1
|
Sobrero F, Roccia F, Omedè M, Merlo F, Dubron K, Politis C, Rabufetti A, Scolozzi P, Ramieri G, Birk A, Vesnaver A, Rizvi AO, Laverick S, Jelovac D, Konstantinovic VS, Vilaplana V, Roig AM, Goetzinger M, Bottini GB, Knežević P, Dediol E, Kordić M, Sivrić A, Derkuş FE, Yilmaz UN, Ganasouli D, Zanakis SN. Current Strategies for Treatment of Mandibular Fractures With Plate Osteosynthesis: A European Prospective Study. J Craniofac Surg 2024; 35:1120-1124. [PMID: 38713082 DOI: 10.1097/scs.0000000000010128] [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: 09/13/2023] [Accepted: 01/22/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE The training and preferences of surgeons influence the type of surgical treatment for mandibular fractures. This multicentre prospective study analyzed the current treatment strategies and outcomes for mandibular fractures with open reduction and internal fixation (ORIF). MATERIAL AND METHODS This prospective study included patients aged ≥16 years who underwent ORIF for mandibular fractures in 12 European maxillofacial centers. Age, sex, pretrauma dental status, fracture cause, site and type, associated facial fractures, surgical approach, plate number and thickness (≤1.4 or ≥1.5 mm), duration of postoperative maxillomandibular fixation, occlusal and infective complications at 6 weeks and 3 months, and revision surgeries were recorded. RESULTS Between May 1, 2021 and April 30, 2022, 425 patients (194 single, 182 double, and 49 triple mandibular fractures) underwent ORIF for 1 or more fractures. Rigid osteosynthesis was performed for 74% of fractures and was significantly associated with displaced ( P =0.01) and comminuted ( P =0.03) fractures and with the number of nonsurgically treated fracture sites ( P =0.002). The angle was the only site associated with nonrigid osteosynthesis ( P <0.001). Malocclusions (5.6%) and infective complications (5.4%) were not associated with osteosynthesis type. CONCLUSION Rigid osteosynthesis was the most frequently performed treatment at all fracture sites, except the mandibular angle, and was significantly associated with displaced and comminuted fractures and the number of nonsurgically treated fracture sites. No significant differences were observed regarding postoperative malocclusion or infections among osteosynthesis types.
Collapse
Affiliation(s)
- Federica Sobrero
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Fabio Roccia
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Michela Omedè
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Francesca Merlo
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Kathia Dubron
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department Oral and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Alessandro Rabufetti
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Paolo Scolozzi
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Faculty of Medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Guglielmo Ramieri
- Department Surgical Science, Division of Maxillofacial Surgery, University of Turin, Turin, Italy
| | - Anže Birk
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Aleš Vesnaver
- Department of Maxillofacial and Oral Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Ali O Rizvi
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Sean Laverick
- Department of Oral and Maxillofacial Surgery, University of Dundee, Dundee, United Kingdom
| | - Drago Jelovac
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vitomir S Konstantinovic
- Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Valentines Vilaplana
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Antonio Mari Roig
- Department of Oral and Maxillofacial Surgery, University Hospital of Bellvitge, Barcelona, Spain
| | - Maximilian Goetzinger
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Gian Battista Bottini
- Department of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Predrag Knežević
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Mario Kordić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Anamaria Sivrić
- Clinic for ENT and OMS, University Clinical Hospital, Mostar, Bosnia and Herzegovina
| | - Fatma Eriş Derkuş
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Utku Nezih Yilmaz
- Department of Oral and Maxillofacial Surgery, Dicle University, Diyarbakir, Turkey
| | - Dimitra Ganasouli
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| | - Stylianos N Zanakis
- Department of Oral and Maxillofacial Surgery, Hippocratio General Hospital, Athens, Greece
| |
Collapse
|
2
|
Analyzing the Fitting of Novel Preformed Osteosynthesis Plates for the Reduction and Fixation of Mandibular Fractures. J Clin Med 2021; 10:jcm10245975. [PMID: 34945272 PMCID: PMC8708228 DOI: 10.3390/jcm10245975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The known preformed osteosynthesis plates for the midface are helpful tools for a precise and fast fixation of repositioned fractures. The purpose of the current study is to analyze the precision of newly developed prototypes of preformed osteosynthesis plates for the mandible. Methods: Four newly designed preformed osteosynthesis plates, generated by a statistical shape model based on 115 CT scans, were virtually analyzed. The used plates were designed for symphyseal, parasymphyseal, angle, and condyle fractures. Each type of plate has three different sizes. For analysis, the shortest distance between the plate and the bone surface was measured, and the sum of the plate-to-bone distances over the whole surface was calculated. Results: A distance between plate and bone of less than 1.5 mm was defined as sufficient fitting. The plate for symphyseal fractures showed good fitting in 90% of the cases for size M, and in 84% for size L. For parasymphyseal fractures, size S fits in 80%, size M in 68%, and size L in 65% of the cases. Angle fractures with their specific plate show good fitting for size S in 53%, size M in 60%, and size L in 47%. The preformed plate for the condyle part fits for size S in 75%, for size M in 85%, and for size L in 74% of the cases. Conclusion: The newly developed mandible plates show sufficient clinical fitting to ensure adequate fracture reduction and fixation.
Collapse
|
3
|
Xu X, Cheng KJ, Liu YF, Fan YY, Wang JH, Wang R, Baur DA, Jiang XF, Dong XT. Experimental validation of finite element simulation of a new custom-designed fixation plate to treat mandibular angle fracture. Biomed Eng Online 2021; 20:15. [PMID: 33546713 PMCID: PMC7866451 DOI: 10.1186/s12938-021-00851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to validate biomechanical characteristics of a 3D-printed, novel-designated fixation plate for treating mandibular angle fracture, and compare it with two commonly used fixation plates by finite element (FE) simulations and experimental testing. METHODS A 3D virtual mandible was created from a patient's CT images as the master model. A custom-designed plate and two commonly used fixation plates were reconstructed onto the master model for FE simulations. Modeling of angle fracture, simulation of muscles of mastication, and defining of boundary conditions were integrated into the theoretical model. Strain levels during different loading conditions were analyzed using a finite element method (FEM). For mechanical test design, samples of the virtual mandible with angle fracture and the custom-designed fixation plates were printed using selective laser sintering (SLS) and selective laser melting (SLM) printing methods. Experimental data were collected from a testing platform with attached strain gauges to the mandible and the plates at different 10 locations during mechanical tests. Simulation of muscle forces and temporomandibular joint conditions were built into the physical models to improve the accuracy of clinical conditions. The experimental vs the theoretical data collected at the 10 locations were compared, and the correlation coefficient was calculated. RESULTS The results show that use of the novel-designated fixation plate has significant mechanical advantages compared to the two commonly used fixation plates. The results of measured strains at each location show a very high correlation between the physical model and the virtual mandible of their biomechanical behaviors under simulated occlusal loading conditions when treating angle fracture of the mandible. CONCLUSIONS Based on the results from our study, we validate the accuracy of our computational model which allows us to use it for future clinical applications under more sophisticated biomechanical simulations and testing.
Collapse
Affiliation(s)
- Xu Xu
- Department of Stomatology, People's Hospital of Quzhou, Quzhou, 324000, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China.
| | - Ying-Ying Fan
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
- National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Joanne H Wang
- Department of Orthopedic Surgery, University Hospitals of Cleveland, Case Medical Center, 11100 Euclid Ave., Cleveland, OH, 44016, USA
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Dale A Baur
- Department of Oral Maxillofacial Surgery, Case Western Reserve University School of Dental Medicine, 10900 Euclid Ave., Cleveland, OH, 44106-4905, USA
| | - Xian-Feng Jiang
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Xing-Tao Dong
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China
- Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China
| |
Collapse
|
4
|
Koper DC, Leung CAW, Smeets LCP, Laeven PFJ, Tuijthof GJM, Kessler PAWH. Topology optimization of a mandibular reconstruction plate and biomechanical validation. J Mech Behav Biomed Mater 2020; 113:104157. [PMID: 33187871 DOI: 10.1016/j.jmbbm.2020.104157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/18/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Reconstruction plates, used to bridge segmental defects of the mandible after tumor resection or traumatic bone tissue loss, are subjected to repeated stresses of mastication. High stress concentrations in these plates can result in hardware failure. Topology optimization (TO) could reduce the peak stress by computing the most optimal material distribution in a patient-specific implant (PSI) used for mandibular reconstruction. The objective of this study was biomechanical validation of a TO-PSI. METHODS A computer-aided design (CAD) model with a segmental defect was created based on the geometry of a polyurethane mandible model. A standard-PSI was designed to bridge the defect. A TO-PSI was then designed with a maximum stress equal to the ultimate tensile stress of Ti6Al4V (930 MPa) during a loading condition of 378 N. Finite element analysis (FEA) was used to analyze stresses in both PSI designs during loading. The standard-PSI and TO-PSI designs were produced in triplicate by selective laser melting of Ti6Al4V, fixated to polyurethane mandible models with segmental defects identical to the CAD model, and subsequently subjected to continuous compression with a speed of 1 mm/min on a universal testing machine, while recording the load. Peak loads before failure in the TO-PSI group within a 30% range of the predicted peak load (378 N) were considered a successful biomechanical validation. RESULTS Fracture of the TO-PSI occurred at a median peak load of 334 N (range 304-336 N). These values are within the 30% range of the predicted peak load. Fracture of the mandible model in the standard-PSI group occurred at a median peak load of 1100 N (range 1010-1460 N). Failure locations during biomechanical testing of TO-PSI and standard-PSI samples corresponded to regions in the FEA where stresses exceeded the ultimate tensile strength of titanium and polyurethane, respectively. CONCLUSION This study demonstrates a successful preliminary biomechanical validation of TO in the design process for mandibular reconstruction plates. Further work is needed to refine the finite element model, which is necessary to ultimately design TO-PSIs for clinical use.
Collapse
Affiliation(s)
- David C Koper
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands; Department of Instructive Biomaterials Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Carine A W Leung
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Lars C P Smeets
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Paul F J Laeven
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Gabriëlle J M Tuijthof
- Department of Instrument Design, Engineering and Evaluation, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Peter A W H Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| |
Collapse
|
5
|
Sigua-Rodriguez EA, de Medeiros RC, Goulart DR, Bomfim-Azevedo VL, Olate S, de Albergaria-Barbosa JR. Comparative evaluation of different fixation techniques of the sagittal split ramus osteotomy in 10 mm advancements: Mechanical testing and screw insertion torque. J Craniomaxillofac Surg 2018; 46:2082-2087. [DOI: 10.1016/j.jcms.2018.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 08/11/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022] Open
|
6
|
Glória JCR, Fernandes IA, Silveira EMD, Souza GMD, Rocha RL, Galvão EL, Falci SGM. Comparison of Bite Force with Locking Plates versus Non-Locking Plates in the Treatment of Mandibular Fractures: A Meta-Analysis. Int Arch Otorhinolaryngol 2018; 22:181-189. [PMID: 29619110 PMCID: PMC5882372 DOI: 10.1055/s-0037-1604056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Mandibular fractures represent a high percentage of all facial fractures, and the bite force is a fundamental parameter to measure the actual mandibular function and, subsequently, the masticatory efficiency and quality of life. Objectives The purpose of the present systematic review was to verify if there is any difference in the bite forces of patients with mandibular fractures fixed by locking or non-locking plates, testing the null hypothesis of no difference in this parameter. Data Synthesis A systematic review of the literature was conducted using four databases (PubMed, Virtual Health Library, Web of Science and Science Direct) without restrictions as to publication date or language. We found 3,039 abstracts, and selected 4 articles for this review. Conclusion The overall results show better performance in bite force for the locking plates when compared with the non-locking plates in the incisor region (mean deviation [MD]: 1.18; 95% confidence interval [95%CI]: 0.13-2.23), right molar region (MD: 4.71; 95%CI: 0.63-8.79) and left molar region (MD: 10.34; 95%CI: 4.55-16.13). Although the results of this study indicated a better bite force result with the locking plates, there is still no sufficient evidence to support this information safely.
Collapse
Affiliation(s)
- José Cristiano Ramos Glória
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Ighor Andrade Fernandes
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | | | - Glaciele Maria de Souza
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Ricardo Lopes Rocha
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Endi Lanza Galvão
- Research Department, Centro de Pesquisas Rene Rachou, Belo Horizonte, MG, Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Oral and Maxillofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| |
Collapse
|