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At least 1,711 records · Page 95Linked to original sources
PubMed2005

Use of resorbable plates and screws in pediatric facial fractures.

PURPOSE: The use of resorbable plates and screws for fixation of pediatric facial fractures is both well tolerated and effective. It enables realignment and stable positioning of rapidly healing fracture segments while obviating any future issues secondary to long-term metal retention. PATIENTS AND METHODS: Forty-four pediatric facial fractures were treated over a 10-year period at our institution using differing techniques of polymeric bone fixation. Twenty-nine mandible fractures in patients under the age of 10 (age range, 6 months to 8 years) were treated. Displaced fractures of the symphysis, parasymphysis, body, and ramus underwent open reduction and either 1.5-mm or 2.0-mm plate and screw fixation in 14 patients. Subcondylar fractures were treated by a short period of maxillomandibular fixation (3 weeks) achieved with suture ligation between resorbable screws placed at the zygoma and symphysis or a circummandibular suture attached to a zygomatic screw. Fifteen patients (age range, 4 to 11 years) with isolated frontal, supraorbital, intraorbital, or orbitozygomatic fractures were treated by open reduction and internal fixation with 1.5-mm resorbable plates, mesh, and screws. RESULTS: No long-term implant-related complications were seen in any of the treated patients. CONCLUSIONS: Resorbable polylactic and polyglycolic acid plates and screws can be an effective fixation method for facial fractures in children in the primary and secondary dentition periods.

Absorbable Implants↗
PubMed2005

Seven years of clinical experience with teleconsultation in craniomaxillofacial surgery.

PURPOSE: In this work the experiences from 50 telemedically supported treatments in craniomaxillofacial surgery are summarized and different setups for their technical realization are described. Furthermore, for the first time the innovative UMTS (universal mobile telecommunication system) is applied for the transmission of arthroscopic videos of the temporomandibular joint and other craniomaxillofacial structures. MATERIALS AND METHODS: The combination of computer-assisted navigation technology in augmented reality environments with telecommunication is used for execution of interactive stereotaxic teleconsultation. Furthermore, treatments without navigation are telemedically supported. This study is composed of 4 technical system configurations: 1) integrated services digital network (ISDN)-based videoconferencing without remote control of the navigation computer; 2) transmission control protocol/internet protocol (TCP/IP)-based interactive teleconsultation via bundled ISDN lines (including remote control of the navigation computer); 3) TCP/IP-based interactive teleconsultation via network; 4) combination of TCP/IP-connection and ISDN-based videoconferencing. The telemedically supported treatments are: orbitozygomatic osteotomies, positioning of the mandibular condyle in orthognathic surgery, insertion of implants, positioning of the maxilla in orthognathic surgery, distraction osteogenesis, arthroscopies of the temporomandibular joint, and operation simulations on stereolithographic models. The surgical interventions are evaluated on a 5-level system performance scale from the technical point of view. In a separate trial 20 videosequences of arthroscopies of the temporomandibular joint are transmitted via UMTS cellular phones and independently evaluated by 3 experts (ie, a total of 60 streamings) to investigate feasibility of this technology in the field of craniomaxillofacial surgery. RESULTS: In the years from 1996 to 2002 a total of 50 treatments were telemedically supported. All intraoperative applications were successfully finished; 48 of 60 UMTS transmissions were finished without any interruptions in constant quality, slight interruptions were observed in 8 tests, and a complete breakdown was observed during 4 streamings that required a restart of the transmission. Resolution was sufficient to diagnose even tiny anatomic structures inside the temporomandibular joint, but orientation was hardly recognizable. CONCLUSION: In many applications telecommunication technology can contribute to a quality improvement in cranio- and maxillofacial surgery because of the global availability of specialized knowledge. The required technical expenditure for teleconsultation crucially depends on the infrastructure that is already available at the clinic and the remote site. UMTS is a promising technology with the potential to be valuable in numerous craniomaxillofacial applications.

Arthroscopy↗
PubMed2006

Open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach: a long-term follow-up study of 15 patients.

PURPOSE: To evaluate the long-term results obtained with open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach. PATIENTS AND METHODS: Fifteen patients with 24 mandibular condylar fractures were retrospectively examined with an average follow-up of 23 months (range, 6-63 months). Clinical and radiographic examination was conducted according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including an evaluation of maximum voluntary bite force measurements and facial nerve function. Statistical analysis was performed on maximum voluntary bite force measurements and maximum pressure pain threshold. RESULTS: Two patients fulfilled the criteria for a RDC/TMD diagnosis. Myofacial pain (group I) and bilateral arthralgia (group III), combined with a moderate nonspecific physical symptom score, was diagnosed in 1 patient and 1 patient received a diagnosis of disc displacement with reduction (group II). Satisfying radiographic fracture healing was seen in 12 joints. However, miniplate fracture occurred in 3 patients and severe bone resorption of the condylar head was seen in one patient. Minor adjustment of the postoperative occlusion was necessary in 6 patients. No significant difference between maximum voluntary isometric bite force measurements or maximum pressure pain threshold was found between the fracture side and the opposite side in unilateral cases or between the operated and nonoperated side in bilateral cases. None of the patients showed facial nerve injury or visible facial scars. CONCLUSION: Within the limitations of a retrospective study, the present study emphasized that optimal management of dislocated bilateral condylar injuries combined with other fractures of the facial skeleton constitute a challenging issue in maxillofacial trauma. Moreover, open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach is a technically demanding surgical procedure associated with a high risk of postoperative complications in these injuries.

Adolescent↗
PubMed2006

An accurate simulation model of anteriorly displaced TMJ discs with and without reduction.

Internal derangement of the temporomandibular joint (TMJ) is defined as an abnormal positional relationship of the disc relative to the mandibular condyle and the glenoid fossa. Among others, the anterior disc displacement is the most common disorder, however its origin and consequences are still unclear. Several finite element simulations of the TMJ have been developed, but none of them has reported dynamic simulations of the disc as a three-dimensional, fiber-reinforced biphasic material under finite deformations, during the opening movement of a pathologic joint affected of an anterior displacement of the disc with and without reduction, using a realistic geometry of the ligaments in the joint. The aim of the work presented here was to compare the stress distribution in the healthy joint and in two pathologic situations, one joint affected of an anterior disc displacement with reduction (ADDWR) and one without reduction (ADDWOR) during an opening movement of the mouth. It was found that, while in the healthy disc the highest compressive stresses were located in the intermediate zone, in the pathologic joints the maximum compressive stresses were located in the posterior band both in the ADDWOR case and in the ADDWR before the reduction. Moreover, although the final stress distribution in the ADDWR was similar to that in the healthy case, the collateral ligaments supported higher stresses, a fact that could lead to degeneration of these components and subsequently to the total anterior displacement of the disc. Finally, the results suggest that an anterior displacement of the disc would lead to higher compressive and tangential stresses in the posterior band of the disc than in the healthy one, and as a consequence, to possible perforations in that zone of the disc which would modify its geometry if no treatment is applied.

Bite Force↗
PubMed2004

MRI and histology of collagen template disc implantation and regeneration in rabbit temporomandibular joint: preliminary report.

INTRODUCTION: We aimed to evaluate regeneration of injured temporomandibular joint (TMJ) discs following reconstituted collagen template implantation in rabbits using contrast-enhanced magnetic resonance imaging (MRI) and to correlate these findings with histology. METHODS: Twenty-four adult rabbits were divided into five groups: group A, partial discectomy without implantation (n = 6); group B, partial discectomy with collagen template implantation (n = 6); group C, partial discectomy with subdermal graft implantation (n = 6); group D, sham operation (n = 4); and group E, control (n = 2). All rabbits received baseline MRI scans before surgery and follow-up MRI studies at 3 months after surgery. All rabbits were sacrificed for histologic analysis after the follow-up MRI. RESULTS: In group A, follow-up MRI showed marked joint effusion in all six injured TMJs, which was accompanied by bony erosion at the tympanic fossa and mandibular condyle. In group B, MRI showed a homogenous low signal intensity in five of six discs, suggestive of regeneration. One disc showed higher signal intensity at its lateral portion than that of the original disc, indicating partial regeneration. MRI of group C depicted a low signal intensity, bandlike regenerative structure in four of the six discs. One disc with partial regeneration demonstrated relatively high signal intensity. The disc in the sixth animal of this group showed no evidence of regeneration. All of the MRI findings were in agreement with the histologic findings. CONCLUSION: TMJ discs can regenerate following implantation of a reconstituted collagen template in discectomied rabbits. Contrast-enhanced MRI can be used to monitor and determine the degree of disc regeneration.

Animals↗
PubMed2004

Benign fibrous histiocytoma in the mandible.

PURPOSE: Benign fibrous histiocytoma (BFH) is a very rare benign tumor occurring in the jaw. The purpose of this article is to describe the clinical, radiographic, and microscopic appearance of BFH occurring in the mandible. STUDY DESIGN: A 42-year-old man had an asymptomatic swelling of the left mandibular posterior area. RESULTS: Conventional radiographs revealed a well-defined multilocular radiolucency involving the left mandibular body, ramus, coronoid process, and condylar head. The lesion showed the thinning and expansion of the cortex. There were many thin, indistinct septa in the lesion. The computed tomography (CT) scans showed bone destruction with marginal sclerosis and a heterogeneous soft-tissue mass expanding the mandible. Microscopic examination revealed a cellular tumor composed of uniform spindle-shaped cells arranged in a storiform pattern. CONCLUSIONS: BFH is a very rare benign tumor occurring in the jaw, so more cases should be reported to understand the characteristics of the lesion.

Adult↗
PubMed2006

Condylar resorption following temporomandibular joint arthroscopy in a patient with essential thrombocythemia.

Condylar resorption of the temporomandibular joint (TMJ) is a poorly understood phenomenon that is the subject of much controversy. The following case report depicts a unique case of condylar resorption (CR) in a 49-year-old female patient with essential thrombocythemia who underwent arthrocentesis of the TMJ. The exact cause of the CR is unclear but it is speculated that it was likely due to hemorrhagic and thrombotic complications during surgery secondary to an elevated platelet count.

Arthroscopy↗
PubMed2006

[Retromandibular approach for subcondylar fractures].

Fractures of the jaw are the second ones in order of frequency, being the condylar region the most frequent. With the coming of the rigid fixation, more surgeons now agree with the open approach for the displaced fractures of subcondylar region, specially in adult patients. When a rigid fixation is necessary, retromandibular approach is an effective and safe technique, specially for condylar displaced fractures, in which the facial nerve is exposed without any damage.

Adult↗
PubMed1987

Multiple radiolucent areas of the jaw.

A case of neurofibromatosis, or von Recklinghausen's disease, was presented. The skin manifestations include the development of numerous, variable sized, smooth-surfaced nodules (benign neural tumors) and asymmetric areas of hyperpigmentation called cafe-au-lait spots. Oral manifestations are not always apparent but, when they do occur, include multiple, discrete, nonulcerated mucosal nodules (typically benign neural tumors). Intraosseous tumors (usually neurofibromas) occasionally develop in the mandible as was reported in this patient. Clinicians should be aware of the characteristics of this hereditary disease, especially the possibility of malignant transformation of the neural tumors.

Adolescent↗
PubMed2000

Collagen crimping in the intra-articular disc and articular surfaces of the human temporomandibular joint.

The presence of crimping within soft fibrous connective tissues has a considerable role in determining the biomechanical properties of the tissue. However, there is little or no information on crimping of collagen in the human temporomandibular joint. To remedy this situation, the presence and nature of any crimping was studied in sections of human temporomandibular joints from individuals varying in age from between 4.5-63 years, using polarized light microscopy and differential interference contrast microscopy. The presence of crimping was looked for in collagen within the intra-articular disc and the articular surfaces of the mandibular fossa and mandibular condyle. By polarized light, crimping was seen throughout all three tissues at all ages studied. Quantification from micrographs enlarged to x250 showed that the periodicity of the banding (representing half a complete crimp wave) had a mean varying between about 15-20 microm. Crimping was also directly visualized by differential interference contrast microscopy. The presence of such a fundamental feature needs to be considered when explaining the normal function of the temporomandibular joint.

Adolescent↗