Teeth located in the line of mandibular fracture.

During the last decade, rigid internal fixation with mini plates and screws has attained widespread use for stabilization of facial bone fractures. This technique permits precise, three-dimensional stabilization of bony segments, decreases the time required for immobilization of the maxillo-masticatory apparatus, and allows patients to return to their preinjury state earlier. However, there is still controversy on the appropriate management of teeth located within the line of mandibular fractures. We review the outcome of teeth retained within the fracture. We performed a retrospective chart review of all patients admitted to the University of California, Davis, Medical Center with mandibular fractures from July 1, 1986, to June 30, 1991, who had retained at least 1 tooth and had had a 3-month follow-up. We were able to include a total of 254 patients who met these criteria. These patients were then divided into groups according to location of the fracture, method of stabilization, and management of dentition within the line of fracture. Data were then analyzed using a linear model to predict the percentages of success for each method of fixation. In conclusion, we found little difference in the outcome of fracture management whether the teeth were routinely extracted or retained as long as rigid fixation was employed for stabilization of the fracture segments.

Pediatric mandibular fractures.

In spite of curiosity, facial fractures, particularly mandibular fractures, in the pediatric age group embrace only a modest proportion of facial fractures that occur within the general population. Several large series report an overall incidence of approximately 1% of all facial bone fractures. A considerable volume of literature has been generated describing the pattern of injury and treatment modalities for pediatric facial bone fractures. At our institution, which is an extremely busy university-based regional trauma center, we have witnessed a persistent escalation in the number of patients requiring repair of their facial bone fractures. During the period of January 1989 through January 1990, we treated a total of 204 patients for repair of mandible fractures. An analysis of the records of this group revealed only 3 patients who were younger than 4 years of age and 2 additional patients younger than 8 years. There were another 10 patients 17 years and younger, for a total incidence of 0.08%. Additionally, we found that within this seemingly small group, there was a surprisingly high incidence of severe, associated injuries.

Treatment decisions in "white coat" hypertension: do we need the whole 24 hours?

Twenty-four hour ambulatory blood pressure monitoring (24BP) is an emerging technology used to further evaluate elevated blood pressure readings obtained during office visits. We wondered whether a less costly approach than 24BP would lead clinicians to similar treatment decisions. Eleven faculty general internists sequentially evaluated sample patients' office blood pressure readings, four intermittent blood pressures (IBP), and 24-hour ambulatory blood pressure reports and made treatment decisions at each step. This yielded 187 "cases," in 173 of which the physicians were able to make treatment decisions. We found that addition of either IBP or 24BP to office readings did change treatment decisions (P less than .0001), but the changes brought about by IBP and 24BP were of statistically similar magnitude. We suggest that during clinical trials designed to evaluate the value of 24-hour ambulatory blood pressure monitoring in various clinical situations, simpler and perhaps less costly technology should be concurrently evaluated as an alternative.