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Floros MC, Bortolatto JF, Lausch AJ, Valiente AJ, Sone ED, Santerre JP, Whyne C, Fialkov JA. BoneTape: A novel osteosynthetic device for the stabilization of zygomatic fractures. J Plast Reconstr Aesthet Surg 2024; 91:276-283. [PMID: 38432085 DOI: 10.1016/j.bjps.2024.02.020] [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: 10/16/2023] [Revised: 12/15/2023] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The study aims to assess the safety and effectiveness of BoneTape™, a new resorbable bone fixation device, using a zygomatic fracture model in rabbits. METHODS The study followed BoneTape™ samples and control (sham) groups over 2-, 6-, and 12-week periods post-zygomaticomaxillary (ZM) osteotomy and zygomaticofrontal (ZF) disarticulation. The osteotomized segments were analyzed for bone healing, inflammatory response, and tissue healing. µCT imaging and histological analysis were used to examine the axial alignment, offset, and quality of new bone formation. RESULTS BoneTape™ samples demonstrated enhanced maintenance of the initial intraoperative positioning, reduced axial offset, and better alignment when compared with the control group, enabling stable bone healing under physiological loading conditions. Complete union was observed at 12-weeks in both groups. The BoneTape™ group experienced minimal immune and tissue reactions, classically associated with wound healing, and showed an increased number of giant cells at 6 and 12-weeks. CONCLUSION BoneTape™ represents a promising advancement in osteosynthesis, demonstrating efficacy in maintaining stable zygomatic reconstruction and eliciting minimal immune response in a rabbit model. This study introduces BoneTape™ as a disruptive solution specifically designed for clinical application in cranio-maxillofacial fracture fixation, with the potential to eliminate the use of over-engineered solutions while offering benefits such as ease of application and fewer biologically disruptive steps.
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Affiliation(s)
| | | | | | | | - Eli D Sone
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Deparment of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - J Paul Santerre
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Cari Whyne
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada
| | - Jeffrey A Fialkov
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada.
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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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Safety of Contemporary Resorbable Fixation Systems for Craniofacial Reconstruction in Pediatric Patients. Plast Reconstr Surg 2021; 148:838-848. [PMID: 34398868 DOI: 10.1097/prs.0000000000008333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resorbable hardware allows adequate strength for maintaining the relative position of the craniofacial skeleton during osseous healing, and allowing subsequent growth in pediatric patients. The purpose of this study was to determine the complication profile of the latest copolymer of resorbable plates for craniofacial reconstruction in pediatric patients. METHODS Retrospective query of the operative billing record was performed for use of the DePuy Synthes Rapidsorb Fixation System at the authors' tertiary children's hospital from 2015 to 2019. Three hundred twenty-five patients were randomly selected for analysis of complications within the first postoperative year. RESULTS Median age at craniofacial reconstruction was 3.0 years, with 127 procedures (39.9 percent) performed for an intracranial mass and 141 procedures (44.3 percent) performed for craniosynostosis. Overall, 7.9 percent patients had a postoperative wound complication. The most common complications were dehiscence (3.8 percent), hematoma/seroma (3.5 percent), and infection (2.5 percent). There were no instances of extrusion, plate fracture, or screw loosening. Hardware complications in the temporoparietal region were more likely to occur at incision sites (p = 0.001), whereas wound complications at the frontal region were more likely to occur away from incision sites (p < 0.001). There were no differences in complications between plates secured with resorbable screws or with the resorbable injectable polymer system (p ≥ 0.161 for all). Radiotherapy was significantly implicated in development of clinical infection (p = 0.001), culture-positive infection (p < 0.001), readmission (p = 0.007), reoperation (p = 0.003), and plate removal (p = 0.007). CONCLUSION Resorbable cranial hardware has an overall favorable complication profile for craniofacial reconstruction in pediatric patients undergoing surgical intervention for craniosynostosis or intracranial mass resection.
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Aloua R, Kerdoud O, Kaouani A, Belem O, Konsem T, Slimani F. Locoregional anesthesia for removal osteosynthesis hardware from healed corpus mandibularis fractures: A descriptive study of a series of 40 cases. Ann Med Surg (Lond) 2021; 68:102619. [PMID: 34381604 PMCID: PMC8340045 DOI: 10.1016/j.amsu.2021.102619] [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: 05/25/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Locoregional anesthesia represents a very interesting modality for the removal of osteosynthesis hardware of the corpus mandibularis. Several procedures have been described, but each is dedicated to a single mandibular segment. MATERIAL AND METHODS The surgical records of 40 patients treated with rigid internal fixation after maxillofacial traumas were reviewed. Study variables included age, sex, site and number of plates, time of plate removal, reasons for plate removal, and postoperative. RESULTS Our study enrolled 40 patients, 45% of whom had single-focal plate placement and 55% of whom had bifocal plate placement. 66% of the patients with bifocal plate placement had the plates removed during the same operation. The average operative time was 45 min for bifocal and 28 min for single-focal approaches. Postoperative complications were observed only for the truncal analgesia procedure of the inferior alveolar nerve at the mandibular foramen. Anesthesia failure was reported in 2 patients. DISCUSSION Various locoregional anesthetic procedures are used to remove mandibular body plates but each has its indication depending on the mandibular segment being treated. Factors that can lead to failure of locoregional anesthesia are dominated by the state of inflammation at the site and patient anxiety which can be minimized by premedication with anxiolytics. CONCLUSION Locoregional anesthesia for removal of osteosynthesis hardware of the corpus mandibularis remains a good anesthetic method that is performed in good conditions when it is done in compliance with standards. Its use avoids the usual risks and complications that can occur under general anesthesia.
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Affiliation(s)
- Rachid Aloua
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Ouassime Kerdoud
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Amine Kaouani
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Ousmane Belem
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
- Oral and Maxillofacial Surgery Department, CHU Yalgado, Ouedraogo, Ouagadougou, Burkina Faso
| | - Tarcissus Konsem
- Oral and Maxillofacial Surgery Department, CHU Yalgado, Ouedraogo, Ouagadougou, Burkina Faso
| | - Faiçal Slimani
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
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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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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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Discussion: Absorbable Fixation Devices for Pediatric Craniomaxillofacial Trauma: A Systematic Review of the Literature. Plast Reconstr Surg 2019; 144:693-694. [PMID: 31461028 DOI: 10.1097/prs.0000000000005934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhang S, Li Y, Wang Y, Zhong S, Liu X, Huang Y, Fang S, Zhuang A, Sun J, Zhou H, Fan X. Comparison of rim-sparing versus rim-removal techniques in deep lateral wall orbital decompression for Graves’ orbitopathy. Int J Oral Maxillofac Surg 2019; 48:461-467. [DOI: 10.1016/j.ijom.2018.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/10/2018] [Accepted: 08/16/2018] [Indexed: 11/15/2022]
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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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The bone lid technique in oral surgery: a case series study. Int J Oral Maxillofac Surg 2017; 46:1490-1496. [DOI: 10.1016/j.ijom.2017.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/20/2022]
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Pakdel AR, Whyne CM, Fialkov JA. Structural biomechanics of the craniomaxillofacial skeleton under maximal masticatory loading: Inferences and critical analysis based on a validated computational model. J Plast Reconstr Aesthet Surg 2017; 70:842-850. [DOI: 10.1016/j.bjps.2017.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/24/2022]
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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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Risk Factors for Post-operative Infection Following Single Piece Osteotomy. J Maxillofac Oral Surg 2016; 16:328-332. [PMID: 28717291 DOI: 10.1007/s12663-016-0983-6] [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: 04/13/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The aim of this retrospective study was to identify the significant risk factors that contribute towards postoperative infection in patients recovering from orthognathic surgery. METHODS Retrospective records of 522 patients who underwent orthognathic surgery over 9 year period were evaluated for postoperative infection within 3 months of surgery and after 3 months of surgery. The variables of interest included age, gender, habits like smoking and alcohol consumption and incidence of postoperative infection. RESULTS The overall infection rate was 4.60%. Patients who underwent bilateral sagittal split osteotomy to advance the mandible had an infection rate of 10.4%. Statistically significant predictor variables (P < 0.05) included patients who had the smoking habit, and those that received bone grafts in both the time periods. CONCLUSION In conclusion, the occurrence of infection after orthognathic surgery is influenced by multiple factors, among which are the type of osteotomy, smoking habit and bone grafting procedures.
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Lee JH, Kwon JS, Moon SK, Uhm SH, Choi BH, Joo UH, Kim KM, Kim KN. Titanium-Silver Alloy Miniplates for Mandibular Fixation: In Vitro and In Vivo Study. J Oral Maxillofac Surg 2016; 74:1622.e1-1622.e12. [DOI: 10.1016/j.joms.2016.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
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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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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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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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Hachleitner J, Enzinger S, Brandtner C, Gaggl A. The role of the titanium functionally dynamic bridging plate for the treatment of the atrophic mandible fractures. J Craniomaxillofac Surg 2013; 42:438-42. [PMID: 23932197 DOI: 10.1016/j.jcms.2013.05.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022] Open
Abstract
The role of the titanium functionally dynamic bridging plate (TFDBP) in the fracture treatment of the severely atrophic mandible was assessed retrospectively. In 28 consecutive patients with fractures of a severely atrophic mandible fixation was carried out with TFDBPs. Twenty-one patients with 27 fractures were included in the study and then followed up for complications and the progress of fracture healing for 17 months postoperatively on average. There was only one case that required plate removal. All patients showed bone healing 3 months after surgery. The mental nerve sensation improved in 12 out of 23 fractures that had presented with nerve function disturbance. Every patient who had dentures prior to sustaining the fracture was able to return to denture wearing 3 weeks after surgery. No major complications occurred. A high proportion of bone healing with a low complication rate was observed with the use of TFDBPs in the treatment of severely atrophic mandible fractures. The TFDBP is an excellent alternative to conventional plating of the severely atrophic mandible.
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Affiliation(s)
- Johannes Hachleitner
- Department of Oral and Maxillofacial Surgery (Head: Prof. DDr. Alexander Gaggl), Paracelsus Medical University, LKH Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria.
| | - Simon Enzinger
- Department of Oral and Maxillofacial Surgery (Head: Prof. DDr. Alexander Gaggl), Paracelsus Medical University, LKH Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria
| | - Christian Brandtner
- Department of Oral and Maxillofacial Surgery (Head: Prof. DDr. Alexander Gaggl), Paracelsus Medical University, LKH Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria
| | - Alexander Gaggl
- Department of Oral and Maxillofacial Surgery (Head: Prof. DDr. Alexander Gaggl), Paracelsus Medical University, LKH Salzburg, Müllner Hauptstrasse 48, A-5020 Salzburg, Austria
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Surgical treatment of facial fracture by using unsintered hydroxyapatite particles/poly l-lactide composite device (OSTEOTRANS MX(®)): a clinical study on 17 cases. J Craniomaxillofac Surg 2013; 41:783-8. [PMID: 23466122 DOI: 10.1016/j.jcms.2013.01.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 11/09/2012] [Accepted: 01/15/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Japan we currently use absorption properties for facial fractures. OSTEOTRANS MX(®) (Takiron co., ltd, Japan) is an absorption device, which is called Super FIXSORB MX(®) in Japan. This absorbable osteosynthetic device constitutes unsintered hydroxyapatite particles/poly l-lactide (u-HA/PLLA) composites. This study focuses on reporting clinical cases of using OSTEOTRANS MX(®). MATERIALS AND METHODS Seventeen patients (16 men and 1 woman) aged 10-80 years (mean: 39.9 years, SD: ±20.7) with 86 fracture sites were treated. In all cases we used 1.0 mm plates and 5 mm or 7 mm screws. The postoperative observation period was 6-60 months (mean: 21.8 months, SD: ±14.5). RESULTS The fracture site recovered in all cases. Complications included one bone excess on the forehead and one foreign-body reaction on the frontozygomatic suture, but the fracture sites were recovered and had no problems. In the case with the longest observation time 60 months, the plate was almost fully absorbed. However, in other cases the plate was not fully absorbed because of a shorter observation time. CONCLUSION OSTEOTRANS MX(®) is a useful device because of its suitable intensity, thinness, radiopaque, and few complications. A longer observation time is required for a plate to be absorbed completely.
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Manor E, Joshua BZ, Levy J, Brennan PA, Bodner L. Pathological fracture of the mandible in a paediatric patient with congenital insensitivity to pain with anhidrosis (CIPA). J Craniomaxillofac Surg 2013; 41:e39-41. [PMID: 22858419 DOI: 10.1016/j.jcms.2012.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 07/03/2012] [Accepted: 07/03/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Esther Manor
- Institute of Human Genetics, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of Negev, Beer Sheva, Israel
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21
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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: 45] [Impact Index Per Article: 3.8] [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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Transzygomatic Kirschner wire fixation for the treatment of blowout fracture. J Plast Reconstr Aesthet Surg 2012; 65:875-82. [PMID: 22373828 DOI: 10.1016/j.bjps.2012.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/15/2011] [Accepted: 01/23/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Total orbital floor reconstruction with sheet-shape materials is available for the treatment of extensive and crushed-type blowout fractures. Simple blowout fractures, on the other hand, require only manual reduction without fixation. Although several types of blowout fractures do not require total reconstruction, some fixation is usually necessary. METHODS Eighteen cases of blowout fracture were treated with transzygomatic Kirschner wire fixation between 2002 and 2009. This technique was applied to simple fracture cases in which periorbital soft tissue re-herniated through the floor defect into the maxillary sinus after manual reduction, despite improvement of the extra-ocular muscle entrapment. The wire was used to directly support the fracture segment in five cases and used together with a maxillary sinus anterior wall bone graft in 13 cases. RESULTS Mean follow-up was 12.5 months. Mild diplopia remained as a subjective symptom in one case. None of the cases developed major complications or conspicuous scars on the cheek. CONCLUSIONS Transzygomatic Kirschner wire fixation for blowout fracture has the advantages of precise and rigid fixation of all parts of the inferior floor, minimal morbidity without requiring an orbital approach and long-term safety without artificial remnants. This technique can be applied for the treatment of simple blowout fractures.
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Murray M, Dean J, Herford A. Poster 70: Internal Hardware Removal After Treatment of Maxillofacial Fractures. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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First Bioabsorbable Fixation System in Craniofacial Surgery on the 15th Anniversary of Its US Utility. J Craniofac Surg 2011; 22:395-401. [DOI: 10.1097/scs.0b013e31820a564a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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