- Email: [email protected]
Endoscopic fixation of subcondylar fractures
414 Symposia of injury is not confined to the paediatric age group. doi:10.1016/j.ijom.2009.03.066
SL13.2 Management strategy for naso-orbito-ethmoidal fractures M. Gabrielli Oral and Maxillofacial Division, Dental School at Araraquara, São Paulo State University, Brazil
Naso-orbito-ethmoidal fractures, whether isolated or as a component of complex facial fractures, are always some of the most challenging skeletal facial injuries to treat. Traumatic telecanthus is usually the dominant feature and associated injuries to the frontal sinus are frequent. Possible functional and aesthetic sequelae include telecanthus; impairment or obstruction of lacrimal drainage; nasal deviation or obstruction; enophthalmos, vertical ocular dystopia, limitation of eye movements, diplopia; and sinus pathology among others. Early open treatment is indicated for dislocated fractures. Traumatic telecanthus correction will demand the use of transnasal wires and canthopexies, and the surgeon has to be familiar with techniques of orbital and nasal reconstruction, as well as with the management of acute trauma to the frontal sinus. This presentation will discuss the current management of naso-orbito-ethmoidal fractures. doi:10.1016/j.ijom.2009.03.067
SL13.3 Anatomic orbital reconstruction and late correction of post-traumatic enophthalmos Y. Zhang Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: Correction of computer-aided individual shaped-adapted fabricated titanium mesh to mirroringreconstruct orbit is reported to be a promise method in correcting posttraumatic enophthalmos (En). This presentation is to demonstrate the application of this technique and evaluate the treatment outcomes. Methods: Twenty one patients with En resulting from the delayed unilateral impure orbital fracture are included
in series. Computed tomography-based mirrored orbit image is prepared for each to fabricate anatomically adaptive Ti-mesh by means of computeraided design/computer-aided manufacturing (CAD/CAM) technique. The internal orbit is reconstructed by following surgical procedures: reduction of orbital rim along with surrounding bones, exposure of orbital defects, reduction of herniated soft tissue and insertion of available Ti-mesh with deep extension of mean 29.33 mm. The measurements are performed to assess the change of En and orbital volume before and after surgery. Paired samples t test and Pearson’s correlation coefficient were used for statistical analysis. Results: The follow-up results demonstrate that En degree decreased to less than 2 mm in 11 patients and 2–4 mm in 9 patients. One patient remained En large than 7 mm. Statistical analysis showed that posttraumatic En in this series was 4.05 ± 2.02 mm, which associated with orbital volume increment (OVI) of 6.61 ± 3.63 cm3 with a regress formula En = 0.446 × OVI + 2.406. Orbital reconstruction produced the orbital volume decrease (OVD) of 4.24 ± 2.41 cm3 and En correction of 2.01 ± 1.46 mm, regress formula being En = 0.586 × OVD + 0.508. After surgery, 2.03 ± 1.52 mm En was unresolved and 2.23 ± 2.86 cm3 orbital volume expansion (OVE) remained, regress formula being expressed as En = 0.494 × OVE + 1.415. Conclusions: From the results above it is concluded that orbital anatomical reconstruction is only expected to reduce the trauma-induced orbital volume increment by 65%, and corresponding, correct 50% of severe late En. Additional augmentation of orbital contents is recommended. Four patients in this series received secondary operation and achieved expected outcomes.
Using the endoscope superior visibility in areas of limited exposure can be achieved by limited incisions in inconspicuous areas. Therefore the risk of facial nerve damage is reduced. In our treatment protocol the endoscopic-assisted treatment by transoral approach is the treatment of choice. However, in severely dislocated fractures the extraoral approach is advantageous for the reduction of displaced condylar fractures and especially in cases with medial override. Endoscopic techniques are more time consuming, however due to a steep learning curve when using endoscopic instruments routinely this disadvantage can be significantly reduced. The transoral use of endoscopes for the control after fracture reduction in areas of limited vision such as the posterior aspect of the ascending ramus provides further information about the quality of fracture reduction. The critical evaluation of the results after fracture reduction may help in improving surgical results and for teaching reasons. The results after endoscopic-assisted treatment of more than 100 patients with condylar fractures have demonstrated the advantage of the use of endoscopes for treatment of condylar fractures. The transoral endoscopic assisted treatment of condylar fractures became a routine procedure in our clinic. Refinements of the minimal invasive techniques and further development of instruments are made in the endoscopic training laboratories in Davos and Freiburg. doi:10.1016/j.ijom.2009.03.069
Symposium 14: Orthognathic Surgery 1
doi:10.1016/j.ijom.2009.03.068
SL14.1 Planning: why don’t we get it right every time?
SL13.4 Endoscopic fixation of subcondylar fractures
P. Ward-Booth Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, United Kingdom
R. Gutwald Department of Oral and Maxillofacial Surgery, University Freiburg, Germany
The evolution of orthognathic surgery since the pioneers in the 20’s, have centred on achieving a normal occlusion with excellent inter-digitation. It has evolved into a precise surgical procedure, in which extraordinary accuracy is achieved at the dental/occlusal level. This is laudable and essential if the surgery is to be justified, as a functional exercise in correcting moderate to severe
The open treatment of condylar fractures via the preauricular, retromandibular and submandibular approach is routinely performed. The disadvantage of the extraoral approach is possible damage of the facial nerve, the creation of visible scars and salivary fistulas.
SL13.2 Management strategy for naso-orbito-ethmoidal fractures M. Gabrielli Oral and Maxillofacial Division, Dental School at Araraquara, São Paulo State University, Brazil
Naso-orbito-ethmoidal fractures, whether isolated or as a component of complex facial fractures, are always some of the most challenging skeletal facial injuries to treat. Traumatic telecanthus is usually the dominant feature and associated injuries to the frontal sinus are frequent. Possible functional and aesthetic sequelae include telecanthus; impairment or obstruction of lacrimal drainage; nasal deviation or obstruction; enophthalmos, vertical ocular dystopia, limitation of eye movements, diplopia; and sinus pathology among others. Early open treatment is indicated for dislocated fractures. Traumatic telecanthus correction will demand the use of transnasal wires and canthopexies, and the surgeon has to be familiar with techniques of orbital and nasal reconstruction, as well as with the management of acute trauma to the frontal sinus. This presentation will discuss the current management of naso-orbito-ethmoidal fractures. doi:10.1016/j.ijom.2009.03.067
SL13.3 Anatomic orbital reconstruction and late correction of post-traumatic enophthalmos Y. Zhang Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
Background and Objectives: Correction of computer-aided individual shaped-adapted fabricated titanium mesh to mirroringreconstruct orbit is reported to be a promise method in correcting posttraumatic enophthalmos (En). This presentation is to demonstrate the application of this technique and evaluate the treatment outcomes. Methods: Twenty one patients with En resulting from the delayed unilateral impure orbital fracture are included
in series. Computed tomography-based mirrored orbit image is prepared for each to fabricate anatomically adaptive Ti-mesh by means of computeraided design/computer-aided manufacturing (CAD/CAM) technique. The internal orbit is reconstructed by following surgical procedures: reduction of orbital rim along with surrounding bones, exposure of orbital defects, reduction of herniated soft tissue and insertion of available Ti-mesh with deep extension of mean 29.33 mm. The measurements are performed to assess the change of En and orbital volume before and after surgery. Paired samples t test and Pearson’s correlation coefficient were used for statistical analysis. Results: The follow-up results demonstrate that En degree decreased to less than 2 mm in 11 patients and 2–4 mm in 9 patients. One patient remained En large than 7 mm. Statistical analysis showed that posttraumatic En in this series was 4.05 ± 2.02 mm, which associated with orbital volume increment (OVI) of 6.61 ± 3.63 cm3 with a regress formula En = 0.446 × OVI + 2.406. Orbital reconstruction produced the orbital volume decrease (OVD) of 4.24 ± 2.41 cm3 and En correction of 2.01 ± 1.46 mm, regress formula being En = 0.586 × OVD + 0.508. After surgery, 2.03 ± 1.52 mm En was unresolved and 2.23 ± 2.86 cm3 orbital volume expansion (OVE) remained, regress formula being expressed as En = 0.494 × OVE + 1.415. Conclusions: From the results above it is concluded that orbital anatomical reconstruction is only expected to reduce the trauma-induced orbital volume increment by 65%, and corresponding, correct 50% of severe late En. Additional augmentation of orbital contents is recommended. Four patients in this series received secondary operation and achieved expected outcomes.
Using the endoscope superior visibility in areas of limited exposure can be achieved by limited incisions in inconspicuous areas. Therefore the risk of facial nerve damage is reduced. In our treatment protocol the endoscopic-assisted treatment by transoral approach is the treatment of choice. However, in severely dislocated fractures the extraoral approach is advantageous for the reduction of displaced condylar fractures and especially in cases with medial override. Endoscopic techniques are more time consuming, however due to a steep learning curve when using endoscopic instruments routinely this disadvantage can be significantly reduced. The transoral use of endoscopes for the control after fracture reduction in areas of limited vision such as the posterior aspect of the ascending ramus provides further information about the quality of fracture reduction. The critical evaluation of the results after fracture reduction may help in improving surgical results and for teaching reasons. The results after endoscopic-assisted treatment of more than 100 patients with condylar fractures have demonstrated the advantage of the use of endoscopes for treatment of condylar fractures. The transoral endoscopic assisted treatment of condylar fractures became a routine procedure in our clinic. Refinements of the minimal invasive techniques and further development of instruments are made in the endoscopic training laboratories in Davos and Freiburg. doi:10.1016/j.ijom.2009.03.069
Symposium 14: Orthognathic Surgery 1
doi:10.1016/j.ijom.2009.03.068
SL14.1 Planning: why don’t we get it right every time?
SL13.4 Endoscopic fixation of subcondylar fractures
P. Ward-Booth Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, United Kingdom
R. Gutwald Department of Oral and Maxillofacial Surgery, University Freiburg, Germany
The evolution of orthognathic surgery since the pioneers in the 20’s, have centred on achieving a normal occlusion with excellent inter-digitation. It has evolved into a precise surgical procedure, in which extraordinary accuracy is achieved at the dental/occlusal level. This is laudable and essential if the surgery is to be justified, as a functional exercise in correcting moderate to severe
The open treatment of condylar fractures via the preauricular, retromandibular and submandibular approach is routinely performed. The disadvantage of the extraoral approach is possible damage of the facial nerve, the creation of visible scars and salivary fistulas.