Rüdiger Emshoff

Trends in the incidence and cause of sport-related mandibular fractures: a retrospective analysis

PURPOSE This study assessed changes in the incidence and causes of mandibular fractures occurring in innsbruck, Austria between 1984 and 1993. PATIENTS AND METHODS Records from 712 patients sustaining 982 mandibular fractures were reviewed and analyzed according to age, sex, date of fracture, place of trauma, cause, anatomic site of fracture, and associated orofacial and craniocerebral injuries. RESULTS Sports were the most common cause of mandibular fractures, accounting for 31.5% of the entire sample, followed by road traffic accidents (27.2%) and falls (20.8%). The yearly distribution of sport-related mandibular fractures showed an increase from 28.6% in 1984 to 1988 to 34.5% in 1989 to 1993. The major causative factor in sports-related mandibular fractures was skiing (55.3%), whereas cycling and soccer accounted for 25.4% and 8.9%, respectively. Significant changes in the occurrence of cycling-related mandibular fractures were observed, with an increase of 19.3% from 1984 to 1988 to 1989 to 1993, whereas skiing-related mandibular fractures showed a decrease of similar magnitude (19.5%). Sex distribution showed a male-to-female ratio of 2.5:1, with the percentage of females involved increasing. In cases of cycling-related accidents, there was a considerable prevalence of associated injuries (133.3 injuries per 100 mandibular fractures), with significantly higher rates of facial lacerations (73.2), tooth fractures (39), tooth luxations (24.4), and orbital fractures (3.7) than in the case of skiing-related injuries, whereas in patients sustaining mandibular fractures caused by soccer, mucosal lacerations, tooth luxations, and cerebral concussions were the only associated injuries found. CONCLUSIONS The results of this study indicate a considerable change in the cause of mandibular fractures, showing that sporting injuries are becoming increasingly common. The high incidence of associated maxillofacial injuries in patients involved in skiing and cycling accidents may suggest an increasing need for preventive and protective measures.

Conservative treatment of unilateral condylar fractures in children: a long‐term clinical and radiologic follow‐up of 55 patients

The purpose of this prospectively designed study was the long-term clinical and radiological evaluation of conservatively treated unilateral condylar fractures in children. Fifty-five children aged between 2 1/2 and 9 3/4 years, presenting with a singular unilateral fracture of the mandibular condyle, were treated in a nonsurgical-functional way using an intraoral myofunctional appliance. In the follow-up period, patients were investigated by standardized clinical examination and by evaluation of panoramic radiographs taken immediately post-traumatically, after 6, 12, 24, 48 and 72 weeks, and then yearly through the period of growth. With a satisfactory clinical course in all patients, there was no instance of functional disturbance or mandibular asymmetry after the respective follow-up periods. The radiographs showed a fairly good shape of the condyle (no or only slight condylar deformity) in the 47 patients of the 2-6 year age group. In the eight patients of the 7-10 year age group presenting with a class II or III condylar fracture, healing was characterized by incomplete condylar regeneration, resulting in a moderate condylar deformity in two cases, a definite reduction in condylar neck height in two cases, and a hypertrophic condylar deformity in four cases. The positive results of this study confirm the concept of a nonsurgical-functional approach in children presenting with various types of unilateral fractures of the mandibular condyle. Condylar remodeling was the mode of fracture healing in instances of displaced and dislocated condylar fractures.

The diagnostic value of ultrasonography to determine the temporomandibular joint disk position

OBJECTIVE Temporomandibular joint (TMJ) arthrography and magnetic resonance imaging are the imaging techniques of choice in patients presenting with signs and symptoms of TMJ disorders suggesting soft tissue pathosis. With the disadvantage of arthrography as an invasive procedure and magnetic resonance imaging posing a problem in clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to assess the presence or absence of disk displacement in patients with TMJ disorders. STUDY DESIGN In 17 patients, 100 TMJ positions were investigated by static and dynamic ultrasonography to analyze the disk-condyle relationship. To compare the respective findings with those of a diagnostic method offering high accuracy, coronal and sagittal magnetic resonance imaging was carried out immediately afterwards. RESULTS With static ultrasonography showing a sensitivity of 0.41 and a specificity of 0.70 and dynamic ultrasonography a sensitivity of 0.31 and a specificity of 0.95, the data revealed that static and dynamic ultrasonography are marginal in detecting the presence of disk displacement, but dynamic ultrasonography is sensitive in detecting the absence of disk displacement. However, with a positive predictive value of 0.61 and a negative predictive value of 0.51 for static ultrasonography, and a positive predictive value of 0.88 and a negative predictive value of 0.55 for the dynamic technique, the results indicate that both modalities are insufficient in establishing a correct diagnosis for the presence or absence of disk displacement. CONCLUSION In view of the fact that dynamic ultrasonography proved to be a reliable diagnostic aid for the detection of normal disk position, the results of this study should be of further interest and encourage research in its potential uses and diagnostic capabilities.

Clinical signs of orbital wall fractures as a function of anatomic location.

OBJECTIVE The objective of this study was to see whether clinical signs of medial orbital wall fractures distinguished these fractures from fractures of the lateral orbital wall and the orbital floor. STUDY DESIGN The orbital fractures of 424 patients were analyzed. The patients were divided into 2 groups: (1) patients with orbital fractures with a medial orbital wall component and (2) patients with orbital fractures without a medial orbital wall component. RESULTS Orbital fractures with involvement of the medial orbital wall showed a significantly higher incidence (P =.001) of diplopia and exophthalmos (P =.039) than fractures without involvement of the medial wall. CONCLUSION Posttraumatic orbital clinical signs are associated with a higher incidence of medial orbital wall component fracture. Apparent lack of involvement of the medial orbital wall should not be an exclusion criterion for a surgical intervention when clinical orbital signs exist.

Ultrasonographic cross-sectional characteristics of muscles of the head and neck

OBJECTIVE Computed tomography and magnetic resonance imaging are the common techniques for evaluating cross-sectional areas and volumes of human jaw muscles. Because computed tomography has the disadvantage of showing cumulative biological effects and because MRI poses a problem in terms of clinical availability and cost, the purpose of this study was to determine whether ultrasonography could be used to measure local linear cross-sectional dimensions of muscles of the head and neck. STUDY DESIGN In 46 patients with signs and symptoms of temporomandibular disorders, the anterior temporalis, anterior masseter, deep masseter, anterior digastric, posterior digastric, and sternocleidomastoid muscles were measured bilaterally by ultrasonography to assess linear local cross-sectional dimensions. Measurements were made in 2 sessions with a time interval of at least 5 minutes. Data were analyzed for reliability and variability through use of the intraclass correlation coefficient (ICC) and the repeatability coefficient (RC). To assess local muscle asymmetry patterns, the absolute asymmetry index was used, with the mean maximum muscle diameters of the respective right and left sides calculated from 3 consecutive measurements. RESULTS Satisfactory visualization of muscles was obtained in 93.8% of 1104 imaging procedures. For the ultrasound measurements there was a significant difference in local cross-sectional dimensions between the first and second sessions for the anterior temporalis muscle only (P < .01). Acceptable intrarater reliabilities were obtained for the deep masseter (ICC = 0.92), anterior digastric (ICC = 0.91), and sternocleidomastoid (ICC = 0.86) muscles, whereas evaluation of the posterior digastric (ICC = 0.74), anterior masseter (ICC = 0.72), and anterior temporalis (ICC = 0.70) muscles was associated with moderate reliability. Variability of repeated measurements was found to be acceptable for the anterior temporalis (RC = 0.32 mm) and posterior digastric (RC = 0.48 mm) muscles. Analysis of muscle site-related local cross-sectional dimensions showed a significant difference between the right and left sides for the deep masseter muscle only (P < .05). The study population investigated revealed mean asymmetry indices ranging from 5.3% for the anterior digastric muscle to 8.7% for the deep masseter muscle. CONCLUSIONS Ultrasonography may prove to be a reliable diagnostic technique for the evaluation of cross-sectional dimensions and areas of muscles of the head and neck.

Necrotizing sialometaplasia in two patients with bulimia and chronic vomiting

The purpose of this report was to present two unusual cases of necrotizing sialometaplasia of the hard palate, in which the patients were suffering from bulimia and chronic self-induced vomiting. It emphasizes the importance of confirming the diagnosis by incisional biopsy and discusses local mucosal trauma as a possible etiologic factor.

Ultrasonographic anatomy of the anterior neck: implications for tracheostomy.

PURPOSE Tracheostomy is the preferred intervention for surgical establishment of an upper airway in the treatment of certain elective maxillofacial procedures. Complication rates associated with surgical tracheostomy are largely related to the restricted possibilities in diagnosis of anatomic variations. Therefore, endoscopic-guided tracheostomy is increasingly being used to enhance precision and safety. The purpose of this study was to assess the ultrasonographic anatomy of the anterior neck with regard to the performance of tracheostomy. PATIENTS AND METHODS Fifty patients underwent ultrasonographic investigation to analyze the relationship of anatomic structures lying in the immediate vicinity of the tracheostomy site. RESULTS The data presented demonstrate the feasibility and advantage of preoperative ultrasonography to visualize the structures of the infrahyoid region. CONCLUSION Preoperative ultrasonography may be of great importance in diagnosing individual anatomic variations at the site of tracheostomy and in avoiding complications.

Primary temporary AO plate reconstruction of the mandible

OBJECTIVE This study assessed the incidence of complications and revisions after primary temporary AO plate reconstructions of the mandible performed from 1971 through 1996. STUDY DESIGN In a retrospective record review, the data of 51 patients undergoing primary temporary AO plate reconstructions after composite mandibular resection were analyzed according to age, gender, date of reconstruction, anatomic location of reconstruction, use of additional radiotherapy and/or flap surgery, and incidence of associated complications and revisions. RESULTS Associated complications and revisions accompanying primary temporary AO plate reconstructions were evaluated through use of the incidence rates of associated complications (IACs) and revisions (IARs), which are reported as the numbers of associated complications and revisions, respectively, per 100 patients. Of the entire sample, the highest incidence rate of associated complications was associated with infection (33.5); this was followed by the rates for plate exposure (27.9) and plate fracture (10.7). With an overall incidence rate of 38.3 revisions per 100 patients, the corresponding site-related incidence rates of associated revisions were found to be 55.0 for reconstructions of the anterior mandible crossing the midline, 37.1 for those of the body segment of the mandible, and 31.1 for reconstructions involving the ramus and/or condyle area of the mandible. Revision rates were observed to be significantly higher in irradiated (53.6 vs 31.5) and non-flap-added reconstructions (43.2 vs 24.8). Analysis of treatment group-related incidences revealed irradiated non-flap-added reconstructions to be associated with the highest failure rates, whereas additional flap surgery resulted in a significant reduction in complications (50.0 vs 108.0) and revisions (20.0 vs 65.7). CONCLUSIONS This study showed primary temporary AO plate reconstructions after composite mandibular resection to be associated with a high rate of complications and revisions. The results emphasize the need to relate outcome measures to site-related and treatment-related parameters.

Condylar erosion and disc displacement: detection with high-resolution ultrasonography

PURPOSE Our goal was to determine the feasibility of high-resolution sonography for the detection of condylar erosion and associated disc displacement at the temporomandibular joint (TMJ) condyle. MATERIALS AND METHODS Forty-eight consecutive patients (96 joints) with TMJ disorders were investigated prospectively using a 12.5-MHz array transducer. Images were assessed for condylar erosion and disc displacements. Sonographic findings were correlated with those of magnetic resonance imaging (MRI). RESULTS At MRI, 18 osseous changes were diagnosed with condylar erosion. Sonographically, 15 of the 18 condylar erosions were diagnosed correctly. Sensitivity, specificity, and accuracy of sonography in the depiction of condylar erosion were 83%, 63%, and 67%, respectively. The positive predictive value was 34%, and the negative predictive value was 94%. Disc displacement without reduction (43 of 96) and disc displacement without reduction concomitant with condylar erosion (16 of 96) were detected with an accuracy of 93% and 80%. CONCLUSION Sonography is an insufficient imaging technique for the detection of condylar erosion. Assessment of disc displacement without reduction may be reliably made with sonography.

Mountainbiking--a dangerous sport: comparison with bicycling on oral and maxillofacial trauma

The popularity of bicycling is reflected in the number of cycling-related oral and maxillofacial injuries. Five hundred and sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, between 1991 and 1996, accounting for 31% of all sports-related accidents and 48.4% of all traffic accidents. A review of the patient records revealed more severe injury profiles in sixty mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma and 23% soft tissue injuries, compared to 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures and 14% soft tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% LeFort I, II and III fractures. Condyle fractures were more common in bicyclists, with 18.8% compared to 10.8% in mountainbikers. Reduction of facial injuries due to cycling-related accidents needs appropriate design of helmets with faceguards and compulsory helmet use for all cyclists, and particularly mountainbikers.