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Two-plate fixation of mandibular angle fracture along Champy's line with Contra-angle handpiece
Poster Session intermaxillary fixation prior to the procedure to maintain occlusion and post operative imaging was utilized to evaluate placement. The animals are monitored clinically for signs of inflammation and infection at the surgical site as well as for diet tolerance and weight maintenance. Care of the animals and monitoring of the health and behavior of the animals is performed by the veterinarian and surgical team. The animals will be sacrificed at one year post implant placement and the prosthesis as well as the surrounding soft tissue will be harvested and evaluated for wear and surrounding tissue reaction. Results: All animals have had excellent occlusion after surgery. Anterior dislocation was observed in one animal immediately postoperatively but was reduced without further occurrence. All wounds have healed well without infection. One animal developed a hematoma that required conservative incision and drainage. No animal had evidence of CN VII injury. All animals have tolerated the post-operative diet protocol. There has been no weight loss by any of the animals postoperatively nor has there been any change in behavior. Conclusions: TMJ replacement materials have required modification over time due unfavorable outcomes. A promising alternative to the current implants lies in nanostructured diamond coating of titanium alloy surfaces. The swine as a model of the human TMJ has been supported due to its similar range of motion and its comparable anatomic and articular relationships. The current goal is focused on development of a device utilizing a more conservative surgical procedure to provide low friction and no wear debris with significantly enhanced articulation. References: 1. Herring, S. W., J. D. Decker, Z. J. Liu, and T. Ma. Temporomandibular joint in miniature pigs: Anatomy, cell replication, and relation to loading. Anat. Rec. 266:152–166, 2002 2. JJ Jacobs, A Shanbhag, TT Glant, J Black and JO Galante. Wear debris in Total Joint Replacements. J Am Acad Orthrop Surg 1994:2:212-220.
with isolated orbital floor and or medial wall fractures to characterize the resulting traumatic defect Patients and Methods: A chart review was performed at a Level 1 Trauma hospital where a search query was implemented for all patients with a diagnostic code during their admission for orbital floor or orbital wall fracture. 398 patients were identified and following exclusion criteria 118 patient’s CT scans were examined. 37 patients with medial orbital wall fractures and 81 patients with orbital floor fractures were measured for fracture area, distance from orbital rim, volume of displacement, and displacement of extraocular muscles. Results: In process and currently being reevaluated for statistical analysis but will include fracture area, displacement volume, Location from inferior orbital rim or anterior lacrimal process Conclusions Relevant to Problem: This will be an epidemiologic report on the average orbital floor/wall traumatic defect size presenting to a level one trauma center. While there is a plethora of literature available regarding post traumatic orbital defect reconstruction available, there seems to be a relative paucity of information detailing orbital floor and wall defects. This study will provide basic data on defects seen in one population. It is hoped that this data may be expanded upon and may help guide future discussion regarding the somewhat controversial indications for orbital floor reconstruction. References: 1. Ploder O, Klug C, Voracek M, et al: Evaluation of computer based area and volme measurement from coronal computed tomography scans in isolated blowout fractures of the orbital floor. J Oral Maxillofacial Surgery 60: 1267, 2002. 2. Schouman T, Couvoisier D S, et al: Can systematic computed tomographic scan assessment predict treatment decision in pure orbital floor blowout fractures? J Oral Maxillofac Surg . 70 1627, 2012
POSTER 311
TRAUMA MANAGEMENT POSTER 310 Computed Tomography Characterization of Traumatic Orbital Floor and Wall Defects D. Cummins: LSUHSC New Orleans, C. Van Meter, W. Y. Zaid, L. V. Reddy Problem: Lack of searchable literature existing regarding size, location, degree of orbital wall and floor traumatic defects. Purpose: In this retrospective study, maxillofacial computed tomography studies were evaluated in patients e-226
Two-plate fixation of mandibular angle fracture along Champy’s line with Contra-angle handpiece S. M. Oh: Hallym University College of Medicine Sacred Heart Hospital, B. E. Yang, J. Y. Kim, K. N. Park, I. H. Woo Purpose: In mandible angle fractures, one rigid fixation is sometimes not sufficient to fix the mandible. One rigid fixation requires an extended intermaxillary fixation period, and its resistance to distortion is not always satisfactory. In comparison, the use of two fixing plates can solve these problems. Materials and Methods: A total of 14 mandible angle fracture patients who visited the Department of Oral Surgery, Hallym University Sacred Heart Hospital between January 2011 and March 2013 were selected for this study. Open reduction and internal fixation were performed AAOMS 2014
Poster Session intraorally under general anesthesia. One fixing plate was attached to the mandibular oblique ridge, and another fixing plate was attached to the side of the mandibular corpus. For the approach to the lateral mandibular corpus, a specially prepared contra-angle drill and a driver were used. The radiologic outcomes, patients’ statements, and changes in the occlusal points were obtained and measured at baseline and at 2, 4, and 6 weeks postoperative. Results: The mean operative time was 85.3 minutes. The number of occlusal points increased postoperatively compared with the baseline. The subjective comfort level of the patients on occlusion increased, but it did not reach the level prior to their trauma. Conclusion: The procedure of using two fixing plates in mandibular angle fracture (MAF) provides patients with the advantage of early mandibular exercise without an extended intermaxillary fixation period. In addition, this method can reduce patient discomfort and can make the procedure simple. References: 1. Deng X, Wan Z, He SS, et al. [The centric relation-maximum intercuspation discrepancy in adult angle’s class II pretreatment patients]. Hua Xi Kou Qiang Yi Xue Za Zhi 2011;29:48-52 2. Seeman R, Schicho K, Wutzl A, Koinig G, Poeschl WP, Krennmair G et al. Complication rates in the operative treatment of mandibular angle fractures: a 10-year retrospective. J Oral Maxillofac Surg 2010;68:647-50
POSTER 312 Rapid Maxillary Expansion with the custom-made palatal anchorage: a case report K. N. Park: Hallym University College of Medicine Sacred Heart Hospital, S. M. Oh, J. Y. Kim, B. E. Yang Background: Rapid Maxillary expansion(RPE) with the tooth-born appliance is not sufficient to apply to the patients with periodontal problem or insufficient tooth anchorage, and it leads to tipping of the anchorage teeth and increasing teeth mobility and root resorption. To avoid these disadvantages, we present the case using palatal screws and custom-made Hyrax. Material and Method: A patient underwent surgically assisted rapid maxillary expansion with the Hyrax expansion using 4 screws. The study models were used to measure the pre-/-post surgical width of the anterior and posterior dental arches with a digital sliding caliper. Results: The custom-made hyrax is suitable for delivering a force to the mid-palatal suture expansion. And it is low cost, small sized and simply applied. Conclusion: The results indicated that maxillary expansion with the custom-made palatal anchorage device is predictable and stable technique without significant complications in patients. AAOMS 2014
References: 1. Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism. J orthod Dentofacial Otho p2010; 137:830-9) 2. Application of a new viscoelastic finiteelement method model and analysis of miniscrew-supported hybrid hyrax treatment. Am J Orhthod Dentofacial Orthop 2013;143:426-35)
POSTER 313 Diagnosis in Treatment of Fractures of the Atrophic Mandible. A Case Series A. E. Manlove: Case Western Reserve University School of Dental Medicine, A. Flores-Hidalgo, M. P. Horan, K. Schneider, F. A. Quereshy, D. A. Baur This study was conducted to evaluate patients that underwent surgical treatment for fractures of the atrophic mandible following the protocol used by Ellis and Price which is open reduction and internal fixation with immediate bone grafting. Patients treated for atrophic mandibles were seen in a 7-year time period in the Oral and Maxillofacial Surgery Department at Case Western Reserve University (Cleveland, OH) and associated hospitals. Patient inclusion criteria include mandibular bone less than 20mm in height, complete mandibular edentulism, and unilateral or bilateral fractures of the mandible due to pathology or trauma. The patients were classified using the Luhr Classification (Class I bone height is 16 to 20mm, Class II bone height is 11 to 15mm and Class III with a bone height of 10mm or less). Electronic as well as film radiographs were used to determine the bone height and the location of the fracture. Patient information (including age, sex, DOB and MRN) was obtained from the Oral and Maxillofacial Surgery Department at Case Western Reserve University patient data base. A total of 8 patients (age range 57-94 years) fit inclusion criteria, presenting preliminary results. All patients had systemic morbidities including HTN, which was the most common between the patients along with anxiety and depression. Two of the eight patients had osteoarthritis and one patient received radiation therapy for breast cancer. Five of the patients presented with bilateral fractures of the mandible and the other 3 presented with unilateral fractures of the mandible, one of which was a non-union. Mandibular bone height in the fracture line was measured and patients were classified using Luhr Classification. Three patients were Luhr Class III, 3 were Luhr Class II and the remaining 2 patients were Luhr Class I. All fractures were approached with an apron incision to the neck staying below the level of the platysma. The mandibular fractures were reduced and fixated with titanium plates and screws. In 6 of the 8 cases, autogenous bone was harvested from the anterior iliac crest to augment e-227
with isolated orbital floor and or medial wall fractures to characterize the resulting traumatic defect Patients and Methods: A chart review was performed at a Level 1 Trauma hospital where a search query was implemented for all patients with a diagnostic code during their admission for orbital floor or orbital wall fracture. 398 patients were identified and following exclusion criteria 118 patient’s CT scans were examined. 37 patients with medial orbital wall fractures and 81 patients with orbital floor fractures were measured for fracture area, distance from orbital rim, volume of displacement, and displacement of extraocular muscles. Results: In process and currently being reevaluated for statistical analysis but will include fracture area, displacement volume, Location from inferior orbital rim or anterior lacrimal process Conclusions Relevant to Problem: This will be an epidemiologic report on the average orbital floor/wall traumatic defect size presenting to a level one trauma center. While there is a plethora of literature available regarding post traumatic orbital defect reconstruction available, there seems to be a relative paucity of information detailing orbital floor and wall defects. This study will provide basic data on defects seen in one population. It is hoped that this data may be expanded upon and may help guide future discussion regarding the somewhat controversial indications for orbital floor reconstruction. References: 1. Ploder O, Klug C, Voracek M, et al: Evaluation of computer based area and volme measurement from coronal computed tomography scans in isolated blowout fractures of the orbital floor. J Oral Maxillofacial Surgery 60: 1267, 2002. 2. Schouman T, Couvoisier D S, et al: Can systematic computed tomographic scan assessment predict treatment decision in pure orbital floor blowout fractures? J Oral Maxillofac Surg . 70 1627, 2012
POSTER 311
TRAUMA MANAGEMENT POSTER 310 Computed Tomography Characterization of Traumatic Orbital Floor and Wall Defects D. Cummins: LSUHSC New Orleans, C. Van Meter, W. Y. Zaid, L. V. Reddy Problem: Lack of searchable literature existing regarding size, location, degree of orbital wall and floor traumatic defects. Purpose: In this retrospective study, maxillofacial computed tomography studies were evaluated in patients e-226
Two-plate fixation of mandibular angle fracture along Champy’s line with Contra-angle handpiece S. M. Oh: Hallym University College of Medicine Sacred Heart Hospital, B. E. Yang, J. Y. Kim, K. N. Park, I. H. Woo Purpose: In mandible angle fractures, one rigid fixation is sometimes not sufficient to fix the mandible. One rigid fixation requires an extended intermaxillary fixation period, and its resistance to distortion is not always satisfactory. In comparison, the use of two fixing plates can solve these problems. Materials and Methods: A total of 14 mandible angle fracture patients who visited the Department of Oral Surgery, Hallym University Sacred Heart Hospital between January 2011 and March 2013 were selected for this study. Open reduction and internal fixation were performed AAOMS 2014
Poster Session intraorally under general anesthesia. One fixing plate was attached to the mandibular oblique ridge, and another fixing plate was attached to the side of the mandibular corpus. For the approach to the lateral mandibular corpus, a specially prepared contra-angle drill and a driver were used. The radiologic outcomes, patients’ statements, and changes in the occlusal points were obtained and measured at baseline and at 2, 4, and 6 weeks postoperative. Results: The mean operative time was 85.3 minutes. The number of occlusal points increased postoperatively compared with the baseline. The subjective comfort level of the patients on occlusion increased, but it did not reach the level prior to their trauma. Conclusion: The procedure of using two fixing plates in mandibular angle fracture (MAF) provides patients with the advantage of early mandibular exercise without an extended intermaxillary fixation period. In addition, this method can reduce patient discomfort and can make the procedure simple. References: 1. Deng X, Wan Z, He SS, et al. [The centric relation-maximum intercuspation discrepancy in adult angle’s class II pretreatment patients]. Hua Xi Kou Qiang Yi Xue Za Zhi 2011;29:48-52 2. Seeman R, Schicho K, Wutzl A, Koinig G, Poeschl WP, Krennmair G et al. Complication rates in the operative treatment of mandibular angle fractures: a 10-year retrospective. J Oral Maxillofac Surg 2010;68:647-50
POSTER 312 Rapid Maxillary Expansion with the custom-made palatal anchorage: a case report K. N. Park: Hallym University College of Medicine Sacred Heart Hospital, S. M. Oh, J. Y. Kim, B. E. Yang Background: Rapid Maxillary expansion(RPE) with the tooth-born appliance is not sufficient to apply to the patients with periodontal problem or insufficient tooth anchorage, and it leads to tipping of the anchorage teeth and increasing teeth mobility and root resorption. To avoid these disadvantages, we present the case using palatal screws and custom-made Hyrax. Material and Method: A patient underwent surgically assisted rapid maxillary expansion with the Hyrax expansion using 4 screws. The study models were used to measure the pre-/-post surgical width of the anterior and posterior dental arches with a digital sliding caliper. Results: The custom-made hyrax is suitable for delivering a force to the mid-palatal suture expansion. And it is low cost, small sized and simply applied. Conclusion: The results indicated that maxillary expansion with the custom-made palatal anchorage device is predictable and stable technique without significant complications in patients. AAOMS 2014
References: 1. Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism. J orthod Dentofacial Otho p2010; 137:830-9) 2. Application of a new viscoelastic finiteelement method model and analysis of miniscrew-supported hybrid hyrax treatment. Am J Orhthod Dentofacial Orthop 2013;143:426-35)
POSTER 313 Diagnosis in Treatment of Fractures of the Atrophic Mandible. A Case Series A. E. Manlove: Case Western Reserve University School of Dental Medicine, A. Flores-Hidalgo, M. P. Horan, K. Schneider, F. A. Quereshy, D. A. Baur This study was conducted to evaluate patients that underwent surgical treatment for fractures of the atrophic mandible following the protocol used by Ellis and Price which is open reduction and internal fixation with immediate bone grafting. Patients treated for atrophic mandibles were seen in a 7-year time period in the Oral and Maxillofacial Surgery Department at Case Western Reserve University (Cleveland, OH) and associated hospitals. Patient inclusion criteria include mandibular bone less than 20mm in height, complete mandibular edentulism, and unilateral or bilateral fractures of the mandible due to pathology or trauma. The patients were classified using the Luhr Classification (Class I bone height is 16 to 20mm, Class II bone height is 11 to 15mm and Class III with a bone height of 10mm or less). Electronic as well as film radiographs were used to determine the bone height and the location of the fracture. Patient information (including age, sex, DOB and MRN) was obtained from the Oral and Maxillofacial Surgery Department at Case Western Reserve University patient data base. A total of 8 patients (age range 57-94 years) fit inclusion criteria, presenting preliminary results. All patients had systemic morbidities including HTN, which was the most common between the patients along with anxiety and depression. Two of the eight patients had osteoarthritis and one patient received radiation therapy for breast cancer. Five of the patients presented with bilateral fractures of the mandible and the other 3 presented with unilateral fractures of the mandible, one of which was a non-union. Mandibular bone height in the fracture line was measured and patients were classified using Luhr Classification. Three patients were Luhr Class III, 3 were Luhr Class II and the remaining 2 patients were Luhr Class I. All fractures were approached with an apron incision to the neck staying below the level of the platysma. The mandibular fractures were reduced and fixated with titanium plates and screws. In 6 of the 8 cases, autogenous bone was harvested from the anterior iliac crest to augment e-227