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Turostowski M, Rendenbach C, Herzog P, Ellinghaus A, Prates Soares A, Heiland M, Duda GN, Schmidt-Bleek K, Fischer H. Titanium vs PEO Surface-Modified Magnesium Plate Fixation in a Mandible Bone Healing Model in Sheep. ACS Biomater Sci Eng 2024; 10:4901-4915. [PMID: 39072479 PMCID: PMC11322917 DOI: 10.1021/acsbiomaterials.4c00602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
Titanium plates are the current gold standard for fracture fixation of the mandible. Magnesium alloys such as WE43 are suitable biodegradable alternatives due to their high biocompatibility and elasticity modulus close to those of cortical bone. By surface modification, the reagibility of magnesium and thus hydrogen gas accumulation per time are further reduced, bringing plate fixation with magnesium closer to clinical application. This study aimed to compare bone healing in a monocortical mandibular fracture model in sheep with a human-standard size, magnesium-based, plasma electrolytic-oxidation (PEO) surface modified miniplate fixation system following 4 and 12 weeks. Bone healing was analyzed using micro-computed tomography and histological analysis with Movat's pentachrome and Giemsa staining. For evaluation of the tissue's osteogenic activity, polychrome fluorescent labeling was performed, and vascularization was analyzed using immunohistochemical staining for alpha-smooth muscle actin. Bone density and bone mineralization did not differ significantly between titanium and magnesium (BV/TV: T1: 8.74 ± 2.30%, M1: 6.83 ± 2.89%, p = 0.589 and T2: 71.99 ± 3.13%, M2: 68.58 ± 3.74%, p = 0.394; MinB: T1: 26.16 ± 9.21%, M1: 22.15 ± 7.99%, p = 0.818 and T2: 77.56 ± 3.61%, M2: 79.06 ± 4.46%, p = 0.699). After 12 weeks, minor differences were observed regarding bone microstructure, osteogenic activity, and vascularization. There was significance with regard to bone microstructure (TrTh: T2: 0.08 ± 0.01 mm, M2: 0.06 ± 0.01 mm; p = 0.041). Nevertheless, these differences did not interfere with bone healing. In this study, adequate bone healing was observed in both groups. Only after 12 weeks were some differences detected with larger trabecular spacing and more vessel density in magnesium vs titanium plates. However, a longer observational time with full resorption of the implants should be targeted in future investigations.
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Affiliation(s)
- Marta Turostowski
- Department
of Oral and Maxillofacial Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Carsten Rendenbach
- Department
of Oral and Maxillofacial Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Paulina Herzog
- Department
of Oral and Maxillofacial Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Agnes Ellinghaus
- Julius
Wolff Institute, Berlin Institute of Health
at Charité − Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Ana Prates Soares
- Department
of Oral and Maxillofacial Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
- Julius
Wolff Institute, Berlin Institute of Health
at Charité − Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Max Heiland
- Department
of Oral and Maxillofacial Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
| | - Georg N. Duda
- Julius
Wolff Institute, Berlin Institute of Health
at Charité − Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Katharina Schmidt-Bleek
- Julius
Wolff Institute, Berlin Institute of Health
at Charité − Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Heilwig Fischer
- Department
of Oral and Maxillofacial Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
- Center
for Musculoskeletal Surgery, Charité
− Universitätsmedizin Berlin, Corporate Member of the
Freie Universität Berlin, Humboldt-Universität zu Berlin
and Berlin Institute of Health, Augustenburger Platz 1, Berlin 13353, Germany
- BIH
Charité Clinician Scientist Program, Berlin Institute of Health at Charité − Universitätsmedizin
Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1 ,Berlin 10117, Germany
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Lynn JV, Daniel MC, Jackson CMK, Ulma RM, Vercler CJ, Kasten SJ, Buchman SR. Reasons for Removal of Rigid Internal Fixation Devices in Craniofacial Surgery: A 20-year Update. J Craniofac Surg 2024; 35:1052-1056. [PMID: 38349348 DOI: 10.1097/scs.0000000000010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/03/2024] [Indexed: 06/04/2024] Open
Abstract
The hardware utilized for rigid internal fixation of the craniofacial skeleton has evolved over time. Thus, the reasons for the unplanned removal of hardware continue to change. The purpose of this study is to compare past (1989-1995) and present (2000-2020) patient cohorts to establish trends related to unplanned removal of craniofacial hardware. A retrospective review study was designed. Data from our institution's original publication describing the unplanned removal of craniofacial hardware (1989-1995) was obtained. Data related to patients who underwent unplanned removal of hardware from 2000 to 2020 was collected from the electronic medical record. A descriptive statistical analysis was performed to compare demographics, reasons for hardware placement, and reasons for unplanned hardware removal between cohorts. This study includes 55 patients treated from 1989 to 1995 and 184 patients treated from 2000 to 2020. The average age at hardware placement decreased from 32 years (1989-1995) to 28 years (2000-2020). The most common reason for hardware placement changed from motor vehicle accident (1989-1995) to congenital deformity (2000-2020). The length of time with hardware in situ increased from 13 months (1989-1995) to 25 months (2000-2020). The most common reason for hardware removal changed from prominent hardware (1989-1995) to hardware exposure (2000-2020). In summary, patients who underwent rigid internal fixation of the craniofacial skeleton from 2000 to 2020 retained their hardware 2 times longer than patients treated from 1989 to 1995. Factors potentially contributing to increased retention include improved surgical technique, decreased profile of hardware, and increased surgeon experience. Further studies are warranted to define preoperative risk factors for unplanned hardware removal.
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Affiliation(s)
- Jeremy V Lynn
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
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Kaplan GO, Küçük KY, Kara M, Calis M, Tunçbilek G. Comparison of closed percutaneous screw reduction versus open reduction and internal fixation in the treatment of frontal sinus fractures: A retrospective study. J Craniomaxillofac Surg 2024; 52:743-747. [PMID: 38580560 DOI: 10.1016/j.jcms.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/01/2024] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
The aim of this study was to compare closed percutaneous screw reduction to traditional open reduction-internal fixation (OR-IF) for the treatment of anterior table fractures. Both groups were evaluated in terms of operative variables, complications, and treatment success. Of 32 patients included, 19 patients underwent OR-IF, while 13 underwent percutaneous screw reduction. The median operative time, length of hospital stays, and treatment cost of the OR-IF group were 100 min (range 60-130), 4 days (range 3-9), and $727 (range $642-$1291), respectively. The same variables for the closed reduction group were 30 min (range 20-40), 2 days (range 1-2), and $303 (range $252-$349), respectively. The closed reduction group exhibited a shorter operative time (p< 0.001), reduced length of hospital stays (p< 0.001), lower treatment cost (p< 0.001), and a lower complication rate (p = 0.025) compared to the OR-IF group. Late-term outcomes in both groups showed no visible contour changes or step deformities. In conclusion, the percutaneous screw reduction technique is a safe and effective option with minimal morbidity in the treatment of frontal sinus anterior table fractures. Therefore, traditional OR-IF should be reserved for fractures that are not suitable for reduction using minimally invasive techniques.
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Affiliation(s)
- Güven Ozan Kaplan
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Kutluhan Yusuf Küçük
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Murat Kara
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Mert Calis
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey.
| | - Gökhan Tunçbilek
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
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James K, Uppada UK, Bharadwaj B, Swayampakula H. Compositional and surface changes of retrieved stainless-steel hardware and its effects on surrounding soft tissues: A prospective study. Natl J Maxillofac Surg 2024; 15:75-81. [PMID: 38690243 PMCID: PMC11057596 DOI: 10.4103/njms.njms_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 05/02/2024] Open
Abstract
Purpose To evaluate the surface, compositional, and histological changes in the overlying soft tissues of retrieved stainless-steel mini-plates and screws used for rigid internal fixation in the maxillofacial skeleton. Materials and Method A prospective study was conducted comprising 60 patients who sustained maxillofacial trauma and underwent ORIF in our unit previously and who required hardware retrieval in the post-operative phase. The retrieved hardware was evaluated for surface and compositional changes with the help of a scanning electron microscope for surface roughness and corrosion changes. Energy-dispersive X-ray study was done to know the composition and metal release from the hardware. The data obtained from these results were compared with a control unused and a sterile stainless-steel mini-plate and screw. The effects of the corrosion changes of this hardware on the adjacent soft tissues were evaluated histologically to assess the cellular changes of the soft tissue cover overlying the stainless-steel mini-plates and screws. Results A total of 96 stainless-steel mini-plates and 380 stainless-steel screws were retrieved from 60 patients. The control plate was smooth without any surface and corrosion defects, while the retrieved mini-plates irrespective of the reason for removal have shown surface roughness. Fe and Ni ions were found to be significantly reduced in the retrieved mini-plates. The presence of CrC in the retrieved plates indicates corrosion, which was seen only in hardware retrieved from symptomatic patients. The histological study revealed chronic inflammatory cell infiltrate with hyalinized connective tissue in all the samples irrespective of the reason for the removal of the plate. Conclusion Stainless-steel mini-plates and screws act as a potent foreign body material and initiate a localized inflammatory reaction due to its corrosive products with longer duration of stay. Hence, the authors advocate the overall shift in the use of stainless-steel hardware to titanium hardware for ORIF.
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Affiliation(s)
- K James
- Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| | - Uday Kiran Uppada
- Department of Dentistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - B Bharadwaj
- Department of Oral and Maxillofacial Surgery, Sri Balaji Dental College, Moinabad, Telangana, India
| | - Himaja Swayampakula
- Department of Oral and Maxillofacial Surgery, MNR Dental College and Hospital, Sanga Reddy, Telangana, India
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Riekert M, Lentzen MP, Tiddens J, Zöller JE, Kreppel M, Schick V. Prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures - A retrospective cohort study. J Craniomaxillofac Surg 2023; 51:454-459. [PMID: 37453892 DOI: 10.1016/j.jcms.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/11/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
The aim of the study was to evaluate prophylactic removal of titanium osteosynthesis miniplates in patients after midface fractures. Complaints after fracture treatment and complications after plate removal were analyzed, retrospectively. A total of 205 patients were included. Plate removal was performed in 99 cases. Complaints related to the osteosynthesis material resulted in more frequent plate removal (p < 0.001). Complications were noted in 22 patients after plate removal. Duration of plate removal did not correlate with postoperative complications. In 69 patients, plates were removed without previous symptoms. Of these patients, postoperative complications were recorded in 15 cases. In patients with complaints after osteosynthesis, complications after plate removal occurred in seven (23.3%) patients. Ectropia developed significantly more often with increasing age (p < 0.05). CONCLUSION: Within the limitations of the study it seems that prophylactic plate removal is a treatment option that is not associated with an increased complication rate.
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Affiliation(s)
- Maximilian Riekert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany.
| | - Max-Philipp Lentzen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Jelle Tiddens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Joachim E Zöller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Matthias Kreppel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Oral and Craniomaxillofacial and Plastic Surgery, Germany
| | - Volker Schick
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Germany
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Sasaki R, Watanabe Y, Miyamoto NS, Agawa K, Okamoto T. Innsbruck-style Retromandibular Anterior Trans-parotid Approach for Condylar Fractures: A Retrospective Review of 39 Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5091. [PMID: 37351120 PMCID: PMC10284331 DOI: 10.1097/gox.0000000000005091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
The retromandibular anterior trans-parotid (RAT) approach and a triangular-positioned double mini-plate osteosynthesis (TDO) technique have been reported from Innsbruck Medical University. This minimally invasive technique involves direct visualization of the condyle and is associated with lower incidence of facial palsy. Methods A retrospective review was performed on the RAT approach and TDO technique conducted by a surgeon and team at two hospitals in Tokyo during a period of 3 years and 10 months. Results This technique was performed on 35 patients with 39 condylar fractures. Sixty-nine percent of cases were due to accidental fall, 17% to traffic accidents, and 9% to sports. Furthermore, 92% cases were condylar base fractures. Nighty-seven percent of cases achieved good occlusion. The mean maximum mouth opening was 49 ± 1.3 mm. Postoperatively, facial palsy developed in three patients (7.7%), and two of them developed Frey syndrome at approximately 2.5 years postoperatively (5.1%). All patients completely recovered within 3 months postoperatively. One case each of salivary fistula, visible scar, and condylar resorption was found (2.6%). No case of massive bleeding during surgery, hematoma, or TMJ pain after surgery was found. Conclusion This technique could achieve good occlusion with low incidence of complications and could contribute to early social reintegration among patients.
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Affiliation(s)
- Ryo Sasaki
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Yorikatsu Watanabe
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Noriko Sangu Miyamoto
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
| | - Kaori Agawa
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Toshihiro Okamoto
- From the Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, School of Medicine, Tokyo, Japan
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Eshghpour M, Samieirad S, Shooshtari Z, Shams A, Ghadirimoghaddam N. Three Different Fixation Modalities following Mandibular Setback Surgery with Sagittal Split Ramus Osteotomy: A Comparative Study using Three-dimensional Finite Elements Analysis. World J Plast Surg 2023; 12:43-57. [PMID: 37220573 PMCID: PMC10200092 DOI: 10.52547/wjps.12.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/30/2023] [Indexed: 05/25/2023] Open
Abstract
Background The provision of sufficient stability after maxillofacial surgery is essential for the reduction of complications and disease recurrence. The stabilization of osteotomized pieces results in rapid restoration of normal masticatory function, reduction of skeletal relapse, and uneventful healing at the osteotomy site. We aimed to compare qualitatively stress distribution patterns over a virtual mandible model after bilateral sagittal split osteotomy (BSSO) bridged with three different intraoral fixation techniques. Methods This study was conducted in the Oral and Maxillofacial Surgery Department of Mashhad School of Dentistry, Mashhad, Iran, from March 2021-March 2022. The mandible computed tomography scan of a healthy adult was used to generate a 3D model; thereafter, BSSO with a 3mm setback was simulated. The three following fixation techniques were applied to the model: 1) two bicortical screws, 2) three bicortical screws, and 3) a miniplate. The bilateral second premolars and first molars were placed under mechanical loads of 75, 135, and 600N in order to simulate symmetric occlusal forces. Finite element analysis (FEA) was carried out in Ansys software, and the mechanical strain, stress, and displacement calculations were recorded. Results The FEA contours revealed that stress was mainly concentrated in the fixation units. Although bicortical screws presented better rigidity than miniplates, they were associated with higher stress and displacement readings. Conclusion Miniplate fixation demonstrated the most favorable biomechanical performance, followed by fixation with two and three bicortical screws, respectively. Intraoral fixation with miniplates in combination with monocortical screws can serve as an appropriate fixation arrangement and treatment option for skeletal stabilization after BSSO setback surgery.
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Affiliation(s)
- Majid Eshghpour
- Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Dental Research Center, Mashhad Univer-sity of Medical Sciences, Mashhad, Iran
| | - Abdolrahim Shams
- Oral and Maxillofacial Surgery Depar-tment, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nafiseh Ghadirimoghaddam
- Oral and Maxillofacial Surgery Depar-tment, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Fischer H, Schmidt-Bleek O, Orassi V, Wulsten D, Schmidt-Bleek K, Heiland M, Steffen C, Rendenbach C. Biomechanical Comparison of WE43-Based Magnesium vs. Titanium Miniplates in a Mandible Fracture Model in Sheep. MATERIALS (BASEL, SWITZERLAND) 2022; 16:102. [PMID: 36614440 PMCID: PMC9821048 DOI: 10.3390/ma16010102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
In fractures of the mandible, osteosynthesis with titanium plates is considered the gold standard. Titanium is an established and reliable material, its main disadvantages being metal artefacts and the need for removal in case of osteosynthesis complications. Magnesium, as a resorbable material with an elastic modulus close to cortical bone, offers a resorbable alternative osteosynthesis material, yet mechanical studies in mandible fracture fixation are still missing. The hypothesis of this study was that magnesium miniplates show no significant difference in the mechanical integrity provided for fracture fixation in mandible fractures under load-sharing indications. In a non-inferiority test, a continuous load was applied to a sheep mandible fracture model with osteosynthesis using either titanium miniplates of 1.0 mm thickness (Ti1.0), magnesium plates of 1.75 mm (Mg1.75), or magnesium plates of 1.5 mm thickness (Mg1.5). No significant difference (p > 0.05) was found in the peak force at failure, stiffness, or force at vertical displacement of 1.0 mm between Mg1.75, Mg1.5, and Ti1.0. This study shows the non-inferiority of WE43 magnesium miniplates compared to the clinical gold standard titanium miniplates.
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Affiliation(s)
- Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Oskar Schmidt-Bleek
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Vincenzo Orassi
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dag Wulsten
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katharina Schmidt-Bleek
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Claudius Steffen
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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9
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Mohamad NH, Murugesan R, Soh CL, Singh J. A 7-Year Retrospective Analysis of Titanium Plates Removal Following Orthognathic Surgery. J Maxillofac Oral Surg 2022; 21:743-746. [PMID: 36274901 PMCID: PMC9475007 DOI: 10.1007/s12663-020-01434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of this study was to investigate the incidence of plate removal in orthognathic surgery patients and the reasons for their removal and to potentially identify the factors that may contribute to it. Methods A retrospective study included all patients who underwent orthognathic surgery at Selayang Hospital from January 2011 to December 2017. The variables of interest recorded included patient age, gender, the existing skeletal deformity, type of surgery undertaken and number and location of plates inserted and removed. In addition, the reasons for plate removal and duration between plate insertion and removal were also recorded. Results Ninety-seven patients with a mean age of 21.33 were included in the study. Nine patients with total of 33 plates had their miniplate fixation removed. Three patients underwent bi-maxillary surgery, and six patients underwent BSSO. The average time from insertion to removal was 22.33 months. The reasons for removal included pain, palpable and exposed plates, infection and on patient request. Conclusion We report a 9.28% incidence of plate removal in patients who undergo orthognathic surgery which is comparable to the existing literature.
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Affiliation(s)
| | - Ravindran Murugesan
- Hospital Selayang, Lebuh Raya Selayang-Kepong, 68100 Batu Caves, Selangor Malaysia
| | - Chen Loong Soh
- Hospital Tengku Ampuan Afzan Pahang, Jalan Tanah Putih, 25100 Kuantan, Pahang Malaysia
| | - Jaswinder Singh
- Hospital Selayang, Lebuh Raya Selayang-Kepong, 68100 Batu Caves, Selangor Malaysia
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10
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Vasile VA, Istrate S, Iancu RC, Piticescu RM, Cursaru LM, Schmetterer L, Garhöfer G, Cherecheanu AP. Biocompatible Materials for Orbital Wall Reconstruction-An Overview. MATERIALS (BASEL, SWITZERLAND) 2022; 15:2183. [PMID: 35329635 PMCID: PMC8954765 DOI: 10.3390/ma15062183] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
The reconstruction of an orbit after complex craniofacial fractures can be extremely demanding. For satisfactory functional and aesthetic results, it is necessary to restore the orbital walls and the craniofacial skeleton using various types of materials. The reconstruction materials can be divided into autografts (bone or cartilage tissue) or allografts (metals, ceramics, or plastic materials, and combinations of these materials). Over time, different types of materials have been used, considering characteristics such as their stability, biocompatibility, cost, safety, and intraoperative flexibility. Although the ideal material for orbital reconstruction could not be unanimously identified, much progress has been achieved in recent years. In this article, we summarise the advantages and disadvantages of each category of reconstruction materials. We also provide an update on improvements in material properties through various modern processing techniques. Good results in reconstructive surgery of the orbit require both material and technological innovations.
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Affiliation(s)
- Victor A Vasile
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
| | - Sinziana Istrate
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
| | - Raluca C Iancu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
| | - Roxana M Piticescu
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Laura M Cursaru
- Nanostructured Materials Laboratory, National R&D Institute for Nonferrous and Rare Metals, 077145 Pantelimon, Romania
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore 639798, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore 637459, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4056 Basel, Switzerland
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, 1090 Vienna, Austria
| | - Alina Popa Cherecheanu
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, District 5, 020021 Bucharest, Romania
- Department of Ophthalmology, University Emergency Hospital, 020021 Bucharest, Romania
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Hardware Removal in Maxillofacial Trauma: A Retrospective Study. ScientificWorldJournal 2021; 2021:9947350. [PMID: 34257626 PMCID: PMC8245212 DOI: 10.1155/2021/9947350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/06/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Miniplates are commonly used for the fixation of maxillofacial fracture segments. Removal of the hardware is controversial. A retrospective study of medical records was performed to observe the reasons for plate removal. Materials and Methods A 10-year retrospective study of medical records was performed. Demographics, type of fracture, location, type of miniplate used, the time gap between the insertion and removal, and causes of hardware removal were assessed. Results About 1472 patients had undergone internal fixation for the facial fractures. Stainless steel miniplate was used in 489 patients, and titanium was used in 983 patients. Out of the 42 cases, 22 cases involved the removal of titanium hardware and 20 patients involved the removal of stainless steel hardware. Infection/osteomyelitis was the main cause of hardware removal. The maximum amount of hardware failure was in the mandible. 78.6% of hardware removal was performed in males. Conclusion Based on our study, routine removal of titanium miniplates can be performed in children to avoid growth disturbances, not indicated in adult patients unless symptomatic.
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Matsuda Y, Karino M, Okui T, Kanno T. Complications of Poly-l-Lactic Acid and Polyglycolic Acid (PLLA/PGA) Osteosynthesis Systems for Maxillofacial Surgery: A Retrospective Clinical Investigation. Polymers (Basel) 2021; 13:polym13060889. [PMID: 33799342 PMCID: PMC8001587 DOI: 10.3390/polym13060889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
Two second-generation PLLA/PGA bioresorbable osteosynthetic plate systems for oral and maxillofacial surgery are available in Japan. The two systems have different PLLA-PGA component ratios (RapidSorb®, 85:15; Lactosorb®, 82:18) and plate and screw shapes. We conducted a retrospective study to compare our clinical evaluation and examine the incidence of postoperative complications between the two plate systems. A retrospective survey was conducted in 148 patients (midfacial fracture/trauma (68.2%) and dentofacial deformity patients (31.8%); males (54.7%); median age, 37.5 years) treated using maxillofacial osteosynthetic plate systems. The complications included plate exposure (7.4%), infection, (2.7%), and plate breakage (0.7%). Multivariate logistic regression analysis showed a significant correlation between sex (female), plate system (Lactosorb®), number of plates, and pyriform aperture and periorbital sites of plate placement (p < 0.05). Additionally, the propensity score-adjusted model showed a significant correlation between Lactosorb® and postoperative complications (odds ratio 1.007 (95% confidence interval, 1.001–1.055), p < 0.01). However, the two plate systems showed a low incidence rate of complications, and the plate integration and survivability were similar using 2.0-mm or 1.5-mm resorbable plate regardless of the plate system. Our findings suggest that female sex and a greater number of plates are risk factors for postoperative complications, whereas pyriform aperture and periorbital plate placements reduce the risk.
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Graillon N, Guyot L, Sigaux N, Louvrier A, Trost O, Lutz JC, Foletti JM. Do mandibular miniplates increase the risk of complex fracture in facial trauma recurrence? Case series. J Craniomaxillofac Surg 2020; 49:613-619. [PMID: 33994291 DOI: 10.1016/j.jcms.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022] Open
Abstract
Whether to conserve or remove miniplates, widely used in oral and maxillofacial surgery, has not been agreed on in the literature. Complications such as pain, infection, and screw exposure or loosening have already been largely described. We present the consequences of a trauma recurrence on a mandible with miniplates. The data of 13 patients who had a mandibular fracture previously surgically treated with miniplates (ten mandibular fractures and three mandibular osteotomies) were analysed. All the patients were male; the average age was 32 years (range, 20-64 years). The mechanism of the second trauma was assault in most of the cases. The average time between the first osteosynthesis and the new fracture was 35 months (range, 6-128 months). The fractures occurred at a distance from the miniplates in all the cases except two. No plate fracture was reported. We hypothesised that miniplates reinforced the underlying bone, protecting it from fractures, and transmitted the forces to areas anterior or posterior to the miniplates or to the condyle. Thus, the risk of mandible trauma recurrence should be taken into account in the indication of plate removal, and the biomechanical consequences of the conservation of the miniplates should be studied.
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Affiliation(s)
- Nicolas Graillon
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, bd Pierre Dramard, 13916 Marseille, France.
| | - Laurent Guyot
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, bd Pierre Dramard, 13344 Marseille, France
| | - Nicolas Sigaux
- Department of Maxillofacial Surgery and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69310 Pierre-Bénite, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbanne, France
| | - Aurélien Louvrier
- Department of Oral and Maxillofacial Surgery, Hospital Dentistry Unit, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25000 Besançon, France; University of Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur, Ingénierie Cellulaire et Génique, 8 Rue du Docteur JFX Girod, F-25000 Besançon, France
| | - Olivier Trost
- Department of Oral and Maxillofacial Surgery, CHU Rouen, Hôpital Charles-Nicolle, 1 Rue de Germont, 76000 Rouen, France; Laboratoire d'anatomie UFR Santé de Rouen, Université Rouen Normandie, 22, Boulevard Gambetta, 76183 Rouen, France
| | - Jean-Christophe Lutz
- Maxillo-Facial Surgery Department, Strasbourg University Hospital, 1, Avenue Molière, 67098 Strasbourg Cedex, France; University of Strasbourg, Faculty of Medicine, 8 Rue Kirschleger, 67000 Strasbourg, France; Laboratory of Engineering Science, Computer Science and Imaging, CNRS, ICUBE University of Strasbourg, 2 Rue Boussingault, 67000 Strasbourg, FMTS, France
| | - Jean-Marc Foletti
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, bd Pierre Dramard, 13916 Marseille, France
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Fani M, Samieirad S, Shooshtari Z, Jamali M, Tohidi E. Is Mini-Plate Removal Necessary for Oral and Maxillofacial Surgery Patients? A Five-Year Case-Control Study. Front Dent 2020; 17:1-6. [PMID: 33615305 PMCID: PMC7882199 DOI: 10.18502/fid.v17i1.3967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives: The purpose of this study was to determine the mini-plate and screw removal rate and reasons in maxillofacial surgery patients under previous semi-rigid fixation treatment in the past five years at the main trauma center of Mashhad. Materials and Methods: This was a census-based retrospective study. All the candidates who admitted to our department for maxillofacial plate removal due to symptomatic or infected mini-plates were included in this study. The patients’ age and gender, plate removal etiologies, and the time between plate insertion and removal were analyzed. Results: Mini-plates were inserted for 1026 patients. However, only 94 patients with a mean age of 29.4±11.1 years were candidates for plate removal. The plate removal rate was 9.16%. Infection and exposure were the most common causes of plate removal. The most prevalent removal site was the mandible (angle and body). The interval between mini-plate insertion and removal was an average of 12.9±5.6 months. It is noteworthy that the shortest lasting duration was when plate removal was secondary to pain (6.67 months) and infection (11.45 months). Conclusion: This research showed that the routine removal of plates does not appear to be generally indicated in healthy subjects unless there is an obvious and definitive clinical indication.
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Affiliation(s)
- Mehdi Fani
- Department of Oral and Maxillofacial Surgery, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahand Samieirad
- Department of Oral and Maxillofacial Surgery, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.,Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Shooshtari
- Student Research Committee, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Jamali
- Student Research Committee, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Tohidi
- Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Khandelwal P, Rai AB, Bulgannawar B, Vakaria N, Sejani H, Hajira N. Miniplate removal in operated cases of maxillofacial region in a dental institute in Rajasthan, India. Med Pharm Rep 2019; 92:393-400. [PMID: 31750441 PMCID: PMC6853036 DOI: 10.15386/mpr-1195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/07/2018] [Accepted: 01/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background The long term management of miniplate fixation osteosynthesis remains debatable and controversial with few authors advocating routine removal of the miniplates after 3–6 months of placement, while others recommend retention of the miniplates unless their removal is clinically indicated. Objective The aim was to study the incidence, indications, time gap, role of metallic composition and site of removal of miniplates in operated cases of maxillofacial region over a two-year period. Methods Patients undergoing removal of miniplates over 2-year period were studied and evaluated regarding the number of miniplates removed, time gap present between fixation and removal of miniplates, indications for removal, metallic composition of miniplates removed, sites of removal and complications. Correlations between indications for miniplate removal based upon time gap, metallic composition, age group and number of miniplates present were determined using Chi-square test. Correlation between metallic composition of miniplate and time gap was also determined using Chi-square test. Results The miniplates were removed in 20 patients (16 males and 4 females). Most common indication for removal was infection (45%). Forty-five percent of the patients underwent miniplate removal within 1 year of placement. Thirty-four miniplates and 118 screws were removed. The correlation between indications for miniplate removal and time gap was found to be statistically significant (P = 0.04). Conclusion Most of the hardware removal is performed subsequent to complications associated with hardware and local factors play more important role than metallic composition. Routine asymptomatic miniplates do not require removal and is not recommended.
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Affiliation(s)
- Pulkit Khandelwal
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - A Bhagavandas Rai
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Bipin Bulgannawar
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Nilay Vakaria
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Hemal Sejani
- Department of Oral and Maxillofacial Surgery, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Neha Hajira
- Department of Prosthodontics, Darshan Dental College, Udaipur, Rajasthan, India
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Borys J, Maciejczyk M, Antonowicz B, Sidun J, Świderska M, Zalewska A. Free Radical Production, Inflammation and Apoptosis in Patients Treated With Titanium Mandibular Fixations-An Observational Study. Front Immunol 2019; 10:2662. [PMID: 31781128 PMCID: PMC6857478 DOI: 10.3389/fimmu.2019.02662] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/28/2019] [Indexed: 12/31/2022] Open
Abstract
Despite high biocompatibility of titanium and its alloys, this metal causes various side effects in the human body. It is believed that titanium biomaterials may induce an innate/adaptive immune response. However, still little is known about changes caused by titanium mandible implants, particularly with regard to bone healing. The latest studies showed disturbances in the antioxidant barrier, increased oxidative/nitrosative stress, as well as mitochondrial abnormalities in the periosteum covering titanium mandible fixations; nevertheless, the impact of titanium implants on free radical production, inflammation, and mandible apoptosis are still unknown. Because severe inflammation and apoptosis are among the main factors responsible for disturbances in osteointegration as well as implant rejection, this study is the first to evaluate pro-oxidant enzymes, cytokines as well as pro- and anti-apoptotic proteins in the periosteum of patients with a broken jaw, treated with titanium miniplates and miniscrews. The study group consisted of 29 patients with double-sided fracture of the mandible body requiring surgical treatment. We found significantly higher activity of NADPH oxidase and xanthine oxidase as well as enhanced rate of free radical production in the periosteum of patients in the study group compared to the control group. The markers of inflammation [interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), transforming growth factor β (TGF-β) and β-glucuronidase (GLU)] as well as apoptosis [Bax, Bax/Bcl-2 ratio, caspase-3 (CAS-3) and nitric oxide (NO)] were significantly elevated in periosteum covering titanium fixations compared to the control group. In the study group, we also demonstrated an increased content of titanium on the periosteum surface, which positively correlated with CAS-3 activity. The study led us to the conclusion that titanium mandible implants increase the production of pro-inflammatory cytokines, and enhance free radical generation in the periosteum covering titanium miniplates and miniscrews. Additionally, exposure to Ti6Al4V titanium alloy induces apoptosis in the mandible periosteum. However, no clinical signs of the said phenomena have been observed.
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Affiliation(s)
- Jan Borys
- Department of Maxillofacial and Plastic Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Bożena Antonowicz
- Department of Oral Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Jarosław Sidun
- Department of Material and Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland
| | - Magdalena Świderska
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Anna Zalewska
- Experimental Dentistry Laboratory, Medical University of Bialystok, Bialystok, Poland
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Yu Y, Liu W, Chen J, Quan L, Zheng X, Liu L. No Need to Routinely Remove Titanium Implants for Maxillofacial Fractures. J Oral Maxillofac Surg 2019; 77:783-788. [PMID: 30503979 DOI: 10.1016/j.joms.2018.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Titanium implants are typically used to fix maxillofacial fractures and their routine removal is a controversial topic in maxillofacial surgery. This study aimed to estimate the removal rate and risk factors associated with removal. MATERIALS AND METHODS The authors designed and implemented a retrospective study. Adult patients who underwent open reduction and internal fixation with titanium implants for maxillofacial fractures were included and those who returned for implant removal were identified from January 2007 to December 2016. The predictor variables were gender, age, preoperative infection, injury time, trauma cause, and fracture site. The primary outcome variable was removal of titanium implants. Descriptive and bivariate statistics were computed. Kaplan-Meier survival methods were used to estimate rate of removal. Univariate and multivariate Cox proportional hazards models were used to identify risk factors associated with removal. RESULTS Of 2,325 patients (1,890 men and 435 women; average age, ∼35.49 yr) registered in this study, 163 (7.01%) had their titanium implants removed and 1-, 2-, and 10-year removal rates were 3, 7, and 8%, respectively. The risk factors most closely associated with removal were preoperative infection, injury by a blow from an object, obsolete fracture, and female gender. CONCLUSIONS Routinely removing titanium implants in patients with maxillofacial fracture is not necessary. When the risk factors listed earlier are present in these patients, follow-up should be scheduled more frequently.
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Affiliation(s)
- Yongchun Yu
- Associate Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China; First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Weilong Liu
- Resident, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jinlong Chen
- Attending Staff, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Quan
- Associate Professor, Business College, China West Normal University, Nanchong, China
| | - Xiaohui Zheng
- Associate Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lei Liu
- Professor, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Balasundram S, Kovilpillai FJ, Royan SJ, Ma BC, Gunarajah DR, Adnan TH. A 4-Year Multicentre Audit of Complications Following ORIF Treatment of Mandibular Fractures. J Maxillofac Oral Surg 2019; 19:289-297. [PMID: 32346242 DOI: 10.1007/s12663-019-01204-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 02/15/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To ascertain the complications arising from open reduction and internal fixation of mandibular fractures and to elucidate if different osteosynthesis plating systems vary in treatment outcome. Materials and Methods This is a retrospective study. Parameters such as patient data, injury details, osteosynthesis implant system information, stability of fracture fragments, occlusion and complications were evaluated at different time intervals and logistic regression applied to determine the association of these factors with complications. Results Five hundred and ninety-three patients with mandibular fractures were included in this study (male 87.9% and female 12.1%), age range of 13-72 years (median = 22 years). Most fractures were caused by motor vehicle accidents (85.8%), assault (6.2%) and falls (4.7%). Parasymphyseal fractures were the most common (50.1%), followed by angle (35.2%) and body of mandible (25%). Median time interval between injury and intervention was 7 days (IQR 4-10). Median duration of follow-up from date of surgery was 72 days (IQR 30-230). 76.9% (456) were completely free of complications. Most complications (46%) occurred in the intermediate post-surgical period (1-6 weeks). Median interval period between surgery and complication was 15 days (IQR 7-67.5). Nerve injury and surgical site infection were the most common complications at 6.7% and 5.7%, respectively. There was a significant difference between the plating system in terms of complication outcome (p = 0.017). Conclusion Whilst the miniplate dimensions may be similar across different manufacturers, the complication outcome may differ between systems.
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Affiliation(s)
- Sathesh Balasundram
- Department of Oral and Maxillofacial Surgery, Sultanah Nora Ismail Batu Pahat Hospital, Ministry of Health Malaysia (Johor), Jalan Korma, Taman Soga, 83000 Batu Pahat, Johor Malaysia
| | - Ferdinand J Kovilpillai
- 2Department of Oral and Maxillofacial Surgery, Taiping Hospital, Ministry of Health Malaysia (Perak), Taiping, Malaysia
| | - Stephen J Royan
- Department of Oral and Maxillofacial Surgery, Malacca Hospital, Ministry of Health Malaysia (Malacca), Malacca, Malaysia
| | - Bee Chai Ma
- 4Department of Oral and Maxillofacial Surgery, Sultanah Aminah Hospital, Ministry of Health Malaysia (Johor), Johor Bahru, Malaysia
| | - Dharmindra Rajah Gunarajah
- Department of Oral and Maxillofacial Surgery, Malacca Hospital, Ministry of Health Malaysia (Malacca), Malacca, Malaysia
| | - Tassha Hilda Adnan
- 5Clinical Research Centre, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Sukegawa S, Kanno T, Manabe Y, Matsumoto K, Sukegawa-Takahashi Y, Masui M, Furuki Y. Is the removal of osteosynthesis plates after orthognathic surgery necessary? Retrospective long-term follow-up study. Int J Oral Maxillofac Surg 2018; 47:1581-1586. [DOI: 10.1016/j.ijom.2018.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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Clinical Evaluation of an Unsintered Hydroxyapatite/Poly-L-Lactide Osteoconductive Composite Device for the Internal Fixation of Maxillofacial Fractures. J Craniofac Surg 2018; 27:1391-7. [PMID: 27428913 PMCID: PMC5023762 DOI: 10.1097/scs.0000000000002828] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX. Methods: The authors treated 35 patients (19 men, 16 women; age, 14–88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines. Results: All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients—plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue. Conclusion: OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures.
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Açil Y, Heitzer MA, Gülses A, Naujokat H, Podschun R, Wiltfang J, Flörke C. The correlation between periodontal health status and suspectibility to infections associated with craniomaxillofacial osteosynthesis plates. J Craniomaxillofac Surg 2017; 45:1868-1874. [PMID: 28927956 DOI: 10.1016/j.jcms.2017.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/17/2017] [Accepted: 08/15/2017] [Indexed: 01/23/2023] Open
Abstract
AIM The aim of the present study was to demonstrate the possible relation between periodontal health status and infections associated with osteosynthesis materials (OMs) used in the oral and maxillofacial reconstruction. MATERIAL AND METHODS The study group consisted of 32 individuals which were subdivided into two groups regarding their PSI scores. After the removal of the osteosynthesis plates, microbial colonization was assessed via microbiological cultivation, fluorescence microscopy and scanning electron microscopy. In addition, samples obtained from gingival crevicular fluids were investigated by fluorescence microscopy. RESULTS A total of 118 osteosynthesis plates were examined. 8.5% (n = 10) of the plates were associated at least one of the clinical signs of infection. There was a positive correlation between periodontal disease and clinical signs of infection (p = 0.022). Patients with infection signs also had a higher number of smoking history (pack years, p = 0.010). Intraorally placed osteosynthesis plates showed wide range of bacterial colonizations compared to extraorally inserted osteosynthesis materials (p = 0.004). CONCLUSION Patients with poor periodontal health might be potential candidates for OM related infections. Early removal of OMs in patients with poor periodontal health status and/or heavy smokers would have clinical benefits. In addition, preferation of extraoral access to the fracture line might decrease the possibility of plate related infections.
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Affiliation(s)
- Yahya Açil
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Marie-Annett Heitzer
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Rainer Podschun
- Institute for Infection Medicine (Head: Prof. Dr. Helmut Fickenscher), University Hospital Schleswig-Holstein, Campus Kiel, Brunswiker Straße 4, 24105 Kiel, Germany.
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Jörg Wiltfang), University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
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Naujokat H, Gülses A, Wiltfang J, Açil Y. Effects of degradable osteosynthesis plates of MgYREZr alloy on cell function of human osteoblasts, fibroblasts and osteosarcoma cells. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:126. [PMID: 28711997 DOI: 10.1007/s10856-017-5938-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
The aim was to evaluate the biocompatibility of osteosynthesis plates of the MgYREZr/WE43 alloy by using human cells in vitro. Eluates of degradable magnesium osteosynthesis plates as well as halved plates were used for incubation with human osteoblasts, fibroblasts and osteosarcoma cells. The cell viability was evaluated by using FDA/PI-Staining and LDH analysis. Cell proliferation was assessed by MTT, WST-Test and BrdU-ELISA. Scanning electron microscope was used for investigation of the cell adhesion. The number of devitalized cells in all treatment groups did not significantly deviate from the control group. According to MTT results, the number of metabolically active cells was not significantly affected by the addition of the eluates. The number of metabolically active cells was reduced by 24 to 38% compared to the control on incubation in direct contact with the osteosynthesis plates. The proliferation of the cells was inhibited by the addition of the eluates. While the eluate of the half-hour elution has only a very small effect, the 24 h eluate significantly inhibits proliferation by 23-25% compared to the control. The roughened surface of the magnesium osteosynthesis plate after incubation showed adherent cells. However, some areas of the plates were also free of adherent cells. WE43 based magnesium alloys showed favorable biocompatibility considering the viability of the cells evaluated; however, proliferation rates were reduced in a time dependent manner, especially in fibroblast group. This might be a potential clinical benefit of magnesium osteosynthesis plates and their superiority to titanium, thus the fibroblastic ingrowth might negatively influence the bone-plate contact.
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Affiliation(s)
- Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Aydin Gülses
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
- Public Hospital Association, Ministry of Health of Turkey, Ankara, Turkey.
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Yahya Açil
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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Prado FB, Freire AR, Cláudia Rossi A, Ledogar JA, Smith AL, Dechow PC, Strait DS, Voigt T, Ross CF. Review of In Vivo Bone Strain Studies and Finite Element Models of the Zygomatic Complex in Humans and Nonhuman Primates: Implications for Clinical Research and Practice. Anat Rec (Hoboken) 2017; 299:1753-1778. [PMID: 27870351 DOI: 10.1002/ar.23486] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/16/2016] [Accepted: 07/27/2016] [Indexed: 11/09/2022]
Abstract
The craniofacial skeleton is often described in the clinical literature as being comprised of vertical bony pillars, which transmit forces from the toothrow to the neurocranium as axial compressive stresses, reinforced transversely by buttresses. Here, we review the literature on bony microarchitecture, in vivo bone strain, and finite-element modeling of the facial skeleton of humans and nonhuman primates to address questions regarding the structural and functional existence of facial pillars and buttresses. Available bone material properties data do not support the existence of pillars and buttresses in humans or Sapajus apella. Deformation regimes in the zygomatic complex emphasize bending and shear, therefore conceptualizing the zygomatic complex of humans or nonhuman primates as a pillar obscures its patterns of stress, strain, and deformation. Human fossil relatives and chimpanzees exhibit strain regimes corroborating the existence of a canine-frontal pillar, but the notion of a zygomatic pillar has no support. The emerging consensus on patterns of strain and deformation in finite element models (FEMs) of the human facial skeleton corroborates hypotheses in the clinical literature regarding zygomatic complex function, and provide new insights into patterns of failure of titanium and resorbable plates in experimental studies. It is suggested that the "pillar and buttress" model of human craniofacial skeleton function be replaced with FEMs that more accurately and precisely represent in vivo function, and which can serve as the basis for future research into implants used in restoration of occlusal function and fracture repair. Anat Rec, 299:1753-1778, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Felippe Bevilacqua Prado
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Alexandre Rodrigues Freire
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Ana Cláudia Rossi
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas-UNICAMP, Piracicaba, São Paulo, Brazil
| | - Justin A Ledogar
- Zoology Division, School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Amanda L Smith
- Department of Anthropology, Washington University in St. Louis, Missouri
| | - Paul C Dechow
- Department of Biomedical Sciences Texas A&M University, College of Dentistry, Dallas, Texas
| | - David S Strait
- Zoology Division, School of Environmental and Rural Science, University of New England, Armidale, NSW, Australia
| | - Tilman Voigt
- Department of Organismal Biology & Anatomy, University of Chicago, Chicago, Illinois
| | - Callum F Ross
- Department of Organismal Biology & Anatomy, University of Chicago, Chicago, Illinois
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Herford AS, Miller M, Lauritano F, Cervino G, Signorino F, Maiorana C. The use of virtual surgical planning and navigation in the treatment of orbital trauma. Chin J Traumatol 2017; 20:9-13. [PMID: 28202368 PMCID: PMC5343092 DOI: 10.1016/j.cjtee.2016.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/29/2016] [Accepted: 12/20/2016] [Indexed: 02/04/2023] Open
Abstract
Virtual surgical planning (VSP) has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three-dimensional (3D) printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.
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Affiliation(s)
- Alan Scott Herford
- Oral and Maxillofacial Surgery, 11092 Anderson St. Loma Linda, CA 92350, USA.
| | - Meagan Miller
- Oral and Maxillofacial Surgery, 11092 Anderson St. Loma Linda, CA 92350, USA
| | - Floriana Lauritano
- Department of Medical Sciences and Odontostomatology, University of Messina, ME, Italy
| | - Gabriele Cervino
- Department of Medical Sciences and Odontostomatology, University of Messina, ME, Italy
| | | | - Carlo Maiorana
- Odontostomatologic Surgery, University of Milan, Milan 20122, Italy
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Park HC, Kim SG, Oh JS, You JS, Kim WG. Mini-plate removal in maxillofacial trauma patients during a five-year retrospective study. J Korean Assoc Oral Maxillofac Surg 2016; 42:182-6. [PMID: 27595084 PMCID: PMC5009191 DOI: 10.5125/jkaoms.2016.42.4.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/11/2015] [Accepted: 06/26/2015] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The purpose of this study was to analyze the incidence of indications for the removal of mini-plates over a five-year period in maxillofacial trauma patients. MATERIALS AND METHODS The medical records of 530 patients who underwent treatment with mini-plate fixation after maxillofacial trauma were reviewed for a five-year period (May 2007 to May 2012). Patients were evaluated concerning the number of mini-plates removed, age and gender distributions, time between insertion and removal, indication for removal, and site of removal. RESULTS The plates of 120 patients were removed (26 females and 94 males). The removal rate was 22.6%. The most frequent indication for removal was patient demand (81.7%), followed by tooth extraction (7.5%), and pain (3.3%). The most frequent removal site was the mandible (95.0%). CONCLUSION The number of mini-plates removed was small, and the most common indication for removal was patient demand. There is no evidence to support a recommendation for the routine removal of titanium mini-plates.
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Affiliation(s)
- Hyun-Chun Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Su-Gwan Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Ji-Su Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Jae-Seek You
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
| | - Won-Gi Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Chosun University, Gwangju, Korea
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Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm. Ann Plast Surg 2016; 75:572-8. [PMID: 25393499 PMCID: PMC4888926 DOI: 10.1097/sap.0000000000000194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised. Materials and Methods A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article’s reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis. Result Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups. Conclusions Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.
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Hernandez Rosa J, Villanueva NL, Sanati-Mehrizy P, Factor SH, Taub PJ. Review of Maxillofacial Hardware Complications and Indications for Salvage. Craniomaxillofac Trauma Reconstr 2015; 9:134-40. [PMID: 27162569 DOI: 10.1055/s-0035-1570074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/25/2015] [Indexed: 10/22/2022] Open
Abstract
From 2002 to 2006, more than 117,000 facial fractures were recorded in the U.S. National Trauma Database. These fractures are commonly treated with open reduction and internal fixation. While in place, the hardware facilitates successful bony union. However, when postoperative complications occur, the plates may require removal before bony union. Indications for salvage versus removal of the maxillofacial hardware are not well defined. A literature review was performed to identify instances when hardware may be salvaged. Articles considered for inclusion were found in the PubMed and Web of Science databases in August 2014 with the keywords maxillofacial trauma AND hardware complications OR indications for hardware removal. Included studies looked at human patients with only facial trauma and miniplate fixation, and presented data on complications and/or hardware removal. Fifteen articles were included. None were clinical trials. Complication data were presented by patient, fractures, and/or plate without consistency. The data described 1,075 fractures, 2,961 patients, and 2,592 plates, nonexclusive. Complication rates varied from 6 to 8% by fracture and 6 to 13% by patient. When their data were combined, 50% of complications were treated with plate removal; this was consistent across the mandible, midface, and upper face. All complications caused by loosening, nonunion, broken hardware, and severe/prolonged pain were treated with removal. Some complications caused by exposures, deformities, and infections were treated with salvage. Exposed plates were treated with flaps, plates with deformities were treated with secondary procedures including hardware revision, and hardware infections were treated with antibiotics alone or in conjunction with soft-tissue debridement and/or tooth extraction. Well-designed clinical trials evaluating hardware removal versus salvage are lacking. Some postoperative complications caused by exposure, deformity, and/or infection may be successfully treated with plate salvage. We propose an algorithm using this review and clinical expertise. We also propose that a national databank be created where surgeons can uniformly compile their patient information and examine it in a standardized format to further our understanding of clinical management.
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Affiliation(s)
- Jonatan Hernandez Rosa
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nathaniel L Villanueva
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paymon Sanati-Mehrizy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie H Factor
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Yamamoto K, Matsusue Y, Horita S, Murakami K, Sugiura T, Kirita T. Routine removal of the plate after surgical treatment for mandibular angle fracture with a third molar in relation to the fracture line. Ann Maxillofac Surg 2015; 5:77-81. [PMID: 26389039 PMCID: PMC4555954 DOI: 10.4103/2231-0746.161077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: The purpose was to analyze the clinical course of surgically treated mandibular angle fractures from the viewpoint of routine removal of the plate because these fractures are associated with high rates of complications and plate removal. Subjects and Methods: The subjects were 40 patients with unilateral mandibular angle fracture, which was intraorally reduced and principally fixed with a single miniplate on the external oblique ridge. The third molar in relation to the fracture line was extracted in seven patients during the surgery. Clinical course was evaluated in terms of removal of the plate, preservation of the third molar and complications. Results: One patient showed a wound infection postoperatively, and two patients developed pericoronitis during the follow-up. These were managed with medication and local irrigation. One patient with a preserved third molar did not make a required visit and was lost from the follow-up. Removal of the plates was performed in 39 patients after confirmation of good fracture healing, mostly within a year. Twenty-four of 32 preserved third molars were simultaneously extracted. These procedures were generally performed under local anesthesia on an outpatient basis, and they did not cause any complications. Conclusions: Routine removal of the plate after surgical treatment for mandibular angle fractures, simultaneously with extraction of the third molar if indicated, may be beneficial to avoid complications related to the plate and the third molar later in life.
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Affiliation(s)
- Kazuhiko Yamamoto
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yumiko Matsusue
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Satoshi Horita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kazuhiro Murakami
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tsutomu Sugiura
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Chemical and structural analyses of titanium plates retrieved from patients. Int J Oral Maxillofac Surg 2015; 44:1005-9. [DOI: 10.1016/j.ijom.2014.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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Llandro H, Langford R. Reasons for plate removal after treatment of orbitozygomatic complex fractures. J Craniomaxillofac Surg 2015; 43:17-20. [DOI: 10.1016/j.jcms.2014.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/11/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022] Open
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El Azem A, Benington PC, Khambay BS, Ayoub AF. Evaluation of an interactive multi-media device for delivering information on Le Fort I osteotomy. J Craniomaxillofac Surg 2014; 42:885-9. [DOI: 10.1016/j.jcms.2014.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 09/10/2013] [Accepted: 01/03/2014] [Indexed: 11/16/2022] Open
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Parmar BS, Makwana KG, Patel AM, Tandel RC, Shah J. Use of a single 2.0-mm locking AO reconstruction titanium plate in linear, non-comminuted, mandible fractures. Ann Maxillofac Surg 2014; 4:51-4. [PMID: 24987599 PMCID: PMC4073463 DOI: 10.4103/2231-0746.133079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: The aim of the following study is to prospectively evaluate the use of a single Arbeitsgemeinschaft für Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear non-comminuted mandibular fractures without the use of a second plate. Materials and Methods: This study consisted of a sample of 10 patients who reported to the department with fractures of the mandible and were treated over a period of 24 months from November 2010 to November 2012. Out of these, there were 8 male patients and 2 female patients. There were four cases of isolated parasymphysis fractures, 1 of the case had a parasymphysis fracture associated with subcondylar fracture, 4 had a body fracture and 2 had a symphysis fracture. Results: All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Only one patient (10%) developed minor complications. Conclusion: The study has demonstrated that treating linear non-comminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plate provides excellent stability at the fracture site which in turn leads to sound bone healing and early functional rehabilitation.
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Affiliation(s)
- Babu S Parmar
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, Gujarat, India
| | - Kalpesh G Makwana
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, Gujarat, India
| | - Aditi M Patel
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, Gujarat, India
| | - Ramanuj C Tandel
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, Gujarat, India
| | - Jay Shah
- Department of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Ahmedabad, Gujarat, India
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Jhass AK, Johnston DA, Gulati A, Anand R, Stoodley P, Sharma S. A scanning electron microscope characterisation of biofilm on failed craniofacial osteosynthesis miniplates. J Craniomaxillofac Surg 2014; 42:e372-8. [PMID: 24780352 DOI: 10.1016/j.jcms.2014.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 02/10/2014] [Accepted: 03/21/2014] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Between 3 and 18% of craniofacial osteosynthesis plates are removed due to chronic infection. Removal of the plate is necessary to manage the chronic infective state i.e. miniplate removal results in resolution of the infection. These observations are suggestive of a biofilm-related infection. The aim of this retrospective study was to characterise the presence of biofilm on the removed miniplates from oral and maxillofacial surgery. MATERIALS AND METHODS A total of 12 plates and associated screws were recovered from eleven patients suffering from persistent, trauma site infection. The recovered plates plus 1 control plate were imaged using scanning electron microscopy (SEM). One recovered plate was also imaged using confocal microscopy (CM) for comparative purposes. RESULTS Of the 12 plates, 3 (25%) demonstrated highly localised polymicrobial biofilms, five (42%) demonstrated coccal biofilms, one possessed a filamentous biofilm and one showed attached yeast. Overall, 75% of the plates and 82% of the patients exhibited evidence of biofilm to varying degrees. All of the infections resolved following removal of the plates and antibiotic treatment. CONCLUSION Microbial biofilms can explain the clinical course of chronic infections associated with miniplates.
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Affiliation(s)
- Aneka K Jhass
- Faculty of Medicine, University of Southampton, Southampton S016 6YD, United Kingdom
| | - David Annandale Johnston
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Aakshay Gulati
- Department of Oral & Maxillofacial Surgery, University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Rajiv Anand
- Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom
| | - Paul Stoodley
- Microbial Tribology, National Centre for Advanced Tribology, Engineering Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom; Microbial Infection and Immunity and Orthopedics, Center for Microbial Interface Biology, The Ohio State University, 43210, USA.
| | - Sanjay Sharma
- Department of Oral & Maxillofacial Surgery, University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
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Removal of reconstruction plates after treatment of mandibular fractures. J Craniofac Surg 2013; 24:1864-5. [PMID: 24036807 DOI: 10.1097/scs.0b013e3182a305af] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee EI, Mohan K, Koshy JC, Hollier LH. Optimizing the surgical management of zygomaticomaxillary complex fractures. Semin Plast Surg 2012; 24:389-97. [PMID: 22550463 DOI: 10.1055/s-0030-1269768] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zygomaticomaxillary complex (ZMC) fractures are a group of fractures that can significantly alter the structure, function, and appearance of the midface, including the globe. Like other facial fractures, the optimal management of operative ZMC fractures requires anatomic reduction of all fractures followed by rigid internal fixation. However, surgical treatment of these fractures can be quite challenging with the potential for high rates of complications. The goal of this article is to provide an overview of ZMC fractures and discuss treatment options, with an emphasis on providing surgical pearls to optimize outcomes.
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Affiliation(s)
- Edward I Lee
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Abstract
BACKGROUND There is agreement that symptomatic plates should be removed, but there is no consensus among maxillofacial surgeons on the need for routine removal of asymptomatic plates. Only by evaluating long follow-up studies conducted with large-volume data that guidelines about when to remove and why remove plates used for internal rigid fixation can be traced. MATERIALS AND METHODS This study was conducted as a retrospective study. Clinical findings of all the patients presented at the department of maxillofacial surgery of 2 Italian hospitals, in whom miniplates were inserted between January 2004 and December 2007, were included: a follow-up of these patients was conducted until August 2009. RESULTS The region most involved with plates' insertion was the upper maxilla (49.8%), followed by mandibular body (38.1%), angle (7.9%), condyle (2.4%), and symphysis (1.8%). The region most involved in plates' removal was the maxilla in 9%, followed by mandibular body in the 7.5%. All plates inserted in angle regions were removed. Plates placed in the condylar area did not need any plate removal. CONCLUSIONS From this study, there is no evidence to support the advice for routine removal of titanium miniplates from the maxillofacial skeleton, although when using plates in the mandibular angle region, it would be necessary to inform the patient about the very high probability of a second operation necessary for the plates' removal.
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Cho PWJ, Burton RG, Gratton D, Cho JH. Biomechanical Study of SonicWeld Rx Pin in Cortical Bone Graft Layering Technique. J Oral Maxillofac Surg 2011; 69:1519-24. [DOI: 10.1016/j.joms.2010.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 02/26/2010] [Accepted: 05/17/2010] [Indexed: 11/16/2022]
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Neumann A, Kevenhoerster K. Biomaterials for craniofacial reconstruction. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2011; 8:Doc08. [PMID: 22073101 PMCID: PMC3199817 DOI: 10.3205/cto000060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Biomaterials for reconstruction of bony defects of the skull comprise of osteosynthetic materials applied after osteotomies or traumatic fractures and materials to fill bony defects which result from malformation, trauma or tumor resections. Other applications concern functional augmentations for dental implants or aesthetic augmentations in the facial region. For ostheosynthesis, mini- and microplates made from titanium alloys provide major advantages concerning biocompatibility, stability and individual fitting to the implant bed. The necessity of removing asymptomatic plates and screws after fracture healing is still a controversial issue. Risks and costs of secondary surgery for removal face a low rate of complications (due to corrosion products) when the material remains in situ. Resorbable osteosynthesis systems have similar mechanical stability and are especially useful in the growing skull. The huge variety of biomaterials for the reconstruction of bony defects makes it difficult to decide which material is adequate for which indication and for which site. The optimal biomaterial that meets every requirement (e.g. biocompatibility, stability, intraoperative fitting, product safety, low costs etc.) does not exist. The different material types are (autogenic) bone and many alloplastics such as metals (mainly titanium), ceramics, plastics and composites. Future developments aim to improve physical and biological properties, especially regarding surface interactions. To date, tissue engineered bone is far from routine clinical application.
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Matsushita K, Kuribayashi K, Nagamine K, Totsuka Y. Removal of broken screws using a hollow rubber tube (Nelaton catheter). Br J Oral Maxillofac Surg 2010; 49:672-3. [PMID: 20951479 DOI: 10.1016/j.bjoms.2010.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 09/15/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Kazuhiro Matsushita
- Department of Oral and Maxillofacial Surgery, Division of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Kita-ku, Sapporo, Japan.
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Thorén H, Snäll J, Kormi E, Lindqvist C, Suominen-Taipale L, Törnwall J. Symptomatic plate removal after treatment of facial fractures. J Craniomaxillofac Surg 2010; 38:505-10. [DOI: 10.1016/j.jcms.2010.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 01/27/2010] [Accepted: 01/29/2010] [Indexed: 11/27/2022] Open
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Pippi R, Solidani M, Broglia S, Cristalli MP. Prevention of mandibular fractures caused by difficult surgical extractions: report of a borderline case. J Oral Maxillofac Surg 2010; 68:1162-5. [PMID: 20188450 DOI: 10.1016/j.joms.2009.07.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 04/14/2009] [Accepted: 07/25/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Roberto Pippi
- Oral Surgery Unit, Department of Odontostomatological Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy.
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O’Connell J, Murphy C, Ikeagwuani O, Adley C, Kearns G. The fate of titanium miniplates and screws used in maxillofacial surgery: A 10 year retrospective study. Int J Oral Maxillofac Surg 2009; 38:731-5. [DOI: 10.1016/j.ijom.2009.02.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/07/2008] [Accepted: 02/13/2009] [Indexed: 10/21/2022]
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Policy of Routine Titanium Miniplate Removal After Maxillofacial Trauma. J Oral Maxillofac Surg 2008; 66:1901-4. [DOI: 10.1016/j.joms.2008.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 01/13/2008] [Accepted: 03/18/2008] [Indexed: 11/23/2022]
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Bakathir AA, Margasahayam MV, Al-Ismaily MI. Removal of bone plates in patients with maxillofacial trauma: a retrospective study. ACTA ACUST UNITED AC 2008; 105:e32-7. [PMID: 18329911 DOI: 10.1016/j.tripleo.2008.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 12/24/2007] [Accepted: 01/07/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to assess the incidence of and indication for the removal of bone plates over a 5-year period in patients with maxillofacial trauma who had received treatment at the Oral and Maxillofacial Surgery Unit, Al-Nahda Hospital, Muscat, Oman. STUDY DESIGN The medical records of all patients who underwent removal of bone plates after facial bone trauma were reviewed over a 5-year period (2000 to 2004). Data concerning age and gender distribution, cause of trauma, year of removal, time between insertion and removal, indication for removal, site of removal, and general medical factors were evaluated for each patient. RESULTS Facial bone fractures in 1,177 cases were diagnosed during the study period, of which 465 cases underwent open reduction and internal fixation using bone plates and screws. In 109 cases bone plates were removed (79 males and 30 females), with an overall removal rate of 23.4%. The most common indication for removal was young age (53.4%) followed by infection (25%). The mandible was the most common site of removal (80%). Most of the plates (86%) that required removal in adults were removed within the first year after insertion. CONCLUSIONS Based on this study, the incidence of bone plate removal was relatively low, and the most common indications for plate removal were young age followed by infection.
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Affiliation(s)
- Abdulaziz A Bakathir
- Oral and Maxillofacial Surgeon, Oral Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
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