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14.5.5 Complications ofFacial Fractures
The complications of facial fractures(104) are as follows:
Structures involved Complications caused
Orbit Loss of vision, ophthalmoplegia and diplopia, exophthalmos
Nerve foramina Unilateral loss of vision, ophthalmoplegia, diplopia, ptosis, anaesthesia
Temporalis muscle Trismus
Teeth Fracture, avulsion, devitalisation, malocclusion
Drainage canals Dacryocystitis
Medial canthal tendon Telecanthus
Cribriform plate CSF leakage
Middle face and condyles Injured carotid artery
Posterior extension Injured carotid artery, nerve foramina affectation
Note. CSF, Cerebrospinal fluid.
14.5.6 Factors Affecting Fracture Healing
Although there is a long list of variables that influence fracture healing, they can be broadly divided
into two categories: local and systemic(105).
14.5.6.1 Local Factors
1) The two most significant local elements influencing the healing process of fractures are the
biological environment and the blood supply. The nearby blood arteries are damaged right
after the fracture, resulting in low blood pressure. After the fracture, this gets better over the
following few hours to days, peaks at two weeks, and eventually returns to normal in three to
five months. Delay or non- union of the fracture site might result from reduced blood supply.
The usage of prostheses and the surgical treatment of fractures should both take into account
the bone’s blood supply. For instance, between 50% and 80% of the endosteal circulation would
be compromised during reaming for intramedullary nailing.
2) Properties of Fractures and Their Mechanical Surroundings: Over- motion and misalignment,
amount of bone comminution and loss, soft tissue damage and its entrapment within the
fracture site cause delayed union/non- union.
3) An infection can seriously impede the healing process, leading to a delayed or non- union union.
14.5.6.2 Systemic Fractures
Advanced Age: Compared to their younger counterparts, the elderly have a reduced ability to heal
fractures. Aging is associated with a weakened immune system and elevated systemic proinflammatory state affecting the inflammatory response(106).
Obesity: Delays fracture healing by lowering FGF and TGF- β levels and raising TNF- α levels in fat
mice, according to animal research(107).
14.5.6.3 Anaemia
Endocrine Disorders: Diabetes mellitus has a number of effects on the healing of fractures, includ-
ing a low cellular content and weak callus. The process of repairing fractures is also hampered
by menopause and parathyroid issues.
t.me/Dr_Mouayyad_AlbtousH
14.5.6.4 Administration ofSteroids
Malnutrition: Metabolic impairment, mainly vitamin D, and calcium deficiency affect bone union.
Smoking: Nicotine slows the formation of weak calluses and angiogenesis, delaying the healing of
fractures overall.
Medication: A number of drugs may have an impact on the fracture healing process, either directly
or indirectly. NSAIDs, corticosteroids and bisphosphonate affect bone healing. Quinolones have
adverse impact on chondrocytes which compromises fracture healing process(108– 110).
14.5.7 Bone Healing Techniques
14.5.7.1 Closed andOpen Reduction andInternal Fixation
Intermaxillary/maxillomandibular fixation (IMF/MMF) is immobilisation of mandibular fractured
segments by externally locking the occlusion into place. Soft tissue, bony fragments or hematoma
in the fracture site prevents anatomic reduction(111). Open reduction and internal fixation uses
plates and screws to fix the fracture site.
14.6 Summary
Dental pulp is the only soft tissue of the tooth structure, which provides vital functions including
nutrition to the rest of the tooth structures. Pulp tissue injury or damage is a frequent and crucial
event, and its healing is important to preserve the tooth vitality. Various dental treatments involve
procedures focusing on preservation of this vital structure. Healing of periodontium is also important for preservation of the tooth, which is anchored firmly to the underlying bone in alveolar
sockets. Thus any injury to the periodontium along with the surrounding bone should be treated
properly to preserve the tooth in the oral cavity. To facilitate the healing of various oral tissues and
avoid complications, it is crucial to understand their healing process along with the underlying
physiology, which varies from tissue to tissue.
221References
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Section 4
Clinical Genetics andDevelopmental Pathology
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15
The Human Genome andInheritance: Key Concepts
Yucel Erbilgin and Muge Sayitoglu
Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye
15.1 Introduction
The deoxyribonucleic acid (DNA) molecule is a double- strand molecule, held together by
hydrogen bonds. A structure consisting of sugar (deoxyribose in DNA and ribose in RNA),
purine (adenine or guanine) or pyrimidine (guanine or cytosine) group nitrogenous bases and
phosphate group is called a nucleotide. Nucleic acids (DNA and RNA) direct protein synthesis
and transmit genetic information from one generation to the next. The genomic information
on DNA is transcribed by mRNA splicing, followed by protein synthesis on ribosomes (translation). One codon, consisting of three base pairs, encodes one amino acid. The 20known basic
amino acids are encoded, and their sequence and modifications determine the function and
activity of proteins. During the cell cycle, DNA undergoes replication and cell division is an
important step in the accurate transmission of genetic information to daughter cells. The double strand of DNA diverges at several points to form replication forks, with one of the two
strands acting as a template. Replication starts in both directions from the starting point and
new strands of DNA are synthesised by DNA polymerases. This pattern of replication is called
‘semi- conservative’ replication (see Figure15.1)(1–3).
The gigantic structure of the human genome composed of nuclear and mitochondrial DNA is a
perfect organisation. In a diploid (2n) genome, six billion base pairs are packaged on 46 chromosomes, consisting of approximately 22,000 genes. Major international genome projects have
demonstrated that more than 80% of the genome is transcribed, but only 2% is translated into protein. It has been known for many years that non- gene regions, called junk DNA, are critical for
maintaining the genome and regulating gene expression, and that the level of sophistication of
organisms depends on the size of non- coding regions rather than coding regions.
229
Pathological Basis of Oral and Maxillofacial Diseases, First Edition. Edited by S. R. Prabhu, Syed Ali Khurram,
Omar Kujan and Merva Soluk Tekkesin.
© 2025 John Wiley & Sons Ltd. Published 2025 by John Wiley & Sons Ltd.
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