• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.32 no.1
• /
• pp.43-48
• /
• 2010

The mandibular condyle fracture occurs at 15-30% frequency of whole mandibular fracture. The treatment of choice is open reduction or closed reduction. In many cases, closed reduction is preferred for treatment of condylar fracture because it is hard to approach to condyle and there is risk of surgical complications, such as nerve damage in open reduction. Open reduction, however, has some advantages like possibility of anatomical reduction, occlusal stability and rapid functional recovery. Furthermore, it is possible to retain original ramal heights and to decrease deviation during mouth opening. There are many surgical approaches for open reduction of subcondyle fracture. At present, transoral approach using trochar device is tried for effective and minimally invasive method for open reduction of subcondyle fracture. And the authors report the cases of reduction of subcondyle fracture with transoral approach using trochar device.

• Archives of Craniofacial Surgery
• /
• v.9 no.1
• /
• pp.12-16
• /
• 2008

Purpose: Closed reduction is most common treatment method for nasal bone fracture but it requires secondary correction operation commonly. For preventing secondary revision, we applied ultrasonography during closed reduction of nasal bone fracture and examined the result of operation. Methods: 80 patients were sorted into 2 groups, ultrasound-guided closed reduction group(n=40) and manual closed reduction group(n=40). We classified the unilateral fracture involving lower 1/2 of nasal bone into type I, the bilateral fracture involving lower 1/2 of nasal bone into type III and the fracture of upper 1/2 of nasal bone into type III. The occurrence rate of overcorrection and undercorrection were evaluated by comparing preoperative and postoperative MDCT(Multi Direction Computed Tomography). Results: In manual closed reduction group, overcorrection were found in 4 patients and undercorrection were found in 3 patients. In ultrasound-guided closed reduction group, overcorrection was not observed and undercorrection was observed in 2 patients. Conclusion: Intraoperative ultrasound evaluation of nasal bone fracture resulted in reduced occurrence rate of secondary nasal deformities, showed easier detection of the fractured site and have superiority upon simple physical examination or simple x-ray.

• Archives of Craniofacial Surgery
• /
• v.10 no.2
• /
• pp.131-134
• /
• 2009

Purpose: Mandible fractures are common in maxillofacial trauma and the incidence of condylar fracture is high. The management of mandibular condylar fracture continues to be controversial. Conservative treatment of it may lead to complications such as asymmetry, malocclusion, temporomandibular joint dysfunction. Moreover, open reduction can cause facial nerve injury, parotid gland injury, scarring and hematoma formation. We present a case of mandibular condylar fracture that was treated by manual reduction without incision under C-arm fluoroscopy. Methods: A 76-year-old female was admitted due to left side mandibular condylar fracture that required surgical intervention. Because of her age, history of diabetes mellitus, hypertension, she underwent closed manual reduction under general anesthesia. We adopted C-arm fluoroscopy as a method of identifying the fracture site and a evaluation of reduction state. C-arm fluoroscopy was set up like modified Towne's view. Results: The reduction was successful and didn't result in any complications that could occur in open reduction-facial nerve injury, infection, parotid gland injury, hematoma, avascular necrosis. The mandibular-maxillary fixations were removed after 4 weeks and patients were could open 3.5 cm after 6 weeks with physical therapy. Conclusion: We tried closed manual reduction of mandibular condylar fracture due to high risk of complication using C-arm fluoroscopy and did achieve anatomic reduction with avoiding open incision. This is simple, effective, reversible, time saving and fairly attemptable method in condylar fracture cases before open reduction.

• Journal of Korean Dental Science
• /
• v.6 no.1
• /
• pp.4-12
• /
• 2013

Purpose: This study sought to verify the usefulness of mini-implant and surgical steel wire in the treatment of mandibular fracture through the objective identifi cation of the change of bone structure and bone density before and after reduction by evaluating radiological change through fractal analysis when mandibular fracture is treated using mini-implant and surgical wire. Materials and Methods: This study looked at 45 patients (males: 38, female: 7) diagnosed with mandibular fracture in the oral and maxillofacial surgery division of Chung-Ang University Dental Hospital and who received open reduction and intra-osseous fi xation. Result: The average fracture dimension values were higher for the group of the patients who had mini-implants and surgical wire treatment. Conclusion: Based on the results of the study on the usefulness of the reduction technique using mini-implant and surgical steel wire in the treatment of mandibular fracture through the fractal analysis method, the reduction technique using mini-implant and surgical steel wire is regarded as an effective method of minimizing the gap between mandibular fracture fragments.

• Archives of Plastic Surgery
• /
• v.32 no.1
• /
• pp.49-54
• /
• 2005

Evaluations and treatments of nasal bone fracture have been mainly focused on aesthetic aspect, but nose has an important role as an airway. The purpose of this study was evaluation of nasal bone fractures in the view of nasal obstruction and its improvement after reduction. Acoustic rhinometry was applied to the 77 nasal bone fractured patients who received closed reduction from August 2002 to July 2003 and received closed reduction. This was tested twice, before and 6 days after reduction, for all 77 patients and additional acoustic rhinometry was also possible in 26 patients after 6 months. The analysis of acoustic rhinometry were based on data of minimal cross-sectional area(MCA) according to fracture sites(one side, both side and tip) and septal displacement. Mean MCA for all cases before reduction was $0.43{\pm}0.21cm^2$, which was 19% decrease compared to normal adult data($0.53{\pm}0.12cm^2$). Depending on fracture sites the MCA were $0.45{\pm}0.16cm^2$ for one side fracture, $0.35{\pm}0.18cm^2$ for both side fracture, and $0.42{\pm}0.25cm^2$ for tip fracture. The patients with septal displacement showed more severe obstruction than ones without septal displacement, $0.26{\pm}0.26cm^2$ and $0.46{\pm}0.10cm^2$, respectively. The MCA was improved up to $0.50{\pm}0.22cm^2$ after reduction and showed slight decrease after 6 month($0.48{\pm}0.23cm^2$). Based on the results of this study, nasal bone fracture really caused airway obstruction(19% decrease). Both side fracture showed more profound decrease than one side fracture and septal displacement was an important parameter which causes nasal obstruction. Closed reduction improved MCA by 14% right after reduction, and 11% after 6 month follow up.

• Clinics in Shoulder and Elbow
• /
• v.19 no.1
• /
• pp.2-7
• /
• 2016

Background: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). Methods: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. Results: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. Conclusions: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.

• Archives of Craniofacial Surgery
• /
• v.14 no.2
• /
• pp.96-101
• /
• 2013

Background: Among facial fractures, nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture take a large portion. Among surgical operations for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture, closed reduction has been generally used but, unlike open reduction, there is a problem in evaluating its accuracy of reduction. Methods: An assessment was made from October 2011 until April 2013 prospectively on 37 patients. For all the operations, closed reductions were executed in a conventional way and simultaneously using C-Arm to verify the reduction of fractures. Two images of plain radiography, one taken before operation and another one taken one day after the operation, were compared. After obtaining images of plain radiography using C-Arm immediately after the correction upon operation, they were compared with the images of plain radiography taken one day after the operation. Results: The fracture reductions of 26 patients among 27 nasal fracture patients were satisfactory but one patient showed a marginal overcorrection of less than 1 mm. The fracture reductions of 7 patients among 8 zygomatic arch fracture patients were satisfactory but one patient showed a marginal undercorrection of less than 2 mm. All of two mandibular subcondyle fracture patients showed less than 2 mm undercorrection. Conclusion: Closed reduction guided by C-Arm for nasal bone fracture, zygomatic arch fracture and mandibular subcondyle fracture was clinically useful because it could make a real-time assessment on fractured areas and add immediate corrections during the operation.

• Archives of Craniofacial Surgery
• /
• v.21 no.1
• /
• pp.7-14
• /
• 2020

Background: It is difficult to completely fix nasal bone fractures with closed reduction, as it is often accompanied by septal cartilage damage, and this often results in postoperative secondary deformities. Thus, patients are often reluctant to undergo closed reduction surgery. The present study aimed to evaluate aesthetic and functional satisfaction, as well as satisfaction with and complications of closed reduction, according to nasal bone fracture type. Methods: The subjects were patients who underwent closed reduction under general anesthesia from January 2017 to December 2018. Based on the modified Murray classification, patients were classified into five groups according to the fracture site, septal fracture, and deviation. A total of 211 patients were sent a web-based survey on postoperative satisfaction and complications, as well as intention for revision and cosmetic surgery. Sixty-one patients (28.9%) responded. Results: There were no significant differences in aesthetic and functional satisfaction or satisfaction with closed reduction according to the fracture type, site, or severity. Postoperative functional complications developed in 14 of 61 patients (22.95%). With 10 out of 24 (41.67%) patients (p = 0.044), the bilateral fracture with septal fracture or prominent septal deviation type had a higher incidence of complications than the other types. Conclusion: The incidence of complications is higher for bilateral fracture with septal fracture or prominent septal deviation compared to the other nasal bone fracture types. Therefore, long-term follow-up after closed reduction surgery for this fracture type can aid in establishing additional postoperative treatment plans and improving patient satisfaction.

• Archives of Craniofacial Surgery
• /
• v.20 no.5
• /
• pp.284-288
• /
• 2019

Background: Closed reduction of nasal fracture with various instrument is performed to treat nasal fracture. Depending on the type of nasal fracture and the situation in which it is being operated, the surgeon will determine the surgical tool. The objective of this study was to investigate whether a periosteal elevator (PE) was a proper device to perform closed reduction for patients with simple nasal fractures. Methods: From March 2018 to December 2018, 50 cases of simple nasal bone fracture underwent closed reduction performed by a single surgeon. These patients were divided into two groups randomly: nasal bone reduction was performed using only PE (freer) and nasal bone reduction was performed using Walsham, Asch forcep, and Boies elevator (non-freer, non-PE). Results: The paranasal sinus computed tomography was performed on patients before and after operation to carry out an accurate measurement of reduction distance at the same level. According to the results, the interaction between instruments and fracture types had a significant influence on reduction distance (p = 0.021). To be specific, reduction distance was significantly (p= 0.004) increased by 2.157 mm when PE was used to treat patients with partial displacement compared to that when non-PEs were used. Conclusion: Closed reduction using PE and other elevator is generally an effective treatment for nasal fracture. In partial-displacement type of simple nasal fracture, closed reduction using PE can have considerable success in comparison with using classic instruments.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.36 no.6
• /
• pp.266-272
• /
• 2014

Purpose: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. Methods: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang's classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. Results: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. Conclusion: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.