Isolated fracture of the first rib associated with facial trauma

Isolated fractures of the first rib are rare and often, though not always, indicative of severe trauma. The causes of first rib fracture are various, as are the sometimes serious complications of such a fracture. Since the oral and maxillofacial surgeon is involved many times in the primary care of the trauma patient, he must consider the possibility of first rib fracture and be alerted to the possible sequelae.     

Mandibular fracture fixation and reconstruction using the lower-border threaded rod: an eleven-year follow-up study

Twenty-five cases in which a lower border threaded rod was used for fracture fixation and mandibular reconstruction were reviewed. These cases were performed during the last 11 years and have been followed for periods of up to five years and ten months. The fixation technique, originally reported in 1978, is well tolerated and provides excellent mechanical stability when enhanced security of fixation is indicated. Three unusual cases are reported in detail.     

Long-term donor site morbidity in head and neck cancer patients and its impact on quality of life: a cross-sectional study

Modern head and neck reconstructive surgery offers a multitude of different reconstructive options. In such cases, donor site morbidity is an important factor in the affected patient’s decision-making. The aim of this study was to perform an objective comparison of donor site morbidity for the five most frequent microvascular donor sites in head and neck reconstructive surgery (radial forearm, anterolateral thigh, fibula, iliac crest, and scapula) using a uniform testing system. In this cross-sectional study, 117 donor sites were analyzed (106 for malignant disease and 11 for non-malignant disease): 73 radial forearm, 14 scapula, 12 anterolateral thigh, 10 fibula, and eight iliac crest. Testing consisted of range of motion, muscle strength, and sensation. The non-affected side served as the control. Quality of life was assessed using the Washington Quality of Life Questionnaire version 4 in its German translation. Range of motion was restricted in 15 cases (12.8%). Muscle strength was decreased in 58 cases (49.6%). Sensation was reduced in 70 cases (60%). Concerning quality of life, 31.2% of patients were limited in their daily activities. The scapula flap showed the highest incidence of overall donor site morbidity. However, correlation between objective and subjective donor site impairment was weak and the majority of patients experienced only minor limitations.     

Comparison of postoperative skeletal stability of maxillary segments after Le Fort I osteotomy,using patient-specific implant versus mini-plate fixation

BackgroundThree-dimensionally (3D) designed osteotomies and customised osteosynthesis are rapidly becoming standard in maxillofacial reconstructive and deformity surgery. Patient-specific implants (PSIs) have been in use for a few years in orthognathic surgery as well. In Le Fort I osteotomy, wafer-free fixation of the maxillary segment can be performed by individually manufactured cutting and drill guides together with PSIs.AimThis retrospective study was performed to compare the postoperative skeletal stability of the maxillary segment fixed by patient-specific implants versus mini-plates after Le Fort I osteotomy.PatientsFifty-one patients were divided into subgroups according to the fixation method and the advancement of the sub-spinal point. The postoperative skeletal stability of the maxillary segment was evaluated from lateral cephalometric radiographs one year postoperatively.ResultsNo statistically significant differences were found between the postoperative skeletal stability of the PSI and mini-plate fixed maxillae. Prospective studies, possibly with 3D fusion analysis, are warranted to confirm the results.ConclusionThe choice between the two fixation methods does not seem to affect the postoperative skeletal stability of the maxillary segments.     

Effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients receiving radiotherapy with or without chemotherapy for oral cancer: a multicentre,phase II,randomized controlled trial

The aim of this phase II, multicentre, randomized controlled trial was to evaluate the effectiveness of a comprehensive oral management protocol for the prevention of severe oral mucositis in patients with oral cancer receiving radiotherapy alone or chemoradiotherapy. In total, 124 patients with oral cancer were enrolled from five institutions. Of these, 37 patients undergoing radiotherapy were randomly divided into an intervention group (n = 18) and a control group (n = 19). The remaining 87 patients, who were undergoing chemoradiotherapy, were also randomized into an intervention group (n = 42) and a control group (n = 45). During radiotherapy, patients in the control group received only oral care, while those in the intervention group additionally received spacers to cover the entire dentition, pilocarpine hydrochloride, and topical dexamethasone ointment for oral mucositis. The primary endpoint was the incidence of severe oral mucositis. The intervention was significantly associated with a decreased incidence of severe oral mucositis in patients receiving radiotherapy alone (P = 0.046), but not in those receiving chemoradiotherapy (P = 0.815). These findings suggest that an oral management protocol can prevent severe oral mucositis in patients with oral cancer undergoing radiotherapy without concurrent chemotherapy.     

Treatment of facial fractures in neurologically injured patients

The clinical records of 53 patients who had head injury and facial trauma were reviewed and analyzed to ascertain what affect head injury had on the repair of facial fractures. The study was designed to establish the incidence of complications and to discover what factors contributed to untoward sequela in such patients. It was found that the neurologically injured patient developed postoperative facial fracture complications, particularly in the mandible, more frequently than those facial trauma patients who were not neurologically compromised.     

The facial plethysmograph: a new instrument to measure facial swelling volumetrically

A critical review of methods used to evaluate postoperative facial swelling is presented. A new, noninvasive method using a feeler arm to trace and measure facial contours is described. The overall accuracy and reproducibility of this method was tested by measuring acrylic "mock swellings." The results suggest that the method was accurate to within 5% in measuring swellings of known volume. The reproducibility of replicate measures also showed a low level of error (3.3%). This device may provide a unique method for the systematic study of treatments designed to minimize postoperative facial swelling.     

Osteoarthritis of the temporomandibular joint: a light microscopic and scanning electron microscopic study of the articular cartilage of the mandibular condyle

The aim of this study was to investigate the organization of collagen fibrils and the histopathologic alterations as well as the morphologic aspects of osteoarthritic articular cartilage of the human mandibular condyle. Nine osteoarthritic condyles, three obtained at necropsy and the other six during surgery, were examined by light microscopy and scanning electron microscopy. Light microscopic observations revealed features of progressive and regressive remodeling and the presence of clefts. Scanning electron microscopic observations showed the presence of thick, coiled fibrils at the joint surface and numerous osmiophilic lipid globules scattered between the collagen fibrils. The collagen fibrils were disordered. It was concluded that collagen fiber network disintegration and fatty degeneration comprise the osteoarthritic changes of the articular cartilage of the human mandibular condyle.     

Subperiosteal onlay augmentation of the mandible: a clinical and radiographic survey

A five-year follow-up study of 26 patients who underwent subperiosteal onlay augmentation of the mandible using corticocancellous bone from the iliac crest is presented. An overall postoperative reduction in mandibular height of 44% was found. The different rates of resorption between the various suggested augmentation methods are discussed, and suggestions are given to prevent the rapid resorption that occurs during the immediate postoperative period.