Fortschritte der Kiefer- und Gesichts-Chirurgie最新文献

The study including fifty children younger than 10-years-old with dislocated unilateral collum fractures concerns the chronological development of morphological alterations in the orthopantomogramm. Regardless of fracture type, the radiographs indicate, that a very good restitution can be attained with an exclusive functional therapy using an activator in all analyzed patients. A realignment can not be found.

In an retrospective analysis of 316 patients with mandibular fractures treated between 1984 and 1993 at the maxillo-facial surgery of university of Cologne could be shown that the application of miniplate in local anesthesia causes no more complication than in general anesthesia. We would therefore recommend this technique for not to complicated cases of isolated or double fractures of the mandible. In cases of obstacles to general anesthesia it may be favoured even in severe cases.

A geometrically closed quadrangular plate secured with bone screws creates stability in three dimensions. The smallest structural component of a 3-D-plate is an open cube or a square stone. Our clinical results and biomechanical investigations have shown a good stability of the 3-D-plates in the osteosynthesis of mandibular fractures without major complications. The thin 1.0 mm connecting arms of the plate allow easy adaptation to the bone without distortion. The free areas between the arms permit good blood supply to the bone.

We report of 5 of 337 patients (1.48%), in whom a fracture of the edentulous atrophied mandible occurred after dental implants had been inserted. In 79 patients a sandwich osteotomy (anterior and/or lateral mandible) had been carried out together with the insertion of implants. The reason for a fracture was infection in 3 patients and weakening of the atrophied mandible by the additional osteotomies in 2 patients. One of the latter two was seen intraoperatively and fixed immediately using miniplates. The other occurred about 4 weeks postoperatively and was not discovered until callus had been developed. Consequently only 4 of the 5 patients were treated by osteosynthesis. In two patients no implants were lost. The application of bone morphogenetic protein (BMP) helped to avoid the loss of implants because it accelerated ossification of the fracture and the integration of the implants.

In a prospective study 150 adult patients with mandible fractures were analysed. Criteria for entry into the study were fractures of the mandibular body with and without associated condylar fractures. The fractures must fit to the Spiessl-classes F1 and F2, L1 to L4, W0 to W3 and the patients must have had a sufficient dentition to judge their occlusion. Not included were patients with combinations of mandible and Le Fort fractures, comminuted and defect fractures and patients who could not communicate preoperatively in order to have a full preoperative examination. The patients were equally distributed among 3 different treatment groups. Group 1 was treated conservatively with MMF, only displaced fractures which needed open reduction were internally fixed with wire osteosynthesis. Group 2 received rigid internal fixation with AO 2.7-plates from an intraoral approach, group 3 internal fixation with miniadaption-plates also from an intraoral approach. Using a standardized treatment protocol the patients were followed in defined intervals up to a maximum of 2 years after therapy. Group 1 presented with the lowest complication rate, group 2 with the highest rate of overall complications as far as disturbances of the occlusion and sensory disturbances were concerned. Except one plate fracture in group 3 with subsequent pseudarthrosis, which required a reosteosynthesis with a rigid plate, no major complications in bone healing were observed.

As a rule, damage to segmental afferent nerves by trauma is accompanied with local impairment of sympathic functions. Standardized quantification of subjective items concerning the deficit of sensibility is quite problematical. Investigation by electrophysiological means yield not more than qualitative issues. In contrast, changes of sympathetic status and reaction of dependent dermatomas are quantitatively measurable by thermography. -26 patients with unilateral mandibular fractures complained of different posttraumatic or postoperative sensible impairment of the third branch of the trigeminal nerve. In the course of onto 3 years area and quality of the concerned neural defect were correlated to skin temperature that was measured by contact thermography and compared to the opposite reference region.- In all cases the early posttraumatic period showed a difference in temperature of the corresponding skin areas (delta T = 0.43 +/- 0.24 C). In 20 of 26 cases a relation between the changes of temperature concerning time and area and the sensible improvement could be seen. There was an individual time-lag between these developments. Side-comparing thermography was able to forecast improvement in 17 of 26 cases. Thus, the issued device provides statements about the amount and the course of posttraumatic loss of sensibility.

Because treatment of fractures of the atrophic mandible still today presents significant difficulties and treatment modalities remain controversial, 87 of these consecutive fractures which were treated by an uniform method as compression osteosynthesis were evaluated. A new classification of the degree of atrophy which considers the special interest of fracture treatment is introduced. It is based on a metrical measurement of the height of the mandible in the fracture area. Mandibles of 16 to 20 mm height are classified as class I atrophy, those of 11 to 15 mm as class II atrophy, and those with a height of 10 mm or less as extremely atrophic mandibles or class III atrophy. This simple and reliable classification could also be used in future investigations on the results of different treatment modalities in atrophic mandibles. In our series of 87 fractures of the atrophic mandible which were treated by compression osteosynthesis 97% resulted in a solid osseous union without the need of a second surgical intervention. Three major complications occurred: 1 osteomyelitis and 2 non-unions (the latter in one patient with a double fracture of a class III atrophy mandible). To the best of our knowledge this series is the largest of fractures of truly atrophic mandibles treated by one uniform method. Compared to other treatment modalities compression osteosynthesis produced acceptable results and is recommended as the treatment of choice in fractures of the atrophic mandible.

In a retrospective study on 302 patients, miniplate osteosynthesis (n = 236) and rigid internal fixation (n = 66) in patients with fractures of the mandible were investigated. The total complication rate following miniplate osteosynthesis was 6.5% compared to 12.7% following rigid internal fixation. Additional intermaxillary immobilisation did not avoid postoperative complications. In patients with multiple or comminuted fractures of the mandible, rigid internal fixation demonstrated a lower complication rate compared to miniplate osteosynthesis.

This paper presents the results of the treatment of fractures of the mandibular angle using miniplate osteosynthesis. From 1984 to 1993 347 patients with 358 fractures were operated in the department of Maxillofacial Surgery at the University of Cologne. In all cases total bone healing could be observed while complications were rare.