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Magnetic resonance imaging of the temporomandibular joints after functional treatment of bilateral condylar fractures in adults
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022-D Trauma
volved in maxillofacial fractures. Two hundred and fortyseven cases of condylar fracture (179 unilateral and 68 bilateral) treated at our department during the 15 year period from October, 1981, to Nov, 1996, were reviewed and analyzed. The majority of patients ranged in age from 10 to 30 years old, and the male to female ratio was 1.8 : 1. The major causes of injury were traffic accidents and falling. Fracture sites and forms were determined according to the classification described by Kubo. Non-surgical treatment was performed in 175 cases consisting mainly of condylar head fracture, subcondylar fracture, and condylar neck fracture with slight displacement. Surgical treatment was performed in 72 cases in which subcondylar and condylar neck fractures with severe dislocation were the most common. In the cases of surgical treatment, osseous wiring, Kirschner pinning, plating, and lag screw osteosynthesis have been employed. Prognosis was determined according to the classification described by Nakatomi. As for the clinical results in the cases of non-surgical treatment, 58% healed completely and 35% ~had disorder. In the cases of surgical treatment, 54% healed completely and 39% had disorder. Some investigators recommend non-surgical treatment for condylar fracture. However, we obtained good results with surgical~ treatment for subcondylar and condylar neck fractures with severe dislocation, compared with non-surgical treatment. As for the fixation method, lag screw osteosynthesis is more suitable for condylar fracture than miniplate osteosynthesis through a preauricular approach, because it has sufficient-fixation-force and minimal complications.
13. Magnetic Resonance Imaging of the Temporomandibular Joints after Functional Treatment of Bilateral Condylar Fractures in Adults
Choi, B. H., Yi, C. K.
14. The Experience of Treatment of Mandibular Fractures
Kubilius, R., Sabalys, G., Tercijonas, P. Department of Maxillo-Facial Surgery, Kaunas Medical Academy, Kaunas, Lithuania
5656 patients with mandibular fractures were treated in a 24 years period (1973-1996). 88,5% of the patients were men and 11,5% women. Stimulation of healing of the fractures was applied taking into consideration the reparative capacity of the mandible. The reparative capacity of the mandible depends on the ability of bone tissue to absorb calcium salts and on the level of injury of the inferior alveolar nerve. Using Suslov'g method 2 degrees of ability to absorb calcium salts could be distinguished: intensive - 53,9%, weak 46,1%. All the patients were divided into four groups according to the data available: patients with good regeneration of the mandible, patients with medium, bad and very bad regeneration. Having analyzed the time of healing of mandibular fractures and the means applied for stimulation we conclude that: a) stimulation is not expedient when regeneration is good; b) when regeneration is medium we recommend to use electric stimulation or medication to increase regeneration of the inferior alveolar bundle; c) when the regeneration is bad fractures are healing much faster when calcitrine or human somatotropic hormone is applied; d) in cases of very bad reparative regeneration, treatment with calcitrine or human somatotropic hormone is applied in combination with medications improving regeneration of the nerve and vascular bundle.
Department of Oral and Maxillofacial Surgery, Yonsei University, South Korea 15. MRI Imaging of Temporomandibular Joint after Trauma and Conservative Treatment in Adult Condylar Fractures The position and functioning of discs in 10 adult patients, whose bilateral condylar fractures were treated following a nonsurgical protocol, were investigated by means of magnetic resonance imaging. In seven TMJ's, where the condylar fragments were situated in the confines of the glenoid fossa, the discs were not displaced and were functioning normally. In 13 TMJ's, where the condylar fragments were medially dislocated out of the fossa, the discs were displaced, together with the condylar head, but moved forward, together with the condyle, during mouth opening. The relationship between disc and condyle appears to play an important role in the re-establishment of function using nonsurgical treatment in patients with condylar fractures.
Lee, S.-H., * Na, J.-B. ** 9Department of Dentistry, **Department of Radiology, Medical College, Gyeongsang University, Korea
Magnetic resonance imaging (MRI) has been carried out on a group of patients who had condylar fractures that were treated conservatively. The examination included M R I immediately post trauma and after treatment. This study contributes to our understanding of the disk position both at the beginnning of the treatment and afterwards.
022-D Trauma
volved in maxillofacial fractures. Two hundred and fortyseven cases of condylar fracture (179 unilateral and 68 bilateral) treated at our department during the 15 year period from October, 1981, to Nov, 1996, were reviewed and analyzed. The majority of patients ranged in age from 10 to 30 years old, and the male to female ratio was 1.8 : 1. The major causes of injury were traffic accidents and falling. Fracture sites and forms were determined according to the classification described by Kubo. Non-surgical treatment was performed in 175 cases consisting mainly of condylar head fracture, subcondylar fracture, and condylar neck fracture with slight displacement. Surgical treatment was performed in 72 cases in which subcondylar and condylar neck fractures with severe dislocation were the most common. In the cases of surgical treatment, osseous wiring, Kirschner pinning, plating, and lag screw osteosynthesis have been employed. Prognosis was determined according to the classification described by Nakatomi. As for the clinical results in the cases of non-surgical treatment, 58% healed completely and 35% ~had disorder. In the cases of surgical treatment, 54% healed completely and 39% had disorder. Some investigators recommend non-surgical treatment for condylar fracture. However, we obtained good results with surgical~ treatment for subcondylar and condylar neck fractures with severe dislocation, compared with non-surgical treatment. As for the fixation method, lag screw osteosynthesis is more suitable for condylar fracture than miniplate osteosynthesis through a preauricular approach, because it has sufficient-fixation-force and minimal complications.
13. Magnetic Resonance Imaging of the Temporomandibular Joints after Functional Treatment of Bilateral Condylar Fractures in Adults
Choi, B. H., Yi, C. K.
14. The Experience of Treatment of Mandibular Fractures
Kubilius, R., Sabalys, G., Tercijonas, P. Department of Maxillo-Facial Surgery, Kaunas Medical Academy, Kaunas, Lithuania
5656 patients with mandibular fractures were treated in a 24 years period (1973-1996). 88,5% of the patients were men and 11,5% women. Stimulation of healing of the fractures was applied taking into consideration the reparative capacity of the mandible. The reparative capacity of the mandible depends on the ability of bone tissue to absorb calcium salts and on the level of injury of the inferior alveolar nerve. Using Suslov'g method 2 degrees of ability to absorb calcium salts could be distinguished: intensive - 53,9%, weak 46,1%. All the patients were divided into four groups according to the data available: patients with good regeneration of the mandible, patients with medium, bad and very bad regeneration. Having analyzed the time of healing of mandibular fractures and the means applied for stimulation we conclude that: a) stimulation is not expedient when regeneration is good; b) when regeneration is medium we recommend to use electric stimulation or medication to increase regeneration of the inferior alveolar bundle; c) when the regeneration is bad fractures are healing much faster when calcitrine or human somatotropic hormone is applied; d) in cases of very bad reparative regeneration, treatment with calcitrine or human somatotropic hormone is applied in combination with medications improving regeneration of the nerve and vascular bundle.
Department of Oral and Maxillofacial Surgery, Yonsei University, South Korea 15. MRI Imaging of Temporomandibular Joint after Trauma and Conservative Treatment in Adult Condylar Fractures The position and functioning of discs in 10 adult patients, whose bilateral condylar fractures were treated following a nonsurgical protocol, were investigated by means of magnetic resonance imaging. In seven TMJ's, where the condylar fragments were situated in the confines of the glenoid fossa, the discs were not displaced and were functioning normally. In 13 TMJ's, where the condylar fragments were medially dislocated out of the fossa, the discs were displaced, together with the condylar head, but moved forward, together with the condyle, during mouth opening. The relationship between disc and condyle appears to play an important role in the re-establishment of function using nonsurgical treatment in patients with condylar fractures.
Lee, S.-H., * Na, J.-B. ** 9Department of Dentistry, **Department of Radiology, Medical College, Gyeongsang University, Korea
Magnetic resonance imaging (MRI) has been carried out on a group of patients who had condylar fractures that were treated conservatively. The examination included M R I immediately post trauma and after treatment. This study contributes to our understanding of the disk position both at the beginnning of the treatment and afterwards.