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Shah KV, Patel SD, Rajasekaran K, Cannady SB, Chalian AA, Brody RM. Risk Factors for Plate Infection, Exposure, and Removal in Mandibular Reconstruction. Otolaryngol Head Neck Surg 2024. [PMID: 39101319 DOI: 10.1002/ohn.928] [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: 09/29/2023] [Revised: 06/12/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE Mandibular plate reconstruction (MPR) is often indicated after tumor ablation, osteoradionecrosis excision, and traumatic bone loss to restore oral functionality and facial cosmetics. There are limited analyses identifying risk factors that lead to plate infection (PIn), exposure, and removal ("plate complications"). STUDY DESIGN Retrospective cohort study. SETTING Academic tertiary medical center. METHODS Patients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model. RESULTS Of the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal. CONCLUSION Plate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher-risk patients, but additional larger-scale studies are needed to validate our findings and resolve discrepancies in the current literature.
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Affiliation(s)
- Keshav V Shah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saawan D Patel
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ara A Chalian
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Hasegawa S, Sasaki J, Nakao H, Tomimatsu M, Yamamoto S, Watanabe S, Miyabe S, Miyachi H, Goto M. Impact of the lateral skeletal stability following bilateral sagittal split ramus osteotomy for mandibular asymmetry. JPRAS Open 2023; 38:36-47. [PMID: 37675277 PMCID: PMC10477061 DOI: 10.1016/j.jpra.2023.08.006] [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: 05/16/2023] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
This study evaluated the stability of bilateral sagittal split ramus osteotomy (BSSRO) associated with positional plagiocephaly and temporal and masseter muscles using posteroanterior cephalogram analysis and three-dimensional computed tomography (3D-CT). This retrospective cohort study included 31 patients who underwent BSSRO for mandibular asymmetry. The cranial vault asymmetry index (CVAI) and the cephalic index were used as indicators of positional plagiocephaly. The distance from the vertical reference line to the menton (Me) was measured on posteroanterior cephalograms immediately and 1 year after surgery, and postoperative stability was assessed. Temporal and masseter muscles were constructed from 3D-CT data and their volumes were measured. Simple regression analysis showed a significant correlation between postoperative changes in the vertical reference line to the Me and the CVAI (R = 0.56, p = 0.001), the amount of surgical movement in the vertical reference line to the Me (R = 0.41, p = 0.023), and the variable temporal muscle volume (R = 0.27, p = 0.028). There was no significant correlation between postoperative changes in the vertical reference line to the Me and the cephalic index (R = 0.093, p = 0.62) and variable masseter muscle volume (R = 0.16, p = 0.38). According to multivariate analysis, CVAI (p = 0.003) and amount of surgical movement in the vertical reference line to the Me (p = 0.014) were significant predictors of postoperative change in the vertical reference line to the Me. Positional plagiocephaly and amount of surgical movement influence lateral skeletal stability following BSSRO for mandibular asymmetry.
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Affiliation(s)
- S. Hasegawa
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - J. Sasaki
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - H. Nakao
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - M. Tomimatsu
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Yamamoto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Watanabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - S. Miyabe
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - H. Miyachi
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
| | - M. Goto
- Department of Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Aichi, Japan
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Bendersky J, Uribe M, Bravo M, Vargas JP, Flores E, Aguero I, Villanueva J, Urrutia G, Bonfill X. Systematic mapping review of orthognathic surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e285-e305. [PMID: 35568120 DOI: 10.1016/j.jormas.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
STUDY DESIGN Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes. METHODS Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened. RESULTS Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence. CONCLUSION Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.
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Affiliation(s)
- Josefina Bendersky
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Macarena Uribe
- School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Maximiliano Bravo
- Oral and Maxillofacial Surgery Program, Universidad de los Andes, Santiago, Chile.
| | - Juan Pablo Vargas
- School of Dentistry, Faculty of Medicine, Pontifical Catholic University of Chile, Vicuña Mackenna 4860, Santiago, Chile.
| | - Enrique Flores
- Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile..
| | - Ignacio Aguero
- Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile..
| | - Julio Villanueva
- Department of Oral & Maxillofacial Surgery and Cochrane Associated Center at Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago, Chile.; Servicio de Cirugía Maxilofacial. Hospital Clínico San Borja-Arriarán. Sta. Rosa 1234, Santiago, Región Metropolitana, Chile.
| | - Gerard Urrutia
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Iberoamerican Cochrane Center, c (IIB Sant Pau). Carrer de Sant Quintí, 77, 08041 Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Xavier Bonfill
- Iberoamerican Cochrane Center, Institut d'Recerca-Servei d'Epidemiologia Clínica i Salut Pública. Carrer de Sant Quintí, 89, 08041 Barcelona, Spain; Iberoamerican Cochrane Center, c (IIB Sant Pau). Carrer de Sant Quintí, 77, 08041 Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP). Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain; Universitat autónoma de Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
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Evaluation of the effect of mandibular length and height on the sagittal split ramus osteotomy rigid internal fixation techniques: A finite element analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:652-657. [DOI: 10.1016/j.jormas.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/24/2022]
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Shin SH, Kang YJ, Kim SG. The effect of botulinum toxin-A injection into the masseter muscles on prevention of plate fracture and post-operative relapse in patients receiving orthognathic surgery. Maxillofac Plast Reconstr Surg 2018; 40:36. [PMID: 30538972 PMCID: PMC6261083 DOI: 10.1186/s40902-018-0174-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/08/2018] [Indexed: 02/06/2023] Open
Abstract
Background Botulinum toxin-A (BTX-A) injection into muscle reduces muscular power and may prevent post-operative complication after orthognathic surgery. The purpose of this study was (1) to evaluate BTX-A injection into the masseter muscle on the prevention of plate fracture and (2) to compare post-operative relapse between the BTX-A injection group and the no injection group. Methods Sixteen patients were included in this study. Eight patients received BTX-A injection bilaterally, and eight patients served as control. All patients received bilateral sagittal split ramus osteotomy for the mandibular setback and additional surgery, such as LeFort I osteotomy or genioplasty. Post-operative plate fracture was recorded. SNB angle, mandibular plane angle, and gonial angle were used for post-operative relapse. Results Total number of fractured plates in patients was 2 out of 16 plates in the BTX-A injection group and that was 8 out of 16 plates in the no treatment group (P = 0.031). However, there were no significant differences in post-operative changes in SNB angle, mandibular plane angle, and gonial angle between groups (P > 0.05). Conclusions BTX-A injection into the masseter muscle could reduce the incidence of plate fracture.
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Affiliation(s)
- Sung-Ho Shin
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo 25457 Republic of Korea
| | - Yei-Jin Kang
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo 25457 Republic of Korea
| | - Seong-Gon Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Jukheon gil 7, Gangneung, Gangwondo 25457 Republic of Korea
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Does Intraoral Miniplate Fixation Have Good Postoperative Stability After Sagittal Splitting Ramus Osteotomy? Comparison With Intraoral Bicortical Screw Fixation. J Oral Maxillofac Surg 2016; 74:181-9. [DOI: 10.1016/j.joms.2015.06.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/18/2015] [Accepted: 06/02/2015] [Indexed: 11/17/2022]
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Al-Moraissi E, Ellis E. Stability of bicortical screw versus plate fixation after mandibular setback with the bilateral sagittal split osteotomy: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2016; 45:1-7. [DOI: 10.1016/j.ijom.2015.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 08/23/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
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Oguz Y, Watanabe ER, Reis JM, Spin-Neto R, Gabrielli MA, Pereira-Filho VA. In vitro biomechanical comparison of six different fixation methods following 5-mm sagittal split advancement osteotomies. Int J Oral Maxillofac Surg 2015; 44:984-8. [PMID: 25840861 DOI: 10.1016/j.ijom.2014.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/07/2014] [Accepted: 11/25/2014] [Indexed: 11/27/2022]
Abstract
The sagittal split ramus osteotomy (SSRO) is a surgical technique used widely to treat many congenital and acquired mandibular discrepancies. Stabilization of the osteotomy site and the potential for skeletal relapse after the procedure are still major problems. The aim of this study was to compare the mechanical stability of six methods of rigid fixation in SSRO using a biomechanical test model. Sixty polyurethane replicas of human hemimandibles were divided into six groups. In group I, the osteotomies were fixed with two four-hole titanium miniplates; in group II, with one four-hole miniplate; in group III, with one four-hole miniplate+a bicortical screw; in group IV, with a grid miniplate; in group V, with a four-hole locking miniplate; and in group VI, with a six-hole miniplate. A linear load in the premolar region was applied to the hemimandibles. The resistance forces (N) needed to displace the distal segment by 1, 3, and 5mm were recorded and the data transmitted from the load cell to a computer. One-way analysis of variance with Tukey's post hoc test was performed to compare the means between groups. For the three displacement conditions, there was a strong tendency for the 2.0-mm plate+screw and the grid plate to have higher values.
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Affiliation(s)
- Y Oguz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey.
| | - E R Watanabe
- Division of Oral and Maxillofacial Surgery, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
| | - J M Reis
- Department of Prosthodontics, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
| | - R Spin-Neto
- Section of Oral Radiology, Department of Dentistry, Faculty of Health, Aarhus University, Denmark
| | - M A Gabrielli
- Division of Oral and Maxillofacial Surgery, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
| | - V A Pereira-Filho
- Division of Oral and Maxillofacial Surgery, Dental School of Araraquara, São Paulo State University - UNESP, Araraquara, São Paulo, Brazil
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Albougha S, Darwich K, Darwich MA, Albogha MH. Assessment of sagittal split ramus osteotomy rigid internal fixation techniques using a finite element method. Int J Oral Maxillofac Surg 2015; 44:823-9. [PMID: 25766461 DOI: 10.1016/j.ijom.2015.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/10/2014] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
In this study, finite element analysis (FEA) was used to evaluate nine rigid internal fixation techniques for sagittal split ramus osteotomy. To achieve this, a computed tomography (CT) scan of a healthy patient was obtained and used to generate the geometry of a half-mandible. The geometries of bicortical screws, miniplates, and monocortical screws were designed and combined with the mandible in nine models simulating various techniques. Four models used bicortical screws in various arrangements and four used miniplates of various designs. One model represented a hybrid technique. A load of 500 N was applied to the posterior teeth and FEA was applied. The most stable techniques were the hybrid technique and a single straight miniplate, presenting the least displacement among all models. Bicortical screws, while presenting reasonable stability, showed high strain areas near the anterior ramus ridge, superoposterior to the screws, implying a risk of bone fracture in this area. On the other hand, the T-shaped and double Y-shaped miniplates were associated with high von Mises stresses that would impair their rigidity, especially where angles appeared in their designs. We recommend the use of a single straight miniplate because it provides sufficient stable fixation with minimal risks or disadvantages.
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Affiliation(s)
- S Albougha
- Department of Oral and Maxillofacial Surgery, Dental Faculty, Damascus University, Damascus, Syria
| | - K Darwich
- Department of Oral and Maxillofacial Surgery, Dental Faculty, Damascus University, Damascus, Syria
| | - M A Darwich
- Faculty of Technical Engineering, Tartous University, Syria; Faculty of Biomedical Engineering, Al Andalus University for Medical Sciences, Syria
| | - M H Albogha
- Section of Orthodontics and Dentofacial Orthopedics, Dental Graduate School, Kyushu University, Japan; Department of Orthodontics, Faculty of Dental Medicine, Damascus University, Syria.
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