ABSTRACT
An endoscopic method of mandibular subcondylar fracture repair has been described recently. To determine the effectiveness of this new technique, we longitudinally studied functional, aesthetic, and radiographic parameters following endoscopic repair of 22 subcondylar fractures in 20 patients. Restoration of mandibular function was achieved without postoperative maxillomandibular fixation. Premorbid occlusion was restored. Clinical jaw motion was found to progressively increase with a mean interincisal jaw opening of 43 mm achieved after the eighth postoperative week. Patients were pleased with the aesthetic restoration of their chin projection,jaw line, and the symmetric midline movement of the chin point onjaw opening. Anatomic fracture reduction with rigid plate fixation was confirmed on early postsurgical radiographs. Late radiographs showed fracture union without remodeling of the condylar head. Endoscopic subcondylar fracture repair was efficacious at functional, aesthetic, and radiographic restoration of the mandible.
Subject(s)
Endoscopy , Mandibular Fractures/surgery , Adult , Female , Humans , Male , Mandibular Fractures/diagnostic imaging , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Inadequate treatment of complex midfacial fractures involving the orbit and zygomatic arch can result in important functional and aesthetic deformity. Accurate repair of fractures at the zygomatic arch and orbital floor has traditionally necessitated coronal scalp and lower eyelid incisions respectively. Complications such as facial nerve injury, alopecia, external scarring, ectropion, and eyelid edema have been associated with these traditionally open surgical techniques. We report an endoscopic-assisted technique of open reduction and rigid fixation of a complex midfacial fracture. The endoscopic-assisted technique facilitated the anatomic repair of associated zygomatic arch and orbital floor fractures. The technique minimized ocular globe manipulation and eliminated the need for coronal scalp and lower eyelid incisions.
Subject(s)
Endoscopy/methods , Fracture Fixation, Internal/methods , Orbital Fractures/surgery , Zygomatic Fractures/surgery , Adult , Bone Plates , Bone Screws , Endoscopes , Fracture Fixation, Internal/instrumentation , Humans , Male , Orbit/diagnostic imaging , Orbit/surgery , Orbital Fractures/diagnostic imaging , Tomography, X-Ray Computed , Zygoma/diagnostic imaging , Zygoma/surgery , Zygomatic Fractures/diagnostic imagingABSTRACT
OBJECTIVE: To assess the effect of insulinlike growth factor I (IGF-I) depletion and restoration on the number of wound macrophages and wound healing variables. DESIGN: Fourteen-day, placebo-controlled trial. SETTING: Animal research laboratory. STUDY PARTICIPANTS: Sham-operated and hypophysectomized healthy male rats weighing 300 g. INTERVENTION: Random assignment to a 14-day IGF-I (10 micrograms per wound per day) or placebo infusion directly into standardized Hunt-Schilling dorsal wound chambers. MAIN OUTCOME MEASURES: Wound healing variables (dry tissue weight, total protein, DNA, and hydroxyproline content), and number and concentration of wound macrophages. RESULTS: The IGF-I depletion in hypophysectomized rats decreased wound protein, DNA, and hydroxyproline content of wounds by 50%, and IGF-I infusion returned these variables to near that of sham-operated rats. Wound macrophage concentrations decreased by 50% from control in the IGF-I depleted rats and increased to 75% of control with IGF-I infusion. CONCLUSION: Insulinlike growth factor I may have a fundamental role in wound healing and may exert part of its stimulatory effect through macrophages. Although an independent effect of hypophysectomy on macrophages and collagen deposition is not excluded, we believe it is unlikely given the return to normal values with IGF-I infusion.
