Julius Berger

Clinical ArticlesTransoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: A prospective study☆☆☆★★★

Purpose: We conducted a study to assess the efficacy of intraoral treatment of mandibular fractures using a 2.0-mm miniplate and 2 weeks of maxillomandibular fixation (MMF). Patients and Methods: Forty-four mandible fractures in 31 patients with a mean of 15 days of MMF were included in this study. A 2.0-mm miniplate was adapted along Champys lines of ideal osteosynthesis and secured with four 8.0-mm monocortical screws. All patients were followed for at least 8 weeks after surgery. The incidences of bone or soft tissue infections, wound dehiscence, nonunion, malunion, malocclusion, plate fractures, and iatrogenic neurosensory deficits were prospectively evaluated. Results: Primary bone healing was achieved in 100% of cases. No soft or hard tissue infection, malocclusion, malunion, nonunion, dental injuries, plate fracture, or iatrogenic nerve injuries were observed. Two (4.52%) minor complications—intraoral wound dehiscences—were noted. Conclusions: The use of a single 2.0-mm miniplate adapted along Champys line of ideal osteosynthesis and stabilized with 4 monocortical screws plus 2 weeks of MMF was a viable treatment modality for mandibular fractures.

Metastatic ameloblastoma to the cervical lymph nodes: a case report and review of literature.

Ameloblastomas make up 1 % of all tumors found in the oral cavity. 1 They occur 80% of the time in the mandible, and 20% of the time in the maxilla.2 - 5 Ameloblastomas are benign tumors that are locally aggressive. Recurrence rates have been reported as high as 50% to 72%, depending on treatment modality. 1 Malignant ameloblastoma is defined as a histologically benign-appearing ameloblastoma with metastasis. 2 Metastasis most commonly occurs in the lungs (75% to 88% of cases) and lymph nodes (15% to 27% of cases), but is also seen in the liver, brain, bones, kidneys, and intestines. 3 It is theorized that metastatic spread occurs via 3 routes: lymphatics, hematogenous, and aspiration. 6,7 .

Cervicofacial Subcutaneous Emphysema: Case Report and Review of Literature

herapeutic decision making. Sclerosing agents, steoids, radiotherapy, lasers, cryotherapy, embolization, nd even continued observation represent reasonable pproaches to the vascular aspect of the lesion. evertheless, when feasible, surgical excision is the reatment method of choice and will also succeed in liminating the phlebolith. Our patient with the IMH opted for no treatment ecause she stated that other than a moderate cosetic asymmetry, she had no subjective problems. he did agree to return every 6 months for evaluation, ut she failed to present for further follow-up. In our patient with the VM, significant symptoms ad developed that prompted her to seek therapy. ormal masticatory function inevitably caused trauma ith associated hemorrhage. Furthermore, she beame increasingly embarrassed about her speech imediment. She was referred to an interventional radilogist who plans to embolize the lesion.

Treatment of protracted bilateral mandibular dislocation with Proplast-Vitallium prostheses

A case of bilateral protracted mandibular dislocation complicated by the presence of unusual degenerative changes in the temporomandibular joints is presented. A synopsis of treatment modalities that have been used previously to treat similar conditions is given. Our treatment consisted of bilateral condylectomies, eminectomies, and insertion of Proplast-coated Vitallium condylar prostheses. These procedures resulted in the re-establishment of normal TMJ anatomy, the maintenance of proper posterior mandibular vertical dimension, correction of malocclusion, and relief of the patients symptoms.

Treatment of mandible fractures using resorbable plates with a mean of 3 weeks maxillomandibular fixation: a prospective study

PURPOSE In this study, a 2.5-mm resorbable plating system (Inion CPS, Tampere Finland) was assessed for the fixation of mandibular fractures with 3 weeks of maxillomandibular fixation. PATIENTS AND METHODS Fifty mandibular fractures in 34 patients (32 males, 2 females) with a mean of 20.8 days of maxillomandibular fixation (MMF) were included in this study. The 2.5-mm resorbable plates were adapted along Champys line of ideal osteosynthesis and secured with four 8 × 2.5 mm monocortical resorbable screws. All patients were followed for a minimum of 6 weeks with an average long-term follow-up of 10 months. The incidence of soft tissue infection, nonunion, malunion, malocclusion, osteomyelitis, nerve injury, and tooth damage was prospectively assessed. RESULTS Primary bone healing was achieved in 100% of cases. Ten minor complications (20%) were observed: 5 soft tissue infections (10%), 4 plate dehiscences (8%), and 1 malocclusion (2%). No evidence of malunion, nonunion, osteomyelitis, plate fracture, or iatrogenic dental or nerve injury was noted; no readmission or reoperation was necessary. CONCLUSION The Inion 2.5-mm resorbable plating system along Champys line of ideal osteosynthesis plus 3 weeks of MMF is a viable option for the treatment of mandible fractures.

β-Thalassemia: Medical and Surgical Considerations in Managing Facial Deformities: Case Report and Review of the Literature

f -Thalassemia is an inherited genetic disorder characterized by a quantitative reduction of -chains of globin. More than 100 different genetic mutations affecting the -globin gene in chromosome 11 exist and ead to varying degrees of -chain production. In general, the heterozygous state is termed -thalassemia minor and is characterized by a silent, mildly hypochromic, and microcytic anemia. The homozygous state is known as -thalassemia major and requires regular blood transfusions and iron chelation therapy for survival. Approximately 10% of individuals with the homozygous trait have the clinical manifestations of intermediate severity to be termed -thalassemia ntermedia. The normal adult hemoglobin, HgA, is a tetramer consisting of 2 and 2 -globins. At 6 months of age, here is a decline in fetal hemoglobin, HgF, and subequent replacement by HgA. Therefore, the clinical anifestation of -thalassemia does not become apparent until 6 months of life when -chains are required for normal production of HgA. The absence or underproduction of -chains leads to unpaired -chains. The -globins by themselves are unstable and precipitate into erythroid precursors in the bone marrow, causing membrane damage and cell death. As a consequence, hypertrophy of erythroid marrow

Technique for Vertical Positioning of the Maxilla After Le Fort Osteotomy

Precise repositioning of the mobilized maxilla before the placement of rigid fixation is a critical step in achieving the predetermined movement and the desired surgical outcome. Clinical experience has shown that traditional intraoral reference lines scored in the wall of the maxilla can be difficult to visualize intraoperatively even with optimal hemostasis. Furthermore, placement of these lines can be somewhat problematic, especially in patients with a hypoplastic maxilla. Extraoral methods such as a tattooing or percutaneous pin placement may eliminate this shortcoming in some instances. However, they are invasive and may interfere with surgical draping.‘” We describe a simple technique that has many advantages over traditional techniques.

Use of the electrosurgical knife and topical thrombin for hemostasis in split-thickness skin graft vestibuloplasty

The use of electrocautery and topical thrombin at the donor and recipient sites has decreased most of the oozing normally present in skin graft vestibuloplasty procedures. It has effectively reduced operating room time, has significantly reduced post-operative morbidity, and has shortened both hospital stay and recovery time for the patient.

Septicemia secondary to administration of a contaminated intravenous fluid

The clinical entities of bacterial contamination, septicemia, and septic shock have been discussed, and an unusual case of septic shock has been presented. The associated risks of intravenous delivery of drugs or fluids are stressed.

Dislodgement of a submandibular gland sialolith during nasal intubation: A case report

A case of dislodgement of a submandibular sialolith into the oropharynx during nasal intubation is presented. The deleterious effect of the patient aspirating the stone into the lungs was averted by the taking of a lateral skull radiograph and localization and removal of the sialolith.