Prospective evaluation of open reduction, internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced fractures. Part II: High condylar and condylar head fractures

Oral Presentations / O40. Trauma I V [-0-'3--~ PDGF CONCENTRATION IN PRP AFTER CONTACT TO GRANULES EITHER ALGAE- OR BOVINE-DERIVED HYDROXYLAPATITE M. Kozakiewicz, D. Dudek, M. Kaminska, B. Walkowiak. Departament of

Cranio-Maxillofacial Surgery, Medical University of Lodz, Poland, Lodz Departament of Biophysics, Technical University of Lodz, Lodz, Poland Platelet rich plasma (PRP) is a promising accelerator used in implantologic procedures which include the application of bone substitute materials. The prediction of this kind of surgery depends on concentration of growth factors in the site of implantation of bone substitute material. Platelet Derived Growth Factor AB belongs to most important oligopeptide in PRR The objective of this study was to evaluate the change in PDGF-AB concentration at PRP after its contact to popular bone substitutes. PRP was collected according to Curasan procedure from 10 healthy volunteers. Algae- (Algipore, AHA) and bovine- derived (Bio-Oss, BVB) hydroxylapatites (particles 1-2mm) were 60 minutes incubated in PRP at temperature 370C in closed vials. PRP incubated in the same conditions but without bone substititute materiale was the control. After incubation supernatant (plasma) was investigated to establish the concentration of PDGF-AB by Elisa method (R&D kits). PDGF-AB concentration in PRP after lh incubation with bone substitute 60 min. t = 37°C. Control AHA BVB Mediana 204.83 pg/mL 112.25 pg/mL* 104.07 pg/mL Mean±s.d. 300.30±253.96 pg/mL 132.98±104.67 pg/mL 198.82±204.43pg/mL *-significant difference to control, Mann-Whitney W-test, p<0.05 Bone substitutes decrease PDGF-AB level in PRR Probably oligopeptide growth factors are adsorbed at a surface protein layer on particles of AHA and BVB.

040. Trauma IV

75 with 36 fractures of the condyle. The fractures were treated surgically with the transparotid facelift approach using miniplates and screws for fixation. Patients were carefully followed up and were also asked to answer a survey paper 6-39 months postoperatively. Facial symmetry was achieved in all of the patients, and occlusion practically identical to pretraumatic was achieved in 31 out of 33 dentate patients (94%). Postoperative interincisal distance was 30 to 61 mm (mean 44 mm), and 4 patients (12%) had postoperative deflection to the side of injury upon mouth opening. Eight out of 36 cases (22%) had a transient weakness of certain ipsilateral facial muscle groups, lasting 4-8 weeks. In one of these patients, mild weakness of the upper lip and lower eyelid remain after 2 years. There were 5 cases of miniplate fracture (14%), all of them in patients where 1.7 or thinner miniplates were used. There were 5 cases of salivary fistula (14%), all of them in patients where the parotid capsule was not closed in a watertight fashion. All of the salivary fistulas resolved spontaneously within 4 weeks. According to a postoperative survey completed by 32 patients, 30 of them (94%) were very satisfied with the outcome of treatment. This transparotid facelift approach enables good and direct exposure of the fracture site, enabling reduction and fixation of even the most difficult, comminuted and/or dislocated (luxative) fractures. As the tensile and compressive forces in this area are large, 2.0 miniplates have to be used, whenever possible, to avoid miniplate fracture. The parotid capsule should be opened sharply and closed in a watertight fashion, to avoid postoperative salivary fistula. When encountered, branches of the facial nerve should be carefully dissected anteriorly and posteriorly. This enables their retraction with less tension, and results in fewer cases of transient postoperative facial nerve weakness. If conducted properly, the transparotid facelift approach is safe and effective in surgical treatment of condyle fractures. [ - G ' ~ ' - ~ PROSPECTIVE EVALUATION OF OPEN REDUCTION, INTERNAL FIXATION OF DISPLACED AND DISLOCATED CONDYLE AND CONDYLAR HEAD FRACTURES AND CLOSED REDUCTION OF NON-DISPLACED FRACTURES. PART h CONDYLE AND SUBCONDYLAR FRACTURES C.A. Landes, R. Lipphardt, R. Sader. Maxillofacial and Facial Plastic

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FUNCTION IMPAIRMENT AND PAIN AFTER CLOSED TREATMENT OF FRACTURES OF THE MANDIBULAR CONDYLE

R.R.M. Bos, RU. Dijkstra, B. Stegenga, L.G.M. de Bont. University

Medical Centre Groningen Department of Oral and Maxillofacial Surgery PO Box 30.001 9700 RB Groningen, the Netherlands To determine the prognosis of fractures of the mandibular condyle after closed treatment. Patients (n =144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on radiographs. Follow-up was after 12 months in which the average pain, experienced during the last week (VAS, 100mm), and mandibular functioning were assessed (mandibular function impairment questionnaire (MFIQ)). Data of 116 (81%) patients, 41 females (35%) and 75 males (65%), were available for analysis. Condylar neck fractures were most common (52%). Bilateral fractures were present in 28% of the patients. Pain (VAS > 0) was found in 9% of the patients. Impaired mandibular function was found in 40% (MFIQ>0) and 24% (MFIQ~>4) of the patients. The most important risk factor for pain was being female. The most important risk factors for function impairment were ~>25 years of age and gross displacement of the fracture parts. In conclusion, the overall prognosis of mandibular function and pain after closed treatment of condylar fractures is good. The most important risk factor for pain persisting for 1 year following closed treatment of a condylar fracture is being female. The most important risk factors for function impairment are an age of ~>25 years, and gross displacement of the fracture parts.

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THE TRANSPAROTID FACELIFT APPROACH IN CONDYLAR FRACTURE TREATMENT

A. Vesnaver, A. Kansky, D. Dov,~ak, A. Eberlinc, M. Gorjanc, N. Ihan Hren. Department of Maxillofacial and Oral Surgery University Medical Center, Ljubljana, Slovenia Treatment of mandibular condyle fractures is still one of the most debated themes in maxillofacial traumatology. The aim of our study was to determine the safety and efficiency of surgical treatment using the transparotid facelift approach. A prospective study was conducted on 34 patients

Surgery The J.-W. Goethe University Medical Center, Frankfurt, Germany This prospective study evaluated outcomes of closed reduction (CR) in non-displaced, non-dislocated condyle and subcondylar fractures (class I after Spiessl & Schroll) and open reduction and internal fixation (ORIF) of displaced (class II) and dislocated (class IV) fractures. 45 patients with 51 fractures (6 (13%) with bilateral fractures), 11(25%) CR, 34(75%) ORIF, were enrolled in a 1-year follow-up that 20 patients with 25 fractures completed. Condylar translation in class I fractures recovered to 12 mm for vertical opening; 9 mm for protrusion; 8 mm for mediotrusion, class II synonymously 10mm; 7mm; 9mm and class IV 8mm; 7mm; 7mm; incisal movements recovered to 46 mm; 8 mm; 9 mm in class I, 44 mm; 7mm; 9mm in class II and 43mm; 5mm; 7mm in class IV. Vertical and angular fragment-reduction versus the non-fractured condyle was +0.3 mm to -1.9 mm, +1.10 to +1.80 in class I, -2.2 mm to -1.9 mm, +0.60 to -1.20 in class II, +2.9 mm to -1.1 mm, +18.40 to +60 in class IV. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. All complications subsided after 6 months, translation and incisal movements returned to norm range in proportion to severity of displacement and dislocation. Vertical opening translation in class IV fractures remained short-to-normal and was compensated by rotation. Unacceptable clinical function according to predefined standards was not found after 1 year. Angular reposition was better than vertical reduction. This study documents successful evidencebased treatment according to predefined criteria. [ - G - 4 - ~ PROSPECTIVE EVALUATION OF OPEN REDUCTION, INTERNAL FIXATION OF DISPLACED AND DISLOCATED CONDYLE AND CONDYLAR HEAD FRACTURES AND CLOSED REDUCTION OF NON-DISPLACED FRACTURES. PART Ih HIGH CONDYLAR AND CONDYLAR HEAD FRACTURES C.A. Landes, R. Lipphardt, R. Sader. Maxillofacial and Facial Plastic

Surgery, The J.-W. Goethe University Medical Center, Frankfurt, Germany This study prospectively evaluated closed reduction (CR) outcomes in non-displaced, non-dislocated high-condylar and condylar-head fractures (class VI after Spiessl & Schroll) and open reduction and internal

Int. J. Oral Maxillofac. Surg. 2005; 34 (Supplement 1): $ 1 - $ 1 8 1

76 fixation (ORIF) of displaced (class III) or dislocated (class V) fractures. 38 patients with 54 fractures (16 (42%)with bilateral fractures), 14(37%) CR, 24(63%) eRIE were enrolled in a 1 year follow-up that 18 patients with 33 fractures completed. Condylar translation in class VI fractures recovered to 11 mm for vertical opening; 8 mm for protrusion; 10 mm for mediotrusion, class III synonymously 8mm; 8 mm; 6mm and class V 7 mm; 6 mm; 7 mm; incisal movements recovered to 38 mm; 8 mm; 8 mm in class VI, 55mm; 7mm; 10mm in class III with 1(8%) malocclusion, 1(8%) impaired vertical opening and 55mm; 7mm; 9mm in class V with 2(18%) malocclusions. Fragment-reduction versus the non-fractured condyle was -0.3 mm to +1.3 mm and +30 to +90 in class VI, -1 mm to -0.2 mm and +30 to +20 in class III, -3.3 mm to +3.1 mm and -11.20 to +10 in class V. Malocclusion and joint locking were unreliable determinants for a treatment decision, being forged by concomitant fractures. Joint movements were within normal range at 1-year follow-up except class III and V vertical opening translation. After predefined criteria, 92% successful outcomes were attained. Multiple factor analysis should be used to prospectively evaluate the unacceptable clinical outcomes. Class VI fractures with intact vertical support should prospectively be evaluated whether these benefit from eRIE

[-0--'~'~ THE INTRA- AND EXTRAORAL APPROACH IN SURGICAL MANAGEMENT OF CONDYLAR NECK FRACTURES A COMPARATIVE CLINICAL, RADIOLOGICAL AND AXlOGRAPHICAL EXAMINATION M. Schneider, G. Lauer, U. Eckelt. Department of Maxillofacial Surgery

University Hospital Carl Gustav Carus Technical University of Dresden, Fetscherstrasse 74, 01307 Dresden, Germany Fractures of the lower jaw and particularly injuries of the condyle are the most frequent traumas of the facial bone. The surgical management of condylar neck fractures is still controversially discussed. The surgical reposition of condylar neck fractures is supposed to be very difficult and bears a high risk of complications. For that reasons the surgical management is met by great restraint. The aim of the study was to compare the clinical outcome of surgically treated fractures via an intraand extraoral approach. We compared clinical, radiological and functional findings. The patient group covers 40 patients with displaced and luxated condylar neck fractures. 20 patients with 22 fractures were treated by an intraoral surgical approach, whereas 20 more patients with 24 fractures underwent an operation via an extraoral periangular approach. Six months after the surgical treatment a comparative functional, axiographical and radiological checkup was carried out. Subjective measurements as pain and impairments due to scaring were registred. There were little differences in both groups concerning the clinical parameters as protrusion, mediotrusion and maximum distance between the incisors. Almost all condylar neck fractures operated via an extraoral approach could be repositioned accurately. But only 50 percent of the intraorally approached fractures resulted in an optimal reposition. An inaccurate reposition leads to an unstable osteosythesis and causes redisplacement and other complications. For these fractures axiographical measurements show that the condylar mobility is impaired to a greater extend compared with fractures that were extraorally approached. Concerning radiological, axiographical as well as subjective measures the intraoral approach tends to show worse results compared with the extraoral approach. The axiographical examination shows an additional limitation of the three-dimensional condylar mobility as the most sensitive indicator in incorrectly repositioned fractures. Concluding from the results of the study, only fractures that suggest an accurate reposition on conditions of limited overview and manipulation ability should be approached by an intraoral procedure to avoid compliactions. These applies nearly regularly to laterally displaced and compressed fractures. For all other displaced and luxated fractures the extraoral reposition and osteosythesis is a safe method because of good overview and handling.

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INJURY LOCATION AND SCREENING QUESTIONNAIRES AS MARKERS FOR INTIMATE PARTNER VIOLENCE

L.R. Halpern, S. Susarlas, M. Finkel, D.B. Dodson. Department of Oral and Maxillofacial Surgery and Department of Emergency Medicine, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, Massachusetts, USA This study's purpose was to evaluate the performance of two different screening questionnaires for IPV, in conjunction with injury location, as

markers for IPV-related injuries. We implemented a cross-sectional study derived from the population of women (age ~>18years) presenting to the emergency department for management of non-verifiable injuries. Study subjects were randomly assigned to receive one of two IPV questionnaires: the Partner Violence Screen (PVS) or the short-Woman Abuse Screening Tool (short-WAST). We evaluated a combination of two markers of IPV-related injury: 1) injury location, classified as head/neck/facial (HNF) or other, and 2) responses to the IPV-questionnaires (positive or negative). Our predictor variable was the probability of self-report of IPV-related injury, i.e. high-probability (HNF injuries were present and there was a positive response to the IPV questionnaire) or low probability (all other combinations of injury location and responses to the questionnaires). The outcome variable was self-reported injury etiology, IPV vs. other. Demographic variables i.e. age, ethnicity, education, family income, social history and visits to the ER/year, were also recorded. Uni- and bivariate statistics were computed. Sensitivities, specificities, positive and negative predictive values, and odds ratios were calculated (p<0.05). N =200 women; 100 in the PVS sample and 100 in the shortWAST sample. There were no statistically significant differences in any of the variables between the two groups. The sensitivities/specificities for the PVS-injury location and short-WAST-injury location combinations were comparable (0.75/0.70 and 0.77/0.61, respectively). Patients receiving the diagnostic protocol with PVS and injury location were 10.2 times more likely to report an IPV-related injury etiology (p < 0.01) when compared with patients given the combination of the short- WAST and injury location who were 3.7 times more likely (p=0.07). A protocol composed of injury location and the PVS questionnaire was statistically associated with the likelihood of reporting IPV-related injuries. References [1] Perciaccante VJ., Ochs HA, Dodson TB. Head, neck and facial injuries as markers for domestic violence in women. J Oral Maxillofac Surg 1999; 57: 760-63. [2] Perciaccante VJ, Carey JW, Dodson TB. Injury location and Woman's Abuse Screening Tool scores as markers for Intimate Partner Violence (IPV). J Dental Research, Abstr, Suppl,Vol 2002; 81:A-492.

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THE TREATMENT OF GUNSHOT INJURIES TO THE FACE

M. Peled. Rambam Medical Center, Department of Oral & Maxillofacial

Surgery, Israel The increasing worldwide terrorists attacks against civilians brought the surgical teams to deal with the treatment of the ballistic injuries to the face especially caused by high velocity missiles. The results of such injuries includs extensive avulsions of both soft and hard tissues of the face which makes their treatment complicated but also challenging due to their devastating functional and esthetic consequences. The immediate management of those patients must be focused on securing the airway and controlling bleeding. The phase I surgical treatment consists of primary closure of soft tissue wounds of the face and primary stabilization of the jawbones. The phase II surgical treatment consists of secondary reconstruction of the face using bone grafting techniques and soft tissue revision procedures. The free vascularized flaps are saved as salvage procedures in case of tissue breakdown or extreme injuries. The purpose of this presentation is to describe our protocol for treatment of ballistic injuries to the face, emphasizing the different natures of various weapons that affect the surgical approach and have impact on the treatment results and final outcome.

O41. CLP III

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MYOMUCOSAL CHEEK FLAP FOR REPAIR OF PALATAL CLEFT (LONG TERM FOLLOW UP)

A. Sadakah. Oral & Maxillofacial Surgery Depart., Faculty of Dentistry,

Tanta University, Tanta, Egypt To Clinically evaluate the validity of using fishtal myomucosal cheek flap in repair of palatal clefts, with emphasis on the long term sequalae. Twenty child with mean age of 28 month, (8) males, (12) females with unilateral (14) and bilateral (6) palatal clefts were included. Patients were