releasing the IMF, the exercise involved the daily use of several tongue blades, and range of motion increased by wedging additional blades until postoperative day 21. More aggressive stretching was continued with 22 blades on postoperative day 28. On the removal of the arch bar, the occlusion was stable and followed by more aggressive stretching and physical therapy. Both cases were successfully restored and had good results. The authors believe the exercise protocols and algorithms they used may serve as a standard procedure of treatment in condylar fracture caused by angle ostectomy.
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3/7. Management of traumatic facial injuries.

    Whether minor or major, traumatic injuries to the maxillofacial area have far-reaching physical and emotional effects. Because the dentition dictates facial form and function, the oral and maxillofacial surgeon, a dental specialist with a minimum of four years of hospital-based surgical training, is uniquely qualified to manage these injuries. At times, the expertise of the general dentist and other dental specialists may be needed to provide definitive care. Several cases are provided to illustrate management of facial trauma.
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4/7. Removal of a medially attached, fractured condyle via an intraoral approach: report of case.

    A case of a medially displaced, fractured condyle is presented; closed reduction was the initial treatment. Fifteen years later, radiographs showed a "double condyle"; there were pain and limitation of motion of the mandible. The displaced fragment was removed via an intraoral approach with resulting improvement in function and complete elimination of pain.
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keywords = motion
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5/7. Comparison of spiral CT and conventional CT in 3D visualization of facial trauma: work in progress.

    Spiral computed tomography (SCT) differs from conventional CT (CCT) in that regions of the body can be rapidly imaged via continuous scanning. This is accompanied by simultaneous advancement of the patient, thus allowing volumetric data acquisition of up to 60 cm in less than a minute. Thus motion is minimized and slice misregistration is minimized when multiplanar and three dimensional reconstructions are performed. This paper compares the utility of SCT and CCT in facial trauma. A total of six patients were studied with either CCT or SCT of the face after trauma. SCT scans were obtained using a Siemens Somatom Plus-S CT scanner (2 mm thick collimation and 3 mm/sec table feed for 32 s). Three-dimensional (3D) and multiplanar reconstruction images of the facial bones were generated after appropriate thresholds were selected by the radiologist; similar images generated with a CCT (GE quick 9800) were compared using a three point scale with kappa analysis. SCT is able to generate axial and reformatted images of comparable quality to CCT (k = 0.47-0.89) in less than half the time to perform an examination (26 min vs 63 min). SCT can rapidly produce (3D) and multiplanar reformatted images of facial trauma with minimal motion, or misregistration artifact when compared to CCT.
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ranking = 2
keywords = motion
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6/7. Pseudofractures of the mandible secondary to motion artifact.

    The case of a patient with a false-positive fracture on the panoramic view of the mandible is presented. The patient motion produced a spurious image that perfectly mimicked a fracture without any evidence of motion. To better assess motion artifact, panoramic views of a "phantom" human skull were developed with movement during the exposure. These radiographs were analyzed with the assistance of a radiologist, and diagnostic features of motion artifact are discussed. Some radiographs were created by movement that mimicked fractures without the telltale signs of motion artifact. These "motion pseudofractures" are diagnosed clinically if the examiner knows that motion can mimic fractures, and all x-ray findings are carefully correlated with clinical findings. diagnosis of a motion pseudofracture will avoid the additional expense and time of a specialty consultation.
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7/7. Endoscopically assisted mandibular subcondylar fracture repair.

    The endoscope has been widely used in aesthetic surgery in recent years, but rarely has it been used in cases of facial trauma. From July of 1996 to December of 1996, the endoscope was used successfully to assist in the repair of mandibular subcondylar fractures in eight patients (five men and three women). Their ages ranged from 15 to 60 years with an average age of 31 years. Six of the patients had other associated mandibular fractures including angular, parasymphyseal, and contralateral subcondylar fractures. A 4.0-mm, 30-degree telescope was introduced to visualize the fracture site by means of an intraoral incision over the ascending ramus. A miniplate was used to stabilize the fracture site with the help of a percutaneous trocar. Intermaxillary fixation was applied for 3 to 6 days. Functionally, all patients returned to normal range of motion within 8 weeks. A slight deviation to the trauma site was noted on maximal opening in three patients, but this condition returned to normal 3 months after surgery. There was no facial palsy or lip numbness. The benefits of the endoscopic approach include not only the provision of better visualization and precise anatomic alignment of bony segments but also the avoidance of large facial scars and facial nerve injuries.
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