RESUMEN
The management of condylar fractures is one of the most controversial topics in the repair of the maxillofacial skeleton. An extensive volume of literature exists describing the various indications for a specific treatment of this injury. This article outlines the absolute and relative indications for an open procedure and describes three different modalities for the immediate reconstruction of the temporomandibular joint system. Three different case reports are used to illustrate the respective procedures--replacement of the temporomandibular joint with autologous rib graft, replacement of the temporomandibular joint with an alloplast, and vertical ramus osteotomy for repositioning of the condylar stump. The discussion section reviews the findings and preferences of various treatment modalities described in the literature, along with the advantages and disadvantages.
Asunto(s)
Cóndilo Mandibular/lesiones , Fracturas Mandibulares/cirugía , Articulación Temporomandibular/lesiones , Adolescente , Adulto , Artroplastia de Reemplazo , Placas Óseas , Tornillos Óseos , Trasplante Óseo , Cuerpos Extraños/cirugía , Fracturas Conminutas/cirugía , Fracturas Mal Unidas/cirugía , Humanos , Luxaciones Articulares/cirugía , Masculino , Mandíbula/cirugía , Cóndilo Mandibular/cirugía , Osteotomía/métodos , Procedimientos de Cirugía Plástica , Articulación Temporomandibular/cirugía , Factores de Tiempo , Heridas por Arma de Fuego/cirugíaRESUMEN
The efficacy of pulsatile pressure saline irrigation has been demonstrated in the orthopedic, surgical, and dental literature. However, its use for treating infected mandibular fractures has not been documented. This article reviews the literature concerning pressure irrigation. The pulsatile pressure saline/antibiotic irrigation technique and indications for its use during the treatment of infected mandibular fractures are demonstrated with two case reports. The pulsatile pressure saline/antibiotic irrigation system is a useful adjunct to the standard therapeutic modalities of infection management. It is also useful for managing infected mandibular fractures, especially when open reduction and internal fixation with bone plates have been planned.