1/10. Reconstructive surgery for complex midface trauma using titanium miniplates: Le Fort I fracture of the maxilla, zygomatico-maxillary complex fracture and nasomaxillary complex fracture, resulting from a motor vehicle accident.maxillofacial injuries resulting from trauma can be a challenge to the Maxillo-Facial Surgeon. Frequent causes of these injuries are attributed to automobile accidents, physical altercations, gunshot wounds, home accidents, athletic injuries, work injuries and other injuries. Motor vehicle accidents tend to be the primary cause of most midface fractures and lacerations due to the face hitting the dashboard, windshield and steering wheel or the back of the front seat for passengers in the rear. Seatbelts have been shown to drastically reduce the incidence and severity of these injuries. In the united states seatbelt laws have been enacted in several states thus markedly impacting on the reduction of such trauma. In the philippines rare is the individual who wears seat belts. Metro city traffic, however, has played a major role in reducing daytime MVA related trauma, as usually there is insufficient speed in traffic areas to cause severe impact damage, the same however cannot be said for night driving, or for driving outside of the city proper where it is not uncommon for drivers to zip into the lane of on-coming traffic in order to overtake the car in front ... often at high speeds. Thus, the potential for severe maxillofacial injuries and other trauma related injuries increases in these circumstances. It is however unfortunate that outside of Metro Manila or other major cities there is no ready access to trauma or tertiary care centers, thus these injuries can be catastrophic if not addressed adequately. With the exception of Le Fort II and III craniofacial fractures, most maxillofacial injuries are not life threatening by themselves, and therefore treatment can be delayed until more serious cerebral or visceral, potentially life threatening injuries are addressed first. Our patient was involved in an MVA in Zambales, seen and stabilized in a provincial primary care center initially, then referred to a provincial secondary care center for further stabilization before his transfer to Manila and then ultimately to our Maxillo-Facial Unit. There was a two week-plus delay in the definitive management because of this. As a result of the delay, fibrous tissue and bone callus formation occurred between the various fracture lines, thus once definitive fracture management was attempted, it took on a more reconstructive nature. Hospital based Oral and Maxillo-Facial Surgeons are uniquely trained to manage all aspects of the maxillo-facial trauma, and their dental background uniquely qualifies them in functional restoration of lower and midface fractures where occlusion plays a most important role. Likewise, their training in clinical medicine which is usually integrated into their residency education (12 months or more) puts them in a unique position to comfortably manage the basic medical needs of these patients. In instances where trauma may affect other regions of the body, an inter-multi-disciplinary approach may be taken or consults called for. In this instance, an opthalmology consult was important. In fresh trauma, often seen in major trauma centers (i.e. overseas), a "Trauma Team" is on standby 24 hours a day, and is prepared to assess and manage trauma patients almost immediately upon their arrival in the ER. The trauma team is usually composed of a Trauma Surgeon who is a general surgeon with subspecialty training in traumatology who assesses and manages the visceral injuries, an Orthopedic Surgeon who manages fractures of the extremities, a Neurosurgeon for cerebral injuries and an Oral and Maxillo-Facial Surgeon for facial injuries. In some institutions, facial trauma call is alternated between the "three major head and neck specialty services", namely Oral and Maxillo-facial Surgery, otolaryngology-head & neck Surgery and Plastic & Reconstructive Surgery. (ABSTRACT TRUNCATED)- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
2/10. Severe panfacial fracture with facial explosion: integrated and multistaged reconstructive procedures.Midface fractures, especially if related to traffic accidents, represent a remarkable problem from a surgical, psychological, and social standpoint. In trauma dynamics, the pattern of the fractures can extend to all bony fragments and is often associated with soft tissue injuries and loss of bony structures. This can lead to posttraumatic deformities that greatly influence the patient psychologically and limit his social rehabilitation, sometimes permanently. Panfacial trauma includes midface fractures associated with fractures of other areas (i.e., mandible, frontal bone). Orbits and the nasoethmoidal area are often involved with loss of soft tissue and, in severe cases, loss of orbital contents. We report an unusual complex clinical case representative of this kind of pathological profile in which the guidelines described in the literature were followed in the reconstructive procedure.- - - - - - - - - - ranking = 174.90608991872keywords = mandible (Clic here for more details about this article) |
3/10. Occlusal reconstruction: orthodontic techniques for treatment of jaw fracture.AIM: Treatment by the multidisciplinary-team approach for jaw fractures, and the role of the orthodontist, are discussed and illustrated through case reports. methods: Two cases of jaw fractures treated with orthodontic techniques, as an alternative noninvasive procedure, are presented. One subject with a fresh mandibular fracture did not consent to surgery, despite a good indication for open reduction. The other subject had maljoined mandibular fractures from surgery, with insufficient occlusal consideration. CONCLUSION: Orthodontists, as well as oral surgeons, participate in every stage of the treatment of jaw fractures, including treatment decisions, in-patient management, dietary guidance, etc. Orthodontists also attend surgical operations to determine the most stable occlusion, making possible more detailed occlusal reconstruction.- - - - - - - - - - ranking = 1329.4101325046keywords = jaw (Clic here for more details about this article) |
4/10. Treatment of 813 zygoma-lateral orbital complex fractures. New aspects.A 10-year experience with surgical treatment of 813 zygomalateral orbital complex fractures is reviewed. Regardless of the type or severity of the fracture pattern, concomitant fractures of the orbital floor and rim were approached exclusively through the transconjunctival approach without a lateral canthotomy. The advantages of this approach compared with the subciliary access are the avoidance of a visible scar and markedly reduced incidence of postoperative lower eyelid complications such as ectropion and edema. Implants of lyophilized dura or cartilage and autogenous bone were used to reconstruct orbital floor defects. Malar asymmetry is a frequent complication of zygoma fractures resulting from inadequate three-dimensional reduction. methods for accurate reduction and stabilization, indications for closed and open reduction, and management of the fractured infraorbital rim are emphasized. The indications for miniplates vs wire ligatures for the infraorbital rim are discussed. Long-term follow up and evaluation of the results with regard to the fracture pattern, complications, maxillary sinus dysfunction, and facial and orbital symmetry are presented.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
5/10. Use of a miniplate to provide intermaxillary fixation in the edentulous patient.A case of severe facial trauma is presented. The fractures were stabilized using wire osteosynthesis and miniplates. Since no dentures were available intermaxillary fixation was achieved with a miniplate from the upper to the lower jaw, which resulted in a very satisfactory stabilization.- - - - - - - - - - ranking = 190.91573321494keywords = jaw, lower (Clic here for more details about this article) |
6/10. Pediatric jaw fractures: indications for open reduction.jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment. During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow-up, no dental problems have been seen.- - - - - - - - - - ranking = 949.57866607472keywords = jaw (Clic here for more details about this article) |
7/10. The vertical avulsion flap.Unilateral vertical tangential maxillofacial trauma may result in a combination of a certain number of charcteristic lesions. Although composed of wounds and fractures in the upper, middle and lower third of the face, this form of injury can be considered to be a separate distinct entity. Two patients are described, illustrating this type of injury. Both also sustained trauma of the ipsilateral shoulder.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
8/10. Complex maxillofacial fractures: management and surgical procedures.Complex maxillofacial fractures may be defined as combined, mixed, or unclassified. Adequate diagnostic technics must be used with the formulation of a plan for general management and sequential maxillofacial surgery. The basic principal of building from the stable mandible to the first superior stable bone must be adhered to. Exploration of all fracture sites with direct reduction and fixation is the most satisfactory technic for best cosmetic and functional results. The maxillary buccal vestibule incision in midfacial fractures provides exploration of the lateral walls of the maxilla, nasal aperture, zygomatic buttress, maxillary tuberosity and pterygoid area, maxillary antrum and roof (or orbital floor), and infraorbital rim. The extent of the injury can be determined and direct reduction and fixation obtained. Additional approaches for reduction and internal stabilization are used according to the findings. When direct wiring technics are inadequate, internal and external skeletal fixation must be used.- - - - - - - - - - ranking = 174.90608991872keywords = mandible (Clic here for more details about this article) |
9/10. Surgical prosthetic splints as an adjunct in treating facial fractures.Surgical splints are a valuable adjunct in managing certain mandible and maxillary fractures. Of the various splint materials, acrylic is the easiest, fastest, and least expensive. Acrylic splints are rigid, strong, easily adjusted and repaired, translucent, lightweight, and tolerated well by the oral mucosa. splints are beneficial not only in the edentulous adult, but also in the child with deciduous dentition and in the patient with a partial dentition. splints are helpful in managing fractures of the symphysis, parasymphyseal region, body, and alveolar ridges of the mandible, sagittal fractures of the hard palate, and severely comminuted mandible fractures. Construction of acrylic splints is simple and rapid if the surgeon uses the services of a dentist or a dental laboratory.- - - - - - - - - - ranking = 524.71826975616keywords = mandible (Clic here for more details about this article) |
10/10. Oral myiasis. A case report.myiasis is a disease commonly seen in animals, especially sheep and cattle. The condition is rare in man. A patient with a neglected fractured mandible with superimposed myiasis is reported.- - - - - - - - - - ranking = 174.90608991872keywords = mandible (Clic here for more details about this article) |
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