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Can orbital volume be reliably restored with alloplastic sheets?
82
027C
Trauma management/m&cellaneous
12. Can Orbital Volume be Reliably Restored with Alloplastic Sheets?
Results Reasons for removal were chronicled as early and late stage, and are related to sensory deficits, pain, infection, thermal sensitivity, swelling, and abnormal reactions.
Baker, A., McMahon, J., Hodder, S., Sugar, A., Moos, K. Canniesburn Hospital, Glasgow, Scotland Purpose The use of alloplastic implants in the repair of moderate sized defects of the orbital wall has been widely advocated. At Canniesburn and Morriston hospitals, a trial of two such implants has been conducted. This report examines the relationship between size of orbital wall defects encountered at repair and subsequently observed enophthalmos, vertical globe position and, diplopia. Patients and method Fifty-four patients were randomly assigned to undergo reconstruction of the orbital wall defect with either polydioxanone or titanium mesh provided the inclusion criteria were met. The nature of the injury sustained, including size of the .orbital wall defect, was recorded. Patient review was at 3 and 12 months. Data was obtained in 41. Results Enophthalmos was seen in 9 of 25 patients whose orbital wall defect was 2 cm or greater in maximum dimension. For the 16 patients where the maximum dimension was less than 2cm, subsequent enophthalmos was observed in 1 (P<0.05, Z2 Test). Conclusion Alloplastic implants should not be used alone in the repair of orbital wall defects where the degree of traumatic disruption is greater than 1.5 cm in its maximum dimension.
13. The Fate of Mandibular Bone Plates: Remove or Retain?
Silverman, S., Bruno, J., Kempers, K., Silverstein, If., Foote, J. University of Pennsylvania Oral and Maxillofacial Surgery, Philadelphia, Pennsylvania Purpose Traditionally, the treatment of mandibular fractures has been by either closed or open reduction. Formerly, open reductions were accomplished with the use of wires and rarely bone plates. Presently, the use of bone plates has become a main option in mandibular fracture treatment. The question arises as to whether the plates should be retained "permanently" or shouldthey be removed. Material and method In this retrospective study, the reasons for the removal of bone plates were identified and tabulated. Included in this review was an evaluation of 175 plates placed and the reason for the removal of 38 plates.
Conclusion There appeared to be a correlation as to anatomic placement and the need for removal.
14. Occlusal Results after Open or Closed Treatment of Fractures of the Mandibular Condylar Process
Ellis Ill, E., Simon, P., Throckmorton, (7,. University of Texas Southwestern Medical Center, Dallas, Texas Problem Historically, condylar process fractures have been managed closed, using a period of maxillomandibular fixation (MMF) and/or functional therapy with inter-arch elastics to maintain the pre-traumatic occlusal relationship. With the introduction of plate and screw fixation, enthusiasm for open treatment has become widespread. However, there are still questions about whether one form of therapy is superior to another for a given fracture. The purpose of this prospective study was to assess occlusal outcomes in a group of patients with unilateral condylar process fractures who were managed either open or closed. Patients and methods 137 patients with unilateral fractures of the mandibular condylar process (neck or subcondylar), 77 treated closed and 65 open, were included in this study. Standardized occlusal photographs obtained at' several postsurgical time intervals (6 wks, 6 mos, 1 yr., 2 yrs., 3 yrs.) were examined and scored by a surgeon and an orthodontist. The orthodontist was blinded to the treatment the patient received. Standard statistical methods were used to assess differences between groups. Results 315 occlusal records were available in 137 patients. There were no significant differences between treatment groups for side of fracture, sex, location of the fracture (neck, subcondylar), or the presence of additional mandibular fractures. There were significant differences between treatment groups for condylar process displacement (none, mild, maximal; P = 0.005). Patients treated closed had a significantly greater percentage of malocclusion compared to patients treated open, in spite of the fact that initial displacement of fractures was greater in patients treated open. Conclusions Based upon the results of this study, more consistent occlusal results can be expected when fractures of the mandibular condylar process are treated open.
027C
Trauma management/m&cellaneous
12. Can Orbital Volume be Reliably Restored with Alloplastic Sheets?
Results Reasons for removal were chronicled as early and late stage, and are related to sensory deficits, pain, infection, thermal sensitivity, swelling, and abnormal reactions.
Baker, A., McMahon, J., Hodder, S., Sugar, A., Moos, K. Canniesburn Hospital, Glasgow, Scotland Purpose The use of alloplastic implants in the repair of moderate sized defects of the orbital wall has been widely advocated. At Canniesburn and Morriston hospitals, a trial of two such implants has been conducted. This report examines the relationship between size of orbital wall defects encountered at repair and subsequently observed enophthalmos, vertical globe position and, diplopia. Patients and method Fifty-four patients were randomly assigned to undergo reconstruction of the orbital wall defect with either polydioxanone or titanium mesh provided the inclusion criteria were met. The nature of the injury sustained, including size of the .orbital wall defect, was recorded. Patient review was at 3 and 12 months. Data was obtained in 41. Results Enophthalmos was seen in 9 of 25 patients whose orbital wall defect was 2 cm or greater in maximum dimension. For the 16 patients where the maximum dimension was less than 2cm, subsequent enophthalmos was observed in 1 (P<0.05, Z2 Test). Conclusion Alloplastic implants should not be used alone in the repair of orbital wall defects where the degree of traumatic disruption is greater than 1.5 cm in its maximum dimension.
13. The Fate of Mandibular Bone Plates: Remove or Retain?
Silverman, S., Bruno, J., Kempers, K., Silverstein, If., Foote, J. University of Pennsylvania Oral and Maxillofacial Surgery, Philadelphia, Pennsylvania Purpose Traditionally, the treatment of mandibular fractures has been by either closed or open reduction. Formerly, open reductions were accomplished with the use of wires and rarely bone plates. Presently, the use of bone plates has become a main option in mandibular fracture treatment. The question arises as to whether the plates should be retained "permanently" or shouldthey be removed. Material and method In this retrospective study, the reasons for the removal of bone plates were identified and tabulated. Included in this review was an evaluation of 175 plates placed and the reason for the removal of 38 plates.
Conclusion There appeared to be a correlation as to anatomic placement and the need for removal.
14. Occlusal Results after Open or Closed Treatment of Fractures of the Mandibular Condylar Process
Ellis Ill, E., Simon, P., Throckmorton, (7,. University of Texas Southwestern Medical Center, Dallas, Texas Problem Historically, condylar process fractures have been managed closed, using a period of maxillomandibular fixation (MMF) and/or functional therapy with inter-arch elastics to maintain the pre-traumatic occlusal relationship. With the introduction of plate and screw fixation, enthusiasm for open treatment has become widespread. However, there are still questions about whether one form of therapy is superior to another for a given fracture. The purpose of this prospective study was to assess occlusal outcomes in a group of patients with unilateral condylar process fractures who were managed either open or closed. Patients and methods 137 patients with unilateral fractures of the mandibular condylar process (neck or subcondylar), 77 treated closed and 65 open, were included in this study. Standardized occlusal photographs obtained at' several postsurgical time intervals (6 wks, 6 mos, 1 yr., 2 yrs., 3 yrs.) were examined and scored by a surgeon and an orthodontist. The orthodontist was blinded to the treatment the patient received. Standard statistical methods were used to assess differences between groups. Results 315 occlusal records were available in 137 patients. There were no significant differences between treatment groups for side of fracture, sex, location of the fracture (neck, subcondylar), or the presence of additional mandibular fractures. There were significant differences between treatment groups for condylar process displacement (none, mild, maximal; P = 0.005). Patients treated closed had a significantly greater percentage of malocclusion compared to patients treated open, in spite of the fact that initial displacement of fractures was greater in patients treated open. Conclusions Based upon the results of this study, more consistent occlusal results can be expected when fractures of the mandibular condylar process are treated open.