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Effect of radiation injury on the growing face.

The literature on the effect of ionizing radiations on developing and rapidly growing tissue has been reviewed, and the effect especially on children who received radiation therapy in the Clinic for Maxillo-Facial and Plastic Surgery of the University of Dusseldorf for various tumours of the head and neck presented. Our findings indicate that we do not yet know the minimal irradiation dosage that may cause growth retardation in infants and children. It has therefore been suggested that surgery should be more frequently considered in the treatment of childhood tumours, since this caused less side effect, and reconstructive surgery is today able to do much for patients who have had parts of their jaws resected.

Adolescent↗

Nerve injury in fractures of the condylar neck.

Although fractures of the condylar neck belong to the most frequent injuries of the jaws, and various nerves are found in close proximity to the temporomandibular joints, only little mention is made in the literature of neurological complications arising from accidents. We have therefore carried out a prospective study on nerve injuries in 237 fractures of the articular process in the period 1971-1975. We found two cases of post-traumatic Frey's syndrome, whereby the syndrome developed from a post-traumatic auriculotemporal neuralgia. We also found loss of function of auriculotemporal buccal and facial nerves, and loss of taste sensation of the tongue in another case, caused by damage to the chorda tympani. This paper discusses the formal and causal origin of the individual damages, and suggests possibilities for their management.

Chorda Tympani Nerve↗

A spectrum of application of autogenous costochondral grafts.

Autogenous costochondral grafts have found application in 26 variegated cases of congenital dysplasia, ankylosis, neoplastic disease, osteoarthritis, and post-traumatic dysfunction. The authors' experience with the grafting procedure has been generally favourable, but various difficulties have also arisen. There is a cursory discussion on the physiological superiority of rib cartilage grafts over those of other autogenous joints in reconstruction of the temporomandibular articulation.

Adolescent↗

Mandibular osteosynthesis by miniature screwed plates via a buccal approach.

The modified Michelet's (1973) technique of mandibular osteosynthesis, which consists of monocortical juxta-alveolar and sub-apical osteosynthesis, without compression and without inter-maxillary fixation, is described. This technique can be used in many types of mandibular fracture, single or multiple, associated or isolated, except in the case of a fracture of the condylar neck and in the presence of pre-existing infection. Infected fractures are treated by orthopaedic methods. Materials used (plates and screws) and particulars of the method have been tested by multi-disciplinary experimentation, particularly by anatomical verification and biomechanical studies. The ideal line of osteosynthesis is described. For the author, this technique is a routine treatment of any type of mandibular fracture.

Bone Plates↗

Stability of the mandibular condylar process after functionally stable traction-screw-osteosynthesis (TSO) with a self-tapping screw-pin.

The behaviour under stress of the condylar processes of the mandible was examined as to possible physiological and pathological influence after traction screw osteosynthesis of experimental condylar neck and base fractures. Stresses were applied in a sagittal direction and laterally in a load device fitted with an electronic power recorder. The behaviour under stress was recorded in load-path diagrams. The interfragmentary compression which can be applied intuitively under operating conditions was measured with an electronically calibrated torque wrench and compared with the maximum resistance to tensile stress, i.e. the force necessary to rip the screw out of the proximal fragment. Compared with the strain on the joint resulting from masticatory pressure and the possible performance of the masticatory muscles traction-screw osteosynthesis of condylar neck and base fractures was seen to be functionally stable, but not mastication stable.

Bone Screws↗

Mandibular reconstruction using a special plate. Animal experiments and clinical application.

The use of a variety of procedures and techniques for mandibular reconstruction suggest that no satisfactory solutions have been found with regard to restoration of functional stability, joint function and masticatory function. In view of the varied clinical problems involving restoration of mandibular function, we developed our own reconstruction plate, a condylar prosthesis, and a reconstruction plate with a condylar head. The U-shaped notches of the reconstruction plate permitted universal adaptation of the plates by means of special pliers. The most important result of the animal experiments was the achievement of stability under functional stress. This made intermaxillary fixation unnecessary. The preliminary experience in our clinical cases with the reconstruction plate showed a reduction of masticatory disability. The clinical results corresponded well with those of the animal experiments, and thus confirmed the value of the experimental model chosen.

Adolescent↗

Fractures of the facial skeleton in the edentulous patient.

An evaluation was made of 112 fractures that occurred in 66 edentulous patients in a 10 year period. There was an average of 1.7 fractures per person. 104 fractures occurred in the mandible and 75% of these were treated without intermaxillary fixation or were not treated at all. In 28.5% of the cases no treatment was provided other than soft or liquid diet and appropriate instructions. As a group, the condylar fractures were those that were left with no treatment to a greater extent than any other group, apart from the Le Fort type of fracture; the latter being very few in absolute numbers. The age group associated with the edentulous state quite often suffers from conditions that may prohibit aggressive treatment. These conditions may be aggravated by the accident and, by the time the patient is ready for maxillofacial surgery, one has to contemplate (and discuss with the patient) the advantages and disadvantages of a procedure. It appears that aesthetics are of minor importance (to a certain degree) for elderly patients and small deviations from the normal (both in appearance and function) are acceptable to them, considering the prospect of an operation or of the prolonged discomfort, such as that associated with intermaxillary fixation. The advisability of the latter should be assessed carefully in view of the respiratory impairment that it may cause in patients whose airway may already be compromised.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Surgery in mandibular condylar hyperplasia.

The experience with 35 patients with unilateral condylar hyperplasia is described. Possibilities of distinction between active and non-active cases are discussed as well as the histological findings. Different surgical procedures were used for treatment. Pain in the joint area is a prominent feature in this group. The treatment was effective in this regard in all patients.

Adolescent↗

Imaging of high-energy midfacial trauma: what the surgeon needs to know.

UNLABELLED: Treatment goals in severe midfacial trauma are restoration of function and appearance. Restoration of function is directed at multiple organ systems, which support visual acuity, airway patency, mastication, lacrimation, smelling, tasting, hearing, and facial expression. Victims of blunt facial trauma expect to look the same after surgical treatment as before injury. Delicate soft tissues of the midface often make cosmetic reconstructive surgery technically challenging. Generally, clinical evaluation alone does not suffice to fully characterize facial fractures associated with extensive swelling, and the deeper midface is not accessible to physical examination. Properly performed computed tomography (CT) overcomes most limitations of presurgical examination. Thus, operative approaches and sequencing of surgical repair are guided by imaging information displayed by CT. Restoration of function and appearance relies on recreating normal maxillofacial skeletal anatomy, with particular attention to position of the malar eminences, mandibular condyles, vertical dimension and orbital morphology. Due to its pivotal role in surgical planning, CT scans obtained for the evaluation of severe midfacial trauma should be designed to easily depict the imaging information necessary for clinical decision making. LEARNING OBJECTIVES: 1. Understand the facial skeletal buttress system; 2. Understand how the pattern of derangement of the buttress system determines the need for and choice of operative approach for repair of fractures in the middle third of the face; 3. Understand the role and importance of CT and CT reformations in the detection and classification of the pattern of buttress system derangement.

Humans↗

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