- Email: [email protected]
Surgical treatment of different condylar fractures
029B - Anesthesia~facialpain~facial cosmetic surgery~nerve repair~trauma management~wound repair~miscellaneous long term deficits in between 10 and 50% of patients. Much has been written on the classification of infra-orbital nerve injuries in association with differ-nt fracture types and the relationship of the prognosis for recovery with varying forms of management of the fracture, Little, however appears in the literature with regard to the management of persistent neurosensory deficit. We present the results of a series of patients presenting with late infra-orbital nerve dysfunction who have undergone microscopic neurolysis. In all patients the infra-orbital nerve was exposed via an infra-orbital incision and a marginal orbitotomy. This allowed decompression of the nerve along the whole length of the infraorbital cana a feature which we believe to be important to the success of the procedure. All patients noted a considerable improvement in sensibility with the rapidity of return of sensation being of particular note.
10. Prognosis after Epineurotomy and Tubulization of the Injured Inferior Alveolar Nerves: A Review of 5 Cases
113
References 1. K~NJI WH. Incidence of nerve injuries after implant placement. JOMS 1995: 53: 264. 2. M R KIM. Regeneration of the mandibular nerve in ePTFE tubes. JOMS 1997: 55(8) suppl. 3.
11. Surgical Treatment of Different Condylar Fractures
Huiying, T., Min, H., Min, H., Jun, Y., Fei, IV.., Chaoxian, L. Department of Oral Maxillofacial Surgery, General Hospital of PLA, Beijing, China Objective To evaluate the results after surgical management of different fractures of the condylar process and to discuss the problems relative to these surgical processes.
Kim, M., Kim, C, Kim, D. Dept. of Dentistry & Oral Surgery, Ewha Womans University, Seoul, Korea Purpose This is to review the painful dysesthesia followed after dental surgeries and to evaluate the effect of epineurotomy & entubulation of the injured trigeminal nerves in the mandibular canals. Materials and methods Five patients who had been injured during dental procedures were examined periodically and underwent microsurgical exploration due to painful dysesthesia lasted for over 4 months without improvement. Three patients injured by implant drills, one by chemical burn (vitapex), one by surgical burs during third molar removal. They had been repaired by epineurotomy and entubulation with e-PTFE membrane. The clinical examinations (SLT, MLTD, 2PD, PPN, TD, and VAS), electro-physiologic studies (SSEP) and thermographs (Digital Infrared Thermal Images) were reviewed comparatively. Results Microscopic examination disclosed neuro-fibromatous changes surrounding the injured nerves or regenerated tissues. Patients who had waited for over 18 months presents pain reduced but dysesthesia persisted, while patient underwent microsurgeries within 6 months revealed marked improvement in sensory tests and self assessment. The painful anesthesia caused by chemical injuries resulted in no improvement by conservative epineurotomy. Conclusion Epineurotomy & tubulization of the IAN with e-PTFE membrane could be a good option to get the sensory recovery presenting painful dysesthesia lasted for 3-6 months, while complete resection and repair modality could be rather recommended for chemical injuries and prolonged painful anesthesia lasted for over one year.
Materials and methods Seventeen patients with different condylar fractures, of them 11 with transverse fractures and 6 with sagittal fractures, were treated by open reduction. The preoperative radiologic examination of all patients consisted of panoramic radiograph, CT and three dimensional imaging reconstruction. Clinical and radiologic examinations were performed 1 months, 3 months, 6 months, 12 months, and 18 months postoperatively. A submandibular incision was made for two kinds of condylar fractures. For transverse condylar fractures subcondylar osteotomy was carried out from sigmoid notch to the angle of the mandible. The fracture was repositioned and fixed using transosseous wiring, and coracoideus process was used for bone splint. For sagittal condylar fractures, sharp bone edges of the fractured condyle were reconstructed following subcondylar osteotomy. Occlusal splint was used for 3-5 weeks and maxillomandibular fixation was maintained for 1-2 weeks. Results The preoperative radiologic examinations showed that the fractured condyle displaced anteriorly and interiorly in transverse condylar fractures, and condyles fractured in middle 1/3 in sagittal condylar fractures. When fracture line was under attachment of capsule the joint capsule and the joint disk maintained complete in transverse fractures. The joint capsule and the joint disk might be injured in sagittal fractures, On follow-up, postoperative occlusion and facial symmetry were normal. No sensory disturbance was recorded. Functional results were clinically satisfactory. Radiographs generally showed excellent fracture reduction. Conclusions Surgical treatment of condylar process fractures aims at exact anatomic positioning of fractured condylar process, rigid fixing of condylar fragments, physiologic reconstructing of the temporomandibular joint, and avoiding secondary injury to relative tissues of the joint. Postoperative occlusal splint treatment is beneficial to healing of fractured condylar process.
10. Prognosis after Epineurotomy and Tubulization of the Injured Inferior Alveolar Nerves: A Review of 5 Cases
113
References 1. K~NJI WH. Incidence of nerve injuries after implant placement. JOMS 1995: 53: 264. 2. M R KIM. Regeneration of the mandibular nerve in ePTFE tubes. JOMS 1997: 55(8) suppl. 3.
11. Surgical Treatment of Different Condylar Fractures
Huiying, T., Min, H., Min, H., Jun, Y., Fei, IV.., Chaoxian, L. Department of Oral Maxillofacial Surgery, General Hospital of PLA, Beijing, China Objective To evaluate the results after surgical management of different fractures of the condylar process and to discuss the problems relative to these surgical processes.
Kim, M., Kim, C, Kim, D. Dept. of Dentistry & Oral Surgery, Ewha Womans University, Seoul, Korea Purpose This is to review the painful dysesthesia followed after dental surgeries and to evaluate the effect of epineurotomy & entubulation of the injured trigeminal nerves in the mandibular canals. Materials and methods Five patients who had been injured during dental procedures were examined periodically and underwent microsurgical exploration due to painful dysesthesia lasted for over 4 months without improvement. Three patients injured by implant drills, one by chemical burn (vitapex), one by surgical burs during third molar removal. They had been repaired by epineurotomy and entubulation with e-PTFE membrane. The clinical examinations (SLT, MLTD, 2PD, PPN, TD, and VAS), electro-physiologic studies (SSEP) and thermographs (Digital Infrared Thermal Images) were reviewed comparatively. Results Microscopic examination disclosed neuro-fibromatous changes surrounding the injured nerves or regenerated tissues. Patients who had waited for over 18 months presents pain reduced but dysesthesia persisted, while patient underwent microsurgeries within 6 months revealed marked improvement in sensory tests and self assessment. The painful anesthesia caused by chemical injuries resulted in no improvement by conservative epineurotomy. Conclusion Epineurotomy & tubulization of the IAN with e-PTFE membrane could be a good option to get the sensory recovery presenting painful dysesthesia lasted for 3-6 months, while complete resection and repair modality could be rather recommended for chemical injuries and prolonged painful anesthesia lasted for over one year.
Materials and methods Seventeen patients with different condylar fractures, of them 11 with transverse fractures and 6 with sagittal fractures, were treated by open reduction. The preoperative radiologic examination of all patients consisted of panoramic radiograph, CT and three dimensional imaging reconstruction. Clinical and radiologic examinations were performed 1 months, 3 months, 6 months, 12 months, and 18 months postoperatively. A submandibular incision was made for two kinds of condylar fractures. For transverse condylar fractures subcondylar osteotomy was carried out from sigmoid notch to the angle of the mandible. The fracture was repositioned and fixed using transosseous wiring, and coracoideus process was used for bone splint. For sagittal condylar fractures, sharp bone edges of the fractured condyle were reconstructed following subcondylar osteotomy. Occlusal splint was used for 3-5 weeks and maxillomandibular fixation was maintained for 1-2 weeks. Results The preoperative radiologic examinations showed that the fractured condyle displaced anteriorly and interiorly in transverse condylar fractures, and condyles fractured in middle 1/3 in sagittal condylar fractures. When fracture line was under attachment of capsule the joint capsule and the joint disk maintained complete in transverse fractures. The joint capsule and the joint disk might be injured in sagittal fractures, On follow-up, postoperative occlusion and facial symmetry were normal. No sensory disturbance was recorded. Functional results were clinically satisfactory. Radiographs generally showed excellent fracture reduction. Conclusions Surgical treatment of condylar process fractures aims at exact anatomic positioning of fractured condylar process, rigid fixing of condylar fragments, physiologic reconstructing of the temporomandibular joint, and avoiding secondary injury to relative tissues of the joint. Postoperative occlusal splint treatment is beneficial to healing of fractured condylar process.