Fixation of mandibular fractures with 2.0-mm miniplates: review of 191 cases

Our goal was to study the use of 2.0-mm miniplates for the fixation of mandibular fractures. Records of 191 patients who experienced a total of 280 mandibular fractures that were treated with 2.0-mm miniplates were reviewed. One hundred twelve of those patients, presenting 160 fractures, who attended a late follow-up were also clinically evaluated. Miniplates were used in the same positions described by AO/ASIF. No intermaxillary fixation was used. All patients included had a minimum follow-up of 6 months. Demographic data, procedures, postoperative results, and complications were analyzed. Mandibular fractures occurred mainly in males (mean age, 30.3 years). Mean follow-up was 21.92 months. The main etiology was motor vehicle accident. The most common fracture was the angle fracture (28.21%). Twenty-two fractures developed infection, for an overall incidence of 7.85%. When only angle fractures are considered, that incidence is increased to 18.98%. Although only 1 patient (0.89%) described inferior alveolar nerve paresthesia, objective testing revealed sensitivity alterations in 31.52% of the patients who had fractures in regions related to the inferior alveolar nerve. Temporary mild deficit of the marginal mandibular branch was observed in 2.56% of the extraoral approaches performed and 2.48% presented with hypertrophic scars. Incidence of occlusal alterations was 4.0%. Facial asymmetry was observed in 2.67% of the patients, whereas malunion incidence was 1.78%. Fibrous union, mostly partial, occurred in 2.38% of the fractures, but only 1 of those presented with mobility (0.59%). Condylar resorption developed in 6.25% of the fixated condylar fractures. Mean mouth opening was 42.08 mm. The overall incidence of complications, including infections, was similar to those described for more rigid methods of fixation.

Utilization of autogenous bone, bioactive glasses, and calcium phosphate cement in surgical mandibular bone defects in Cebus apella monkeys

Purpose: the purpose of the present study was to evaluate the histologic results of bone cavities that were surgically created in the mandibles of Cebus apella monkeys and filled with autogenous bone, PerioGlas, FillerBone, or Bone Source. Materials and Methods: Surgical cavities 5 mm in diameter were prepared through both mandibular cortices in the mandibular angle region. The cavities were randomly filled, and the animals were divided into groups according to the material employed: Group 1 cavities were filled with autogenous corticocancellous bone; group 2 cavities were filled with calcium phosphate cement (BoneSource); and group 3 and group 4 cavities were filled with bioactive glass (FillerBone and PerioGlas, respectively). After 180 days the animals were sacrificed, and specimens were prepared following routine laboratory procedures for hematoxylin/eosin staining and histologic evaluation. Results: the histologic analysis showed that autogenous bone allowed total repair of the bone defects; bioactive glasses (FillerBone and PerioGlas) allowed total repair of the defects with intimate contact of the remaining granules and newly formed bone; and the cavities filled with calcium phosphate cement (BoneSource) were generally filled by connective fibrous tissue, and the material was almost totally resorbed. Discussion: the autogenous bone, FillerBone, and PerioGlas provided results similar to those in the current literature, showing that autogenous bone is the best Choice for filling critical-size defects. Synthetic implanted materials demonstrated biocompatibility, but the bioglasses demonstrated osteoconductive activity that did not occur with calcium phosphate (BoneSource). Conclusion: According to the methodology used in this study, it can be concluded that the utilization of autogenous bone and bioactive glasses permitted the repair of surgically created critical-size defects by newly formed bone; the synthetic implanted materials demonstrated biocompatibility, and the bioactive glasses demonstrated osteoconductive activity. The PerioGlas was mostly resorbed and replaced by bone and the remaining granules were in close contact with bone; the FillerBone showed many granules in contact with the newly formed bone; BoneSource did not permit repair of the critical-size defects, and the defects were generally filled by connective fibrous tissue.

Caracterização físico-química, morfológica, análise mecânica e de elementos finitos 3D, de diferentes placas e parafusos metálicos e técnicas de fixação interna, empregadas em fraturas de ângulo mandibular

Pós-graduação em Odontologia - FOA

Sagittal Mandibular Osteotomy for Removal of Intraosseous Lesion

The ramus sagittal split osteotomy or mandibular body is an established technique for correction of dentofacial deformities but can have an accurate indication in cases requiring surgical access to remove lesions or more teeth included in the region of the mandibular angle. The main advantages of this technique are the possibility of preservation of the inferior alveolar nerve bundle and significant reduction in postoperative morbidity. In this article, the authors show a case in which the sagittal osteotomy of the mandible was used to gain access for removal of a lesion (complex odontoma).

Trauma traqueal associado à fratura mandibular: relato de caso

Introduction: The mandibular injuries account for about 20% to 50% of cases of facial fractures. Some consider the jaw the second most commonly fractured bone of the skull, and is the only mobile bone of the facial framework, which results in decreased stability compared to the trauma. When one takes into account the degree of airway obstruction in patients with facial fractures, the problem becomes much more serious since it is one of the most troubling complications of trauma. Objective: the relevance of the topic is aimed to report a case of a patient victim of mandibular fracture associated with trauma to the trachea. Case report: Case report: Patient 24 years old patient with tracheal trauma concomitant mandibular fracture surgically treated in conjunction with the thoracic surgeon. After 5 months postoperatively, the patient is in good condition general, no complaints. Final comments: This form is observed that the key to proper treatment of tracheal trauma associated with facial fractures is the knowledge of the type of injury, and an accurate diagnosis multidisciplinary.

Facial symmetry evaluation after experimentally displaced condylar process fracture in methotrexate treated rats

PURPOSE: To investigate the facial symmetry of high and low dose methotrexate (MTX) treated rats submitted to experimentally displaced mandibular condyle fracture through the recording of cephalometric measurements. METHODS: One hundred male Wistar rats underwent surgery using an experimental model of right condylar fracture. Animals were divided into four groups: A - saline solution (1mL/week); B - dexamethasone (DEX) (0,15mg/Kg); C - MTX low dose (3 mg/Kg/week); D - MTX high dose (30 mg/Kg). Animals were sacrificed at 1, 7, 15, 30 and 90 days postoperatively (n=5). Body weight was recorded. Specimens were submitted to axial radiographic incidence, and cephalometric mensurations were made using a computer system. Linear measurements of skull and mandible, as well as angular measurements of mandibular deviation were taken. Data were subjected to statistical analyses among the groups, periods of sacrifice and between the sides in each group (alpha=0.05). RESULTS: Animals regained body weight over time, except in group D. There was reduction in the mandibular length and also changes in the maxilla as well as progressive deviation in the mandible in relation to the skull basis in group D. CONCLUSION: Treatment with high dose methotrexate had deleterious effect on facial symmetry of rats submitted to experimentally displaced condylar process fracture.

Angle class II correction with MARA appliance

Objective: To assess the effects produced by the MARA appliance in the treatment of Angle’s Class II, division 1 malocclusion. Methods: The sample consisted of 44 young patients divided into two groups: The MARA Group, with initial mean age of 11.99 years, treated with the MARA appliance for an average period of 1.11 years, and the Control Group, with initial mean age of 11.63 years, monitored for a mean period of 1.18 years with no treatment. Lateral cephalograms were used to compare the groups using cephalometric variables in the initial and final phases. For these comparisons, Student’s t test was employed. Results: MARA appliance produced the following effects: Maxillary growth restriction, no change in mandibular development, improvement in maxillomandibular relationship, increased lower anterior facial height and counterclockwise rotation of the functional occlusal plane. In the upper arch, the incisors moved lingually and retruded, while the molars moved distally and tipped distally. In the lower arch, the incisors proclined and protruded, whereas the molars mesialized and tipped mesially. Finally, there was a significant reduction in overbite and overjet, with an obvious improvement in molar relationship. Conclusions: It was concluded that the MARA appliance proved effective in correcting Angle’s Class II, division 1 malocclusion while inducing skeletal changes and particularly dental changes.

Estabilidade em longo prazo do tratamento da má oclusão de classe II, divisão 1, com a utilização de um aparelho funcional propulsor mandibular fixo: relato de caso

O tratamento da má oclusão de Classe II sem extrações dentárias vem ganhando popularidade na comunidade ortodôntica já há três décadas. Aparelhos funcionais fixos vêm sendo utilizados por profissionais, de maneira crescente, para promover compensações dentoalveolares e corrigir a má oclusão de Classe II. Os efeitos mais significativos são observados em pacientes com padrão de crescimento horizontal. Um caso clínico será relatado com o uso do aparelho fixo Twin Force Bite Corrector em uma paciente do sexo feminino, para a correção da Classe II. Esse dispositivo de ancoragem fixa dispensa o uso de aparelhos funcionais removíveis e não necessita da cooperação do paciente.

Population-Based Design of Mandibular Plates Based on Bone Quality and Morphology

In this paper we present a new population-based implant design methodology, which advances the state-of-the-art approaches by combining shape and bone quality information into the design strategy. The method enhances the mechanical stability of the fixation and reduces the intra-operative in-plane bending which might impede the functionality of the locking mechanism. The method is presented for the case of mandibular locking fixation plates, where the mandibular angle and the bone quality at screw locations are taken into account. Using computational anatomy techniques, the method automatically derives, from a set of computed tomography images, the mandibular angle and the bone thickness and intensity values at the path of every screw. An optimisation strategy is then used to optimise the two parameters of plate angle and screw position. Results for the new design are presented along with a comparison with a commercially available mandibular locking fixation plate. A statistically highly significant improvement was observed. Our experiments allowed us to conclude that an angle of 126° and a screw separation of 8mm is a more suitable design than the standard 120° and 9mm.

Population-based design of mandibular fixation plates with bone quality and morphology considerations

In this paper we present a new population-based implant design methodology, which advances the state-of-the-art approaches by combining shape and bone quality information into the design strategy. The method may enhance the mechanical stability of the fixation and reduces the intra-operative in-plane bending which might impede the functionality of the locking mechanism. The computational method is presented for the case of mandibular locking fixation plates, where the mandibular angle and the bone quality at screw locations are taken into account. The method automatically derives the mandibular angle and the bone thickness and intensity values at the path of every screw from a set of computed tomography images. An optimization strategy is then used to optimize the two parameters of plate angle and screw position. The method was applied to two populations of different genders. Results for the new design are presented along with a comparison with a commercially available mandibular locking fixation plate (MODUS(®) TriLock(®) 2.0/2.3/2.5, Medartis AG, Basel, Switzerland). The proposed designs resulted in a statistically significant improvement in the available bone thickness when compared to the standard plate. There is a higher probability that the proposed implants cover areas of thicker cortical bone without compromising the bone mineral density around the screws. The obtained results allowed us to conclude that an angle and screw separation of 129° and 9 mm for females and 121° and 10 mm for males are more suitable designs than the commercially available 120° and 9 mm.

Gas-bearing fluid influx sub-system for gas hydrate geological system in Shenhu Area, Northern South China Sea

Based on the comprehensive interpretation and study of the Neogene fracture system and diapiric structure, it can be concluded that the diapiric structures, high-angle fractures and vertical fissure system are the main gas-bearing fluid influx sub-system for gas hydrate geological system in Shenhu Area, northern South China Sea. The Neogene fractures widely developed in the study area may be classed into two groups: NW (NNW)-trending and NE (NNE)-trending. The first group was active in the Late Miocene, while the second one was active since the Pliocene. The NE (NNE)-trending fractures were characterized by lower activity strength and larger scale, and cut through the sediment layers deposited since the Pliocene. Within the top sediment layers, the high-angle fracture and vertical fissure system was developed. The diapiric structures display various types such as a turtle-back-like arch, weak piercing, gas chimney, and fracture (or crack, fissure). On the seismic profile, some diapiric structures show the vertical chimney pathway whose top is narrow and the bottom is wide, where some ones extend horizontally into pocket or flower-shaped structures and formed the seismic reflection chaotic zones. Within the overlying sediment layers of the diapiric structure, the tree branch, flower-shaped high-angle fractures and vertical fissures were developed and became the pathway and migration system of the gas-bearing fluid influx. In the study area, the diapiric structures indicate a high temperature/over pressure system ever developed. Closely associated and abundant bright-spots show the methane-bearing fluid influx migrated vertically or horizontally through the diapiric structures, high-angle fractures and vertical fissures. In the place where the temperature and pressure conditions were favor for the formation of gas hydrate, the hydrate reservoir deposition sub-system was developed.

火成岩储层裂缝识别、预测理论与方法研究－以济阳坳陷火成岩油藏为例

Since 1970s, igneous reservoirs such as Shang741, Bin674 and Luol51 have been found in Jiyang depression, which are enrichment and heavy-producing. Showing good prospect of exploration and development, igneous reservoirs have been the main part of increasing reserves and production in Shengli oilfield. As fracture igneous reservoir being an extraordinary complex concealed reservoir and showing heavy heterogeneity in spatial distribution, the study of recognition, prediction, formation mechanism and the law of distribution of fracture is essential to develop the reservoir. Guided by multiple discipline theory such as sedimentology, geophysics, mineralogy, petroleum geology, structural geology and reservoir engineering, a set of theories and methods of recognition and prediction of fractured igneous rock reservoir are formed in this paper. Rock data, three-dimensional seismic data, log data, borehole log data, testing data and production data are combined in these methods by the means of computer. Based on the research of igneous rock petrography and reservoir formation mechanism, emphasized on the assessment and forecast of igneous rock reservoir, aimed at establishing a nonhomogeneity quantification model of fractured igneous rock reservoir, the creativity on the fracture recognition, prediction and formation mechanism are achieved. The research result is applied to Jiyang depression, suggestion of exploration and development for fractured igneous rock reservoir is supplied and some great achievement and favourable economic effect are achieved. The main achievements are gained as follows: 1. The main facies models of igneous rock reservoir in JiYang depression are summarized. Based on data and techniques of seism, well log and logging,started from the research of single well rock facies, proceeded by seismic and log facies research, from point to line and line to face, the regional igneous facies models are established. And hypabyssal intrusion allgovite facies model, explosion volcaniclastic rock facies model and overfall basaltic rocks facies model are the main facies models of igneous rock reservoir in JiYang depression. 2. Four nonhomogenous reservoir models of igneous reservoirs are established, which is the base of fracture prediction and recognition. According to characteristics of igneous petrology and spatial types of reservoir, igneous reservoirs of Jiyang depression are divided into four categories: fractured irruptive rock reservoir, fracture-pore thermocontact metamorphic rock and irruptive rock compound reservoir, pore volcanic debris cone reservoir and fracture-pore overfall basaltic rock reservoir. The spatial distribution of each model's reservoir has its features. And reservoirs can be divided into primary ones and secondary ones, whose mechanism of formation and laws of distribution are studied in this paper. 3. Eight geologic factors which dominate igneous reservoirs are presented. The eight geologic factors which dominates igneous reservoirs are igneous facies, epigenetic tectonics deformation, fracture motion, intensity of intrusive effect and adjoining-rock characters, thermo-contact metamorphic rock facies, specific volcano-tectonic position, magmatic cyclicity and epigenetic diagenetic evolution. The interaction of the eight factors forms the four types nonhomogenous reservoir models of igneous reservoirs in Jiyang depression. And igneous facies and fracture motion are the most important and primary factors. 4. Identification patterns of seismic, well log and logging facies of igneous rocks are established. Igneous rocks of Jiyang depression show typical reflecting features on seismic profile. Tabular reflection seismic facies, arc reflection seismic facies and hummocky or mushroom reflection seismic facies are the three main facies. Logging response features of basic basalt and diabase are shown as typical "three low and two high", which means low natural gamma value, low interval transit-time, low neutron porosity, high resistivity and high density. Volcaniclastic rocks show "two high and three low"-high neutron porosity, high interval transit-time, low density, low-resistance and low natural gamma value. Thermo-contact metamorphic rocks surrounding to diabase show "four high and two low" on log data, which is high natural gamma value, high self-potential anomaly, high neutron porosity, high interval transit-time and low density and low-resistance. Based on seismic, well log and logging data, spatial shape of Shang 741 igneous rock is described. 5. The methods of fracture prediction and recognition for fractured igneous reservoir are summarized. Adopting FMI image log and nuclear magnetic resonance log to quantitative analysis of fractured igneous reservoir and according to formation mechanism and shape of fracture, various fractures are recognized, such as high-angle fracture, low-angle fracture, vertical fracture, reticulated fracture, induced fracture, infilling fracture and corrosion vug. Shang 741 intrusive rock reservoir can be divided into pore-vug compound type, pore fracture type, micro-pore and micro-fracture type. Physical properties parameters of the reservoir are computed and single-well fracture model and reservoir parameters model are established. 6. Various comprehensive methods of fracture prediction and recognition for fractured igneous reservoir are put forward. Adopting three-element (igneous facies, fracture motion and rock bending) geologic comprehensive reservoir evaluation technique and deep-shallow unconventional laterolog constrained inversion technique, lateral prediction of fractured reservoir such as Shang 741 is taken and nonhomogeneity quantification models of reservoirs are established.

Measuring the state of consciousness in a free-living diving sea turtle

We report on results from two types of data-logger attached to hawksbill turtles (Eretmochelys coriacea) in the breeding season at the Seychelles, Indian Ocean. Conventional time-depth recorders (TDRs) showed prolonged bouts of long dives to the seabed, consistent with benthic resting. This behaviour has been widely reported in sea turtles and appears to be a common feature for energy conservation. An Inter-Mandibular Angle Sensor (IMASEN) recorded mouth opening and buccal pumping by one turtle for 2.5 days. Buccal pumping occurred widely while the turtle was submerged, consistent with a function of olfactory sensory perception of the turtle's environment. However, buccal pumping stopped during the middle of long benthic dives consistent with the turtle entering a phase of sleep. It therefore appears that by recording buccal oscillations, it is possible to assess the state of consciousness of turtles allowing the eco-physiology of diving to be more fully explored. (C) 2007 Elsevier B.V. All rights reserved.

Using the Condylar Prosthesis After Resection of a Large Odontogenic Myxoma Tumor in the Mandible

Odontogenic myxomas are considered to be a benign odontogenic tumor with locally aggressive behavior. Because these neoplasms are rare in the oral cavity, the possible surgical management can be quite variable. Literature recommendation can vary from simple curettage and peripheral ostectomy to segmental resection. The authors report a case of a 20-year-old patient with an odontogenic myxoma tumor located in the left mandibular angle, ascending ramus, and mandibular symphysis. It was treated by radical resection followed by titanium reconstruction with condylar prosthesis, which allowed rapid return of function with improvement in quality of life and restoration of cosmetic and functional deficits. The lesion did not recur after surgical procedure.

Decompression for Management of Keratocystic Odontogenic Tumor in the Mandible

Keratocystic odontogenic tumor (KCOT) is a benign intraosseous neoplasm of odontogenic origin with high recurrence rate. To date, various conservative or aggressive management strategies have been suggested as a method of treatment. Decompression is a conservative method that has been used in the treatment of large odontogenic cysts. The present paper reports a case of KCOT located in the mandible and discusses the importance of its management using conservative methods. The authors present a case of a 38-year-old patient with a KCOT located in the right mandibular angle and ascending ramus, which was treated by decompression followed by enucleation and curettage. The lesion did not recur during a follow-up period of 3 years after surgery. Preserving important structures of the bone and soft tissue decompression is a method with low morbidity. In addition, according to the literature, decompression has a success rate at least as high as the one of most aggressive treatments.