• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.33-36
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• 2009

Purpose: Fractures of the mandibular condylar area are common injuries that account for 29% to 40% of fractures of the facial bones and represent 20% to 62% of all mandibular fractures. Currently 3 main methods are being used in the treatment of mandibular subcondylar fractures: closed reduction; open reduction and internal fixation; Endoscopic reduction and internal fixation. Each method has its proponents and opponent as well as advantages and disadvantages, and indications for each vary among surgeons. There are six approaches of open reduction: submandibular, retromandibular, preaurilcular, postauricular, intraoral, transparotid approach. Among them, transparotid approach has been described for subcondylar exposure with dissection in the direction of facial nerve fibers to expose the bone through the parotid gland. This approach carries the risk of a parotid glandular fistula as well as facial nerve injury but has the advantage of being directly over the fracture site. We report safety and efficacy of surgical treatment using a transparotid approach for direct plating. Methods: A 43-year-old man sustained multiple facial bone fractures by driver traffic accident. Mandibular subcondyle was fractured and dislocated internally. We performed open reduction and internal fixation by transparotid approach. Fractured site was fixed by titanium mini plate & screw. We applicated arch bar for approximately 3 weeks. Results: Follow-up length was about 5months. Scar of surgical incision was indistinct, there was no symptoms and signs of facial nerve and parotid gland injury, and maximal mouth opening was measured 49.5 mm. Conclusion: Transparotid approach has high risks of facial nerve and parotid gland injury, but paradoxically it is the most effective technique in saving facial nerve. Open reduction and internal fixation of mandibular subcondylar fracture by transparotid approach with precise and versed procedure, best outcome can be expected.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.27 no.1
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• pp.32-38
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• 2005

The efficacy of bioresorbable fixation has recently been described in the osseosynthesis of the oral & maxillofacial region. However, a liitle data exist regarding the use of biodegradable plates and screws for the internal fixation of human mandible fractures. The purpose of this study is to analyze and compare the treatment of mandibular fractures by using a bioresorbable fixation system with conventional titanium system in human mandible fractures. eighteen patients constituted the bioresorbable fixation group and twenty-five patients constituted the titanium fixation group. Both groups underwent open reduction and internal fixation by use of a bioresorbable system or a titanium fixation system. Panoramic radiograph were obtained preoperatively, immediately postoperatively after reduction, at 6 months and at 12 months postoperatively. In the bioresorbable fixation group, complication(infection) occurred in 1 patient(5.6%) and was resolved by incision & drainage, plate removal and antibiotics without untoward sequelae. 2 patients(8.0%) experienced complications in the titanium fixation group and were treated using conservative treatment. There was no statistical difference in complication rates between two groups. Our data supported the use of bioresorbale plate fixation in mandibular fractures as a means of avoiding the potential and well documented problems with rigid titanium fixation systems. In conclusion, the bioresorbable fixation system provide a reliable and sufficient alternative to conventional titanium plate system.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.6
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• pp.631-635
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• 2007

Purpose: The classic technique for open reduction of subcondylar fractures is the submandibular approach. The aim of this study was to evaluate clinical result of retromandibular approach to displaced subcondylar fractures. Material and methods: During a period of 24months we perfomed a prospective study with a retromandibular approach in 23 patients with displaced subcondylar fractures. In this article we describe clinical result in 23 patients with follow ups for 3 months after surgery. Preoperatively all patients had malocclusion and radiology demonstrated displacement. Result: The retromandibularl approach for ORIF was good in all case. Mouth opening(M/O) was 49mm. Occlusion was good too. Permanent facial nerve palsy was not detected. Conclusion: Our findings indicate that the retromandibular approach is a safe technique for subcondylar fractures.

• The Journal of Advanced Prosthodontics
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• v.10 no.2
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• pp.155-162
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• 2018

PURPOSE. The aim of this study was to compare the fracture of implant component behavior of external and internal type of implants to suggest directions for successful implant treatment. MATERIALS AND METHODS. Data were collected from the clinical records of all patients who received WARANTEC implants at Seoul National University Dental Hospital from February 2002 to January 2014 for 12 years. Total number of implants was 1,289 and an average of 3.2 implants was installed per patient. Information about abutment connection type, implant locations, platform sizes was collected with presence of implant component fractures and their managements. SPSS statistics software (version 24.0, IBM) was used for the statistical analysis. RESULTS. Overall fracture was significantly more frequent in internal type. The most frequently fractured component was abutment in internal type implants, and screw fracture occurred most frequently in external type. Analyzing by fractured components, screw fracture was the most frequent in the maxillary anterior region and the most abutment fracture occurred in the maxillary posterior region and screw fractures occurred more frequently in NP (narrow platform) and abutment fractures occurred more frequently in RP (regular platform). CONCLUSION. In external type, screw fracture occurred most frequently, especially in the maxillary anterior region, and in internal type, abutment fracture occurred frequently in the posterior region. placement of an external type implant rather than an internal type is recommended for the posterior region where abutment fractures frequently occur.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.35-42
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• 2011

Purpose: Blow-out fractures can be reduced using various methods. The orbital reconstruction technique using a balloon under endoscopic control has advantages over other methods. However, this method has some problems too, such as postoperative follow-up, management of the balloon catheter, and reduction of the posterior orbital floor. Thus, we developed a simple, effective method for orbital floor reduction that involves molding and shaping the antral balloon catheter. Methods: A 0, 30, or $70^{\circ}$, 4-mm endoscope was placed though a two-point, 5-mm maxillary antrostomy. The balloon catheter is placed directly at the orbital apex to reconstruct the anterior shelf (spherical shape), while it is turned in a U-shape towards the anterior maxilla for the posterior shelf (elliptical shape). Orbital floor defects, compound or comminuted fractures are reconstructed with alloplastic materials through an open lid incision under the endoscopic control. Results: This technique was applied to ten patients with orbital floor fractures: five anterior shelf and five posterior shelf fracture, respectively. Four of the patients had zygomatico-orbital fractures, while the rest had isolated orbital floor fractures. Two patients were given porous polyethylene implants Synpor$^{(R)}$) and three underwent reconstruction with a resorbable mesh plate. No complication associated with this technique was identified. Conclusion: The freestyle placement and selection of a urinary balloon catheter under endoscopic control and the preoperative estimation of the volume enhanced the stabilization of the orbital contour. This method improves the adaptation of the orbital floor without the risk of injuring the surrounding orbital contents, dissecting blindly, or using sharp traction. One drawback of this method is the patient's discomfort from the catheter during treatment.

• Archives of Plastic Surgery
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• v.38 no.3
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• pp.263-272
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• 2011

Purpose: The human face is the most exposed part of the body, and in patients with simple or complex trauma from traffic accidents, industrial calamities, sports injuries, human assaults, and daily accidents, facial trauma occupies an important portion. The etiology of facial trauma vary on a society's economic, cultural, and environmental status. Methods: Regarding patients who were admitted from between the years 2000 to 2009 at the Hanyang University hospital, the authors studied how the changes in the economic status in the past 10 years of our country influences the incidence of facial bone fractures. Results: In this study, 1) The unemployment rate showed a strong negative relationship with the total number of inpatients with facial bone fractures, the number of male patients, the number of female patients, the number of patients with facial bone fractures caused by fall down, the number of patients who were admitted for shorter than 7 days, and the number of the facial bone fracture patients with their age in the twenties. 2) The consumer price index showed a strong positive relationship with the number of female patients, the number of patients who were admitted for shorter than 7 days, and the number of the facial bone fracture patients with their age in the teens and fifties. Conclusion: Looking at the results of correlation analysis and multiple regression analysis with economic indicators, the unemployment rate showed negative influence to the total number of inpatients with facial bone fractures, and the number of inpatients with facial bone fractures caused by fall down, with statistical significance.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.561-564
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• 2012

Nasal bone fractures are often accompanied by septal fractures or deformity. Posttraumatic nasal deformity is usually caused by septal fractures. Submucosal resection and septoplasty are commonly used surgical techniques for the correction of septal deviation. However, septal perforation or saddle nose deformity is a known complication of submucosal resection. Hence, we chose to perform septoplasty, which is a less invasive procedure, as the primary treatment for nasal bone fractures accompanied by septal fractures. During septoplasty, we used a bioabsorbable mesh as an internal splint. We used the endonasal approach and inserted the mesh bilaterally between the mucoperichondrial flap and the septal cartilage. The treatment outcomes were evaluated by computed tomography (CT) and the nasal obstruction symptom evaluation (NOSE) scale. The CT scans demonstrated a significant improvement in the septal deviation postoperatively. The symptomatic improvement rated by the NOSE scale was greater at 1 month and 6 months after surgery compared to the preoperative status. There were no cases of extrusion or infection of the implant. In cases of moderate or severe septal deviation without dislocation from the vomerine groove on the CT scan, our technique should be considered one of the treatments of choice.

• Journal of Veterinary Clinics
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• v.35 no.4
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• pp.137-140
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• 2018

A five-month-old toy poodle was referred for treatment of bilateral mandibular fractures. Preoperative skull and dental radiographs showed rostral mandibular fractures and permanent teeth that had not yet erupted. In addition to providing stability for the healing of fractures, it is very important to focus on restoring normal occlusion. The mandibular fractures were repaired using interdental wiring in a dentate area where the deciduous canines and fourth premolars were stable and could be used to anchor the interdental fixation. In the absence of an erupted permanent mandibular first molar, the modified Risdon wiring was performed using the deciduous mandibular fourth premolars as anchor teeth. An intraoral splint was placed on the mandibular teeth using self-curing composite resin. Five months after surgery, the patient had experienced no complications, and the permanent teeth had erupted normally. In this case, which involves a small-breed puppy with deciduous dentition, treatment with a wire-reinforced interdental splint using intact deciduous fourth premolar teeth as anchor teeth can be considered as a suitable method for rostral mandibular fracture restoration.

• Archives of Craniofacial Surgery
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• v.18 no.2
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• pp.92-96
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• 2017

Background: All nasal bone fractures have the potential for worsening of olfactory function. However, few studies have studied the olfactory outcomes following reduction of nasal bone fractures. This study evaluates posttraumatic olfactory dysfunction in patients with nasal bone fracture before and after closed reduction. Methods: A prospective study was conducted for all patients presenting with nasal bone fracture (n=97). Each patient consenting to the study underwent the Korean version of Sniffin' Sticks test (KVSS II) before operation and at 6 month after closed reduction. The nasal fractures were divided according to the nasal bone fracture classification by Haug and Prather (Types I-IV). The olfactory scores were compared across fracture types and between preoperative and postoperative settings. Results: Olfactory dysfunction was frequent after nasal fracture (45/97, 46.4%). Our olfactory assessment using the KVSS II test revealed that fracture reduction was not associated with improvements in the mean test score in Type I or Type II fractures. More specifically, the mean posttraumatic Threshold, discrimination and identification score decreased from 28.8 points prior to operation to 23.1 point at 6 months for Type II fracture with septal fracture. Conclusion: Our study has revealed two alarming trends regarding post-nasal fracture olfactory dysfunction. First, our study demonstrated that almost half (46.4%) of nasal fracture patients experience posttraumatic olfactory dysfunction. Second, closed reduction of these fractures does not lead to improvements olfaction at 6 months, which suggest that olfactory dysfunction is probably due to factors other than the fracture itself. The association should be further explored between injuries that lead to nasal fracture and the mechanism behind posttraumatic olfactory dysfunction.

• Archives of Craniofacial Surgery
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• v.21 no.5
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• pp.294-300
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• 2020

Background: Mandibular fractures are one of the most common types of facial fractures, the treatment of which can be delayed due to the severity of the trauma resulting in an increase of complications; thus, early evaluation of trauma severity at the time of visit is important. In South Korea, trauma patients are triaged and intensively treated in designated regional trauma centers. This study aimed to analyze the relationship between trauma severity and mandibular fracture patterns. Methods: A medical records review was performed on patients who visited the regional trauma center at our hospital for mandibular fracture between 2009 and 2018. Epidemiologic data and mandibular fracture patterns were analyzed and compared with the conventional facial injury severity scale (FISS). Results: Among 73 patients, 51 were classified as non-severe trauma patients and 22 as severe trauma patients. A higher trauma severity was associated with older age (odds ratio [OR], 1.164; 95% confidence interval [CI], 1.057-1.404) and lower risk was associated with fractures located in the angle (OR, 0.001; 95% CI, 0-0.022), condylar process (OR, 0.001; 95% CI, 0-0.28), and coronoid process (OR, 0.004; 95% CI, 0-0.985). The risk was lower when the injury mechanism was a pedestrian traffic accident (OR, 0.004; 95% CI, 0-0.417) or fall (OR, 0.004; 95% CI, 0-0.663) compared with an in-car traffic accident. Higher FISS (OR, 1.503; 95% CI, 1.155-2.049) was associated with a higher trauma severity. The proposed model was found to predict the trauma severity better than the model using FISS (p< 0.001). Conclusion: Age, location of mandibular fractures, and injury mechanism showed significant relationships with the trauma severity. Epidemiologic data and patterns of mandibular fractures could predict the trauma severity better than FISS.