• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.1
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• pp.35-41
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• 2006

It is well known that concentration of C-reactive protein(CRP) in the serum increase as nonspecific reaction of the various tissue injury. The CRP, synthesized in the hepatocyte, is one of 'acute phase proteins' in the serum. The main signal patterns of this protein are regulated by synthesis of interleukin-I secreted from macrophage in the area of tissue injury. Many studies were performed for quantitative analysis for CRP according to various surgical operation, but the study for fracture patients associated with trauma, especially in mandible, are rare. The mandible fracture have intrinsic danger for infection in oral bacteria associated with open wound in oral cavity, and, are difficult for detection of tissue reaction between surgical swelling and infection by facial swelling. In this study, quantitative analysis for CRP associated tissue injury in mandibular fracture and surgical intervention was done, the results were as follows: 1. After initial mandibular trauma, the value of serum CRP diminished sequentially, most high value was presented in post-traumatic 2 days. 2. The CRP was diminished significantly 2 days after surgical intervention, and maintained normal value in 5 days after surgery. 3. The change of CRP are higher value in surgical intervention than initial trauma, it suggested that tissue injury from surgery was severe than trauma. 4. The high value of CRP was obtained in mandibular fracture combined soft tissue injury than no associated soft tissue injury. 5. In measurement of CRP according to surgical approach, highest serum value in patients of combined intra-oral and extra-oral approach was showed, and intra-oral approach, extra-oral approach, in sequential orders. 6. The CRP value are more higher in patient of 2 fracture site than only one fracture site. From the results obtained in this study, CRP has showed different values in mandibular fracture associated with severity of tissue injury and surgical intervention, and quantitative analysis of CRP value in serum can be applied to the clinical management of mandibular fracture.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.370-375
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• 2019

Background: Some parts of a maxillary fracture-for example, the medial and posterior walls-may remain unreduced because they are unapproachable or hard to deal with. This study aimed to investigate the self-healing process of unreduced maxillary membranous parts of fractures through a longitudinal computed tomography (CT) analysis of cases of unilateral facial bone injuries involving the maxillary sinus walls. Methods: Thirty-two patients who had undergone unilateral facial bone reduction surgery involving the maxillary sinus walls without reduction of the medial and posterior walls were analyzed in this retrospective chart review. Preoperative, immediate postoperative, and 3-month postoperative CT scans were analyzed. The maxillary sinus volume was calculated and improvements in bone continuity and alignment were evaluated. Results: The volume of the traumatized maxillary sinuses increased after surgery, and expanded significantly by 3 months postoperatively (p< 0.05). The significant preoperative volume difference between the normal and traumatized sides (p= 0.024) resolved after surgery (p> 0.05), and this resolution was maintained at 3 months postoperatively (p > 0.05). The unreduced parts of the maxillary bone showed improved alignment and continuity (in 75.0% and 90.6% of cases, respectively), and improvements in bone alignment and bone continuity were found to be correlated using the Pearson chi-square test (p= 0.002). Conclusion: Maxillary wall remodeling through self-healing occurred concomitantly with an increase in sinus volume and simultaneous improvements in bone alignment and continuity. Midfacial surgeons should be aware of the natural course of unreduced fractured medial and posterior maxillary walls in complex maxillary fractures.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.181-186
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• 2008

Purpose: Until now, many kinds of treatment modalities for facial bone fractures have been proposed. Among them, the semi-rigid fixation using miniplates has become the most popular procedure due to its simplicity and good clinical results. However, achieving anatomic reduction of bone fragments with miniplates may be difficult because of inadequate instrumentation for fracture fragment stabilization. We examined the use of inter-maxillary fixation screws or titanium screws tied with stainless steel wire to assist in positioning of fractured segment. Methods: We used this method for reduction in 50 cases of facial bone fractures. Inter-maxillary fixation screws or titanium screws tied with stainless steel wire were used to assist in aligning bony segment. Postoperative radiologic and clinical follow-ups were performed.Results: Radiologic follow-up showed correct reduction and fixation in all cases. Nonnunion and malunion were not shown. Clinical follow-up showed an satisfactory results. Conclusion: By using Inter-maxillary fixation screws tied with stainless steel wire, it was shown that reducing the bony segment to their preinjury position is easy to perform and it enables us to make more accurate reduction, ensure wider visual field.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.17 no.3
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• pp.264-276
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• 1995

This is a clinical and retrospective study on the patients with oral and maxillofacial trauma. This study was based on a series of 917 patients were treated as in-patients, at Chon-buk National University Hospital, during the period of Jan., 1989 through Dec., 1993. The results obtained were as follows : 1. The ratio of men to women were 3.59 : 1 in oral and maxillofacial injuries, 3.92 : 1 in facial bone fractures, and 3.18 : 1 in soft tissue injuries. 2. The oral and maxillofacial injuries occurred most frequently in the third decade(32.2%), and fourth, second, fifth decade in orders. 3. The major etiologic factors were traffic accident(57.4%) and fall-down(17.1%), interpersonal accident(16.6%), and industrial accident were next in order of frequency. 4. The incidence of facial bone fracture was 72.1%, soft tissue injury 58.8%, and dental injury 40.5%. 5. The most common site of fracture were mandible(62.9%) and maxilla(19.9%), zygoma and zygomatic arch(18.7%), and nasal bone(4.7%) were next in order of frequency. 6. The most common type of soft tissue injury was laceration(51.0%). The lesion of soft tissue injuries were mostly 1 or 2 lesions and deep.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.289-294
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• 2008

Purpose: The nasal bone fracture is known as the most common facial fracture. Several authors reported the classification of nasal bone fracture. Stranc classified the type of nasal fractures based on a pattern of impaction and level of injuries. Stranc classification proposed here is based on careful clinical observation and relates to both treatment and prognosis. The aim of this study is to determine any predictive value to the preoperative classification of nasal fracture, using the description by Stranc and Robertson. Methods: We reviewed 310 patients with nasal bone fracture treated at our hospital for last two years. Results: Lateral impact type of nasal bone fracture predominated more than frontal impact in the ratio of 2.3:1. The most common type of Stranc classification was lateral impact plane I(48.4%). Male predominated more than female in the ratio of 3:1. The most frequent age group was first decade(27.1%), second decade in frontal impact(30.5%), first decade in lateral impact (30.7%). The most common etiology was violence (31.3%) followed by slip down(21.3%), and traffic accident(18.1 %).The most common associated fracture was orbital(22.9%) followed by zygoma(10%), and maxilla (6.1%). The most common complication was septal deviation(20.0%) in frontal impact, and nasal deformity (26.0%) in lateral impact. The incidence of nasal deformity in lateral impact(26.0%) was more higher than frontal impact(15.8%) Conclusion: By assessing the pathomechanics and resultant degree of injury to the nasal skeleton, a better understanding of the treatment plan and prognosis was obtained. Using this information, satisfactory informed patient consent can be obtained.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.553-559
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• 2008

Purpose: The lateral orbital wall fractures have been previously classified by some authors. As there are some limitations in applying in their own classifications, we hope to present a refined classification system of the lateral orbital wall fracture and to identify the correlation between the specific type of the fracture and clinical diagnosis. Methods: The facial bone CT scans and medical records of 78 patients with the lateral orbital wall fractures were reviewed in a retrospective manner. The classification is based on the CT scan. In type I, the fracture and its segments are away from the lateral rectus muscle and in type II, they are next to or slightly pushing the muscle in axial CT scan. In type III, the fracture segments compress and displace the longitudinal axis of the muscle or the optic nerve in axial view of CT scan. Type IV fracture includes multiple fractures found around the orbital apex or optic canal in coronal view of CT scans of the type I and type II fractures. Results: The most common fracture pattern was type I(43.6%), followed by type IV(29.5%), type II(20.5%), and type III(6.4%). As diplopia and restriction of extraocular muscles were found in type I and II fractures, severe ophthalmic complications such as superior orbital fissure syndrome, orbital apex syndrome, and traumatic optic neuropathy were found in type III and IV fractures almost exclusively. Conclusion: We propose an easy classification system of the lateral orbital wall fracture which correlates closely with ophthalmic complications and may help to make further treatment plan. In Type III and IV fractures, severe ophthalmic complications may ensue in higher rates, so early diagnosis and treatment should be performed.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.4
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• pp.255-263
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• 2011

Introduction: Maxillomandibular fixation (MMF) is essential before surgery under general anesthesia in maxillofacial trauma patients. MMF is used basically to reconstruct the occlusion and occlusal stability to recover the facial shape and oral functions. The arch bar and wire is a traditional method for MMF, but it can not only bring pressure to the periodontal ligaments and teeth but also cause a penetrating injury to the surgeons. Materials and Methods: In this study, 198 patients with an open reduction using a manual reduction without MMF from September 2005 to May 2010 in Dankook University Dental Hospital were subjected to a follow-up evaluation during the postoperative 4 months periods. This study evaluated the incidence of complications according to the condition of the patient (gender, age), the state of bony union of the fracture sites and a numeric rating scale evaluation for postoperative pain scoring. Results: 1. The complications were classified into major and minor according to the seriousness, and the major complication rate was as low as 2.02%. Only 2 cases of re-operations (1.01%) were encountered. In the classification according to the fracture line, plate fracture was observed in both cases of mandibular symphysis fracture, and angle fractures and loosening of two screws were noted in the case of mandibular angle fracture. 2. The complication rate was similar regardless of gender and age. 3. The degree of bony union was satisfactory, and the complication rate was reduced as the bony union improved. 4. More patients complained of pain as the operation time was increased. Conclusion: The use of MMF is not always necessary if a skilled assistant is provided to help manually reduce the fracture site. Compared to other studies of mandibular fracture surgery using MMF, the complication rate was similar using only manual reduction and the patients' discomfort was reduced without MMF.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.270-276
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• 2001

The treatment of mandibular subcondylar fractures is a matter of controversy. The majority of mandibular subcondylar fracture are treated by closed reduction, but the displaced or dislocated mandibular subcondylar fractures may be treated by open reduction. The characteristics of open reduction are the anatomical reduction, the functional restoration, the rapid function, the maintenance of vertical ramus dimension, the better appearance and the less resultant TMJ problem etc. When an open reduction is considered, the wire, miniplate, lag screw and Kirschner wire are available with internal fixation. Of these, Kirschner wire is a simple method relatively and correct positioning of the wire achieves rigid fixation. But many open reduction methods for mandibular subcondylar fractures require extraoral approach. The extraoral approach has some problems, the facial scar and the risk of facial nerve injury. On the other hand, the intraoral approach eliminates the potency of the facial scar and the facial nerve injury, but is difficult to access the operation site. Since the intraoral approach was first described by Silverman (1925), the intraoral approach to the mandibular condyle has been developed with modifications. The purpose of this article is to describe the intraoral technique with the Kirschner wire on mandibular subcondylar fractures. Conclusion : The intraoral reduction with Kirschner wire on mandubular subcondylar fractures avoids the facial scar and facial nerve injury and is simple method to the extraoral approach. And it has minimal morbidity and better esthetics.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.45 no.4
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• pp.192-198
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• 2019

Objectives: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. Materials and Methods: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. Results: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. Conclusion: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.1
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• pp.43-52
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• 2010

Purpose: To research about maxillofacial traumatic injuries of children in aspects of gender difference, various incidence rates between age, trauma type, cause, monthly and daily incidence rate, type of tooth damage, gingival damage, soft tissue damage, and type of facial bone fracture. Materials and methods: Study group consisted of children under 15 years of age who visited Dental Hospital, School of Dentistry, Kyung Hee University from 2004/7/1 to 2007/6/30 with chief complaint of oral and maxillofacial traumatic injuries. 1,559 cases of traumatic injuries were studied from 1,556 (1,004 male, 552 female) children. Conclusion: 1. There were slightly more boys than girls, giving a male-to-female ratio of 1.82:1.0. The 1-3 year old boys and girls had the highest number of traumatic injuries. 2. Of the 1,556 patients, 68.63% had soft tissue injuries, 50.22% had periodontal injuries, 29.89% had teeth injuries, and 3.85% had maxillofacial bone fractures. 3. Falling down was the most common cause of injury in both sexes. 4. The months with the highest incidence rates were in order May (12.12%), June (11.74%), and October (11.13%). Most of the injuries occurred on weekends. 5. The most common tooth injury was uncomplicated crown fracture, and the most common periodontal injury was subluxation. The majority of traumatizes teeth were the upper central incisors. 6. The most common soft tissue injury was intraoral lacerations. 7. Mandibular fractures were most frequent in facial bone fractures; symphysis, condylar head, and angle fractures were most frequent in mandibular fractures; maxillary and nasal bone fractures were most frequent in midfacial bone fractures.