Obesity: prevalence and considerations in oral and maxillofacial surgery.

PURPOSE: This article examines the prevalence of obesity in an urban hospital-based office population and describes the associated health risks and systemic complications. PATIENTS AND METHODS: A total of 225 randomly selected patient charts were reviewed. The patients' height and weight were recorded, and a body mass index (BMI) was calculated. Patients were considered to have a normal weight with a BMI between 20 and 24.9 kg/m2, to be overweight with a BMI between 25 and 29.9 kg/m2, and to be obese with a BMI of 30 kg/m2 or greater. Comparisons between sex, age, and race were examined. RESULTS: Eighty-five males and 140 females were included in the study. The ages ranged from 9 to 86 years, with a mean age of 37.4+/-16.4 years. The BMIs ranged from 13.9 to 57.7 kg/m2, with a mean BMI of 26.5+/-6.8 kg/m2. Over half (51%) of the population studied was overweight, and 23% were obese. Forty-three percent of males were considered overweight, and 18.8% of males were obese. Women tended to be more overweight: 55.7% of women were overweight and 25.7% were obese. The African-American females had mean BMIs that were considered overweight in all age-groups and obese in most age-groups, which included the less than 29-year-old and over 50-year-old groups. Caucasian females had normal mean BMIs at all ages except for the 30- to 39-year-old and 40- to 49-year-old groups. CONCLUSION: The increasing prevalence of overweight and obese populations has several considerations in oral and maxillofacial surgery. The associated health risks and increased morbidity and mortality pose a serious threat to the patient being treated in an outpatient setting.

Posttraumatic carotid-cavernous sinus fistula.

BACKGROUND AND OBJECTIVES: Posttraumatic carotid-cavernous sinus fistula is a rare complication of maxillofacial trauma and is seldom discussed in the literature. Motor vehicle accidents, falls, and other crush injuries contribute to the incidence of basilar skull fractures and the formation of fistulae. When injuries occur in the vessel wall, the carotid artery has the potential to fill the low-pressure cavernous sinus. The symptoms include chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits, and blindness. METHODS AND MATERIALS: The conventional treatments include carotid ligation and embolization. These techniques have often proved to be ineffective. A new method--the occlusive balloon technique--has been developed and is described in this article. A clinical case is used to illustrate the procedure. RESULTS AND/OR CONCLUSIONS: Utilization of balloon catheters provides a minimally invasive technique to treat patients, without significant morbidity or mortality. The procedure is found to be successful and predictable.

Treatment of traumatic mandibular nonunion.

BACKGROUND AND OBJECTIVES: Nonunion is a complication in mandibular fractures. The causative factors include delay in treatment, infection, inadequate immobilization, and improper internal fixation; concomitant infection may be present. Pain, mobility of the fracture segments, and radiographic evidence of radiolucency did in diagnosis. METHODS AND MATERIALS: Three clinical cases are used to present the methods of treatment to manage nonunion following a gunshot wound, assault with a blunt object, and a fall. Treatment included antimicrobial therapy, fracture site debridement, segment immobilization, and bone grafting. Maxillomandibular fixation, debridement, and placement of a reconstruction plate were used in the first case; reconstruction plate, autogenous bone graft in a polyglactin resorbable mesh, and screw buttons in the second; and custom reconstruction plate and iliac crest bone graft in the third. RESULTS AND/OR CONCLUSIONS: All cases healed uneventfully. Due to rapid revascularization, use of autogenous cancellous bone grafts is preferred to cortical bone. Custom-molded polyglactin mesh provides control of the loose cancellous bone graft.

Surgical approaches to mandibular condylar fractures: a review.

BACKGROUND AND OBJECTIVES: The estimates of mandibular condyle fracture incidence lack consensus, as these fractures are frequently overlooked or misdiagnosed, resulting in adverse effects. The purpose of this article is to review the anatomy of the mandibular condyle and the surgical approaches currently available. METHODS AND MATERIALS: Surgical treatment of mandibular condyle fractures remains controversial, due to the indications and difficulty with the associated vital structures. To aid in selecting the appropriate approach, the authors present a review of the mandibular anatomy and the approaches utilized, as reported in the literature and observed in the clinical practice of the authors. RESULTS AND/OR CONCLUSIONS: In selecting the approach, the knowledge of the mandibular anatomy is vitally important. A survey found that the preauricular, submandibular, and intraoral approaches (in that order) were preferred. When treating the fractured mandibular condyle with open reduction and internal fixation, a thorough knowledge of the anatomy of vital structures, exercise of care, and careful dissection through the soft tissues will reduce the risk for morbidity.