[Animal experiment studies of alloplastic replacement of the temporomandibular joint].
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Biomedical subjects
Publications and source records attributed to J Härtel.
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From 1971 to 1982, 1316 patients suffering from fractures of this kind underwent treatment. In 200 patients out of them concomitant lesions could be demonstrated. The therapy of fractures of the facial bone should be practised in close cooperation with the oral surgeon and without loss of time.
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The present paper analyzes the results of 100 osteosyntheses performed on 79 patients, with the ends of fractured lower jaw bones having been brought into close appostion through the use of plates and draw-in bolts. The major emphasis of this study centered on localizing the fracture and determining the etiology, the measures to be taken before performing an operation, the time of operation, and the duration of hospitalization.--Inflammatory disturbances of fracture healing were observed in 4 percent of the cases, and malocclusion was determined for another 4 percent of the cases included in this study. Also discussed by the author in his present paper are the results of post-hospital examinations of 51 patients, with 8 patients showing unesthetic operation scares. Temporary incapacity to work was, on average, 27.2 days for patients with isolated lower jaw bone fractures.--In conclusion, the author discusses the advantages and disadvantages of bringing the ends of fractured lower jaw bones into close apposition with the use of plates and bolts.
Biomechanical studies on a model of the mandible served to verify the stability of a fracture treated with the techniques of pressure-plate osteosynthesis, traction-bandage osteosynthesis and percutaneous compression osteosynthesis, respectively. Stress distribution in the model were determined photoelastically. In this way, it has been possible to obtain informations about stresses caused by different loads (biting-off, stress on the left or right lateral region). Of the methods of osteosynthesis under investigation, plate osteosynthesis yielded the most stable union of the fragments. Satisfactory values were also achieved by means of traction-bandage osteosynthesis and percutaneous compression osteosynthesis. Consequently, these methods may be regarded as function-stable. Conclusions as to the optimal location of the osteosynthesis material can be drawn from an exact analysis of the stress curves. Maximum stress on the mandible, especially in the anterior region, should be avoided for a least 3 weeks.
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After application of stable osteosynthesis on 18 experimentally fractured canine mandibles combined mechanic and histologic examinations were carried out at different times during the postoperative period. The preparations revealed relatively fair mechanic stability and in most cases a favorable histologic pattern with primary healing. Single cases, however, showed reverse behavior. There was a direct relation between stability of the mandible and broadth of the fractures' clefts.
From the many kinds of treatment which are indicated in the literature, the authors selected for presentation those methods which have proved useful at the Rostock University Clinic and Policlinic of Stomatology, during many years, in managing mandibular fractures, their indications being precisely established. The therapeutical measures still centre on conservative methods, modern operation techniques being optimal complements. If surgical management of the fracture is necessary, a stable osteosynthesis technique should be used on principle, condylar process fractures being excepted.
The temporomandibular joints of 977 students of the Rostock University were examined clinically and radiographically. Objective findings (laterodeviation of the mandible, crackling noises of the joint, radiographic changes of the position of the condyle) were frequently obtained, whereas subjective complaints (arthralgia, crackling noises of the joint) were rare. Only the occurrence of both symptom complexes requires an exact diagnosis and therapy of the temporomandibular joint disease after optimal oral rehabilitation.
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