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Tooth in fracture line—a surgeons dilemma
1082
Trauma
each. A standardized data sheet was formulated and was given to operators for pre- and postoperative clinical and radiological evaluation. The information obtained from the data sheet was analysed to evaluate the need of routine postoperative radiograph in the management of maxillofacial fractures, and a protocol was formulated for advising postoperative radiographs. Result: Parasymphysis (60%) was the most commonly encountered fracture site. Orthopantomograph (95%) was the most commonly used radiograph. Around 85% of the operator advised postoperative radiograph. Assessment of the reduction following fixation was the commonest reason (75%) elicited. Intraoperative reduction and immediate postoperative occlusion were found to be better indicators (p < 0.5) for assessment of reduction than immediate postoperative radiographs. Conclusion: There is no much role for routine immediate postoperative radiographs in the management of maxillofacial fractures. doi:10.1016/j.ijom.2007.08.455
O17.49 Oculocardiac reflex and maxillofacial surgical procedures R. Sharma*, G. K. Thapliyal, R. Sinha, P. S. Menon Department of Oral Maxillofacial Surgery, Armed Forces Medical College, India Cardiac dysrhythmias resulting from surgical manipulation of the eye have been well documented in ophthalmology literature. These dysrhythmias are attributed to a pressure-induced neural reflex that causes a cardiac depression through vagal nerve stimulation. This phenomenon is referred to as the oculocardiac reflex and may be generated as a result of procedures or conditions that produce pressure on the globe. Increased intraocular pressure is thought to stimulate the reflex through the ophthalmic division of the trigemlnal nerve. Development of cardiac dysrhythmias has been observed in zygomatic complex fracture reduction, orbital floor reconstruction, downfracture during Le Fort I, II osteotomies. The cases presented here are the reported incidences of reflex sinus bradycardia occurring during surgical instrumentation and its management. doi:10.1016/j.ijom.2007.08.456
O17.50 Tooth in fracture line—a surgeons dilemma K. O. Bang*, K. P. Pandilwar Government Dental College and Hospital, Nagpur, Maharashtra, India Tooth in fracture line has always posed a dilemma to individuals responsible for treatment. This paper is a study done in our institute on selected cases of mandibular fracture during July 2005–2007 with an aim to highlight the fate of permanent teeth in mandibular fracture in cases of close reduction and open reduction and comparison of incidence of complications in both group. doi:10.1016/j.ijom.2007.08.457
O17.51 Evaluation of submental intubation in maxillofacial trauma J. Visakan*, S. M. Kotrasheti, S. D. Baliga Department of Oral Surgery, K.L.E. Society’s Institute of Dental Science, Belgaum 590010, Karnataka, India Background and objectives: The treatment of maxillofacial trauma requires modification of the standard anaesthesia technique. Nasal endotracheal intubation is often contraindicated in the presence of fracture of base of the skull. Comminuted midfacial fractures cause physical obstruction to the passage of nasotracheal tube. Further, the presence of nasotracheal tube can interfere with surgical reconstruction of fractures of the nasoorbital ethmoid (NOE) complex. Surgical reconstruction often involves maxillomandibular fixation in the intraoperative period to restore patient’s dental occlusion. This precludes the use of oral endotracheal intubation. Thus, a study was done to evaluate the use of submental intubation in maxillofacial trauma. Methods: Fifty patients with multiple maxillofacial fractures reported to KLE Dental College and Hospital were selected. Results and observations: It was observed that submental intubation provided better accessibility and manoeuvrability in all cases. Only disadvantage being scarring but was imperceptible. Conclusion: In conclusion, we state that submental route of endotracheal intubation becomes the most simple, secure and valuable technique in maxillofacial trauma, with an overall benefit of free accessibility, and evasion of the complications
inherent to nasotracheal intubation and tracheostomy. doi:10.1016/j.ijom.2007.08.458
O17.52 Self-drilling intermaxillary fixation screw: an efficacious alternative to selftapping screw A. Dhawan*, J. N. Shetty Government Dental College and Research Center, Bangalore 02, Karnataka, India Objectives: This prospective study was carried out to compare the efficacy of self-drilling and predrilled self-tapping IMF screws along with rate of complications encountered. Methods: Sixty patients with fractures of the mandible, requiring intra- or postoperative control of their occlusion with IMF screws were divided in two groups (n = 30). The incidence of screw to tooth contact in the placement of IMF screws and its clinical significance was prospectively studied in each group patients. Following screw removal, contact was assessed radiographically and all teeth adjacent to screws were tested for vitality. Other parameters assessed were abnormal tooth mobility, infection and sequestra at the screw placement site, shearing of screws at bone level and neurosensory disturbance. The proportions were compared using chi-square test of significance. Results: The incidence of loss of tooth vitality was significantly less in self-drilling IMF screw group (1.25%) than with self-tapping group (4.60%) while results of abnormal tooth mobility and neurosensory disturbance, though less in self drilling screw group, but was statistically insignificant. Conclusion: Selfdrilling screw is more efficacious alternative to pre drilled self-tapping screw with minimal rate of complications, for achieving IMF. doi:10.1016/j.ijom.2007.08.459
O17.53 Risk assessment for bone fractures in the cranio-maxillofacial traumatology in the course of our lifetime T. Tuli*, O. Haechl, N. Berger, F. R. Kloss, R. Gassner, M. Rasse Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck, Austria Introduction: The aim of this study was to analyse if there is a difference in the
Trauma
each. A standardized data sheet was formulated and was given to operators for pre- and postoperative clinical and radiological evaluation. The information obtained from the data sheet was analysed to evaluate the need of routine postoperative radiograph in the management of maxillofacial fractures, and a protocol was formulated for advising postoperative radiographs. Result: Parasymphysis (60%) was the most commonly encountered fracture site. Orthopantomograph (95%) was the most commonly used radiograph. Around 85% of the operator advised postoperative radiograph. Assessment of the reduction following fixation was the commonest reason (75%) elicited. Intraoperative reduction and immediate postoperative occlusion were found to be better indicators (p < 0.5) for assessment of reduction than immediate postoperative radiographs. Conclusion: There is no much role for routine immediate postoperative radiographs in the management of maxillofacial fractures. doi:10.1016/j.ijom.2007.08.455
O17.49 Oculocardiac reflex and maxillofacial surgical procedures R. Sharma*, G. K. Thapliyal, R. Sinha, P. S. Menon Department of Oral Maxillofacial Surgery, Armed Forces Medical College, India Cardiac dysrhythmias resulting from surgical manipulation of the eye have been well documented in ophthalmology literature. These dysrhythmias are attributed to a pressure-induced neural reflex that causes a cardiac depression through vagal nerve stimulation. This phenomenon is referred to as the oculocardiac reflex and may be generated as a result of procedures or conditions that produce pressure on the globe. Increased intraocular pressure is thought to stimulate the reflex through the ophthalmic division of the trigemlnal nerve. Development of cardiac dysrhythmias has been observed in zygomatic complex fracture reduction, orbital floor reconstruction, downfracture during Le Fort I, II osteotomies. The cases presented here are the reported incidences of reflex sinus bradycardia occurring during surgical instrumentation and its management. doi:10.1016/j.ijom.2007.08.456
O17.50 Tooth in fracture line—a surgeons dilemma K. O. Bang*, K. P. Pandilwar Government Dental College and Hospital, Nagpur, Maharashtra, India Tooth in fracture line has always posed a dilemma to individuals responsible for treatment. This paper is a study done in our institute on selected cases of mandibular fracture during July 2005–2007 with an aim to highlight the fate of permanent teeth in mandibular fracture in cases of close reduction and open reduction and comparison of incidence of complications in both group. doi:10.1016/j.ijom.2007.08.457
O17.51 Evaluation of submental intubation in maxillofacial trauma J. Visakan*, S. M. Kotrasheti, S. D. Baliga Department of Oral Surgery, K.L.E. Society’s Institute of Dental Science, Belgaum 590010, Karnataka, India Background and objectives: The treatment of maxillofacial trauma requires modification of the standard anaesthesia technique. Nasal endotracheal intubation is often contraindicated in the presence of fracture of base of the skull. Comminuted midfacial fractures cause physical obstruction to the passage of nasotracheal tube. Further, the presence of nasotracheal tube can interfere with surgical reconstruction of fractures of the nasoorbital ethmoid (NOE) complex. Surgical reconstruction often involves maxillomandibular fixation in the intraoperative period to restore patient’s dental occlusion. This precludes the use of oral endotracheal intubation. Thus, a study was done to evaluate the use of submental intubation in maxillofacial trauma. Methods: Fifty patients with multiple maxillofacial fractures reported to KLE Dental College and Hospital were selected. Results and observations: It was observed that submental intubation provided better accessibility and manoeuvrability in all cases. Only disadvantage being scarring but was imperceptible. Conclusion: In conclusion, we state that submental route of endotracheal intubation becomes the most simple, secure and valuable technique in maxillofacial trauma, with an overall benefit of free accessibility, and evasion of the complications
inherent to nasotracheal intubation and tracheostomy. doi:10.1016/j.ijom.2007.08.458
O17.52 Self-drilling intermaxillary fixation screw: an efficacious alternative to selftapping screw A. Dhawan*, J. N. Shetty Government Dental College and Research Center, Bangalore 02, Karnataka, India Objectives: This prospective study was carried out to compare the efficacy of self-drilling and predrilled self-tapping IMF screws along with rate of complications encountered. Methods: Sixty patients with fractures of the mandible, requiring intra- or postoperative control of their occlusion with IMF screws were divided in two groups (n = 30). The incidence of screw to tooth contact in the placement of IMF screws and its clinical significance was prospectively studied in each group patients. Following screw removal, contact was assessed radiographically and all teeth adjacent to screws were tested for vitality. Other parameters assessed were abnormal tooth mobility, infection and sequestra at the screw placement site, shearing of screws at bone level and neurosensory disturbance. The proportions were compared using chi-square test of significance. Results: The incidence of loss of tooth vitality was significantly less in self-drilling IMF screw group (1.25%) than with self-tapping group (4.60%) while results of abnormal tooth mobility and neurosensory disturbance, though less in self drilling screw group, but was statistically insignificant. Conclusion: Selfdrilling screw is more efficacious alternative to pre drilled self-tapping screw with minimal rate of complications, for achieving IMF. doi:10.1016/j.ijom.2007.08.459
O17.53 Risk assessment for bone fractures in the cranio-maxillofacial traumatology in the course of our lifetime T. Tuli*, O. Haechl, N. Berger, F. R. Kloss, R. Gassner, M. Rasse Department of Oral and Maxillofacial Surgery, University Hospital of Innsbruck, Austria Introduction: The aim of this study was to analyse if there is a difference in the