• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.26.1-26.4
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• 2015

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

• Imaging Science in Dentistry
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• 제52권4호
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• pp.421-427
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• 2022

McCune-Albright syndrome (MAS) is a rare multisystem disorder characterized by a clinical triad of polyostotic fibrous dysplasia (FD), skin pigmentation, and hyperfunctioning endocrinopathies. A 42-year-old man visited our medical hospital for the treatment of intermittent headaches and was diagnosed with MAS with acromegaly. This patient showed various clinical features of MAS, including pituitary adenoma, polyostotic FD, and hypogonadotropic hypogonadism. The FD lesions showed characteristic radiographic features, such as widespread, sclerotic bony lesions in the cranial bones, mixed radiolucent-radiopaque multilocular lesions in the mandible, and radiolucent lesions in the axial and appendicular skeleton. Over the years, the patient had been hospitalized multiple times due to accidental bony fractures associated with the fragile bony state of FD. This report presents a retrospective description of a case of MAS, with a review of the relevant literature.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권6호
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• pp.544-549
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• 2009

Failure to use effective methods of reduction, fixation and immobilization may lead to osteomyelitis with the exposed necrotic bone, as the overzealous use of transosseous wires & plates that devascularizes bone segments in the compound comminuted fractures of mandible. Once osteomyelitis secondary to fractures has become established, intermaxillary fixation should be instituted as early as possible. Fixation enhances patient comfort and hinders ingress of microorganisms and debris by movement of bone fragments. Teeth and foreign materials that are in the line of fracture should be removed and initial debridement performed at the earliest possible time. Grossly necrotic bone should be excised as early as possible ; no attempt should be made to create soft tissue flaps to achieve closure over exposed bone. The key to treatment of chronic osteomyelitis of the mandible is adequate and prolonged soft tissue drainage. If good soft tissue drainage is provided over a long period, sequestration of infected bone followed by regeneration or fibrous tissue replacement will occur so that appearance and function are not seriously altered. Localization and sequestration of infected mandible are far better performed by natural mechanism of homeostasis than by cutting across involved bone with a cosmetic or functional defect. As natural host defenses and conservative therapy begin to be effective, the process may become chronic, inflammation regresses, granulation tissue is formed, and new blood vessels cause lysis of bone, thus separating fragments of necrotic bone(sequestra) from viable bone. The sequestra may be isolated by a bed of granulation tissue, encased in a sheath of new bone(involucrum), and removed easily with pincettes. This is a case report of the long-term conservative drainage care in osteomyelitis associated with mandibular fractures.

• 대한치과교정학회지
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• 제33권2호
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• pp.85-90
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• 2003

하악골 정중부 골절은 종종 폭경의 붕괴를 초래한다. 견인골 신장술을 이용한 폭경의 회복은 교합재건에 만족스런 결과를 유도한다. 편측성과 양측성 하악폭경이 붕괴된 환자에서 견인골 신장술을 적용할 때 벡터와 힘의 적용에서 차이를 보인다. 본 연구는 이러한 차이를 교정학적 관점에서 살펴보고자 한다.

• 대한두개안면성형외과학회지
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• 제21권6호
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• pp.384-386
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• 2020

This report describes osteotomy and iliac bone graft for malunion caused by failed mandibular fracture reduction. A 27-year-old man was referred 3 months after a motor vehicle accident. At another hospital, two operations had been performed for symphyseal fracture using two resorbable plates. Malocclusion was noted, and panoramic radiography and computed tomography revealed a misaligned dental arch, with a 9.37-mm gap between the central and the lateral incisor of the left mandible. A wafer was made from the patient's dental model, and a maxillary arch bar was applied. Through a lower gingivolabial incision, osteotomy was performed between the malunited symphyseal fracture segments. Both segments were reduced to their original position using the wafer and fixed with titanium miniplates via intermaxillary fixation (IMF). The intersegmental gap was filled with cancellous bone from the iliac crest. The gingival defect was covered with a mucosal transposition flap from the gingivolabial sulcus. IMF and the wafer were maintained for 5 and 9 weeks, respectively. At postoperative week 13, the screws were removed from the mandible and satisfactory occlusion was noted. His mouth opening improved from 2.5 to 3 finger breadths (40 mm). This case demonstrates the need for sufficient IMF when using resorbable plates.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권6호
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• pp.530-535
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• 2004

Objectives. The purpose of this study was to evaluate mandibular third molars as risk factors for angle fracture in a patient sample with fractured mandible. Materials and methods. The medical records and panoramic radiographs of 107 patients with mandibular fractures were examined. The presence and absence and degree of impaction of the lower third molar were assessed for each patient and related to the occurrence of fracture of the mandibular angle. Data were also collected for age, sex and mechanism of injury. Data were analyzed by a chisquare statistics and Student t test. Result. The incidence of mandibular angle fracture was found to be significantly greater when a lower third molar was present(p <0.05) especially at class III state.(p < 0.05)(by Pell & Gregory system) Of the 78 patients with a lower third molar, 46(58.97%) had angle fractures. Of the 29 without a lower third molar, 24(82.76%) had not angle fractures. Conclusion. The result of this study showed that the mandibular angle that have a lower third molar is more susceptible to fracture when exposed to an impact than an angle without an lower third molar.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제18권4호
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• pp.712-717
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• 1996

The term osteomyelitis literally means inflammation of bone marrow. It is described as an inflammatory condition of bone primarily engaging the medullary cavity extending to the periosteum. Following circulatory collapse and ischemia, the involved portions of the bone become necrotic. Cellulitis and osteomyelitis are the most frequent complications of fractures of the mandible and maxilla, because there is an abscessed tooth in the line of fracture. Since most fractures are compound fractures, infection may develop because of contact with oral secretions or outside air. The treatment of chronic osteomyelitis is still under debate. Some authors rely on antibiotics alone, while others advocate combination with surgery. But when infection occurs, establish proper drainage and administer antibiotics. Author treated a case of infected mandibular fracture with mandibular osteotomy, sequestrectomy, iliac bone graft and hyperbaric oxygen therapy, who had suffered suppurative osteomyelitis and mandibular nonunion following the open reduction of the mandibular fracture.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제35권1호
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• pp.51-54
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• 2013

Purpose: The purpose of this study is to evaluate the difference between open reduction and internal fixation (ORIF) and intermaxillary fixation (IMF) of mandibular fractures. Methods: A total of one hundred twenty-seven patients who were treated for mandibular fractures at Chosun University Dental Hospital, from January 2008 to December 2010, and analyzed their prognoses based on the use of IMF at the time of fracture reduction. The patients were divided into two groups; the manual reduction group without IMF and IMF group. Results: After reduction of the mandibular fracture, good results were obtained with majority patients. Nonetheless, seven patients (13.0%) in manual reduction method without arch bars or IMF, developed complications after surgery. Three patients underwent IMF due to occlusal instability after surgery, while one patient underwent re-operation. Thus, a significant difference was not observed between the IMF and manual reduction groups. Conclusion: Manual reduction and IMF at mandibular simple fracture could produce good results. In case of mandibular simple fracture, it was recommended with only manual reduction without IMF or IMF during a short period.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권2호
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• pp.87-95
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• 1989

하악골 과두골절의 치로에 대해서는 여러가지 술식이 문헌상 보고되었으나 어떤 특정한 술식이 모든 증례에 적용될 수는 없으므로 각 증례에 따라 방사선 사진검사와 세밀한 임상검사 및 술자의 판단등에 따라 보존적인 치료법이나 외과적 수술법이 적절하게 선택되어야 한다. 대부분의 과두골절은 보존적인 치료만으로 만족스러운 결과를 얻을 수 있으나 보존적 처치후 장기간에 걸친 술후 검사시 하악의 기능장애, 부정교합, 하악골의 이환측으로의 전위, 위관절증 및 악관절 강직등의 병발증이 나타날 수 있으므로 골편이 심하게 전위된 경우나 무치악 환자, 구치부 고경유지가 어려운 환자 및 보존적 처치후 기능장애를 초래한 골편의 부정유합이나 비유합 환자에서는 관혈적 정복술로 보다 양호한 결과를 얻을 수 있다. 저자는 하악골 과두골절시 골편전위가 비교적 심한 6증례에서 악하부 피부절개를 통해 통상의 금속선 고정법, Kirschner 금속선을 이용한 고정법을 각 1예씩 사용하였고 4예는 골절선이 비교적 높아 통상의 수술방법으로 접근이 용이하지 않아 시상골절단과 사선골절단술을 이용하여 골편정복과 고정술을 시행하여 다소의 지견을 얻어 이에 보고하는 바이다.

• Archives of Plastic Surgery
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• 제32권6호
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• pp.739-743
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• 2005

Subcondylar fractures have generally been treated by intermaxillary fixation except in cases where there is an absolute indication for open reduction. The reason behind a less aggressive surgical approach lies on the inherent difficulties in manipulating fragments in such a small area at the risk of damaging facial nerves or vessels such as the internal maxillary artery. However, long-term follow-up studies showed that conservative treatment of subcondylar fractures results in disturbances of occlusal function, deviation of the mandible, internal derangement of the temporomandibular joint, and ankylosis of the joint. We carried out open reduction of dislocated subcondylar fractures in 14 patients from 2000 to 2004 by a retromandibular approach. After the reduction of fractured bone, two H-shaped miniplates with 6 holes were fixed with screws at the anterior and posterior surfaces of the subcondyle. The retromandibular approach allowed good access and easy manipulation of the subcondyle. Immediate relief from malocclusion and correction of mandibular midline shifting were observed in all patients. Late temporomandibular dysfunction and ankylosis were not observed. Open reduction with plate osteosynthesis made it possible to avoid IMF in 7 of the 14 patients. The present study shows that open reduction through this retromandibular approach can produce good outcome in adult patients with subcondylar fracture.