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Effect of intermaxillary fixation on pulmonary function
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025F- Trauma management
4. Effect of Intermaxillary Fixation on Pulmonary Function
regarding etiology, common associated injuries, diagnosis, treatment, and complications of facial injuries in pediatric patients.
Kim, C., Kim, M., Kim, H. Department of Oral and Maxillofacial Surgery, Eul-Ji Medical College, Taejon, Korea Intermaxillary fixation is a routine procedure in the oral and maxillofacial area in jaw bone fracture, surgical correction of jaw deformity and osseous reconstruction of the jaw. After transoral surgery, accompanied by intermaxillary fixations, dysphagia or airway obstruction may follow due to blood clot, vomitus, or laryngeal spasm resulting from irritation by blood or secretions. Lingual or pharyngeal edema is another contributing factor of airway obstruction. In addition, intermaxillary fixation itself may cause obstruction of the airway. In this study, pulmonary function test and arterial blood gas analysis were evaluated before and after intermaxillary fixation in 30 patients suffered from mandibular fractures. Comparative analysis was performed by estimated values. The results were as follows: 1. The spirometric values of FEV1, FEV1/FVC a n d FEF25-75% without intermaxillary fixation were reduced from 97.5%, 85.1%, 98.3% to 71.7%, 66.5%, 61.2% with intermaxillary fixation, indicating the presence of obstructive pulmonary impairment. 2. Spirometric value of MVV was changed from 84.5% to 46.48%, as the most influencing value of sensitive to extrapulmonary factors. 3. After intermaxillary fixation, the spirometric value of FVC, as indicator of restrictive pattern of pulmonary function, was not significantly reduced as measured from 94.47% to 89.97%. 4. 02 saturation of arterial blood gas analysis without intermaxillary fixation was 97.86%. After intermaxillary fixation, 0 2 saturation was 97.47%. The results indicate that careful airway management is mandatory undergoing intermaxillary fixation of various oral and maxillofacial surgeries.
Materials and methods From the files of the Department of Oral and Maxillofacial Surgery at the Rambam Medical Center, the files of patients under 16 years old with maxillofacial injuries (1990-1997) were retrieved and analyzed. Data was collected regarding sex, age, etiology, associated injuries, airway maintenance, treatment, and complications. Results There were 104 patients included in the study. There were 72 boys and 32 girls, and the most common maxillofacial fracture was the mandible. Additional injuries were common (57%), brain injury being the most dominant. Airway securing was needed in 56 patients, using either oral, nasal, or tracheal intubation. When open reduction with internal fixation was employed, all fixation devices were subsequently removed. In several fractures treatment was delayed due to misdiagnosis by the pediatric surgeon of the facial injury. All those patients developed subsequent facial asymmetry necessitating further surgery. Conclusion Although rare, the maxillofacial region may be traumatized in pediatric patients. Suspicion of the trauma team to facial injuries, often masked in the presence of more severe injuries, will enable expeditious treatment and avoid possible subsequent facial disfiguration. The maxillofaeial surgeon treating pediatric patients, should be influenced by the child's unique anatomy and the need for future development of the facial skeleton, as well as additional injuries which are often present.
6. Endoscopic Treatment of Condylar Fractures of the Mandible
Laue~ (7,., Schon, R., Schmelzeisen, R. Oral and Maxillofacial Surgery, University Clinic, Freiburg, Germany 5. Maxillofacial Injury and the Pediatric Patient
Rosen, D., Ardekian, L., Eleftheriou, S., Peled, M., Laufer, D. The Department of Oral and Maxillofacial Surgery, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa, Israel Introduction Maxillofacial trauma is rare in children. The underdeveloped anatomy, elasticity of bone, small face/craniui-~ volume, presence of tooth buds, and the child's protected environment directly influence the consequence of trauma to the face. The aim of this presentation is to document our experience with pediatric maxillofacial trauma, and to review the literature
Subject Reduction and plate osteosynthesis of condylar fractures often requires a wide extraoral approach With the risk of aesthetic impairment and possible facial nerve palsy. In order to avoid complications, the purpose of this pilot study was to use an endoscopic device for the treatment of condylar fractures allowing also for endoscopically assisted plate application. Material and methods 7 condylar fractures were operated under endoscopic control. In three patients a newly developed device for endoscopically controlled plate application was clinically tested. The new device and the application technique is described in detail.
025F- Trauma management
4. Effect of Intermaxillary Fixation on Pulmonary Function
regarding etiology, common associated injuries, diagnosis, treatment, and complications of facial injuries in pediatric patients.
Kim, C., Kim, M., Kim, H. Department of Oral and Maxillofacial Surgery, Eul-Ji Medical College, Taejon, Korea Intermaxillary fixation is a routine procedure in the oral and maxillofacial area in jaw bone fracture, surgical correction of jaw deformity and osseous reconstruction of the jaw. After transoral surgery, accompanied by intermaxillary fixations, dysphagia or airway obstruction may follow due to blood clot, vomitus, or laryngeal spasm resulting from irritation by blood or secretions. Lingual or pharyngeal edema is another contributing factor of airway obstruction. In addition, intermaxillary fixation itself may cause obstruction of the airway. In this study, pulmonary function test and arterial blood gas analysis were evaluated before and after intermaxillary fixation in 30 patients suffered from mandibular fractures. Comparative analysis was performed by estimated values. The results were as follows: 1. The spirometric values of FEV1, FEV1/FVC a n d FEF25-75% without intermaxillary fixation were reduced from 97.5%, 85.1%, 98.3% to 71.7%, 66.5%, 61.2% with intermaxillary fixation, indicating the presence of obstructive pulmonary impairment. 2. Spirometric value of MVV was changed from 84.5% to 46.48%, as the most influencing value of sensitive to extrapulmonary factors. 3. After intermaxillary fixation, the spirometric value of FVC, as indicator of restrictive pattern of pulmonary function, was not significantly reduced as measured from 94.47% to 89.97%. 4. 02 saturation of arterial blood gas analysis without intermaxillary fixation was 97.86%. After intermaxillary fixation, 0 2 saturation was 97.47%. The results indicate that careful airway management is mandatory undergoing intermaxillary fixation of various oral and maxillofacial surgeries.
Materials and methods From the files of the Department of Oral and Maxillofacial Surgery at the Rambam Medical Center, the files of patients under 16 years old with maxillofacial injuries (1990-1997) were retrieved and analyzed. Data was collected regarding sex, age, etiology, associated injuries, airway maintenance, treatment, and complications. Results There were 104 patients included in the study. There were 72 boys and 32 girls, and the most common maxillofacial fracture was the mandible. Additional injuries were common (57%), brain injury being the most dominant. Airway securing was needed in 56 patients, using either oral, nasal, or tracheal intubation. When open reduction with internal fixation was employed, all fixation devices were subsequently removed. In several fractures treatment was delayed due to misdiagnosis by the pediatric surgeon of the facial injury. All those patients developed subsequent facial asymmetry necessitating further surgery. Conclusion Although rare, the maxillofacial region may be traumatized in pediatric patients. Suspicion of the trauma team to facial injuries, often masked in the presence of more severe injuries, will enable expeditious treatment and avoid possible subsequent facial disfiguration. The maxillofaeial surgeon treating pediatric patients, should be influenced by the child's unique anatomy and the need for future development of the facial skeleton, as well as additional injuries which are often present.
6. Endoscopic Treatment of Condylar Fractures of the Mandible
Laue~ (7,., Schon, R., Schmelzeisen, R. Oral and Maxillofacial Surgery, University Clinic, Freiburg, Germany 5. Maxillofacial Injury and the Pediatric Patient
Rosen, D., Ardekian, L., Eleftheriou, S., Peled, M., Laufer, D. The Department of Oral and Maxillofacial Surgery, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa, Israel Introduction Maxillofacial trauma is rare in children. The underdeveloped anatomy, elasticity of bone, small face/craniui-~ volume, presence of tooth buds, and the child's protected environment directly influence the consequence of trauma to the face. The aim of this presentation is to document our experience with pediatric maxillofacial trauma, and to review the literature
Subject Reduction and plate osteosynthesis of condylar fractures often requires a wide extraoral approach With the risk of aesthetic impairment and possible facial nerve palsy. In order to avoid complications, the purpose of this pilot study was to use an endoscopic device for the treatment of condylar fractures allowing also for endoscopically assisted plate application. Material and methods 7 condylar fractures were operated under endoscopic control. In three patients a newly developed device for endoscopically controlled plate application was clinically tested. The new device and the application technique is described in detail.