Tapia's syndrome after repair of a fractured mandible.

A 41-year-old gentleman underwent surgical repair of the fractured right parasymphisis and left condyle of his mandible. Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapia's syndrome was made.

Outcomes of prophylactic antibiotics following surgery for zygomatic bone fractures.

Data regarding the use of prophylactic antibiotics and infection rate following surgery for fractures of the zygomatic bone is scarce. Therefore an audit of the use and outcomes of antibiotic prophylaxis for surgery of fractures of the zygoma was undertaken. Following audit approval, four maxillofacial surgery units in the Yorkshire Region gathered prospective data for 134 patients undergoing surgery for fractures of the zygoma. Data was collected on four groups of patients undergoing surgery for fractures of the zygomatic bone: uncomplicated reductions of the zygomatic arch, reductions of the zygomatic complex without mini-plate fixation, reductions of the zygomatic complex using mini-plate fixation but excluding zygomatico-maxillary buttress, and fixation of the zygomatic complex with miniplates including the zygomatico-maxillary buttress. The choice and timing of any antibiotics given peri-operatively was recorded, and 30 days after the operation, the patients' notes were reviewed to identify any episodes of surgical site infection (SSI) requiring the prescription of antibiotics, or any instances of plate removal in the post-operative period. This data has demonstrated that the prescription of antibiotic prophylaxis for surgery for fractures of the zygomatic bone is extremely variable, and that the infection rate is low.

Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level.

PURPOSE: This randomized, clinical multicenter trial investigated the treatment outcomes of displaced condylar fractures, and whether radiographic fracture level was a prognostic factor in therapeutic decision-making between open reduction and internal fixation (ORIF) versus closed reduction and mandibulomaxillary fixation (CRMMF). PATIENTS AND METHODS: Sixty-six patients with 79 displaced fractures (deviation of 10 degrees to 45 degrees, or shortening of the ascending ramus >or=2 mm) of the condylar process of the mandible at 7 clinical centers were enrolled. Patients were randomly allocated to CRMMF (n = 30 patients) or ORIF (n = 36 patients) treatment. The following parameters were measured 6 months after the trauma. Clinical parameters included mouth opening, protrusion, and laterotrusion. Radiographic parameters included level of the fracture, deviation of the fragment, and shortening of the ascending ramus. Subjective parameters included pain (according to a visual analogue scale), discomfort, and subjective functional impairment with a mandibular functional impairment questionnaire. RESULTS: The difference in average mouth opening was 12 mm (P or=2 mm, should be treated with ORIF, irrespective of level of the fracture.

Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle.

PURPOSE: We examined the use of cannulated lag screw osteosynthesis for the treatment of fractures of the mandibular condylar head in providing a high-quality durable fixation, while at the same time reducing the trauma necessary for an open approach to the fracture site. PATIENTS AND METHODS: A preauricular approach was used for exposure, reduction, and osteosynthesis in 5 cases of type B condylar fractures. A cannulated screw system was used that allowed optimum placement of the self-cutting cannulated lag screw following insertion of a guiding wire and using clinical control to ensure its correct position. The joints were submitted to functional exercises immediately following surgery and postoperative radiologic, axiographic, and clinical follow-ups were performed. RESULTS: Radiologic follow-up revealed correct reduction and fixation in all 5 cases. Axiographic and clinical follow-up showed an initial limitation, but normal mobility of the condyles was achieved within 3 months postoperatively, with a maximum mouth opening of 41.2 +/- 9.4 mm after 6 months. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. CONCLUSION: By using a cannulated lag screw, it was shown that the major factor in the extent of the trauma relating to surgical access was the reduction of the fracture fragments. The method ensured stable fixation of the fracture with a minimum of osteosynthesis material, while reducing the operative time. In combination with intraoperative imaging techniques it can also successfully be applied to other fractures in maxillofacial surgery.