Knut Tornes

Maxillofacial fractures in a Norwegian district

Records of 169 patients referred to Haukeland Hospital, Bergen, Norway, for treatment of maxillofacial fractures during the period 1989-91 were studied with respect to socio-etiologic aspects, frequency and localization of jaw fractures, treatment, and complications. The number of maxillofacial fractures found in the present study was about twice as many as found in a study from the same area during the period 1974-9. Recent trends in the etiology of maxillofacial traumas were confirmed, such as increased number of fractures caused by interpersonal violence, and a reduction of cases related to traffic accidents. Alcohol abuse was a contributing factor in 28% of the patients. Mandibular fractures were 4.8 times more frequent than maxillary fractures. Reduction and fixation with miniplate osteosynthesis was the preferred treatment in most patients.

Cranial dislocation of the mandibular condyle : a case report with an unusual hearing loss

The case of a 37-year-old woman who suffered a condylar dislocation into the middle cranial fossa is reported. The mechanisms of injury, the problems of clinical diagnosis and the management are discussed.

Long-Term Follow-Up of Mandibular Condylar Fractures in Children

PURPOSE The aim of this prospective study was to evaluate the long-term clinical and radiographic outcomes of nonsurgically treated mandibular condylar fractures in children. MATERIALS AND METHODS This study includes 42 children (23 girls and 19 boys) with 54 mandibular condylar fractures. All patients were younger than 18 years at the time of injury and were followed for at least 2 years (mean follow-up 4 years). Treatment was either observation or intermaxillary fixation (rigid and/or guiding elastics). Clinical outcome was categorized as favorable or unfavorable. Condylar remodeling was defined as complete, moderate, or poor on the basis of radiographic findings. RESULTS Thirty-one patients (74%) presented with favorable and 11 (26%) with unfavorable clinical long-term outcome. Unilateral fractures showed a statistically significant increase of unfavorable clinical outcomes compared with bilateral fractures (P = .018). The radiologic examinations showed complete remodeling in 47 (87%), moderate remodeling in 5 (9%), and poor remodeling in 2 (4%) of the condylar fractures. One patient developed condylar overgrowth. No statistically significant relationship between clinical and radiologic outcome was found. Thirty-five patients (83%) had no subjective symptoms, and 41 (98%) described normal chewing function at the last follow-up examination. CONCLUSIONS Nonsurgical treatment of mandibular condylar fractures leads to acceptable remodeling of the condylar process, good clinical long-term outcome, and minimal subjective symptoms in most children. Unilateral fractures significantly increase the risk for unfavorable clinical outcome.

Radiographic changes in the temporomandibular joint subsequent to vertical ramus osteotomy

The position of the mandibular condyle in patients treated for mandibular protrusion by the oblique vertical osteotomy of the mandibular rami was studied on temporomandibular joint radiographs exposed according to the oblique transcranial projection. Forty-four adults participated in the study, and the radiographs were taken before the operation, 6 weeks postoperatively and 1 year postoperatively. At the 6-week postoperative control all the variables measured indicated a significant downward and forward displacement of the condylar fragment of about 1mm. The changes did not increase the variability of the joint morphology. At the 1-year postoperative control there were still significant differences in the position of the condyle compared with the pretreatment recording. A slight tendency to normalization was, however, observed. The mobility of the condyle, which was greatly restricted at the 6-week postoperative control, was fully restituted 1 year after the operation.

Oral verrucous carcinoma

Verrucous carcinoma is a well-defined variant of the squamous cell carcinoma. Although it is reported to be rare in the Scandinavian countries, 16 cases have been diagnosed in the Southern part of Norway from 1975 to 1982. The clinical and histological characteristics were investigated. The most common site of occurrence was the mandibular alveolar ridge. The average age was 71 years, and unlike most other series of verrucous carcinoma, there was a female predominance and use of tobacco seemed to be the exception. The patients mainly complained of ill-fitting dentures. Adequate surgical excision appears to be the treatment of choice.

Extraoral and intraoral vertical subcondylar ramusosteotomy for correction of mandibular prognathism

Vertical subcondylar ramusosteotomy for correction of mandibular prognathism was performed in 203 cases with an extraoral (EVSO) and in 55 cases with an intraoral (IVSO) approach. Clinical and surgical observations were analyzed and the 2 techniques compared with regard to operation time, per- and postoperative complications, postoperative morbidity of the patients and the duration of hospital stay. The extraoral approach demonstrated significantly shorter operation time, less blood loss and shorter hospital stay. The extent of postoperative swelling, nausea and vomiting was also in favour of the EVSO. Serious complications were few, and both techniques were considered as satisfactory and safe.

Primary chronic osteomyelitis of the jaw--a microbial investigation using cultivation and DNA analysis: a pilot study.

OBJECTIVES The aims of this study were to investigate the infectious etiology of primary chronic osteomyelitis (PCO) of the jaw using an extraoral sampling approach and molecular methods. STUDY DESIGN In this pilot study, bone biopsies from the mandibles of 5 patients with PCO were sampled with an extraoral sterile approach. Cultivation and polymerase chain reaction (PCR) were performed. RESULTS Two of the biopsies yielded growth of Propionebacterium acnes. One biopsy also demonstrated Staphylococcus capitis. The biopsies with bacterial growth were also positive for the same bacteria by PCR analysis. CONCLUSION No specific bacterial etiology was demonstrated. However, the results of bacterial cultivation and PCR analysis were in agreement. Based on these findings, the molecular procedure used in this study can be considered to be suitable for identification of bacterial specimens in mandibular biopsies. Further studies are needed with larger patient populations to confirm these findings.

Correction of jaw deformities subsequent to treatment of acromegaly

In acromegaly, growth of facial bones and changes of oral and laryngeal mucosa are well accepted facts. Orthognathic surgical procedures should in these cases be postponed until the acromegalic process is well controlled. 2 cases of mandibular osteotomies (patients aged 61 and 38 years) are reported. The surgical procedures and the postoperative course of these patients were uneventful and did not deviate from those of otherwise healthy patients.

Traumatic eosinophilic granuloma of the gingiva

Abstract A patient with a solitary traumatic eosinophilic granuloma of the gingiva is presented. Most of the previous cases involving the oral mucosa have been localized to the tongue, only one occurring in the gingiva. The size and duration of the present lesion, as well as the sex and age of the patient, also differ from cases published before. The lesion is difficult to classify, and further knowledge should be gained from the study of additional cases.

Dental or Skeletal Relapse After Sagittal Split Osteotomy Advancement Surgery? Long-Term Follow-Up

PURPOSE To evaluate the short- and long-term stability of mandibular advancement surgery with sagittal split osteotomy (SSO), and to investigate when relapse occurs and identify variables contributing to relapse. PATIENTS AND METHODS Thirty-six patients with Class II anomalies were included; the mean age at surgery was 33.0 years. All underwent SSO surgery and clinical and radiologic follow-up at 8 weeks, 1 year, and 13 years. Model analysis, cephalometric analysis, and clinical examinations were performed at each control. RESULTS Mean overjet relapse from 8 weeks to 13 years was 2.3 mm (range, 0 to 7.0 mm). Between 8 weeks and 1 year, mean overjet relapse was 0.6 mm (range, -1.0 to 4.0 mm), and it was 1.7 mm (range, -1.0 to 6.0 mm) between 1 year and 13 years. Overjet relapse greater than 4 mm was found in 13.9% of the patients. Mean overjet 1 year after surgery was 2.6 mm and was significantly increased compared with 8 weeks (P = .006). Mean overjet 13 years after surgery was 4.3 mm and was significantly increased compared with 1 year (P < .001). Inferior incisor line to nasion-B-point was 29.0° at 8 weeks after surgery and 25.4° at 13 years (P = .001). Insignificant changes in the other cephalometric variables were found at follow-up. CONCLUSION SSO advancement surgery is a relatively stable technique over time. Mean overjet relapse was found to be 2.3 mm after 13 years, following a continuous pattern over time. The cephalometric variables showed insignificant changes during follow-up, indicating that relapses are mainly of dental and not skeletal origin.