Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases.

PURPOSE: This article introduces a simple and reproducible classification of the degree of atrophy in fractures of the atrophic edentulous mandible, and evaluates the results of treatment in 84 consecutive fractures based on this classification. MATERIAL AND METHODS: Eight-four fractures of the edentulous mandible, with a height at the fracture site of < or = 20 mm, were included. Using the ratio of actual plate width to plate width on the postoperative radiograph, the actual height of the mandible at the fracture site was calculated. Twenty-five fractures (30%) were in the Class I atrophy group (height at the fracture site 16 to 20 mm), 33 fractures (39%) occurred in Class II atrophic mandibles (height 11 to 15 mm), and 26 fractures (31%) were seen in extremely atrophic Class III mandibles (height < or = 10 mm). The treatment was performed by compression plating without any postoperative MMF. Primary bone grafting was used in six cases (7%) because a partial bone defect was present at the fracture site. RESULTS: In 81 (96.5%) of the 84 fractures an uncomplicated, solid, bony union was achieved. Three major complications occurred: one osteomyelitis and two nonunions. The two nonunions occurred in bilateral fracture of an extremely atrophied mandible (Class III atrophy). Minor soft tissue infections, without interference with fracture healing, were observed in six cases (7%). CONCLUSIONS: Because there is an obvious relation between the height of the mandible and the incidence of complications in fracture healing, a special classification of the degree of atrophy is needed. In fractures of the extremely atrophic mandible (Class III atrophy) periosteal degloving should be avoided and supraperiosteal placement of plates is recommended. Compression osteosynthesis has proved to be a successful method, with minimal impairment of the patient and a low frequency of serious complications.

[Fractures of the atrophic mandible--a challenge for therapy]. / Frakturen des atrophischen Unterkiefers--eine Herausforderung für die Therapie.

Because treatment of fractures of the atrophic mandible still today presents significant difficulties and treatment modalities remain controversial, 87 of these consecutive fractures which were treated by an uniform method as compression osteosynthesis were evaluated. A new classification of the degree of atrophy which considers the special interest of fracture treatment is introduced. It is based on a metrical measurement of the height of the mandible in the fracture area. Mandibles of 16 to 20 mm height are classified as class I atrophy, those of 11 to 15 mm as class II atrophy, and those with a height of 10 mm or less as extremely atrophic mandibles or class III atrophy. This simple and reliable classification could also be used in future investigations on the results of different treatment modalities in atrophic mandibles. In our series of 87 fractures of the atrophic mandible which were treated by compression osteosynthesis 97% resulted in a solid osseous union without the need of a second surgical intervention. Three major complications occurred: 1 osteomyelitis and 2 non-unions (the latter in one patient with a double fracture of a class III atrophy mandible). To the best of our knowledge this series is the largest of fractures of truly atrophic mandibles treated by one uniform method. Compared to other treatment modalities compression osteosynthesis produced acceptable results and is recommended as the treatment of choice in fractures of the atrophic mandible.

[The treatment results in the differential therapy of mouth carcinomas. A retrospective study of the patient population of the Oral Surgery Department (1978-1986) of the University of Göttingen]. / Behandlungsergebnisse unterschiedlich therapierter Mundhöhlencarcinome. Retrospektive Untersuchung aus dem Patientengut der Kieferchirurgischen Abteilung (1978-1986) der Universität Göttingen.

In a retrospective observational study on malignomas of the oral and maxillofacial region a data material of 157 patients has been analyzed. Results of the therapy and the course of disease are presented. The average delay between the appearance of the first symptom respectively the beginning of a therapy and the treatment in a specialized department for maxillofacial surgery runs up to 4.3 month and 2.8 month respectively. This dissatisfying situation is corroborated by the results for TNM categories with more advanced tumors. Only 16.6% of the patients belong to the T1 category, 42% to the T2 category and 35.7% to the T3 category. In 30.5% of cases tumor cells are found in cervical lymph nodes. Correlations between the size and the localisation of the primary tumor and metastases are obviously. The results of treatment are presented in form of survival curves and curves for times of no recurrence. There is no advantage in a combination of chemotherapy and surgery instead of single surgical therapy. In cases of more advanced tumors in T2 and T3 category there is no recurrence after 2 years in 70% of surgical treatment and in 69% of combined surgical treatment and chemotherapy. The censored estimated survival rate after 5 years in cases of surgical treatment comes to 63%, in cases of combined therapy to 62%. The consistent radical neck dissection is of distinctive signification. Recurrencies in the neck dissection region appear in 8.2% of patients.