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Use of titanium dental implants as an integrated part of a CLP protocol
96
CURRENT LITERATURE
day 10 combined with HBO impaired any beneficial effect that had been seen in any previous studies with HBO treatment.-K. BENSON Reprint Biology, mark.
requests Institute
to Dr Quirinia: Department of Connective Tissue of Anatomy, University of Aarhus, Aarhus, Den-
Use of Titanium Dental Implants as an Integrated Part of a CLP Protocol. Lilja J, Yontcher E, Friede H, et al. Stand J Plast Reconstr Hand Surg 32:213, 1998 Cleft lip and palate (CLP) patients present many challenges to the surgical team for management, not the least of which is edentulousness in the alveolar cleft area. Often times the lateral incisor is missing or extensively malformed, requiring extraction, This presents a unique restorative question with many options. It is possible with early bone grafting to allow the permanent canine to erupt close to the central incisor and achieve a satisfactory arch with orthodontics, but in 10% to 50% of patients this is not possible. The edentulous area in these patients were formerly addressed with fixed bridge construction, often with suboptimal results. Fortunately, with the advent of titanium implants, restoration of the edentulous area in CLP patients has become Increasingly more reliable and predictable. In this study, Lilja et al took 16 CLP patients, 11 men and 5 women, all previously operated in infancy according to the CLP protocol and divided them into two groups: group I consisted of six patients who did not require additional bone grafting and group II consisted of the remaining 10 patients who did require additional bone grafting before Iixture installation. Using the implant protocol developed by Professor Bratremark, the authors garnered excellent results with 29 of 31 fixtures becoming osseointegrated to give a 93% success rate. Interestingly, the two nonintegrated fixtures were from group II leading the authors to conclude there is an increased risk for nonintegration when grafting is performed before the fixture is installed, but excellent results can still be obtained and expected. The authors believe this technique of implantation should become routine in cleft centers and become integrated in the CLP treatment protocol -R. DORIOT
use ceftazidime in the treatment of severe chronic otitis media in conjunction with surgical therapy.-J. BROKLOFF Reprint Avenue
requests to Dr Begue: Hospital des Infants, A. Trosseau, du Docteus Arnold Netter, 75012 Paris Cedex, France.
26,
A Clinical Evaluation of the Long-Term Outcome of Patients Treated for Bilateral Fractures of the Mandibular Condyles. Newman L. Br Oral Maxilliofac Surg 36: 176, 1998 Mandibular fractures are very common traumatic fractures of the face and about 35% of these fractures are of the mandibular condyle. Condylar fractures are classified as either intracapsular, condylar neck, or subcondylar. Most condylar fractures are treated with closed reduction and have subsequent good outcomes; however, the author here notes that results can be suboptimal with regard to occlusion secondary to underestimating the severity of fracture. Open reduction internal fixation (ORIF) of condylar fractures has increased to establish better anatomic relationships. The author’s objective was to examine the long-term outcome of treatment for patients with bilateral condylar fractures. Sixty-one patients had bilateral condylar fractures and fit inclusion criteria; only 33 attended review. Thirtynine patients were treated with closed reduction, 9 patients with ORIF and 13 treated conservatively. The most common complaint after treatment was limitation in mouth opening. The ORIF group maximum vertical opening mean value was 44 mm and intermaxillary fixation mean was 28 mm. No patients were troubled with clicking, pain, or deviation with opening. No reports of facial nerve injury or facial scars were included for the ORIF group. The author concludes that the retromandibular approach to the fractured condyle for ORIF should be considered because it is suited for miniplate applications. It is also pointed out that any condylar fracture has potential to telescope regardless of degree of displacement. Because patients with ORIF had a significantly lower degree of limitation of opening compared with closed reduction, the author suggests the ORIF is appropriate in bilateral condylar fractures for at least one condyle regardless of the degree of dislocation.-K. BENSON
Reprint requests to Dr Lilja: Department of Plastic Surgery, Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden.
Reprint requests to Dr Newman: Surgery, The QueenVictoria Hospital, RH19 3D2, United Kingdom.
Department of Maxillofacial East Greinstead, West Sussex,
Penetration of Ceftazidime Into Middle Ear Fluid in Children With Effusion. Begue P, Garabedian EN, Bertrand C, et al. Laryngoscope 108:662,1998
Initial Evaluation and Management of Gunshot Wounds to the Face. Demetriades D, Chahwan S, Gomez H, et al. J Trauma 45:39, 1998
Chronic otitis media is a childhood infection commonly caused by gram-negative organisms such as Pseudomonas aeruginosa. Early antibiotic treatment and surgical drainage can reduce the risk of permanent ear damage and other complications such as mastoiditis or suppurative otitis media. This study was an examination of 25 pediatric patients with chronic otitis media who were given intravenous ceftazidime 50 mg/kg before bilateral myringotomy with insertion of tympanoplasty tubes. Concentrations of ceftazidime were measured in middle ear fluid at specific time intervals throughout the outpatient treatment course. Mean peak concentrations occured 30 to 90 minutes after the injection and reached a peak concentration of 11 to 14 mg/dL. These concentrations in middle ear fluid exceed the minimum inhibitory concentrations of most gram-negative pathogens, including Paeruginosa, and thus support the
Patients that present to the trauma center with a gunshot wound (GSW) to the face exhibit common sequella because of the extensive force and penetrating nature of the projectile. This study attempts to identify these diagnostic and therapeutic problems during the initial treatment phase and recommends management guidelines for these injuries. The data was collected retrospectively over a 4-year period and contained 247 GSWs to the face or 6% of all GSW admitted. On admission, 93 patients had isolated injuries to the face. The other 154 patients had concomitant injuries to the extremities (90 patients), chest (48 patients), abdomen (49 patients), and the head (24 patients). Twenty four patients had both abdominal and chest trauma while 28 patients had chest or abdominal trauma with associated extremity injuries. Of the patients with isolated GSW to the face, only 7 of 93 were in shock on admission, comprising a fraction of the
CURRENT LITERATURE
day 10 combined with HBO impaired any beneficial effect that had been seen in any previous studies with HBO treatment.-K. BENSON Reprint Biology, mark.
requests Institute
to Dr Quirinia: Department of Connective Tissue of Anatomy, University of Aarhus, Aarhus, Den-
Use of Titanium Dental Implants as an Integrated Part of a CLP Protocol. Lilja J, Yontcher E, Friede H, et al. Stand J Plast Reconstr Hand Surg 32:213, 1998 Cleft lip and palate (CLP) patients present many challenges to the surgical team for management, not the least of which is edentulousness in the alveolar cleft area. Often times the lateral incisor is missing or extensively malformed, requiring extraction, This presents a unique restorative question with many options. It is possible with early bone grafting to allow the permanent canine to erupt close to the central incisor and achieve a satisfactory arch with orthodontics, but in 10% to 50% of patients this is not possible. The edentulous area in these patients were formerly addressed with fixed bridge construction, often with suboptimal results. Fortunately, with the advent of titanium implants, restoration of the edentulous area in CLP patients has become Increasingly more reliable and predictable. In this study, Lilja et al took 16 CLP patients, 11 men and 5 women, all previously operated in infancy according to the CLP protocol and divided them into two groups: group I consisted of six patients who did not require additional bone grafting and group II consisted of the remaining 10 patients who did require additional bone grafting before Iixture installation. Using the implant protocol developed by Professor Bratremark, the authors garnered excellent results with 29 of 31 fixtures becoming osseointegrated to give a 93% success rate. Interestingly, the two nonintegrated fixtures were from group II leading the authors to conclude there is an increased risk for nonintegration when grafting is performed before the fixture is installed, but excellent results can still be obtained and expected. The authors believe this technique of implantation should become routine in cleft centers and become integrated in the CLP treatment protocol -R. DORIOT
use ceftazidime in the treatment of severe chronic otitis media in conjunction with surgical therapy.-J. BROKLOFF Reprint Avenue
requests to Dr Begue: Hospital des Infants, A. Trosseau, du Docteus Arnold Netter, 75012 Paris Cedex, France.
26,
A Clinical Evaluation of the Long-Term Outcome of Patients Treated for Bilateral Fractures of the Mandibular Condyles. Newman L. Br Oral Maxilliofac Surg 36: 176, 1998 Mandibular fractures are very common traumatic fractures of the face and about 35% of these fractures are of the mandibular condyle. Condylar fractures are classified as either intracapsular, condylar neck, or subcondylar. Most condylar fractures are treated with closed reduction and have subsequent good outcomes; however, the author here notes that results can be suboptimal with regard to occlusion secondary to underestimating the severity of fracture. Open reduction internal fixation (ORIF) of condylar fractures has increased to establish better anatomic relationships. The author’s objective was to examine the long-term outcome of treatment for patients with bilateral condylar fractures. Sixty-one patients had bilateral condylar fractures and fit inclusion criteria; only 33 attended review. Thirtynine patients were treated with closed reduction, 9 patients with ORIF and 13 treated conservatively. The most common complaint after treatment was limitation in mouth opening. The ORIF group maximum vertical opening mean value was 44 mm and intermaxillary fixation mean was 28 mm. No patients were troubled with clicking, pain, or deviation with opening. No reports of facial nerve injury or facial scars were included for the ORIF group. The author concludes that the retromandibular approach to the fractured condyle for ORIF should be considered because it is suited for miniplate applications. It is also pointed out that any condylar fracture has potential to telescope regardless of degree of displacement. Because patients with ORIF had a significantly lower degree of limitation of opening compared with closed reduction, the author suggests the ORIF is appropriate in bilateral condylar fractures for at least one condyle regardless of the degree of dislocation.-K. BENSON
Reprint requests to Dr Lilja: Department of Plastic Surgery, Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden.
Reprint requests to Dr Newman: Surgery, The QueenVictoria Hospital, RH19 3D2, United Kingdom.
Department of Maxillofacial East Greinstead, West Sussex,
Penetration of Ceftazidime Into Middle Ear Fluid in Children With Effusion. Begue P, Garabedian EN, Bertrand C, et al. Laryngoscope 108:662,1998
Initial Evaluation and Management of Gunshot Wounds to the Face. Demetriades D, Chahwan S, Gomez H, et al. J Trauma 45:39, 1998
Chronic otitis media is a childhood infection commonly caused by gram-negative organisms such as Pseudomonas aeruginosa. Early antibiotic treatment and surgical drainage can reduce the risk of permanent ear damage and other complications such as mastoiditis or suppurative otitis media. This study was an examination of 25 pediatric patients with chronic otitis media who were given intravenous ceftazidime 50 mg/kg before bilateral myringotomy with insertion of tympanoplasty tubes. Concentrations of ceftazidime were measured in middle ear fluid at specific time intervals throughout the outpatient treatment course. Mean peak concentrations occured 30 to 90 minutes after the injection and reached a peak concentration of 11 to 14 mg/dL. These concentrations in middle ear fluid exceed the minimum inhibitory concentrations of most gram-negative pathogens, including Paeruginosa, and thus support the
Patients that present to the trauma center with a gunshot wound (GSW) to the face exhibit common sequella because of the extensive force and penetrating nature of the projectile. This study attempts to identify these diagnostic and therapeutic problems during the initial treatment phase and recommends management guidelines for these injuries. The data was collected retrospectively over a 4-year period and contained 247 GSWs to the face or 6% of all GSW admitted. On admission, 93 patients had isolated injuries to the face. The other 154 patients had concomitant injuries to the extremities (90 patients), chest (48 patients), abdomen (49 patients), and the head (24 patients). Twenty four patients had both abdominal and chest trauma while 28 patients had chest or abdominal trauma with associated extremity injuries. Of the patients with isolated GSW to the face, only 7 of 93 were in shock on admission, comprising a fraction of the