Nicholas Zachariades

Neoplasms metastatic to the mouth, jaws and surrounding tissues.

5% of all malignancies involve the oral cavity. One percent of these malignancies are secondary to neoplasms that are usually found below the level of the clavicles. As it is widely accepted that the jaws do not contain a lymphatic system, it is believed that metastases there occur via the blood stream, a fact that is supported by the occurrence of metastatic foci in areas where spongiosa and slowing of the circulation favour the entrapment of metastatic emboli. This however does not explain why most of the metastases occur in the lower jaw (and in particular in the premolar-molar area) and not in the maxilla, where the spongiosa is more abundant. Batsons plexus has also been mentioned as a possible route of metastasis to the head and neck, thus explaining why, in some cases of metastases, the lungs are not involved, as the blood has not been filtered through the pulmonary bed before reaching the head and neck. In our review of the literature we found 422 metastatic lesions in the mouth, jaws and the surrounding tissues in 365 patients equally divided between men and women. 56.5% of the cases were above the age of 50. In 228 cases there were other metastases as well, whereas in 114 cases the only metastasis found was the one under study. In 22% of the cases, the metastatic focus in our area was the first indication of the existence of an undiagnosed primary malignant tumour somewhere else.(ABSTRACT TRUNCATED AT 250 WORDS)

Changing trends in the treatment of zygomaticomaxillary complex fractures: A 12-year evaluation of methods used

PURPOSE The efficacy of the current methods for the treatment of fractures of the zygomaticomaxillary complex was evaluated. PATIENTS AND METHODS One thousand two hundred seventy-seven patients with fracture of the zygomaticomaxillary complex and 196 patients with fractures of the zygomatic arch that were admitted between 1984 and 1995 were evaluated. One thousand one hundred fifty surgical procedures were performed, and in 401 cases, no operative treatment was considered necessary. The Gillies approach was used in 514 cases, intraosseous wiring in 89 cases, bone plate osteosynthesis in 322 cases, Roger-Anderson pins in 180 cases, antral packing in 17 cases, and elevation with a hook in 28 cases. RESULTS The best results were achieved with the use of semirigid fixation with miniplates applied at one or more sites of the fractured complex, occasionally used in combination with other methods such as Roger-Anderson pins. CONCLUSIONS Semirigid fixation with miniplates offers the most reliable method available today for the treatment of zygomatico-orbital complex fractures and has practically replaced every other method in our institution. The increased cost and occasionally the necessity to remove the hardware are the main disadvantages of the method.

Fractures of the facial skeleton in children

Among 3,908 patients with fractures of the facial skeleton hospitalized in a 25-year period, 202 were children. 69% were boys and 31% girls. A child is most active at the age of fourteen. Fractures of the upper alveolar bone and the condyle were the most common. We compared the pattern of fractures in children and those in adults recorded at the same period of time.

Blindness after facial trauma

Blindness after facial fractures has been reported to occur with an incidence that ranges between 0.67% and 3% depending on the reporting institution. To verify this finding we undertook a retrospective chart review of 5936 patients with facial fractures that occurred over a 12 1/2-year period. We found that vision in 19 eyes were lost in 18 patients. Vision loss was more frequently encountered in Le Fort III level fractures (2.2%) followed distantly by Le Fort II level fractures (0.64%), and zygomatic fractures (0.45%). The cause of blindness was most frequently associated with motor vehicle accidents and gunshot injuries. Injuries of this type require immediate and prompt consultation by the ophthalmologic surgery service.

Facial trauma in women resulting from violence by men

In a 2 1/2-year period, 546 women with facial injuries were treated. In 8.2%, the injury was related to some form of violence exerted by a man. In cases where the individual was known, it was usually the husband or boyfriend (almost 67%). The assault consisted of a beating with the hands in over 70% of the cases. Fracture of the mandible was the most common injury. There were also 62 cases of home accidents.

The pattern and aetiology of maxillofacial injuries in Greece: A retrospective study of 25 years and a comparison with other countries

In comparison with other countries, Greece demonstrates a high incidence of road traffic accidents (RTAs). Most are the result of violation of the highway code. Violence as a causative agent of fractures of the facial skeleton is still a minor factor in comparison with other countries. Most of the people involved are young. In a 25-year period we have treated 6,847 fractures of the facial skeleton. Fractures of the mandibular condyle, the genial symphysis and the zygomatico-maxillary complex were the most numerous. 25% of the patients were women and 75% men. 56% were treated conservatively; an open reduction was the treatment of choice in 37%, while no treatment was considered necessary in 7%. In the period under study, K.A.T. Hospital admitted 60% of the maxillofacial trauma in the whole country.

The superior orbital fissure syndrome

The superior orbital fissure syndrome is a very rare condition, characterized by a fixed dilated pupil, ptosis and proptosis of the eye and ophthalmoplegia. We have had the opportunity to observe a number of such cases, and now report four of them.

Fractures of the facial skeleton in Greece: A retrospective study covering 1791 cases in 10 years

1791 fractures of the facial skeleton covering 10 years are reviewed. There was a 3:1 male/female relationship and the majority of the cases involved the 11 to 30 years old group. Road traffic accidents by far (58%) outnumber any other cause for the injury. 56.03% of the cases arrived from the greater Athens area, which is inhabited by 40% of the population of the country. There were 1.5 fractures per patient and in the majority of the cases (78%) the mandible was involved.

Ossifying fibroma of the jaws. Review of the literature and report of 16 cases

Ossifying fibroma is a fibro-osseous lesion rarely occurring in the jaws, although more often than in other bones of the skeleton. It is not clear whether it represents a distinct entity or a certain stage of the fibro-osseous condition. We are presenting our experience with 16 cases of ossifying fibroma treated with local excision or resection and bone graft. Their radiographic picture varied significantly from one case to another. One case was peripheral and one recurred.

Complications associated with rigid internal fixation of facial bone fractures

Rigid internal fixation is now a common method for treating fractures of the facial skeleton. However, it is a very precise technique that requires more time than intraosseous wiring. This article reports the complications associated with rigid internal fixation of facial fractures in 223 patients and compares the findings with those accompanying intraosseous wiring.