ABSTRACT
Mandibular fractures are a common injury encountered by facial trauma surgeons. A majority of these cases are in dentate patients and can predictably be treated with several different open or closed techniques. Edentulous mandible fractures can be challenging as maxillomandibular fixation, either as the sole treatment or used for fracture reduction and stabilization prior to internal fixation, is not possible. The atrophic edentulous mandible fracture poses an even greater challenge, as there is more sclerotic bone present and less bone volume for bony contact, both of which can impair healing. In addition, with less bone mass, available plate adaptation and fixation are difficult. In recent years, virtual surgical planning (VSP) has been increasingly used in craniofacial and maxillofacial surgeries as well as in dentistry. Utilizing VSP to fabricate the necessary hardware prior to open reduction and internal fixation of atrophic edentulous mandible fractures can be helpful in treating these cases. Two cases where this method was used are presented.
ABSTRACT
OBJECTIVE: A retrospective study was undertaken to investigate the clinical outcomes resulting from the microsurgical repair of lingual nerve injuries. The study was based on patient chart review. PATIENTS AND METHODS: A total of 20 patients referred to the principal investigator (V.B.Z.), with a diagnosis of lingual nerve injury who underwent trigeminal nerve microsurgery during a 3-year period (1999 to 2002), were entered in this study. All patients received a complete history and physical examination, and thorough preoperative and postoperative neurosensory testing to evaluate clinical response to hot, cold, cotton wisp, vibration, 2-point discrimination, directional stroke, and fine touch as determined by Von-Frey filaments. RESULTS: All patients underwent an external neurolysis procedure in combination with an internal neurolysis, neuroma excision, or primary neurorrhaphy under microscopic guidance depending on the intraoperative findings. The average time from injury to surgery was 8 months. The patients were followed for an average of 9 months after surgery, and assessment was based on the patients subjective experience as well as standardized neurosensory testing. Eighteen patients (90%) had some improvement in neurosensory function and 2 patients (10%) reported no improvement. One of the patients exhibiting no clinical improvement had a prolonged delay in seeking treatment, and the distal nerve could not be localized intraoperatively. Most patients were operated on between 2.5 and 7 months after injury, and there was no statistical difference in outcome as a function of the time from injury to repair in this group of patients. This subgroup of responding patients averaged at least 50% improvement in neurosensory function. CONCLUSION: Microsurgical repair of lingual nerves provides moderate to significant improvements in clinical sensory function and is a useful option in treating affected individuals, especially when implemented soon after injury.
