Complications associated with intra oral cortical bone fixation screws for intermaxillary fixation in closed reduction of mandibular fractures

The objects of this study were to determine the rate of complications associated with Intra Cortical Bone Fixation Screws for Inter-maxillary fixation [IMF] and as a possible alternative to Arch-Bars in patients with un-displaced mandibular fractures. A descriptive case series study involving 25 adult patients [age range: 16- 60 years] and requiring intra cortical bone fixation screws IMF was conducted from 1[st] August 2011 to 30[th] April 2012] at the Department of Oral and Maxillofacial Surgery, Abbasi Shaheed Hospital / Karachi Medical and Dental College [KMDC] Karachi. The sampling technique was non-probability purposive. Clinical examination and radiograph 1-OPG [Ortho-Pentomogram], 2-PA View of Face were taken for confirmation of un-displaced mandibular fractures. Patients with pre-existing mental nerve injury and / or soft tissue infection were excluded from the study. IMF was done with using intra cortical bone fixation screws, patients were followed over 6-weeks period at regular weekly interval. Postoperative frequencies of complication including mental nerve injury and soft tissue infection were recorded at review. Overall complications were in [3] 12% patients. The distribution of the various complications were; soft tissue infection in [1] 4% and mental nerve injury in [2] 8% patients. The high proportion of 12% complications including those related to nerve injury suggests appropriate selection of both the patients and size of Intra oral cortical bone fixation screw [ICBFS] as well as the use of this technique by surgeons having expertise and skills in the technique

Displacement of maxillary third molar in the infra-temporal fossa

Removal of an impacted maxillary third molar is a simple and easy procedure for an Oral and Maxillofacial Surgeon. Nevertheless, complications are possible and include infection, facial swelling, trismus, wound dehiscence, root fracture or even orosinusal fistula. Iatrogenic displacement into the infratemporal fossa is frequently mentioned but rarely reported. This anatomical fossa includes several important structures such as the internal maxillary artery, the venous pterygoid plexus, the sphenopallatinun nerve, the coronoid process of the mandible and the pterygoid muscles. Recommended treatment includes immediate surgical removal if possible or initial observation and secondary removal, as necessary, because of infection, limited mandibular motion, inability to extract the tooth, or the patient's psychologic unease. Sometimes, the displaced tooth may spontaneously migrate inferiorly and becomes accessible intraorally. A 24 year old male patient presenting with pain and swelling in the left third molar region. History, examination and x-rays confirmed a displaced third molar was present in the infratemporal fossa. The molar was displaced during extraction by a dental practitioner. The tooth was recovered successfully