[Long-term outcome of dentoalveolar trauma in relation to post-traumatic instability]. / Langzeitergebnisse dentoalveolärer Verletzungen in Abhängigkeit von der posttraumatischen Beweglichkeit.

PURPOSE: The aim of this retrospective study was to investigate the long-term outcomes of dental injuries. Subluxated and laterally luxated teeth were evaluated according to the findings of CO2 sensitivity, obliteration, pulpal sclerosis, and the duration of post-traumatic fixation of the injured teeth. MATERIAL AND METHODS: The data of 725 patients were analyzed retrospectively over a period of 14 years. Of these, 108 patients could be investigated for a long-term follow-up. Dental trauma was classified according to the degree of luxation (I-III). RESULTS: There was a significant correlation between the degree of luxation and the post-traumatic findings of CO2 sensitivity. There was no significant correlation between the degree of luxation and the post-traumatic findings of apical inflammation, pulpal sclerosis, and/or obliteration. Long-term fixation of injured teeth had no effect on the short- and long-term occurrence of pathologic processes at the root such as root resorption. CONCLUSION: The post-traumatic finding of CO2 sensitivity was related to the degree of luxation of the injured teeth. Apical inflammation, pulpal sclerosis, and obliteration were not related to the degree of luxation. The results suggest that long-term fixation of injured teeth has no negative effects on the long-term outcomes of subluxated and laterally luxated teeth.

[Management of mid-facial fractures]. / Versorgung von Mittelgesichtsfrakturen.

In the past, treatment of maxillofacial fractures was characterized by low incidences of midface fractures, while severe cases were associated with a high death rate. Over the last decades the application of new techniques has provided a successful outcome in the management of these more frequently observed injuries. With the introduction of antibiotics and the principles of modern anesthesiology, conservative methods of fracture treatment such as intermaxillary fixation and the application of extension devices were increasingly replaced by surgical techniques. The development of different osteosynthesis plate and screw systems in the early 1970s has made three-dimensional reconstruction a standard of care in the surgical treatment of midface fractures. With the recent introduction of commercially available bioresorbable systems, removal of osteosynthesis material has become an unnecessary procedure. Further research in innovative techniques of maxillofacial surgery and imaging, such as image-guided surgery by computer navigation, may be warranted to minimize surgical approaches and decrease incidences of perioperative morbidity.

Conservative treatment of unilateral condylar fractures in children: a long-term clinical and radiologic follow-up of 55 patients.

The purpose of this prospectively designed study was the long-term clinical and radiological evaluation of conservatively treated unilateral condylar fractures in children. Fifty-five children aged between 2 1/2 and 9 3/4 years, presenting with a singular unilateral fracture of the mandibular condyle, were treated in a nonsurgical-functional way using an intraoral myofunctional appliance. In the follow-up period, patients were investigated by standardized clinical examination and by evaluation of panoramic radiographs taken immediately post-traumatically, after 6, 12, 24, 48 and 72 weeks, and then yearly through the period of growth. With a satisfactory clinical course in all patients, there was no instance of functional disturbance or mandibular asymmetry after the respective follow-up periods. The radiographs showed a fairly good shape of the condyle (no or only slight condylar deformity) in the 47 patients of the 2-6 year age group. In the eight patients of the 7-10 year age group presenting with a class II or III condylar fracture, healing was characterized by incomplete condylar regeneration, resulting in a moderate condylar deformity in two cases, a definite reduction in condylar neck height in two cases, and a hypertrophic condylar deformity in four cases. The positive results of this study confirm the concept of a nonsurgical-functional approach in children presenting with various types of unilateral fractures of the mandibular condyle. Condylar remodeling was the mode of fracture healing in instances of displaced and dislocated condylar fractures.

Trends in the incidence and cause of sport-related mandibular fractures: a retrospective analysis.

PURPOSE: This study assessed changes in the incidence and causes of mandibular fractures occurring in innsbruck, Austria between 1984 and 1993. PATIENTS AND METHODS: Records from 712 patients sustaining 982 mandibular fractures were reviewed and analyzed according to age, sex, date of fracture, place of trauma, cause, anatomic site of fracture, and associated orofacial and craniocerebral injuries. RESULTS: Sports were the most common cause of mandibular fractures, accounting for 31.5% of the entire sample, followed by road traffic accidents (27.2%) and falls (20.8%). The yearly distribution of sport-related mandibular fractures showed an increase from 28.6% in 1984 to 1988 to 34.5% in 1989 to 1993. The major causative factor in sports-related mandibular fractures was skiing (55.3%), whereas cycling and soccer accounted for 25.4% and 8.9%, respectively. Significant changes in the occurrence of cycling-related mandibular fractures were observed, with an increase of 19.3% from 1984 to 1988 to 1989 to 1993, whereas skiing-related mandibular fractures showed a decrease of similar magnitude (19.5%). Sex distribution showed a male-to-female ratio of 2.5:1, with the percentage of females involved increasing. In cases of cycling-related accidents, there was a considerable prevalence of associated injuries (133.3 injuries per 100 mandibular fractures), with significantly higher rates of facial lacerations (73.2), tooth fractures (39), tooth luxations (24.4), and orbital fractures (3.7) than in the case of skiing-related injuries, whereas in patients sustaining mandibular fractures caused by soccer, mucosal lacerations, tooth luxations, and cerebral concussions were the only associated injuries found. CONCLUSIONS: The results of this study indicate a considerable change in the cause of mandibular fractures, showing that sporting injuries are becoming increasingly common. The high incidence of associated maxillofacial injuries in patients involved in skiing and cycling accidents may suggest an increasing need for preventive and protective measures.

[Fractures of the mandibular collum in childhood--a long-term follow-up with orthopantomography]. / Kiefergelenkfortsatzfrakturen im Kindesalter--eine Langzeitstudie im Orthopantomogramm.

The study including fifty children younger than 10-years-old with dislocated unilateral collum fractures concerns the chronological development of morphological alterations in the orthopantomogramm. Regardless of fracture type, the radiographs indicate, that a very good restitution can be attained with an exclusive functional therapy using an activator in all analyzed patients. A realignment can not be found.

[Reconstructive procedures for improving the facial contour]. / Rekonstruktive Massnahmen zur Verbesserung der Gesichtskontur.

From 1986 to 1992 in the Department of Oral and Maxillofacial Surgery in Innsbruck, in 102 patients with a congenital or acquired deformity of the face, 128 augmentations with Hydroxylapatite granules (in 36 cases) or with Ethylenoxid-sterilised lyophilised cartilage (in 92 cases) have been performed. Hydroxylapatite granules, filled in a Vicryl-tube and implanted subperiosteal solely, proved to be at well tolerated material and consistently in form. In different areas of the face implanted Ethylenoxid-sterilised lyophilised cartilage showed no loss of substance up to now.

[Sports-related maxillofacial trauma in young patients]. / Sportbedingte Gesichtsschädelverletzungen im Wachstumsalter.

314 young patients with sports-related maxillofacial trauma were classified into 34.7% facial fractures, 35.9% dentoalveolar trauma and 28.4% soft tissue injuries. In the alpine regions the distribution of fractures by aetiology is dominated by skiing accidents. 43% of the midface fractures are due to fractures of the zygomatic bone and arch. Children up to ten years are more prone to dentoalveolar trauma. Opportune preventive measures are recommended.