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O.440 Endoscopic transantral reduction of blowout fractures
Oral Presentations O.439 Endoscopic surgery of condyle fractures: long term outcomes S. Fusetti, A. Tronchet, G. Saia, O. Procopio, G. Ferronato. University of Padova Medical School, Padova, Italy Objectives: Assessment of the long term functional outcomes of endoscopic-assisted approach in the treatment of condylar neck fractures of the mandible. Materials and Methods: From August 2001 to March 2008, 25 adult patient were included in the study. Inclusion criteria were; displacement of the proximal fragment, clinical possibility to place at least 2 screws in the proximal fragment. Four patients presented other mandibular fractures. All fractures were treated with endoral and transbuccal approaches. Results: All fractures were explored endoscopically, 20 fractrures were reduced and plated successfully using fuctional fixation. In 5 patients plating was not possible. Of the 20 patients that were plated, all presented adequate functional reduction radiographically and functional occlusion with normal function and normal mouth opening. Postoperatively, one patient presented a transient partial deficit of the facial nerve. Follow up ranged from 6 months to 6 years. Patients were evaluated for occlusion, presence of pain, joint clicks, and overall satisfaction. Conclusion: All patients were satisfied with the occlusion, with no major functional derangement. Endoscopic-assisted surgery in the treatment of mandibular condyle neck fractures is a minimally invasive technique, with reduced morbidity, which can be applied to selected patients with a displaced fracture, but requires adequate training in the use of the endoscope O.440 Endoscopic transantral reduction of blowout fractures S. Fusetti, K. Piacentile, G. Saia, O. Procopio, G. Ferronato. University of Padova Medical School, Padova, Italy Objective: The purpose of our study was to evaluate the possibility to treat orbital blow out fractures via a transantral endoscopic approach. Methods: 6 patients with symptomatic (dyplopia) orbital floor blow out fracture were included in this study. Endoscopy was performed with a 4 mm, 30 degrees endoscopes through rectangular bony windows on the anterior wall of the maxillary sinus. Treatment consisted of the insertion of a medical polyethilene porous sheet to reconstruct the orbital floor, after reducing the content, via the transantral approach. The bony window was repositioned using standard fixation techniques. Mean follow-up was 6 months. Results: Endoscopic reduction and reconstruction via the transantral approach was possible only in 2 patients. These 2 patients present only minimal orbital edema, and had a quicker recovery time after surgery. In the other patients, insertion of the floor implant was performed via a standard transconjunctival approach. Dyplopia disappeared in all patients about 6 months after surgery. Conclusion: Endoscopy allowed for better visualization of the floor, more precise and faster placement of the alloplastic material in the orbital floor via the conventionalr. It eliminated the need for a eyelid approach in 2 cases. It also proved to be an excellent teaching device. O.441 Endoscopic-assisted treatment of mandibular condyle fracture D. Hirjak, M. Beno, J. Zajko. University Hospital, Dept. Oral and Maxill. Surg., Bratislava, Slovakia Fractures of mandibular condyle are common and represent from 19% to 52% of all mandibular fractures. Controversy has existed for decades regarding the treatment of these fractures. Dislocated condylar fractures have been traditionally managed by close
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reduction. Open reduction has become more prevalent after introducing various kinds of internal fixation devices. Conventional extraoral access (submandibular, retromandibular, preauricular) can easily injure the facial nerve and create an undesirable scar. Authors present an intraoral approach in the treatment of condylar fractures. Experiences using intraoral approach show a new therapeutical way. Intraoral approach connected with endoscopicassisted access create a detail view of fragments position and reposition in correct anatomic position. A total of 23 fractures were treated through intraoral access, 12 of them using intraoral endoscopic-assisted access. There is no risk of facial nerve injury and no visible scar.
Tuesday, 9 September 2008, 14.00–16.00
Room 3
Osteosyntheses and traumatology II O.442 Epidemiology of mandibular fractures in Central Switzerland B. Schaller, J. Zix, H. Thoren, T. Iizuka. Department of CranioMaxillofacial Surgery, Inselspital, Bern University Hospital, Bern, Switzerland Objectives: To determine epidemiological characteristics of mandibular fractures in Central Switzerland of approximately 2.5 Million population. Methods: This study included all adult patients that had been diagnosed for mandibular fracture during the 7-years period (2000–2007) at the Department of Cranio-Maxillofacial Surgery, University Hospital of Bern. Patients’ data including gender, age, mechanism of accidents, fracture site and associated injuries, were retrospectively analysed. Results: There were a total of 402 patients. Of these, 292 (72%) were male and 110 (28%) were female with the mean age of 37 years (range 16−97 years). The most common cause of injury was a road traffic accident (31%), followed by various types of sports injuries (23%) and violence (20%). Thirteen percent of the patients were under the influence of alcohol or drugs at admission. More than a half of the patients (58%) had multiple mandibular fractures, and 42% had only one fracture in the mandible. Fractures were predominantly situated in the condyle (56%) and in the symphysis/parasymphysis region (52%). Occurrences of fractures in the angle and in the body were low, being 19% and 11% respectively. 93 patients (23%) had associated maxillary and midfacial fractures (the zygoma 41 and nasal bone 36). Brain commotion was observed in 19%, but severe brain injuries were extremely rare. Conclusions: In most cases, fractures occurred in the symphyseal and condylar region, with relatively minor associated injuries. Compared to previous reports from other countries, the proportion of violence was markedly lower. Sports- and leisure-related accidents were more frequent, instead. O.443 Experimental results – condylar fractures in the growing period J.H. Lenz, M. Kirchhoff, K.O. Henkel, A. Wree, K.K.H. Gundlach. Department of Oral and Maxillofacial Palstic Surgery, Rostock University, Rostock, Germany Aims: Fractures of the mandibular condyle are frequent in infancy. A potential of growing disturbances has been reported following osteosynthesis as well as conservative treatment. Histological observations of foetal mandibles (A) and experimental results following osteosynthesis after condylar fractures in growing mammals (B) were undertaken in order to look for mandibular development and growing disturbances following osteosynthesis. Materials and Methods: (A) In 10 human foetal mandibles (age: 16 to 26 weeks of gestation) metrical and histological analyses
Osteosyntheses and traumatology II
S111
reduction. Open reduction has become more prevalent after introducing various kinds of internal fixation devices. Conventional extraoral access (submandibular, retromandibular, preauricular) can easily injure the facial nerve and create an undesirable scar. Authors present an intraoral approach in the treatment of condylar fractures. Experiences using intraoral approach show a new therapeutical way. Intraoral approach connected with endoscopicassisted access create a detail view of fragments position and reposition in correct anatomic position. A total of 23 fractures were treated through intraoral access, 12 of them using intraoral endoscopic-assisted access. There is no risk of facial nerve injury and no visible scar.
Tuesday, 9 September 2008, 14.00–16.00
Room 3
Osteosyntheses and traumatology II O.442 Epidemiology of mandibular fractures in Central Switzerland B. Schaller, J. Zix, H. Thoren, T. Iizuka. Department of CranioMaxillofacial Surgery, Inselspital, Bern University Hospital, Bern, Switzerland Objectives: To determine epidemiological characteristics of mandibular fractures in Central Switzerland of approximately 2.5 Million population. Methods: This study included all adult patients that had been diagnosed for mandibular fracture during the 7-years period (2000–2007) at the Department of Cranio-Maxillofacial Surgery, University Hospital of Bern. Patients’ data including gender, age, mechanism of accidents, fracture site and associated injuries, were retrospectively analysed. Results: There were a total of 402 patients. Of these, 292 (72%) were male and 110 (28%) were female with the mean age of 37 years (range 16−97 years). The most common cause of injury was a road traffic accident (31%), followed by various types of sports injuries (23%) and violence (20%). Thirteen percent of the patients were under the influence of alcohol or drugs at admission. More than a half of the patients (58%) had multiple mandibular fractures, and 42% had only one fracture in the mandible. Fractures were predominantly situated in the condyle (56%) and in the symphysis/parasymphysis region (52%). Occurrences of fractures in the angle and in the body were low, being 19% and 11% respectively. 93 patients (23%) had associated maxillary and midfacial fractures (the zygoma 41 and nasal bone 36). Brain commotion was observed in 19%, but severe brain injuries were extremely rare. Conclusions: In most cases, fractures occurred in the symphyseal and condylar region, with relatively minor associated injuries. Compared to previous reports from other countries, the proportion of violence was markedly lower. Sports- and leisure-related accidents were more frequent, instead. O.443 Experimental results – condylar fractures in the growing period J.H. Lenz, M. Kirchhoff, K.O. Henkel, A. Wree, K.K.H. Gundlach. Department of Oral and Maxillofacial Palstic Surgery, Rostock University, Rostock, Germany Aims: Fractures of the mandibular condyle are frequent in infancy. A potential of growing disturbances has been reported following osteosynthesis as well as conservative treatment. Histological observations of foetal mandibles (A) and experimental results following osteosynthesis after condylar fractures in growing mammals (B) were undertaken in order to look for mandibular development and growing disturbances following osteosynthesis. Materials and Methods: (A) In 10 human foetal mandibles (age: 16 to 26 weeks of gestation) metrical and histological analyses