• 제목/요약/키워드: maxillofacial injury

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Post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve in mandibular fracture: a prospective study

  • Yadav, Sunil;Mittal, Hitesh Chander;Malik, Sunita;Dhupar, Vikas;Sachdeva, Akash;Malhotra, Vijaylaxmy;Singh, Gurdarshan
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.42 no.5
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    • pp.259-264
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    • 2016
  • Objectives: We evaluated and recorded post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve (IAN) in mandibular fracture in order to identify associated risk factors. Materials and Methods: This was a prospective cohort study composed of 60 patients treated for mandibular fracture. The primary study variable was the change between the post-traumatic IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, fracture displacement, and treatment. Appropriate descriptive and bivariate statistics were computed. Results: Sixty patients with unilateral mandibular fracture reported within 24 hours of injury were evaluated over a one-year period. A post-traumatic neurosensory deficit was observed in 52 patients (86.7%), the percentage of which was reduced to 23.3% over the follow-up period. Abnormal postoperative neurosensory scores were significantly higher in angle fracture cases (33.3%) compared to body fracture cases (11.1%). When recovered and non-recovered neurosensory scores were compared by fracture location, 88.9% of body fracture cases showed significant recovery compared to 66.7% of mandibular angle fracture cases. Cases with less than 5 mm fracture displacement showed statistically significantly higher neurosensory recovery scores (90.6%) compared to those with more than 5 mm fracture displacement (60.7%). Conclusion: Use of a miniplate with mono-cortical screws does not play a role in increasing IAN post-traumatic neurosensory deficit. Early management can reduce the chances of permanent neurosensory deficit. Mandibular fracture displacement of 5 mm or more and fracture location were found to be associated with an increased risk of post-traumatic IAN neurosensory score worsening.

A retrospective analysis of mandibular fractures in Mewat, India

  • Malhotra, Vijay Laxmy;Sharma, Amita;Tanwar, Rajiv;Dhiman, Meenu;Shyam, Radhey;Kaur, Depinder
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.5
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    • pp.365-372
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    • 2021
  • Objectives: Mandibular fractures vary significantly with respect to epidemiological and demographic parameters among populations. To date, no study has evaluated these aspects of mandibular fractures in Nuh, Mewat, Haryana, India. To retrospectively analyze the incidence, age and sex distributions, etiology, anatomic distribution, occlusal status, treatment modality provided, and their correlation in patients who suffered isolated mandibular fractures. Materials and Methods: The records of maxillofacial injury patients who reported to the Department of Dentistry, SHKM Government Medical College from January 2013 to December 2019, were retrieved from our database, and necessary information was collected. The data collected were analyzed statistically using IBM SPSS ver. 21. Results: Totals of 146 patients and 211 fractures were analyzed. There were 127 males and 19 females with an age range of 3-70 years (mean age, 26 years). Road traffic accident (RTA) was the most common cause of fracture (64.4%), followed by fall (19.9%), assault (15.1%), and sports injury (0.7%). Of all patients, 42.5% had bilateral fractures, 31.5% had left side fracture, 21.2% had right side fracture, 3.4% sustained midline symphyseal fracture, and 1.4% had symphyseal fracture along one side of the mandible. Site distribution was as follows: parasymphysis (34.6%), angle (23.7%), condyle (20.4%), body (12.8%), symphysis (4.3%), ramus 2.4%, and dentoalveolar 1.9%. The most common facture combination was angle with parasymphysis (17.8%). Occlusion was disrupted in 69.2% patients. Closed reduction was the predominant treatment modality. Conclusion: The data obtained from retrospective analyses of maxillofacial trauma increase the understanding of variables and their outcomes among populations. The results of the present study are comparable to those of the literature in some aspects and different in others.

Management of maxillofacial injuries in bear mauling cases: a review of 20 cases

  • Kar, Indu Bhusan;Chopda, Prashant Dilip;Mishra, Niranjan;Sethi, Alok Kumar;Mahavoi, Bikas Ranjan
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.42 no.1
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    • pp.13-19
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    • 2016
  • Objectives: As the craniofacial and neck regions are prime areas of injury in bear attacks, the careful management of soft and hard tissue injuries and selection of reconstructive options is of the utmost importance. This study will review the incidence and patterns of bear mauling in eastern India reported to our department and the various modalities used for their treatment over a period of 7 years. It also documents the risks of infection in bear mauling cases and the complications that have occurred. Materials and Methods: Twenty cases were treated over the study period. Cases were evaluated for soft and hard tissue injuries including tissue loss and corresponding management in the craniofacial region. Cases were also evaluated for other associated injuries, organ damage and related complications. Results: Various modalities of treatment were used for the management of victims, ranging from simple primary repairs to free tissue transfers. Simple primary repairs were done in 75% of cases, while the management of the injured victims required reconstruction by local, regional or distant flaps in 25%. Free tissue transfers were performed in 15% of cases, and no cases of wound infection were detected in the course of treatment. Conclusion: Knowledge of various reconstructive techniques is essential for managing maxillofacial injuries in bear mauling cases. Modern reconstructive procedures like free tissue transfer are reliable options for reconstruction with minimal co-morbidity and dramatic improvement in treatment outcomes.

Three-dimensional intraoperative computed tomography imaging for zygomatic fracture repair

  • Peleg, Oren;Ianculovici, Clariel;Shuster, Amir;Mijiritsky, Eitan;Oz, Itay;Kleinman, Shlomi
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.5
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    • pp.382-387
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    • 2021
  • Objectives: Zygomatic complex (ZMC) fractures comprise up to 40% of all facial fractures. Misaligned bone fragments and misplaced fixation hardware traditionally detected postoperatively on plain radiographs of the skull might require re-operation. The intraoperative O-Arm (Medtronic, USA) is a three-dimensional (3D) computed tomographic imaging system. Materials and Methods: This retrospective single-center study evaluated the utility of O-Arm scanning during corrective surgeries for ZMC and zygomatic arch (ZA) fractures from 2018 to 2020. Three females and 16 males (mean age, 31.52 years; range, 22-48 years) were included. Fracture instability (n=6) and facial deformity (n=15) were the most frequent indications for intraoperative 3D O-Arm scan. Results: The images demonstrated that all fracture lines were properly reduced and fixed. Another scan performed at the end of the fixation or reduction stage, however, revealed suboptimal results in five of the 19 cases, and further reduction and fixation of the fracture lines were required. Conclusion: Implementation of an intraoperative O-Arm system in ZMC and ZA fracture surgeries assists in obtaining predictable and accurate results and obviates the need for revision surgeries. The device should be considered for precise operations such as ZMC fracture repairs.

Changes of Compound Muscle Action Potential in Short-term Steroid Therapy for Compression Injury of Rat Sciatic Nerve (백서 좌골신경의 압박손상에 대한 단기간 스테로이드 투여 시 복합근활동전위의 변화)

  • Kim, So-Hyun;Park, Kwang-Won;Baek, Joon-Seok;Jung, Tae-Young;Kim, Mee-Lee;Park, Sang-Jun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.35 no.1
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    • pp.25-30
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    • 2013
  • Purpose: Many surgical procedures in oral and maxillofacial area can induce trauma to the peripheral nerve. The aim of the study is to evaluate the effects of short-term steroid therapy on nerve recovery after crush injury. Methods: Sixteen rats were randomly divided into two groups. The right sciatic nerves were exposed, crushed, and sutured. The control group was not given steroids. The test group was injected with dexamethasone disodium phosphate (2 mg/kg body weight/day) for 7 days. In all animals, compound muscle action potential (CMAP) was recorded before and at 1, 7, 14, 21, and 28 days after injury. Results: The amplitude of the CMAP before and at 1, 7, 14, 21, and 28 days after injury were $53.20{\pm}4.80$ mV, $20.12{\pm}5.38$ mV, $30.01{\pm}14.15$ mV, $31.14{\pm}13.56$ mV, $31.73{\pm}16.33$ mV, and $37.23{\pm}16.98$ mV in the control group, and $55.25{\pm}6.72$ mV, $18.62{\pm}6.26$ mV, $29.50{\pm}13.06$ mV, $32.90{\pm}13.226$ mV, $30.17{\pm}11.80$ mV, and $38.41{\pm}12.27$ mV in the test group, respectively. The nerve conduction velocity was $18.82{\pm}3.94$ m/s, $16.73{\pm}3.48$ m/s, $19.60{\pm}2.45$ m/s, $18.68{\pm}3.94$ m/s, $18.02{\pm}3.51$ m/s, and $19.25{\pm}3.88$ m/s in the control group, and $18.94{\pm}3.48$ m/s, $17.28{\pm}2.53$ m/s, $7.57{\pm}2.54$ m/s, $18.77{\pm}2.12$ m/s, $19.48{\pm}1.55$ m/s, and $19.22{\pm}2.97$ m/s in the test group, respectively. There was no significant difference between both groups (P>0.05). Conclusion: This study did not show any therapeutic effect of short-term administration of steroids on injured rat sciatic nerve. Further studies are needed.

AN ELECTRON MICROSCOPIC STUDY ON THE COBALT-60 IRRADIATION EFFECTS ON THE SALIVARY GLAND OF THE WHITE RAT (Cobalt-60 방사선조사가 백서의 타액선에 미치는 영향에 관한 전자현미경적 연구)

  • Park Chang Seo
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.15 no.1
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    • pp.27-40
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    • 1985
  • This study was undertaken to observe the histopathologic changes in salivary gland of the white rats when exposed to megavoltage fractionated dose of cobalt-60 irradiation and 78 female white rats, weighing approximately 180gm, were divided into control and 3 experimental groups. Irradiation on experimental groups was delivered by using 6000 curies MeV ALCYON cobalt-60 teletherapy unit with exposure rate 183 rads per minute, in source skin distance 80cm, 600 rads every 3 days. In experimental groups, Group Ⅰwas irradiated of total dose 1200 rads for a period of 6 days, Group Ⅱ was irradiated of total dose 2400 rads for a period of 12 days and Group Ⅲ was irradiated of total dose of 4800 rads for a period of 24 days. The animals were sacrificed serially at 3 hours, 6 hours, 10 hours, 1st day, 4th day, 7th day after each completion of irradiation exposure. At sacrifice, salivary glands were excised and examined microscopically and electromicroscopically. The results were as follows: 1. The acinar cells of parotid and submaxillary gland showed damage varied with dose, 1200 rads resulted in very mild injury while 4800 rads caused most extensive injury. 2. The acinar cells of parotid and submandibular gland showed similar ultrastructural alterations, appeared as pleomorphic nucleus, decreased numbers and pleomorphism of secretory granules, distention of rough endplasmic reticulum, expansion and pallor appearance of mitochondria, and hypertrophy of Golgi complex. 3. Parotid serous cells were the most sensitive components, displaying morphological alterations of radiation damage as early as 3 hours, followed by submandibular seromucinous cells and secretory tubular cells. 4. The mucous cells of sublingual gland, as well as the whole ductal lining cells of each salivary gland, displayed no significant alterations. No evidence of microvascular injury through whole experimental groups indicated that microvascular impairment does not contribute to early salivary gland injury.

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Complications Related to Orthognathic Surgery (악교정 수술의 합병증)

  • Kim, Jin-Ha;Kim, Su-Gwan;Oh, Ji-Su
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.5
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    • pp.416-421
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    • 2010
  • Purpose: The purpose of this study was to evaluate the incidence of intra- and postoperative complications of orthognathic surgery and their relevance. Materials and Methods: The clinical records and X-rays of 418 patients who underwent surgery at Chosun University Dental Hospital, Korea, over a 12-year period between 1998 and 2009 were examined. Results: The followings are some of the most common complications which happened during the oper-ations: Inadequate osteotomy in 25 cases, excessive bleeding in 11 cases, nerve injuries in 6 cases, soft tis-sue injuries in 8 cases, and tooth injury, and insertion of foreign bodies in 4 cases respectively. The most frequent complications which happened after surgery are shown below. Paraesthesia in 262 cases, dyspnea in 78 cases, pain in cervical region in 49 cases, open bite in 14 cases, plus 62 cases where other complications occurred. Despite the great variety of complications, severe life threatening complication frequency seems to be extremely low. Conclusion: Orthognathic surgery appears to be a relatively safe procedure but complications related to orthognathic surgery do still occur. Accurate evaluation and precise surgery are needed to minimize complications.

Use of a Miniplate for Skeletal Anchorage in the Forced Eruption of a Severely Impacted Mandibular Second Molar: Case Report (Miniplate를 골격성 고정원으로 사용한 심도있는 매복 하악 제2대구치의 맹출 치료: 증례보고)

  • Lim, Jae-Sung;Yoon, Hyun-Joong;Lee, Sang-Hwa
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.33 no.2
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    • pp.185-189
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    • 2011
  • Tooth impaction represents the stop of eruption by clinical and radiographical disturbance in eruption path or the dislocation of tooth germ. The most common factor in tooth eruption disorders are spacial deficiency with other causes reported to be odontogenic tumors, periodontal ligament injury, etc. Impaction of the mandibular second molar is relatively rare and reported in about 3 out of 1,000 people. Because the second molars tend to erupt in a mesial direction, this situation can lead to serious problems if untreated, including dental caries, periodontal disease and root resorption of the first molar. Treatment of this problem includes, surgical repositioning and orthodontic forced eruption. Because each procedure have the definite advantages and disadvantages, and influenced by circumferential environment, these have limits for successfu1 recovery as independent treatment. In a case at St. Mary's Hospital, we performed successful correction of a horizontal impacted mandibular second molar using a miniplate skeletal anchorage system. We introduce this treatment as a valid method for an impacted second molar and consider a oromaxillofacial surgeon's role in tooth movement treatment.

ENDOSCOPE-ASSISTED REPAIR OF FACIAL BONE FRACTURES (내시경을 이용한 안면골 골절 수술)

  • Cho, Yeong-Cheol;Sung, Iel-Yong;Byun, Ki-Jung
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.29 no.2
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    • pp.174-181
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    • 2007
  • Today, endoscopic procedures are common in diagnostic and other surgical procedures, with endoscopically enhanced and magnified images permitting surgical access through minimal incisions. This has expanded the treatment options for many difficult anatomic sites, and the endoscope facilitated safe anatomic reduction and fixation. The use of the endoscope may reduce the disadvantages of open fracture repair and should be considered for broad application in the treatment of displaced facial bone fractures. Optical endoscopic magnification minimizes the disadvantages associated with open surgical repair, including the risk of facial nerve injury and external facial scarring, and no postoperative complications have been attributable to the endoscopic approach. This technique was used in 14 patients treated at Ulsan University Hospital, Korea, from September 2004 to August 2006, including six mandibular subcondyle fractures, five blowout fractures and three zygomaticomaxillary complex (ZMC) fractures. Careful preoperative evaluation and proper surgical technique were essential to achieve optimal results in the selected patients.

POSTAURICULAR APPROACH FOR SURGERY OF THE TEMPOROMANDIBULAR JOINT REGION (악관절부 수술에서의 후이개접근법에 대한 고찰)

  • Kim, Myung-Jin;Seo, Byoung-Moo;Kim, Jong-Won
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.12 no.2
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    • pp.82-87
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    • 1990
  • There are some methods of approach to the temporomandibular joint. The preauricular, the endaural and the postauricular incision are frequently used among those. The preauricular incision necessiates a preauricular scar, possible postopertive facial nerve damage and is the least cosmetically desirable incision. The endaural incision is more esthetic than preauricular incision, but it is not sufficient. The postauricular approach allows adequate exposure with decreased occurence of injury to facial nerve and excellent cosmetic results. The purpose of this report is to discuss the surgical approach of postauricular incision to the cases of TMJ ankyloses, internal derangement and condylar fracture of mandible.

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