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The complex treatment optimalization of mandibular fractures


Author: Nicolae Chele
Degree:doctor of medicine
Speciality: 14.00.21 - Stomatology
Year:2007
Scientific adviser: Dumitru Şcerbatiuc
doctor habilitat, professor
Institution:
Scientific council:

Status

The thesis was presented on the 6 December, 2006
Approved by NCAA on the 18 January, 2007

Abstract

Adobe PDF document – 0.29 Mb / in romanian

Keywords

mandible fractures, surgery-orthopaedic treatment, retrospective analysis, determination of the degree of dolour sensibility, functional disorders

Summary

Mandibular Fractures occupy the top level in the oral maxillofacial surgery through an increased frequency, as well as by means of exceedingly various aspects that can be supported, due to etiological factors quite various, considering the violence and the destructive power of the traumatized agents, as well as the intercourse between these ones and the body.

The main etiological factor factors which produce a trauma involving the inferior mandible are almost the same in all the countries, but it could differ due to geographical area, the density of population, the socio-economic status of a certain country.

The objective basic elements of the research were: the assessment of incidence involving mandible traumas according to the information about patients’ hospitalization and optimalization of the complex treatment of people who received fractures by means of new diagnostic methods, treatment and control of consolidation processes.

There were analysed 4819 health records of patients with mandibular fractures, who where treated in the republican maxillofacial and oral surgical center, placed in (C.N.P.Ş.D.M.U.) from Chişinău, Republic of Moldova, during the 1990-2004 years. In the performed research on a period of 15 years, the mandibular fractures took the first place, with 68.84 % out of the entire mechanic lesions of facial bones.

The overall of 4819 from those patients who experienced similar unilateral fractures of mandible were observed in 3142 cases – 65.20 % and in 1677 cases – 34.80 % with more foci. The percent of foci localization in mandibular arch fracture in the well individualized atomic areas are presented in a decreasing way: the fracture line in the region of the mandibular angle – 46.11 % in the symphysic and parasymphysic body – 20.53 %, mandibular branch – 16.49 %.

Bilateral fractures may appear through a wide diversity of combinations taking into consideration the localization of fracture foci. The most frepuent associations were registered: angle – symphysic and parasymphysic area – 35.56 %; body angle – 30.55 % and the most rarely met are the ones involving body – body relation – 4.55 %.

In order to solve the task of the work out, there were used special methods of treatment as investigation at a group of 110 fractured patients in the mandible area who were administred both: a complex and simple treatment: the method of fixing back the bony fragments using bicorticale screams for proper construction of ,,Syntez’’ firm, the method of fastening the vertical occlusion dimentions with dental implants of proper construction in the eatensed edentation, the correction of plastic metabolism by way of administration of aminoacid mixture ,,Alvezin’’, there were advanced procedures of clinical objective evaluation considering mandible fractures by way of detecting the sensitiveness of pain in the fractured area, the assessment of the degree in the process of mouth opening, the assessment of the electroexitability of dental pulp from the fractured area, as well as the bucal hygiene assessment.

The obtained data were analysed statistically following the usual methods of biologic researches considering the criteria Fischer-Student, bilcocson – for the envolved pairs and Man – Uitni – for small groups.

The administration of the aminoacid mixture supply the tissues with a plastic material for the biosynthesis of proteins, thus making up for a partial malnutrition. In consequence, the patients who were administred a complex treatment, the qualitative and quantitative changes of biochemical indexes were less marked than those who received a traditional treatment.

The usage of bicorticale screws, in comparison with the usage of bimaxillar splints has a more acceptable priority as the screws offer the possibility of tight asseous fragment fixing without any repeated adjustments of intramaxilla blocking. The method is used in a very simple way, it doesn’t require some necessary equipment. By way of dental implant there are fixed the vertical occlusion dimentions in extensed edentation. These types of patients should follow a satisfactory oral hygiene. These screws do not harm the paradental tissue and intradental papillae.

The complex treatment reduces the complications and normalized the function of orthognathic system, it assesses the volume in the process of oral cavity opening necessary for an adequate phonetics usual nutrition, it contributes to the quick involvement of the patient in the process of working. The examination of pain sensibility in the fracture region corresponds with the clinic and on its basis the process of regeneration and fracture consolidation can be observed.