Michael Perry

Displacement of mandibular fractures: is there a correlation with sensory loss and recovery?

Fractures of the mandible are common. However, the correlation between the severity of the fracture and the recovery of any associated inferior dental (ID) nerve injury is still poorly understood. We aimed to examine the relationship between the amount of fracture displacement and how it relates to the recovery of sensation to the lower lip. One hundred and fifty patients requiring treatment of a mandibular fracture (where the fracture passed across the ID canal) were assessed. One hundred were initially assessed in a retrospective double-blinded study. A further 50 patients were then followed up prospectively. Both the maximal displacement of the fracture and the displacement specifically at the ID canal were measured. Sensory recovery, or persistence of numbness, was also recorded for each patient. Although there appeared to be a correlation between increasing displacement at the ID canal and a poorer recovery, there was not a clear relationship between the two, and there were many exceptions. Persistent numbness (>1 year) still occurred in fractures with relatively minimal displacement (≤3mm). Possible reasons for persistent numbness are discussed.

Initial Assessment and Management of Life- and Sight-Threatening Complications

Injuries to the face vary widely in severity, from the most trivial to those associated with life-threatening complications. Although in most cases such complications are immediately apparent, occasionally they can be concealed, or they can develop over a period of several hours. Airway obstruction from progressive swelling is an example of this. Injuries to the face can either occur in isolation, or they can be associated with significant injuries elsewhere on the patient, some of which may also go unnoticed initially.

Fractures of the Cheek: The Zygomaticomaxillary Complex (ZMC)

Cheek fractures are very common injuries and comprise a spectrum from relatively simple fractures to complex patterns causing gross disfigurement and considerable functional disability. The classic description of the fracture pattern is that of a tetrapod (although they are sometimes confusingly referred to as “tripod”) fractures. The “feet” or “pods” in this description refer to the main sites of fracture displacement, which can be identified either clinically or radiographically. The arch fractures separately from the remaining sites, which are bridged by a continuous ring of interlinking fractures.

Manual of operative maxillofacial trauma surgery

Atlas of operative maxillofacial trauma surgery : , Atlas of operative maxillofacial trauma surgery : , کتابخانه دانشگاه علوم پزشکی و خدمات درمانی زاهدان

Alternative approach for the removal of problem miniscrews—a serendipitous finding

1 Removal of devices used for osteosynthesis can be difficult t times, particularly when there is a degree of osseointegraion, the wrong kit is used, or the head of the screw has become amaged.1 During one such procedure we were attempting to remove miniplate from the infraorbital margin in a patient having secondary operation after repair abroad. Initial attempts to emove the screws using our “universal screwdriver kit” were ot successful, and eventually damage to the heads of two crews prevented the screwdriver being engaged securely. As an alternative we decided to drill the bone circumferntially, and use a clip to grasp the head – a commonly used, nd a tried and tested technique, although others have been escribed.2 However, unknown to us the drill motor was set in everse and when applied, the Toller fissure burr engaged the rst screw with enough frictional torque to remove it easily Fig. 1). The second screw was removed in a similar way by placing he burr directly over it to maximise grip. It also came out ith relative ease. The technique has now worked on several ccasions and is a conservative way of removing problem