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Treatment strategies of mandibular fracture in children and adolescents
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V27 - Video presentations
7. Correlation Between Arthroscopic and MRI Findings of the Pathologic TMJ
Martin-Granizo, R., Sanchez-Gutierrez, s Gomez, E, de Pedro, M., Perez, 3/1., Sanchez-Cuellar, A., Falahat, E, Berguer, A. Department of Oral and Maxillofacial Surgery, University "'Hospital Clinico San Carlos'; Madrid, Spain Aims To correlate the magnetic resonance (MRI) prior to surgery, with the arthroscopic findings of pathologic temporomandibular joints. Method Fifty (50) arthroscopies of the TMJ with previous saggital views MRI in open and close mouth position were evaluated. Most of the cases were classified as intermedium-late stages of the Wilkes system (III, IV and V). The Bronstein-Merrill classification of intrarticular findings was applied. Followup consisted in visits at 1, 3, 6 and 12 months after surgery. A 1 year MRI was performed. Different arthroscopic images are shown in video, and the surgical methods used to repair them (suture of the disk, pterygoid muscle release, coagulation of the retrodiscal tissue, fibrous grasping, sclerotherapy of the posterior ligament ...). Results Significant correlation between arthroscopic and MRI findings was found in the most advanced pathologic cases, as well as in those with anterior displacement of the disk without reduction (ADDWoR). Conclusions Further prospective randomized studies are needed to correlate the MRI with internal derangement of the TMJ, prior to surgery. However, MRI seems to be an accurate method to evaluate the ADDWoR.
8. Costochondral Grafts to Reconstruct the Mandibular Condyle: The "Green-Stick" Fracture Technique
Martin-Granizo, R., Sanchez-Cuellar, A., Perez, M., de Pedro, M., Gomez, F., Sanchez-Gutierrez, s Falahat, E, Monje, E, Berguer, A. Department of Oral and Maxillofacial Surgery, University "Hospital Clinico San Carlos'; Madrid, Spain Aims To present the surgical technique of the "green-stick" fracture for securely fixing the costochondral graft to the mandible. Method A 6 year-old male with a bilateral temporomandibular joint ankylosis of unknown origin, previously treated with bidi-
rectional extraoral bilateral distractor with poor results. The surgical technique, along with the grafting of the ribs, are shown in detail. Also, the modeling and osteosynthesis of the grafts according to the "green-stick" fracture technique are reported. Results The preoperative oral opening was 11 ram., whereas after surgery was 29 mm. A dental splint was placed postoperatively to securely protect the rib grafts against excessive occlusal forces. With a follow-up period of one year, outcomes were satisfactory with good aesthetic and functional results. Conclusions Costochondral graft presents as a good treatment option to reconstruct the damaged mandibular condyle. The "greenstick" fracture technique turns to be a better way to accurately adapt and fix the graft to the concavity of the inferior jaw, than classic methods do.
9. Treatment Strategies of Mandibular Fracture in Children and Adolescents
Godoroja, P., Raileau, S. State Medical University "N. Testemitanu'; Chishinau, R. Moldava Aims To determine an optimal treatment strategy of mandibular fracture in children of different ages. Methods Between 1993-1997, 30 patients with mandibular fractures were treated: 11 females, 29 males. Patients were divided into three age groups: A: 0-5, B: 6-12, C: 13-17. Mandibular fractures were posed: 1. Complicated fractures (that communicate with oral cavity), complete and incomplete: 2. Simple fracture (that does not communicate with oral cavity), complete and incomplete. Patients with isolated condylar or subcondylar fractures were excluded from the study. The treatment was perfomed using miniplate osteosynthesis (Champy system) for internal fixation, bonding Edejewise system for maxillo-mandibular fixation, orthodontic devises. Results In this study the optimal treatment of mandibular fracture for deferent age ranges was evaluated. In all cases we have achieved a good stability of the fragments. Conclusions Miniplate osteosynthesis (Chumpy system) does not disturb normal dental eruption (A and B groups). An additional component for internal fixation maintaining jaw function and stability of the fragments (A and B groups) is the orthodontic device. Edgewise system in treatment of mandibular fracture avoid old damage of the gingival tissues (B and C groups).
V27 - Video presentations
7. Correlation Between Arthroscopic and MRI Findings of the Pathologic TMJ
Martin-Granizo, R., Sanchez-Gutierrez, s Gomez, E, de Pedro, M., Perez, 3/1., Sanchez-Cuellar, A., Falahat, E, Berguer, A. Department of Oral and Maxillofacial Surgery, University "'Hospital Clinico San Carlos'; Madrid, Spain Aims To correlate the magnetic resonance (MRI) prior to surgery, with the arthroscopic findings of pathologic temporomandibular joints. Method Fifty (50) arthroscopies of the TMJ with previous saggital views MRI in open and close mouth position were evaluated. Most of the cases were classified as intermedium-late stages of the Wilkes system (III, IV and V). The Bronstein-Merrill classification of intrarticular findings was applied. Followup consisted in visits at 1, 3, 6 and 12 months after surgery. A 1 year MRI was performed. Different arthroscopic images are shown in video, and the surgical methods used to repair them (suture of the disk, pterygoid muscle release, coagulation of the retrodiscal tissue, fibrous grasping, sclerotherapy of the posterior ligament ...). Results Significant correlation between arthroscopic and MRI findings was found in the most advanced pathologic cases, as well as in those with anterior displacement of the disk without reduction (ADDWoR). Conclusions Further prospective randomized studies are needed to correlate the MRI with internal derangement of the TMJ, prior to surgery. However, MRI seems to be an accurate method to evaluate the ADDWoR.
8. Costochondral Grafts to Reconstruct the Mandibular Condyle: The "Green-Stick" Fracture Technique
Martin-Granizo, R., Sanchez-Cuellar, A., Perez, M., de Pedro, M., Gomez, F., Sanchez-Gutierrez, s Falahat, E, Monje, E, Berguer, A. Department of Oral and Maxillofacial Surgery, University "Hospital Clinico San Carlos'; Madrid, Spain Aims To present the surgical technique of the "green-stick" fracture for securely fixing the costochondral graft to the mandible. Method A 6 year-old male with a bilateral temporomandibular joint ankylosis of unknown origin, previously treated with bidi-
rectional extraoral bilateral distractor with poor results. The surgical technique, along with the grafting of the ribs, are shown in detail. Also, the modeling and osteosynthesis of the grafts according to the "green-stick" fracture technique are reported. Results The preoperative oral opening was 11 ram., whereas after surgery was 29 mm. A dental splint was placed postoperatively to securely protect the rib grafts against excessive occlusal forces. With a follow-up period of one year, outcomes were satisfactory with good aesthetic and functional results. Conclusions Costochondral graft presents as a good treatment option to reconstruct the damaged mandibular condyle. The "greenstick" fracture technique turns to be a better way to accurately adapt and fix the graft to the concavity of the inferior jaw, than classic methods do.
9. Treatment Strategies of Mandibular Fracture in Children and Adolescents
Godoroja, P., Raileau, S. State Medical University "N. Testemitanu'; Chishinau, R. Moldava Aims To determine an optimal treatment strategy of mandibular fracture in children of different ages. Methods Between 1993-1997, 30 patients with mandibular fractures were treated: 11 females, 29 males. Patients were divided into three age groups: A: 0-5, B: 6-12, C: 13-17. Mandibular fractures were posed: 1. Complicated fractures (that communicate with oral cavity), complete and incomplete: 2. Simple fracture (that does not communicate with oral cavity), complete and incomplete. Patients with isolated condylar or subcondylar fractures were excluded from the study. The treatment was perfomed using miniplate osteosynthesis (Champy system) for internal fixation, bonding Edejewise system for maxillo-mandibular fixation, orthodontic devises. Results In this study the optimal treatment of mandibular fracture for deferent age ranges was evaluated. In all cases we have achieved a good stability of the fragments. Conclusions Miniplate osteosynthesis (Chumpy system) does not disturb normal dental eruption (A and B groups). An additional component for internal fixation maintaining jaw function and stability of the fragments (A and B groups) is the orthodontic device. Edgewise system in treatment of mandibular fracture avoid old damage of the gingival tissues (B and C groups).