The Use of MMF Screws: Surgical Technique, Indications, Contraindications, and Common Problems in Review of the Literature

Craniomaxillofacial trauma: synopsis of 14,654 cases with 35,129 injuries in 15 years

Craniomaxillofacial (CMF) trauma occurs in isolation or in combination with other serious injuries, including intracranial, spinal, and upper- and lower-body injuries. It is a major cause of expensive treatment and rehabilitation requirements, temporary or lifelong morbidity, and loss of human productivity. The aim of this study was to evaluate patterns of CMF trauma in a large patient sample within a 15-year time frame. Between 1991 and 2005, CMF trauma data were collected from 14,654 patients with 35,129 injuries at the Department of Cranio-Maxillofacial and Oral Surgery in Innsbruck, assessing a plethora of parameters such as injury type and mechanism as well as age and gender distribution over time. Three main groups of CMF trauma were evaluated: facial bone fractures, dentoalveolar trauma, and soft tissue injuries. Statistical comparisons were carried out using a chi-square test. This was followed by a logistic regression analysis to determine the impact of the five main causes for CMF injury. Older people were more prone to soft tissue lesions with a rising risk of 2.1% per year older, showing no significant difference between male and female patients. Younger patients were at higher risk of suffering from dentoalveolar trauma with an increase of 4.4% per year younger. This number was even higher (by 19.6%) for female patients. The risk of sustaining facial bone fractures increased each year by 4.6%. Male patients had a 66.4% times higher risk of suffering from this type of injury. In addition, 2550 patients (17.4%) suffered from 3834 concomitant injuries of other body parts. In summary, we observed changing patterns of CMF trauma over the last 15 years, paralleled by advances in refined treatment and management options for rehabilitation and reconstruction of patients suffering from CMF trauma.

Use of orthodontic mini-implants for maxillomandibular fixation in mandibular fracture

Orthodontic appliances for skeletal anchorage are becoming increasingly more common in clinical practice. Similarly, different terms such as mini-implants, microimplants, and miniscrews have been used. There is a wide array of appliances currently on the market, in different designs and sizes, diameters, degree of titanium purity, and surface treatment. These appliances have been used for a variety of indications, including tooth retraction, intrusion, and traction. This study aimed to report the clinical case of a 19-year-old patient with a fractured mandible and to propose a novel use of mini-implants: the perioperative placement of mini-implants as anchors for maxillomandibular fixation steel wire ligatures. We concluded that this appliance provides an effective maxillomandibular fixation in patients with mandibular fracture, with little increase in the cost of surgery.

[Maxillary and mandibular fractures. Treatment concepts in maxillofacial surgery]

Maxillary and mandibular fractures are a relatively frequent occurrence due to the exposed location of the jaws and are caused mainly by acts of violence, traffic and recreational accidents. Mandibular fractures can be treated conservatively with dental splints and intermaxillary fixation. Since Michelet, miniplate osteosynthesis via intraoral access has become the method of choice. Champy showed that the monocortical fixation of miniplates at the level of the linea obliqua results in stable osteosynthesis, despite postoperative micro-movements in the fracture gap, and postulated the principle of dynamic compression. Dislocated fractures of the mandibular collum are treated with stable osteosynthesis via an intra- or extraoral approach, while fractures of the mandibular joint are usually treated conservatively and early functional rehabilitation is favored. For mandibular fractures, the principle of load-bearing and load-sharing should be considered, i.e. in the case of sufficient bone and uncomplicated fractures, the bone can bear most of the force, such that miniplates are sufficient (load-sharing). If bones are weakened by atrophy or in the case of infected, comminuted or defect fractures osteosynthesis plates must bear the load alone (load-bearing).