The Treatment for Mandibular Condyle Fracture of Children by a Threaded Kirshcner Wire and External Rubber Traction

PURPOSE: The treatment of children mandibular condyle fracture that is severely displaced is controversial. The conservative treatment of it may lead to complications- mandibular deficiency, asymmetry, malocclusion and temporomandibular joint dysfunction. Moreover, open reduction carries risks for growth retardation, facial nerve injury, scarring and joint stiffness. The aim of this article is to present an alternative technique of the treatment by using a threaded Kirschner wire and external rubber traction. METHODS: From November 2005 to May 2008, three patients underwent the management by using a threaded Kirschner wire and external rubber traction. A threaded Kirschner wire was inserted in the condylar segment by using a C-arm. We applied the external rubber traction, and we reducted the segment progressively until complete reduction. The mandibular-maxillary fixations were removed after 3 weeks, and patients were sent to training for mouth opening. RESULTS: The technique didn't result in complications- joint dysfunction, facial nerve injury, sore, infection and nonunion during follow-up period. Radiologic follow-up examinations revealed correct reduction in all patients. In all cases, we found restoration of preinjury occlusion and temporomandibular joint function. CONCLUSION: Closed reduction of children mandibular condyle fracture by using a threaded Kirschner wire and external rubber traction did achieve anatomic reduction and restore mandibular height. This alternative technique is simple, effective, inexpensive, easy to apply and minimally invasive.

Alar Base Augmentation by Various Methods in Secondary Lip Nasal Deformity

The definitive correction of secondary lip nasal deformities is a great challenge for plastic surgeons. To rectify the secondary lip nasal deformities, various procedures and its modifications have been reported in many centers. However, no universal agreement exist to correct the various components of secondary nasal deformities. The secondary nasal deformity of the unilateral cleft lip has its own characteristic abnormalities including the retroplaced dome of the ipsilateral nasal tip, hooding of the alar rim, a secondary alar-columellar web, short columella, depressed alar base and so forth. Among these components of secondary nasal deformity, maxillary hypoplasia, especially in the area of piriform aperture, and alveolar bone defect can make the alar base depressed, which in turn, leads to wide and flat nasal profile, obtuse nasolabial angle coupled with subnormal nasal tip projection in aspect of aesthetic consideration. Moreover, the maxillary hypoplasia contributes to reduced size of the nasal airway in combination with other component of external nasal deformity and therefore the nasal obstruction may be developed functionally. Therefore, the current authors have performed corrective rhinoplasty with the augmentation of alar base with various methods which include rearrangement of soft tissue, vertical scar tissue flap and use of allogenic or autologous materials in 42 patients between 1998 and 2003. The symmetric alar base could be achieved, which provides the more accurate evaluation and more appropriate management of the various component of any coexisting secondary nasal deformity. In conclusion, the augmentation of alar base, as a single procedure, is a basic and essential to correct the secondary lip nasal deformities.

External Traction Technique for the Adjuvant Treatment of Zygomaticomaxillary Complex Fracture

The fixation of zygomaticomaxillary complex fracture is accomplished by the various internal placement of interosseous wiring, miniplates, microplate and even absorbable miniplate across properly reduced fracture lines to resist torsional rotation and masticatory force. However, in cases of comminuted compound fracture which makes zygomaticomaxilary complex fixed unstably, asymmetric malar height due to incomplete intraoperative reduction and predictable re-depression of zygoma postoperatively, we can hardly solve the malar asymmetry only by internal fixation device. So we employ the new external traction device which is made of hard board paper, cast, Steinmman pin, and rubber band. It is easy to make and apply it to the patient and morever, it is a dynamic traction method because it can control of traction force by rubber band and control of traction vector variously depending on degree of placement of fracture segment and fracture location, respectively. And it has less limitation to patient's hospital activity. Whereas it makes tiny traction pain during the traction device applied and the patient can feel uncomfortable head tightness. In summary, The authors' external rubber tration device can be used as a simple and convenient method in combination with internal fixation method in the postoperative management of malar symmetry.