The prospective preliminary clinical study of open reduction and internal fixation of mandibular angle fractures using 2 miniplates

INTRODUCTION: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. MATERIALS AND METHODS: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. RESULTS: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. CONCLUSION: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients' discomfort and simplify the surgical procedure.

A Case of Bleeding from Proximal Jejunal GIST Diagnosed by Colonoscopy through the Oral Approach / 대한소화기내시경학회지

Gastrointestinal bleeding from small bowel lesions is uncommon but it is the most common cause of obscure gastrointestinal bleeding that can go undiagnosed using traditional upper endoscopy and colonoscopy. Recently, various new methods, including wireless capsule endoscopy and double-balloon enteroscopy have been used to detect and manage small bowel lesions. A 51-year-old man was admitted with hematochezia. The source of bleeding could not be identified using conventional upper endoscopy and colonoscopy. Wireless capsule endoscopy revealed a mass-like lesion with active blood spurting in the proximal jejunum. Finally, a tumor with central ulceration was detected at the proximal jejunum using a clean colonoscope through the oral approach. This lesion was surgically resected, and the histology findings were consistent with a gastrointestinal stromal tumor. We report a case of gastrointestinal bleeding from a proximal jejunal GIST diagnosed by clean colonoscopy through the oral approach with a review of the relevant literature.

Open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach / 中华创伤杂志

Objective To discuss the way of open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach aiming to avoid the facial incision. Methods Fifteen cases (17 sides) with mandibular condyle fractures underwent open reduction and osteosynthesis with plates and screws. After the mandibular ramus was under vertical osteotomy with an oscillating saw, the posterior border bone block of mandibular ramus as well as the free condyle neck were taken out. The fractured condyle neck and the posterior border bone block of mandibular ramus were fixated with a titanium miniplate in vitro. The reunion bone was implanted and reposited in the mouth incision. Of all, two cases suffered fracture of the condyle neck in the other hospital when they received esthetic surgery and resection of prominent mandible angle (PMA). Results Anatomic reduction was achieved in all cases, without damage to facial nerve and major auricular nerve or salivary fistula. There were slight bony resorption and good temporomandibular joint function one year after surgery, with range of mouth opening for 25-40 mm (mean 35.8 mm). Two cases regained their occlusion before their PMA operation. One case had premature contact of the buccal teeth,with 1 mm diverging to medline of the incisor teeth. Intraoral approach not only could avoid large facial scars and facial nerve injury, but also allow visualization of the occlusion during the procedure. Conclusions As more and more consideration is taken to cosmetology, the transoral approach is a reliable surgical alternative for fractures of the condyle neck, without leaving extensive visible scars or damaging facial nerve. The disadvantage is vertical osteotomy of the posterior border of the mandibular ramus.