• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.23 no.3
• /
• pp.217-225
• /
• 2001

Any fracture passing through the socket of a teeth is compounded intraorally, even if the fracture is not displaced and the tooth is firm in its socket. Before the advent of antibiotic therapy the danger of infection in a compounded fracture posed severe problems in treatment. Infection is reduced by antibiotic therapy but prolonged use of antibiotics is not justified in an attempt to save a tooth which might eventually be sacrificed. There is still controversy in the management of third molar in mandibualr angle fracture, particulary in regard to their retention or removal at the time of fracture treatment. So we surveyed the 159 patients who were treated with open reduction of mandibular angle fracture containing third molar in fracture line, and compared with the postoperative infection rate depending on time intervals between injury and operation, eruption state of third molar, non-extraction or extraction of third molar related to eruption state, non-extraction or extraction of third molar related to condiition of third molar and its surrounding periodontium and were to propose treatment guidline of third molar in mandibular angle fracture The results obtained were as follows : 1. There were no statistical significance between the time from injury to operation and postoperative infection. 2. There were no statistical significance between eruption state of third molar and postoperative infection. 3. In case of retention of the third molar, there were no statistical significance between eruption state of third molar and postoperative infection, but in case of extraction, postoperative infection was high rate in complete impacted cases. 4. There were no statistical significance between non-extraction or extraction of third molar and postoperative infection depending on condition of third molar. There are no difference in infection rate statistically according to the time from injury to operation, eruption state and condition of third molar, but retention of third molar revealed lowered infection rate in completely impacted cases. By terms of the manegement of third molar, we should extract or preserve third molar in the line of the mandibular angle fracture according to possibility of infection.

• Imaging Science in Dentistry
• /
• v.43 no.2
• /
• pp.105-109
• /
• 2013

Purpose: Preoperative radiographic assessment of the mandibular third molars is essential to prevent inferior alveolar nerve damage during extraction. The purpose of this study was to assess the reliability of panoramic signs of association between the roots of teeth and the canal, and to compare the panoramic signs with cone beam computed tomography (CBCT) findings. Materials and Methods: CBCT images of 132 impacted mandibular third molars were evaluated to determine the association of the root to the canal. The CBCT findings were compared with the corresponding panoramic images. Logistic regression analysis was used to define the diagnostic criteria of the panoramic images. Results: Among the panoramic signs, loss of the cortical line was the most frequent radiographic sign predicting association (sensitivity: 79.31). Contact of the tooth with the canal was observed in all cases in which the loss of cortical line of the canal or darkening of the roots was found on the panoramic radiographs. Conclusion: Darkening of the roots and loss of the cortical line on panoramic radiographs might be highly suggestive of the risk of nerve injury.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
• /
• v.24 no.2
• /
• pp.413-423
• /
• 1994

The purpose of this study was to clarify the spatial relationship in presurgical examination and to aid surgical planning and postoperative evaluation of patients with facial bone injury. For this study, three-dimensional images of facial bone fracture were reconstructed by computed image analysis system and three-dimensional reconstructive program integrated in computed tomography. The obtained results were as follows: 1. Serial conventional computed tomograms were value in accurately depicting the facial bone injuries and three-dimensional reconstructive images demonstrated an overall look. 2. The degree of deterioration of spatial resolution was proportional to the thickness of the slice. 3. Facial bone fractures were the most distinctly demonstrated on inferoanterior views of three-dimensional reconstructive images. 4. Although three-dimensional reconstructive images made diagnosis of fracture lines, it was difficult to identify maxillary fractures. 5. The diagnosis of zygomatic fractures could be made equally well with computed image analysis system and three-dimensional reconstructive program integrated in computed tomography. 6. The diagnosis of mandibular fractures could be made equally well with computed image analysis system and three-dimensional reconstructive program integrated in computed tomography.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.36 no.6
• /
• pp.273-279
• /
• 2014

Purpose: This study assessed the association between eye symptoms (enophthalmos or diplopia) and site of damage, volume, deviated inferior rectus muscle (IRM) and type of fracture with computed tomography (CT). The intent is to anticipate the prognosis of orbital trauma at initial diagnosis. Methods: Forty-five patients were diagnosed with fractures of the inferior wall of one orbit. Fracture area, volume of displaced tissue, deviated IRM, and type of fracture were evaluated from coronal CT by one investigator. The association of those variables with the occurrence of eye symptoms (diplopia and enophthalmos) was assessed. Results: Of 45 patients, 27 were symptom-free (Group A) and 18 had symptoms (Group B) of enophthalmos and/or diplopia. In Group B, 12 had diplopia, one was enophthalmos, and five had both. By CT measurement, group A mean area was $192.6mm^2$ and the mean volume was $673.2mm^3$. Group B area was $316.2mm^2$ and volume was $1,710.6mm^3$. The volume was more influential on symptom occurrence. Each patient was categorized into four grades depending on the location of IRM. Symptom occurrence and higher grade were associated. Twenty-six patients had trap-door fracture (one side, attached to the fracture), and 19 had punched-out fracture (both sides detached). The punched-out fracture was more strongly associated with symptoms and had statistically significantly higher area and volume. Conclusion: In orbital trauma, measurement of fracture area and volume, evaluation of the deviated IRM and classification of the fracture type by coronal CT can effectively predict prognosis and surgical indication.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.40 no.6
• /
• pp.272-277
• /
• 2014

Objectives: Non-vascularized iliac crest bone graft (NVIBG) is a known treatment option in mandibular reconstruction following jaw resection, but no documented review of patients treated with NVIBG exists for northern Nigeria. The experience and technique from a Nigerian tertiary hospital may serve as baseline data for comparison and improvement of practice for other institutions. Materials and Methods: A retrospective review of medical records and patient case files from January 2012 to December 2013 was undertaken. All case files and other medical records of patients who had reconstruction with NVIBG for benign or malignant lesions with immediate or delayed reconstruction were selected for review. Results: Twenty patients had mandibular reconstruction with NVIBG during the study period. Two patients were excluded because of incomplete medical records. Eighteen patients' (male=14, female=4) records were reviewed. Their ages ranged from 13 to 62 years (mean $26.0{\pm}10.6years$). Indications for NVIBG included jaw tumors (n=16; 88.3%), jaw cyst (n=1; 5.6%) and gunshot injury (n=1; 5.6%). Jaw tumors seen were ameloblastoma (n=15; 83.3%) and osteosarcoma (n=1; 5.6%). Treatments done were mandibular resection with condylar resection (n=7; 38.9%), mandibular segmental resection (n=10; 55.6%) and subtotal mandibulectomy (n=1; 5.6%). Patients' postoperative reviews and radiographs revealed good facial profile and continued bone stability up to 1 year following NVIBG. Conclusion: NVIBGs provide an acceptable alternative to vascularized bone grafts, genetically engineered bone, and distraction osteogenesis for mandibular reconstruction in resource-limited centers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.45 no.4
• /
• pp.192-198
• /
• 2019

Objectives: Oral and maxillofacial surgeons must gain mastery of various approaches to the midface due to the increasing incidence, complexity, and severity of presenting midfacial fractures. Unlike in the case of other body parts, the need to preserve facial aesthetics makes it more difficult for the surgeon to select an approach for managing the facial injuries. The midfacial degloving (MFD) approach is a combination of intraoral and intranasal incisions made to access the midface without any external incision. The aim of the present study was to evaluate the efficacy of MFD in maxillofacial surgery and to assess its advantages and complications. Materials and Methods: The MFD approach was used in five cases, with three cases treated with open reduction and internal fixation and two cases operated on for posttraumatic deformity. Nasal dorsum augmentation was completed in three cases and nasal osteotomy was performed in one case. The bicoronal flap technique was combined with MFD for frontal bone augmentation in one case. The intraoperative time required for flap completion and the ease of performing the planned procedures were noted. Postoperative evaluation was done for reduction, aesthetics, function, and complications. Results: Access was excellent for performing all planned procedures. Average time spent for flap elevation and exposure of the midface was 63 minutes. Complications like postoperative swelling, infraorbital nerve paresthesia, and intranasal crusting were all transient. No long-term complications like stenosis of the nose, sneer deformity, or weakness of the facial muscles were noticed. Additionally, no complications were noted when MFD was combined with bicoronal flap. Conclusion: Though the MFD approach is technically demanding and takes more time than other facial approaches, it should be learned and applied by maxillofacial surgeons in selective cases, as it provides complete exposure of the midface without facial scarring.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.29 no.2
• /
• pp.174-181
• /
• 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.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.16 no.1
• /
• pp.43-50
• /
• 1994

It is a generally known fact that the patient can experience mouth opening limitation, mandibular deviation and malocclusion as a result of injury of tissues around the articular disc and complications even after successful open reduction surgery for fractured mandibular condyle. We have experienced a rare case of reconstruction using metallic condylar prostheses for a patient with complications resulted by unsuccessful management of fractured mandibular condyle. The case strongly suggested to us that careful selection of treatment methods should be taken for patient with fractured mandibular condyle. Accordingly, we are presenting a case in conjunction with reviews of fractured mandibular condyle.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.32 no.5
• /
• pp.416-421
• /
• 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.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.33 no.2
• /
• pp.185-189
• /
• 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.