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The choice of osteosynthesis method and approach in condylar neck fracture
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025F- Trauma management
10. Limits of Diagnosis and Therapy of Facial Trauma in Children
Mischkowski, R., Stefanescu, L., Klesper, B., Siessegger, M., Zoller, J. Department of Oral and Maxillofacial Surgery, University of Cologne, Germany The treatment of facial trauma in children is considered as a surgical challenging task aimed at the prevention of debilitating sequels physiological facial development. The objective of this retrospective study was to evaluate the diagnostic and therapeutic methods of primary trauma management in children with facial fractures. From July 1990 to September 1998, 110 children between 1 and 12 years of age were treated in our department due to a fracture of facial skeleton. The mean age of the 42 female and 68 male patients was 8.2 years. For the most frequent injuries accounted fractures of the mandible (31.6%), orbital floor (17.1%) and zygomatico-orbital complex (14.5%). For diagnostic purposes, plane radiographs were performed in 41%, in 28% CT scans and in 31% CT scans in addition to plane radiographs. Except 24 cases all mandibular and midfacial fractures were treated by open reduction and rigid fixation using micro- and miniplates. The results indicated that state of the art, contemporary osteosynthesis has no significant influence on the development of the facial skeleton. The analysis of the diagnostic management showed that in more than one third of all cases an inadequate radiographic approach has been chosen. This concerned mainly patients who were referred from a hospital without a specialized maxillofacial trauma unit. Hence it is to postulate that once unequivocal clinical signs of a maxullofacial trauma are detected, the primary imaging diagnostic should be handed over to a specialized center which can also provide the surgical care for the injured child.
11. The Choice of Osteosynthesis Method and Approach in Condylar Neck Fracture
Eckelt, U. Department of Maxillofacial Surgery, University Dresden, Dresden, Germany Different methods of osteosynthesis have been known for treating fractures of the articular process of the mandible for many years. Surgical treatment is still controversial. In the examination at hand, 263 patients who had fractures with dislocation or displacement of condyle neck replaced and affixed with lag screws or miniplates were checked clinically and using X-rays according to the same criteria following their treatment as a group of 100..patients after conservative functional therapy. Roentgenological examinations have revealed that there are considerably more cases where fragments are properly repositioned after surgical treatment (89%) than after nonsurgical therapy (38%). We have also observed significantly
less deformities of the condyle (4%), as compared (48%) for the non-surgical method. In clinical examinations, significant reduction of the maximal mouth opening to less than 30 mm have been found after non-surgical treatment only (3%). Likewise, reduced laterotrusion (6% as against 3%) and reduced protrusion (18% as against 6%) occurred more often where the non-surgical method had been applied. In conclusion of these results, we put the indication for surgical therapy in: 1. Badly dislocated temporomandibular joint fractures and luxation fractures by a periangular or oral approach using miniplates or lag screws. 2. Intracapsular fractures with shortening of the ramus by a preauricular approach using lag screws.
12. The Analysis of Complications in Mandibular Angle Fractures: A Study with Finite Element Computations and Evaluation of 277 Patients with Mandibular Angle Fractures
Feller, K., Hlawitschka, M., Eckelt, (7.. Clinicfor Oral and Maxillofacial Surgery, University of Dresden, Dresden, Germany Purpose Miniplate osteosynthesis, according to Champy, is a standard method for the treatment of mandibular angle fractures. In fractures in the mandibular angle region, the use of sturdier osteosynthesis materials or the application of a second nliniplate is still discussed controversially. It was the objective of our study to discover, on the basis of the analysis of our patients data and a computer-aided finite element model, those groups of patients in whom complications occur in large numbers. Material and methods The data of 277 patients with 293 fractions in the mandibular ang!~ region who had been treated at our clinic between 1990 and 1998 were analyzed pro- and retrosepectively. As major complications , osteomyelitides, malocclusions, pseudarthroses, and necessary reosteosyntheses were included. Thirty minor complications (impaired wound healing, intermaxillary refixation) icould be treated in the out-patient department. The pr0gram Analysis was used to simulate an idealized mandibular angle region and.to compute the forces applied. The causes o f the failure of miniplate osteosynthesis were to be determined. Results 72 patients were tread conservatively and 205 patients were treated with miniplate osteosynthesis for the most part. 42 fractures (14.3%) did not heal without complications. 4.1% of the fractures required reoperation under insufflation anesthesia. The clinical data that were compared with the finite element computations show that there is an increased risk of a major complication in particular groups of patients. Conclusion In particular patients, the use of a sturdier osteosynthesis
025F- Trauma management
10. Limits of Diagnosis and Therapy of Facial Trauma in Children
Mischkowski, R., Stefanescu, L., Klesper, B., Siessegger, M., Zoller, J. Department of Oral and Maxillofacial Surgery, University of Cologne, Germany The treatment of facial trauma in children is considered as a surgical challenging task aimed at the prevention of debilitating sequels physiological facial development. The objective of this retrospective study was to evaluate the diagnostic and therapeutic methods of primary trauma management in children with facial fractures. From July 1990 to September 1998, 110 children between 1 and 12 years of age were treated in our department due to a fracture of facial skeleton. The mean age of the 42 female and 68 male patients was 8.2 years. For the most frequent injuries accounted fractures of the mandible (31.6%), orbital floor (17.1%) and zygomatico-orbital complex (14.5%). For diagnostic purposes, plane radiographs were performed in 41%, in 28% CT scans and in 31% CT scans in addition to plane radiographs. Except 24 cases all mandibular and midfacial fractures were treated by open reduction and rigid fixation using micro- and miniplates. The results indicated that state of the art, contemporary osteosynthesis has no significant influence on the development of the facial skeleton. The analysis of the diagnostic management showed that in more than one third of all cases an inadequate radiographic approach has been chosen. This concerned mainly patients who were referred from a hospital without a specialized maxillofacial trauma unit. Hence it is to postulate that once unequivocal clinical signs of a maxullofacial trauma are detected, the primary imaging diagnostic should be handed over to a specialized center which can also provide the surgical care for the injured child.
11. The Choice of Osteosynthesis Method and Approach in Condylar Neck Fracture
Eckelt, U. Department of Maxillofacial Surgery, University Dresden, Dresden, Germany Different methods of osteosynthesis have been known for treating fractures of the articular process of the mandible for many years. Surgical treatment is still controversial. In the examination at hand, 263 patients who had fractures with dislocation or displacement of condyle neck replaced and affixed with lag screws or miniplates were checked clinically and using X-rays according to the same criteria following their treatment as a group of 100..patients after conservative functional therapy. Roentgenological examinations have revealed that there are considerably more cases where fragments are properly repositioned after surgical treatment (89%) than after nonsurgical therapy (38%). We have also observed significantly
less deformities of the condyle (4%), as compared (48%) for the non-surgical method. In clinical examinations, significant reduction of the maximal mouth opening to less than 30 mm have been found after non-surgical treatment only (3%). Likewise, reduced laterotrusion (6% as against 3%) and reduced protrusion (18% as against 6%) occurred more often where the non-surgical method had been applied. In conclusion of these results, we put the indication for surgical therapy in: 1. Badly dislocated temporomandibular joint fractures and luxation fractures by a periangular or oral approach using miniplates or lag screws. 2. Intracapsular fractures with shortening of the ramus by a preauricular approach using lag screws.
12. The Analysis of Complications in Mandibular Angle Fractures: A Study with Finite Element Computations and Evaluation of 277 Patients with Mandibular Angle Fractures
Feller, K., Hlawitschka, M., Eckelt, (7.. Clinicfor Oral and Maxillofacial Surgery, University of Dresden, Dresden, Germany Purpose Miniplate osteosynthesis, according to Champy, is a standard method for the treatment of mandibular angle fractures. In fractures in the mandibular angle region, the use of sturdier osteosynthesis materials or the application of a second nliniplate is still discussed controversially. It was the objective of our study to discover, on the basis of the analysis of our patients data and a computer-aided finite element model, those groups of patients in whom complications occur in large numbers. Material and methods The data of 277 patients with 293 fractions in the mandibular ang!~ region who had been treated at our clinic between 1990 and 1998 were analyzed pro- and retrosepectively. As major complications , osteomyelitides, malocclusions, pseudarthroses, and necessary reosteosyntheses were included. Thirty minor complications (impaired wound healing, intermaxillary refixation) icould be treated in the out-patient department. The pr0gram Analysis was used to simulate an idealized mandibular angle region and.to compute the forces applied. The causes o f the failure of miniplate osteosynthesis were to be determined. Results 72 patients were tread conservatively and 205 patients were treated with miniplate osteosynthesis for the most part. 42 fractures (14.3%) did not heal without complications. 4.1% of the fractures required reoperation under insufflation anesthesia. The clinical data that were compared with the finite element computations show that there is an increased risk of a major complication in particular groups of patients. Conclusion In particular patients, the use of a sturdier osteosynthesis