Evaluation of the transparotid retromandibular approach for the treatment of mandibular condyle fractures: analysis of clinical cases

ICOMS 2011—Abstracts: Oral Papers

20 Comparative study of 2 surgical treatment philosophies for mandibular fractures C. Fuenzalida Kakarieka 1,∗ , G. Laissle Casas del Valle 1 , I. Vargas Farren 1,2,3 , E. González Mora 2 , C. Pedemonte Trewhela 2,4 1 Cirugía Oral y Máxilofacial, Universidad Mayor, Santiago, Chile 2 Cirugía Máxilofacial, Hospital Mutual de Seguridad, Santiago, Chile 3 Cirugía Máxilofacial, Hospital de Carabineros de Chile, Santiago, Chile 4 Cirugía Máxilofacial, Clínica Las Condes, Santiago, Chile

At present the treatment of mandibular fractures is most based on reduction and rigid internal fixation using plates and screws. There are 2 treatment philosophies in maxillofacial traumatology, both supported by the literature with positive results. On the one hand, the AO philosophy based on fracture reduction and installation of 2 plates, a lower (2.0 or 2.4 mm) with bicortical screws and a top one with monocortical screws (micro or miniplate), using oral approaches, existing injuries, cutaneous or oral with transdermal support. On the other hand SORG philosophy based on fracture reduction and installation of 2 microplates with monocortical screws for stable fractures or one microplate and one miniplate with using monocortical screws for unstable fractures. The aim of this study was to compare the results obtained in 10 patients with mandibular fractures, 5 treated with SORG philosophy and 5 with AO philosophy. The surgeries were performed by the maxillofacial surgery team of Hospital Mutual de Seguridad. Patients were evaluated clinically and radiologically at 6 weeks, 3 months and 6 months postoperatively. Clinically, the outcome measures were VAS pain, mandibular dynamics, neurosensory disorders, symptoms on teeth, infectious complications and perception of cutaneous scarring of the patient. Panoramic radiograph was used to evaluate bone healing. The results of the various parameters evaluated are presented in tables and graphs. Conflict of interest: None declared. doi:10.1016/j.ijom.2011.07.021

21 Evaluation of the transparotid retromandibular approach for the treatment of mandibular condyle fractures: analysis of clinical cases C. Droguett Tidy 1,2,∗ , R. Rojas Sánchez 3 , E. Navia Gomez 1 1 Hospital San Jose, Santiago, Chile 2 Clinica Davila, Santiago, Chile 3 Hospital Del Trabajador, Santiago, Chile

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22 Ordered water within microtubules as a separate and significant hydration fraction to be measured in brain edema A.R. Kunz 1,∗ , C. Iliadis 2 Evolutionary Anthropology, Harvard University (Extension), Boston, MA, USA 2 Department of Neurosurgery, University of Patras Medical School, Patras, Greece

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Several surgical approaches have been proposed for the treatment of condylar fractures: submandibular, preauricular, intraoral and retromandibular. This study pretends to evaluate the efficiency of the transparotid retromandibular approach to reduce and fix condylar fractures, by evaluating the quality of the anatomical reduction, neurological aftereffects, salivary fistula, occlusion and post-operative mandibular dynamics. Methodology: Report of 18 clinical cases performed at the San José Hospital, Trabajador Hospital and Davila Clinic by means of transparotideal retromandibular approach, with a clinical and imaging monitoring of 6 months minimum. Results: All the patients presented the same occlusion they had before the fracture and mandibular dynamics with normal parameters. This was evaluated according to the magnitude of mouth aperture with absence of symptomatology. Two patients presented paresis of facial muscles, innervated by frontal branches of the facial nerve, which recovered within a 6 month period, and one case of salivary fistula, which disappeared in 7 days. Conclusions: The transparotid retromandibular approach is a technique that provides a good access since it allows an adequate reduction and osteosynthesis; it allows the recovery of an adequate mandibular dynamics and presents a low morbidity rate in relation with the facial nerve, due to the low incidence of paresis within the analyzed group of patients and the low incidence of salivary fistula. Conflict of interest: None declared.

Objective: MRI’s T1 measures the rate nuclei in a magnetic field approach thermal equilibrium, dependent upon Watertotal + hydration fraction, the latter the major source of uncertainty. Methods: This paper explores the contribution of the hydration fraction within intracellular microtubules’ (MTS) compartment to edema, using MRI’s T2, due to a theoretically described quantum function of dipole-dipole interactions between ordered water and MTS’ protein, tubulin, endowing a coherence of increased order, lower heat capacity, and complexity of functioning. Results/discussion: MTS are hollow cylinders 102 –103 nm in length, with 25 nm exterior/15 nm interior diameter(s); MTS represent 2–10% of brain’s protein; concentration in axons/dendrites is 200 × 10−6 M. Ordered water fills the MTS’s hollow core, 31% of MTS by volume. In rat studies using T2 , which can separate out ordered and non-ordered water fractions, the mean fraction size of ordered water with shortest T2 was 13%. In man, upper limits of just 100 ml, a 7–8% volume increase, are available to accommodate any brain edema, yet the low compliance of man’s evolutionary significant gray matter tolerates only a 1.5%, or 18 ml, increase. Conclusion: In brain edema, the window to irreversibility is narrow; an inclusion of MTS’s quantum functioning of ordered water, and measurement of this separate and significant hydration fraction may bring options to management, and lead to the reversibility of life-threatening edema. Conflict of interest: None declared.

doi:10.1016/j.ijom.2011.07.022

doi:10.1016/j.ijom.2011.07.023