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Oral and Maxillofacial Surgery VOL.18 NO.11 November 2013 Oral and Maxillofacial Surgery OFFICIAL PUBLICATION FOR THE FEDERATION OF MEDICAL SOCIETIES OF HONG KONG ISSN 1812 - 1691 VOL.18 NO.11 NOVEMBER 2013 Contents Contents Editorial Science n Editorial 2 n 3D Printing in Medical Field 31 Dr. Philip KM LEE Prof. Ian GIBSON Dental Bulletin Radiology Quiz n Mandibular Condylar Fracture – 4 n Radiology Quiz 32 A Review of Management and Case Reports CME Dr. Agnes WONG Dr. Philip KM LEE n MCHK CME Programme Self-assessment Questions 8 Federation News 35 n Controversies and Advances of Orbital Fractures 11 Medical Diary of November 33 and Reconstruction Dr. Mike YY LEUNG Calendar of Events 34 n Zygomaticomaxillary Complex Fractures – 15 The Sunken Tripod of the Face Dr. Alfred SL LAU Scan the QR-code n Overview of Dentoalveolar Fractures 20 Dr. Jeni LI HO To read more about The Federation of Medical n About 3D Printing 26 Dr. James KF CHOW Societies of Hong Kong New Edition of Medical and Dental Directory Submit your data NOW! http://www.fmshk.org/directory2012.php Disclaimer All materials published in the Hong Kong Medical Diary represent the opinions of the authors responsible for the articles and do not reflect the official views or policy of the Federation of Medical Societies of Hong Kong, member societies or the publisher. Publication of an advertisement in the Hong Kong Medical Diary does not constitute endorsement or approval of the product or service promoted or of any claims made by the advertisers with respect to such products or services. The Federation of Medical Societies of Hong Kong and the Hong Kong Medical Diary assume no responsibility for any injury and/or damage to persons or property arising from any use of execution of any methods, treatments, therapy, operations, instructions, ideas contained in the printed articles. Because of rapid advances in medicine, independent verification of diagnoses, treatment method and drug dosage should be made. The Cover Shot A Sunday afternoon in Tsim Sha Tsui. The scene has not much colour due to the thin mist over the harbour. More for a black and white photograph than for a coloured one. Leica Monochrome, 35mm Summicron (8 elements) at f/8, 1/1500 sec (auto), ISO 320 Processed with Adobe Lightroom 4 and Silver Efex Pro 2 Dr. Edward HUI MBBS(HK), BDS(HK), MDS(HK), FDSRCS(Eng), FRCD,FCDSHK(OMS),FHKAM(DS) Specialist in oral and maxillofacial surgery 1 VOL.18 NO.11 NOVEMBER 2013 Editorial Published by The Federation of Medical Societies of Hong Kong EDITOR-IN-CHIEF Dr. MOK Chun-on Editorial 莫鎮安醫生 EDITORS Dr. Philip KM LEE Prof. CHAN Chi-fung, Godfrey 陳志峰教授 (Paediatrics) BDS, MDS(OMS), FFDRCSI, FRACDS, Dr. CHAN Chi-kuen FCDSHK(OMS), FHKAM(DS) 陳志權醫生 (Gastroenterology & Hepatology) Specialist in Oral and Maxillofacial Surgery Dr. KING Wing-keung, Walter 金永強醫生 (Plastic Surgery) Editor Dr. LO See-kit, Raymond 勞思傑醫生 (Geriatric Medicine) EDITORIAL BOARD Dr. Philip KM LEE Dr. AU Wing-yan, Thomas 區永仁醫生 (Haematology and Haematological Oncology) The face could be considered as a special organ and probably is the Dr. CHAK Wai-kwong most complex one of the human body. Not only does it contain the 翟偉光醫生 (Paediatrics) “five senses” that we interact with our surroundings, it is also essential Dr. CHAN Chun-kwong, Jane 陳真光醫生 (Respiratory Medicine) for social interactions. Individual faces are unique and represent one’s Dr. CHAN Hau-ngai, Kingsley identity. 陳厚毅醫生 (Dermatology & Venereology) Dr. CHAN, Norman However, when there is trauma to the head and maxillofacial region, 陳諾醫生 (Diabetes, Endocrinology & Metabolism) Dr. CHEUNG Fuk-chi, Eric our face is dispensable anatomically. Our facial skeletons could 張復熾醫生 (Psychiatry) collapse and be displaced relatively easily. This cushion effect helps Dr. CHIANG Chung-seung to decrease the impact to our cranial vault, which harbours one other 蔣忠想醫生 (Cardiology) important organ of our body, our brain. However, the trauma to the Prof. CHIM Chor-sang, James 詹楚生教授 (Haematology and Haematological Oncology) facial skeletons could have severe impacts on the patient’s “five senses” Dr. CHONG Lai-yin and the well-being as an individual. 莊禮賢醫生 (Dermatology & Venereology) Dr. CHUNG Chi-chiu, Cliff In this issue, we shall discuss a few topics that are commonly seen in 鍾志超醫生 (General Surgery) Dr. FONG To-sang, Dawson patients with maxillofacial trauma. 方道生醫生 (Neurosurgery) Dr. HSUE Chan-chee, Victor As the dentition is closely related to the facial skeleton, it is not 徐成之醫生 (Clinical Oncology) uncommon to see associated malocclusion in those patients with facial Dr. KWOK Po-yin, Samuel 郭寶賢醫生 (General Surgery) trauma. Restoration of the traumatised dentition is always a challenge Dr. LAM Siu-keung to clinicians. When we are treating patients with maxillofacial trauma, 林兆強醫生 (Obstetrics & Gynaecology) rehabilitation of functions and restoration of anatomy are equally Dr. LAM Wai-man, Wendy imperative in the treatment planning. 林慧文醫生 (Radiology) Dr. LEE Kin-man, Philip 李健民醫生 (Oral & Maxillofacial Surgery) Dr. LEE Man-piu, Albert 李文彪醫生 (Dentistry) Dr. LI Fuk-him, Dominic 李福謙醫生 (Obstetrics & Gynaecology) Prof. LI Ka-wah, Michael, BBS 李家驊醫生 (General Surgery) Dr. LO Chor Man 盧礎文醫生 (Emergency Medicine) Dr. LO Kwok-wing, Patrick 盧國榮醫生 (Diabetes, Endocrinology & Metabolism) Dr. MA Hon-ming, Ernest 馬漢明醫生 (Rehabilitation) Dr. MAN Chi-wai 文志衛醫生 (Urology) Dr. NG Wah Shan 伍華山醫生 (Emergency Medicine) Dr. PANG Chi-wang, Peter 彭志宏醫生 (Plastic Surgery) Dr. TSANG Kin-lun 曾建倫醫生 (Neurology) Dr. TSANG Wai-kay 曾偉基醫生 (Nephrology) Dr. WONG Bun-lap, Bernard 黃品立醫生 (Cardiology) Dr. YAU Tsz-kok 游子覺醫生 (Clinical Oncology) Prof. YU Chun-ho, Simon 余俊豪教授 (Radiology) Dr. YUEN Shi-yin, Nancy 袁淑賢醫生 (Ophthalmology) Design and Production www.apro.com.hk 2 VOL.18 NO.11 NOVEMBER 2013 Dental Bulletin Mandibular Condylar Fracture – A Review of Management and Case Reports Dr. Philip KM LEE BDS, MDS(OMS), FFDRCSI, FRACDS, FCDSHK(OMS), FHKAM(DS) Specialist in Oral and Maxillofacial Surgery Dr. Philip KM LEE This article has been selected by the Editorial Board of the Hong Kong Medical Diary for participants in the CME programme of the Medical Council of Hong Kong (MCHK) to complete the following self-assessment questions in order to be awarded 1 CME credit under the programme upon returning the completed answer sheet to the Federation Secretariat on or before 30 November 2013. Introduction with an open bite. Much more serious complications include fracture of the tympanic plate, mandibular fossa The condyles of the mandible are the weakest parts of of temporal bone fracture with or without dislocation the mandible, which by itself basically is a solid piece of of the condylar head into the middle cranial fossa. Any bone. Condylar fractures commonly occur when there disturbance in growth of the developing jaw or even is trauma to the lower jaw. The “Guardsman Fracture” ankylosis of the temporomandibular joint must be typically describes such trauma. The syncope of the considered in the treatment of fractured condyles in a 2,3 long standing solider leads to a fall and impact at the growing patient. chin which results in a unilateral or bilateral condylar fractures as well as the symphysis fracture. (Fig. 1) The aims of treatment are to restore the occlusion and the function of the temporomandibluar joints. Condylar fractures are treated through surgical open reduction with internal rigid fixation or non-surgical functional therapy through closed reduction with intermaxillary fixation. With advances in osseous synthesis techniques and materials, and the emergence of titanium micro-screws and plates, open reduction and internal rigid fixation is getting more and more common and predictable with less disturbance to joint function. In closed reduction, the joint function is restored by allowing active mobilisation of the joint after a short period of intermaxillary fixation. The condyle is allowed to remodel. Elastic traction might be necessary to control any occlusal disharmony. There are advantages and disadvantages with both these techniques. Fig. 1 Guardsman Fracture The general consensus is to treat young growing patients with condylar fractures non-surgically. (Fig. 2, Condylar fractures can be classified according to the Fig. 3) However, controversies exist in choosing which 4 anatomical location of the fracture and the degree of technique is the best for a particular patient. dislocation of the condylar head. Classifications according to Lindahl (1977)1 Fracture level 1. Intracapsular fracture 2. Conylar neck fractue 3. Subcondylar fracture Fig. 2 Fracture right condyle in a young child According to its relationship with the mandible, the condylar fragment is then described and classified as displaced or non-displaced; and according to its relationship with the fossa as dislocated or non-dislocated. Unilateral or bilateral condylar fractures could occur. Depending on the degree of injury, displacement of fractured fragments; and dislocation of the condylar head, the patient may present with pain, a limited mouth opening, a deviated lower jaw and malocclusion Fig. 3 Remodelled right condyle after closed reduction 4 VOL.18 NO.11 NOVEMBER 2013 Dental Bulletin Ellis et al5 compared the outcomes of one hundred The CT scan confirmed the patient’s left unilateral forty-six patients, 81 were treated by closed and 65 condylar fracture and right parasymphyseal fracture. by open methods. The patients who were treated by The condylar fracture was at the subcondylar level and closed methods had significantly shorter posterior the condyle was displaced
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