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Dargusch MS, Balasubramani N, Yang N, Johnston S, Ali Y, Wang G, Venezuela J, Carluccio J, Lau C, Allavena R, Liang D, Mardon K, Ye Q. In vivo performance of a rare earth free Mg–Zn–Ca alloy manufactured using twin roll casting for potential applications in the cranial and maxillofacial fixation devices. Bioact Mater 2022; 12:85-96. [PMID: 35087965 PMCID: PMC8777300 DOI: 10.1016/j.bioactmat.2021.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022] Open
Abstract
A magnesium alloy containing essential, non-toxic, biodegradable elements such as Ca and Zn has been fabricated using a novel twin-roll casting process (TRC). Microstructure, mechanical properties, in vivo corrosion and biocompatibility have been assessed and compared to the properties of the rare earth (RE) element containing WE43 alloy. TRC Mg-0.5 wt% Zn- 0.5 wt% Ca exhibited fine grains with an average grain size ranging from 70 to 150 μm. Mechanical properties of a TRC Mg-0.5Zn-0.5Ca alloy showed an ultimate tensile strength of 220 MPa and ductility of 9.3%. The TRC Mg-0.5Zn-0.5Ca alloy showed a degradation rate of 0.51 ± 0.07 mm/y similar to that of the WE43 alloy (0.47 ± 0.09 mm/y) in the rat model after 1 week of implantation. By week 4 the biodegradation rates of both alloys studied were lowered and stabilized with fewer gas pockets around the implant. The histological analysis shows that both WE43 and TRC Mg-0.5Zn-0.5Ca alloy triggered comparable tissue healing responses at respective times of implantation. The presence of more organized scarring tissue around the TRC Mg-0.5Zn-0.5Ca alloys suggests that the biodegradation of the RE-free alloy may be more conducive to the tissue proliferation and remodelling process. Mg-0.5Zn-0.5Ca alloy plates were fabricated by a twin-roll casting (TRC) process. TRC alloy showed an ultimate strength and elongation of 221 ± 2 MPa and 9 ± 2%. Gas development during in vivo degradation was analysed using μ-CT techniques. Histological analysis revealed a good biocompatibility and promoted healing.
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Fifteen-Year Review of the American Board of Plastic Surgery Maintenance of Certification Tracer Data: Clinical Practice Patterns and Evidence-Based Medicine in Zygomatico-Orbital Fractures. Plast Reconstr Surg 2021; 147:967e-975e. [PMID: 34019507 DOI: 10.1097/prs.0000000000007955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND From 2005 to 2020, the American Board of Plastic Surgery collected data on 20 common plastic surgery operations as part of the Maintenance of Certification process. These data allow the authors to examine national trends in zygomatico-orbital fracture repair over a 15-year period. METHODS Tracer data for zygomatico-orbital fracture repair were reviewed in cohorts from 2005 to 2013 and 2014 to 2020. Results were categorized based on their presence in evidence-based medicine articles published during this period. Differences between years were assessed using the t test or chi-square test as appropriate. RESULTS Four hundred thirty patients were included as of March of 2020. Average age was 37 years (range, 6 to 85 years), and 76 percent were male. Operations took place on average 10 days from injury. There were significant decreases in the use of subciliary (31.9 percent versus 10.0 percent; p < 0.001), gingival buccal (84.3 percent versus 56.4 percent; p < 0.001), and lateral brow (45.2 percent versus 22.3 percent; p < 0.001) incisions, with an increase in lower lid external incisions (15.2 percent versus 30.9 percent; p < 0.001); 2.7 percent of patients had a complication requiring readmission and 4.5 percent required reoperation. The incidence of postoperative diplopia was 7.7 percent, and the infection rate was 1.7 percent. CONCLUSIONS This article reviews the American Board of Plastic Surgery tracer data for zygomatico-orbital fracture repair. The Maintenance of Certification tracer data provide a national database with longer follow-up and more specific information than comparable databases. Analysis of these data over time enables the authors to describe practice trends and gives surgeons the opportunity to compare their outcomes to national norms.
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Rohit, Vishal, Prajapati VK, Shahi AK, Prakash O, Ekram S. Etiology, Modalities of Zygomaticomaxillary Complex Fracture, open reduction and fixation. J Clin Exp Dent 2021; 13:e215-e220. [PMID: 33680322 PMCID: PMC7920566 DOI: 10.4317/jced.57445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background Zygomatic complex fracture is second most common mid face fracture and frequent amongst the maxillofacial trauma. Fracture pattern ranges from simple to comminuted and from minimally displaced to severely displaced depending on various factors.
Material and Methods 98 patients with zygomaticomaxillary complex fracture reporting during December 2017 to January 2020 were included in the study. On the basis of radiographic evaluation and computerized tomography scan (CT scan) with 3D reconstruction severity of fracture was assessed and different treatment options were selected.
Results Road traffic accident accounted as the leading cause of fracture (57.1%) followed by self-fall (16.3%), interpersonal violence (12.3%). Reduction and semi rigid fixation was done in (83.7%), in which 1-point fixation in (22.9%), 2-point fixation in (42.4%) and 3-point fixation in (18.4%). Rest 16.3 % of the cases were managed conservatively since they had minimal displacement.
Conclusions Road traffic incident was the main etiology in our study and younger age group patients were more involved. Occipitomental radiograph and computerized tomography scan (CT scan) were used to confirm the diagnosis and to determine the severity of displacement of zygomatic fracture on the basis of which treatment options were decided. Key words:Incidence, etiology and management zygomaticomaxillary complex fracture
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Affiliation(s)
- Rohit
- Tutor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Vishal
- Tutor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Virendra-Kumar Prajapati
- Professor. Head of Department. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Ajoy-Kumar Shahi
- Associate Professor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Om Prakash
- Assistant Professor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
| | - Subia Ekram
- Tutor. Department of Oral and Maxillofacial Surgery. Dental Institute. Rajendra Institute of Medical Sciences
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da Silva BCL, Souto-Souza D, de Souza GM, Magesty RA, de Cassia Ávila B, Galvão EL, Falci SGM. Comparison between resorbable plates vs. titanium plates for treatment of zygomatic fractures: a systematic review with meta-analysis. Oral Maxillofac Surg 2021; 25:289-301. [PMID: 33398647 DOI: 10.1007/s10006-020-00937-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare resorbable plates with titanium plates for the fixation of zygomatic fractures, taking into account postoperative complications. METHODS This systematic review followed the guidelines of PRISMA and the recommendations of the Cochrane Handbook and was registered in PROSPERO. The electronic search was performed in the Web of Science, PubMed, Virtual Health Library, and Cochrane Library databases and in the gray literature. The study selection and the data extraction were performed by three calibrated and independent researchers. The assessment of the risk of bias in the studies was performed using the Cochrane Risk of Bias Tool for clinical trials. Meta-analyses were performed using Review Manager Software version 5.3, using the Peto's Odds Ratios (PORs), and when I2 > 30, the random effect model was used. The evaluation of the quality of the evidence was carried out through GRADE. RESULTS A total of 2651 studies were screened and only nine were included; 7 of which were used for quantitative assessment. The follow-up time for patients ranged from 6 months to 5 years. All studies showed a low risk of bias in the "incomplete outcome data" domain. The need for plate removal (POR: 0.11, 95% CI: 0.02 to 0.81, I2 = 0%) and dehiscence (POR 0.12, 95% CI 0.02 to 0.63, I2 = not applied) was lower for the group of patients who used resorbable plates than for titanium plates. CONCLUSION There was no difference in the occurrence of infection, diplopia, or paresthesia between the fixation methods. Resorbable plates showed better postoperative clinical performance.
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Affiliation(s)
- Bianca Cristina Lopes da Silva
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Debora Souto-Souza
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Glaciele Maria de Souza
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Rafael Alvim Magesty
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Bruna de Cassia Ávila
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil
| | - Saulo Gabriel Moreira Falci
- (Department of Dentistry), Section of Oral and Maxilofacial Surgery, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, Minas Gerais, Brazil.
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Juncar RI, Tent PA, Juncar M, Arghir IA, Arghir OC, Rivis M. Interrelation between facial soft tissue lessions, underlying fracture patterns and treatment of zygomatic bone trauma: a 10 year retrospective study. Head Face Med 2020; 16:30. [PMID: 33243244 PMCID: PMC7690189 DOI: 10.1186/s13005-020-00246-y] [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: 07/16/2020] [Accepted: 11/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background The pattern of zygomatic bone fractures varies in the literature, their features being frequently masked by the presence of associated soft tissue lesions. In this context the clinical diagnosis and the therapeutic indications can be difficult. The aim of this study was to evaluate the clinical features of zygomatic bone fractures and their interrelation with concomitant overlying soft tissue injuries, as well as to assess the type of treatment methods applied depending on the fracture pattern and the results achieved depending on the incidence rate of postoperative complications. We will use these results in order to improve the diagnosis and the establishment of correct treatment of this pathology. Methods A 10-year retrospective evaluation of midface fractures was performed in patients diagnosed and treated in a tertiary Clinic of Oral and Maxillofacial Surgery. Statistical analysis was performed with the MedCalc Statistical Software version 19.2 (MedCalc Software bvba, Ostend, Belgium; 53 https://www.medcalc.org; 2020). Nominal data were expressed as frequency and percentage. The comparisons of the frequencies of a nominal variable among the categories of another nominal variable were made using the chi-square test. Multivariate logistic regressions were used in order to establish the independent association between variables and lacerations/excoriations. After using the Bonferroni correction for multiple comparisons, a value of p < 0.025 was considered statistically significant. Results The study included 242 patients with zygomatic bone fractures. The majority of the fractures were displaced n = 179 (73.9%), closed n = 179 (73.9%) and complete n = 219 (90.5%). Hematoma was the most frequent associated soft tissue lesion n = 102 (42.1%) regardless of the fracture pattern (p = 1.000). Complete zygomatic fracture (OR – 2.68; p = 0.035) and fractures with displacement (OR – 3.66; p = 0.012) were independently associated with the presence of laceration. Fractures with displacement (OR – 7.1; p = 0.003) were independently associated with the presence of excoriation. The most frequent type of treatment applied was Gillies reduction (61.9%), followed by ORIF (30.9%). The most frequent postoperative complication was malunion secondary to Gillies treatment (4,6%). Conclusions Patients presenting lacerations and excoriations on clinical soft tissue examination will most frequently have an underlying complete, displaced or comminuted zygomatic fracture. In the case of displaced, open or comminuted fractures we achieved the best results secondary to ORIF treatment method, while in the case of non-displaced and closed fractures, the best results achieved were secondary to conservative treatment.
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Affiliation(s)
- Raluca Iulia Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Paul Andrei Tent
- Department of Oral and Maxillofacial Surgery, University of Oradea, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania.
| | - Mihai Juncar
- Department of Oral and Maxillofacial Surgery, University of Oradea, Str. Piața 1 Decembrie, no.10, 410073, Oradea, Romania
| | - Ioan Anton Arghir
- Pulmonology Department, Faculty of Medicine, Ovidius University of Constanta, Consteanta, Romania
| | - Oana Cristina Arghir
- Pulmonology Department, Faculty of Medicine, Ovidius University of Constanta, Consteanta, Romania
| | - Mircea Rivis
- Discipline of Oral Surgery, 2nd Department of Dental Medicine, "Victor Babeş" University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041, Timisoara, Romania
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Gareb B, van Bakelen N, Dijkstra P, Vissink A, Bos R, van Minnen B. Biodegradable versus titanium osteosynthesis in maxillofacial traumatology: a systematic review with meta-analysis and trial sequential analysis. Int J Oral Maxillofac Surg 2020; 49:914-931. [DOI: 10.1016/j.ijom.2019.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/02/2019] [Accepted: 11/20/2019] [Indexed: 01/18/2023]
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Abstract
BACKGROUND Orbital fractures are one of the most common sequelae of facial trauma. OBJECTIVE The objective of this study was to summarize published data for resorbable implants in orbital reconstruction, including polymer composition, degradation characteristics, osteoconductivity, and complications such as enophthalmos, diplopia, and peri-implant inflammation. A literature search of the National Library of Medicine was performed via PubMed using the keyword resorbable orbital implant. A total of 27 studies were reviewed. Strength of data was assessed according to the Oxford Centre criteria. RESULTS Most commercially available implants provide adequate tensile strength for up to 6 months (with the exception of polydioxanone, which loses strength within 1 month, and poly(D,L-lactide) within 3 months). This is sufficient for the isolated orbital floor or medial wall (tensile strength, ~300 MPa) but insufficient for reconstruction of load-bearing areas (eg, the inferior orbital rim with tensile strength of ~1.2 GPa). Thicker products (>1 mm) have increased risk for delayed inflammation than thinner products. Postoperative complications including delayed inflammation (0%-9%), eyelid malposition (0%-5%), enophthalmos (5%-16%), diplopia (0%-16%), infection (0%-2%), and infraorbital nerve hypesthesia (2%-18%) are variably distributed across implants with several notable exceptions: poly(L-lactide) has an increased risk of delayed inflammation, and polydioxanone has a risk of delayed enophthalmos and hematoma. CONCLUSIONS Resorbable implants are suitable for isolated medial wall or floor fractures with intact bony buttresses and function as a barrier rather than a load-bearing support.
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Amano Y, Fujimoto A, Ichikawa N, Sato K, Baba S, Nishimura M, Enoki H, Okanishi T. Cranioplasty with Titanium Might Be Suitable for Adult Epilepsy Surgery After Subdural Placement Surgery To Avoid Surgical Site Infection. World Neurosurg 2019; 131:e503-e507. [PMID: 31382070 DOI: 10.1016/j.wneu.2019.07.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/26/2019] [Accepted: 07/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of the present study was to compare the surgical site infection (SSI) rates between resorbable plates and titanium plates used for adult patients with intractable epilepsy who had undergone epilepsy surgery after subdural electrode placement. METHODS We performed subdural electrode surgery, followed by epilepsy surgery, for 87 adult patients with intractable epilepsy. The epilepsy surgery included 75 focus resections and 12 corpus callosotomies. We compared the SSI rates between patients who had undergone cranioplasty with titanium and resorbable plates after epilepsy surgery. RESULTS Of the 87 patients, 43 had undergone cranioplasty with resorbable plates (group A) and 44 had undergone cranioplasty with titanium plates (group B). The frequency of SSI was significantly greater in group A (7 patients; 16.3%) than in group B (1 patient; 2.3%; P = 0.03, Fisher's exact test). Univariate regression analysis also showed a significantly greater infection rate with the resorbable plates (P = 0.024). CONCLUSION For epilepsy surgery of adult patients after subdural electrode placement surgery, the SSI rate for cranioplasty was greater with resorbable plates than with titanium plates.
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Affiliation(s)
- Yuki Amano
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
| | - Naoki Ichikawa
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Keishiro Sato
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Shimpei Baba
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Mitsuyo Nishimura
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Tohru Okanishi
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
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Finite Element Simulation of Displacement of the Broken Zygoma and Forces Exerted to the Complex After Fixation with Resorbable and Non-Resorbable One-Point Mini-Plates and Applying Normal or Severe Occlusal Loads. Trauma Mon 2019. [DOI: 10.5812/traumamon.85586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND Rigid internal fixation of the jaw bones is a routine procedure for the management of facial fractures. Titanium plates and screws are routinely used for this purpose. The limitations of this system has led to the development of plates manufactured from bioresorbable materials which, in some cases, omits the necessity for the second surgery. However, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. OBJECTIVES To compare the effectiveness of bioresorbable fixation systems with titanium systems for the management of facial fractures. SEARCH METHODS We searched the following databases: The Cochrane Oral Health Group's Trials Register (to 20th August 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to 20th August 2008), EMBASE (from 1980 to 20th August 2008), http://www.clinicaltrials.gov/ and http://www.controlled-trials.com (to 20th August 2008). SELECTION CRITERIA Randomised controlled trials comparing resorbable versus titanium fixation systems used for facial fractures. DATA COLLECTION AND ANALYSIS Retrieved studies were independently screened by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS The search strategy retrieved 53 potentially eligible studies. None of the retrieved studies met our inclusion criteria and all were excluded from this review. One study is awaiting classification as we failed to obtain the full text copy. Three ongoing trials were retrieved, two of which were stopped before recruiting the planned number of participants. In one study, the excess complications in the resorbable arm was declared as the reason for stopping the trial. AUTHORS' CONCLUSIONS This review illustrates that there are no published randomised controlled clinical trials relevant to this review question. There is currently insufficient evidence for the effectiveness of resorbable fixation systems compared with conventional titanium systems for facial fractures. The findings of this review, based on the results of the aborted trials, do not suggest that resorbable plates are as effective as titanium plates. In future, the results of ongoing clinical trials may provide high level reliable evidence for assisting clinicians and patients for decision making. Trialists should design their studies accurately and comprehensively to meet the aims and objectives defined for the study.
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Affiliation(s)
- Mojtaba Dorri
- Bristol Oral and Dental SchoolDepartment of Restorative DentistryLower Maudlin StreetBristolUKBS1 2LY
| | - Richard Oliver
- STD Pharmaceutical Products LtdPlough LaneHerefordUKHR4 0EL
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Sato A, Shimizu Y, Imai Y, Mukai T, Yamamoto A, Miura C, Muraki K, Sano Y, Ikeo N, Tachi M. Initial organ distribution and biological safety of Mg
2+
released from a Mg alloy implant. Biomed Mater 2018; 13:035006. [DOI: 10.1088/1748-605x/aaa9d5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sukegawa S, Kanno T, Matsumoto K, Sukegawa-Takahashi Y, Masui M, Furuki Y. Complications of a poly-L-lactic acid and polyglycolic acid osteosynthesis device for internal fixation in maxillofacial surgery. Odontology 2018; 106:360-368. [PMID: 29417376 DOI: 10.1007/s10266-018-0345-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to retrospectively evaluate and examine the incidence of complications using poly-L-lactic acid and polyglycolic acid (PLLA/PGA) copolymer plate system in maxillofacial osteosynthesis. The retrospective study included 87 patients (50 men, 37 women), who needed maxillofacial surgery. We examined the proportion of complications and their factors from clinical data. A comparison was also made for plate decomposition using the molecular weight of the plate without plate exposure and complications. Osteosynthesis sites healed in all patients. Ten cases (11.5%) showed plate exposure-related complications, with all occurring at intraoral surgical sites. There was no significant difference in molecular weight changes of plates in resorbable process. Statistical analysis of study variables between patients with and without exposed plates showed that the plate thickness was significantly associated with the risk of exposed plates (p < 0.05). The commercially available PLLA/PGA device could be a useful rapid resorbable material for maxillofacial osteosynthesis. When thick plates are used on the intraoral site, it may be necessary to pay attention to the complication of plate exposure. Even if exposure-related complications have occurred, resorption and degradation of this material proceeds, suggesting the ease of appropriate risk management.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-cho, Takamatsu, 760-8557, Kagawa, Japan.
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Shimane University, Matsue, Shimane, Japan
| | - Kenichi Matsumoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-cho, Takamatsu, 760-8557, Kagawa, Japan
| | - Yuka Sukegawa-Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-cho, Takamatsu, 760-8557, Kagawa, Japan
| | - Masanori Masui
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-cho, Takamatsu, 760-8557, Kagawa, Japan
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-cho, Takamatsu, 760-8557, Kagawa, Japan
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Lee HR, Shin HK, Lee DL, Jung GY. Delayed-Onset Methicillin-Resistant Staphylococcus aureus Infection at 18 Months after Absorbable Plate Fixation for Zygomaticomaxillary Complex Fracture. Arch Craniofac Surg 2017; 17:229-232. [PMID: 28913290 PMCID: PMC5556843 DOI: 10.7181/acfs.2016.17.4.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022] Open
Abstract
None of the reports of delayed infection mentioned a latent period exceeding 13 months. we report an infection that developed 18 months after implantation of an absorbable plate. A 16-year-old adolescent girl had undergone reduction and fixation with an absorbable plate for Lefort I and zygomaticomaxillary complex fractures 18 months prior at our hospital. In her most recent hospital visit as an outpatient, abscess was observed in periocular area. Computed tomography revealed sinusitis with an abscess above the infraorbital rim. Wound culture yielded methicillin-resistant Staphylococcus aureus . Despite conservative treatments, wound state did not improve. Therefore, our department decided to perform surgery. Absorbable plate had been mostly absorbed but remained a bit. Bony depression of infraorbital rim and mucosal exposure of maxillary sinus anterior wall were observed. After the surgery, the patient recovered. We believe that the reason the wound infection and sinusitis manifested at the same time is because of several factor such as alcohol abuse, smoking, and mucosal exposure of maxillary sinus anterior wall. Absorbable plate takes 9 months to 3 years to be completely absorbed, thus we suggest studies with a follow-up of at least 3 years be undertaken to determine the outcomes of patients with many risk factors.
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Affiliation(s)
- Hyun Rok Lee
- Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hea Kyeong Shin
- Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine, Gyeongju, Korea
| | - Dong Lark Lee
- Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine, Gyeongju, Korea
| | - Gyu Yong Jung
- Department of Plastic and Reconstructive Surgery, Dongguk University College of Medicine, Gyeongju, Korea
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Wu CM, Chen YA, Liao HT, Chen CH, Pan CH, Chen CT. Surgical treatment of isolated zygomatic fracture: Outcome comparison between titanium plate and bioabsorbable plate. Asian J Surg 2017; 41:370-376. [PMID: 28501387 DOI: 10.1016/j.asjsur.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Zygoma fracture is of clinical importance because malar prominence plays an essential role in facial appearance. Traditionally, most maxillofacial surgeons perform osteosynthesis with titanium plates and screws for rigid fixation. However, this procedure has certain disadvantages that include the possibility of implant exposure, palpability or loosening of the screws, painful irritation, temperature sensitization, and radiographic artifacts. In this study, we compared the function and satisfaction outcome between Bonamates® bioabsorbable implant and Leibinger titanium implant. METHOD Consecutively 53 patients with isolated unilateral zygomatic fracture that were treated with the Bonamates® bioabsorbable plate system, n = 53 were compared to patients with the titanium plate system, n = 55 in the period between 2009 and 2013. All patients were followed-up at least 6 months. Preoperative and postoperative facial computed tomography (CT) scans were performed and scored from 0 to 2 in the 5 areas of zygoma. A score of 2 indicated the most severely displaced fracture in one of the areas. A visual analogue scale ranging from 0 to 10 was used to assess the postoperative aesthetic and functional satisfactions. RESULT The mean ages of the patients in the bioabsorbable and titanium plate groups were 33 years and 30 years, respectively. The male to female ratios were 1.2:1 (bioabsorbable plate group) and 1.1:1 (titanium plate group). The average preoperative CT scan scores of the bioabsorbable and titanium plate groups were 5.7 and 5.1, respectively. The postoperative CT scan scores of the bioabsorbable and titanium plate groups were 1.3 and 1.1, respectively. The implant cost of the bioabsorbable group was approximately 6-fold higher than that of the titanium plate group. The complication rate was similar in both groups and included complications such as palpable implant, skin irritation, and hypersensitive cheek. The patients in both groups attained similar mouth-opening function and a satisfactory score at 6 months after operation. CONCLUSION This study revealed that the bioabsorbable plate outcome was similar to the titanium plate outcome for patients with isolated unilateral zygomatic fracture. The bioabsorbable implant system provides another option for internal fixation devices in the treatment of zygomatic fractures and avoids implant removal surgery; however, the implant cost of bioabsorbable plates is higher than that of titanium plates in Taiwan.
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Affiliation(s)
- Chao-Ming Wu
- Department of Plastic Surgery, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | - Ying-An Chen
- Craniofacial Center, Department of Plastic Surgery, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Han-Tsung Liao
- Division of Trauma Plastic Surgery, Department of Plastic Surgery, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chih-Hao Chen
- Division of Trauma Plastic Surgery, Department of Plastic Surgery, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chun-Hao Pan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Craniofacial Research Center, Taoyuan, Taiwan
| | - Chien-Tzung Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, College of Medicine, Chang Gung University, Craniofacial Research Center, Taoyuan, Taiwan.
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Choi SH, Lee JH. Absorbable Plate-Related Infection after Facial Bone Fracture Reduction. Arch Craniofac Surg 2016; 17:1-4. [PMID: 28913243 PMCID: PMC5556715 DOI: 10.7181/acfs.2016.17.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 11/11/2022] Open
Abstract
Absorbable plates are used widely for fixation of facial bone fractures. Compared to conventional titanium plating systems, absorbable plates have many favorable traits. They are not palpable after plate absorption, which obviates the need for plate removal. Absorbable plate-related infections are relatively uncommon at less than 5% of patients undergoing fixation of facial bone fractures. The plates are made from a mixture of poly-L-lactic acid and poly-DL-lactic acid or poly-DL-lactic acid and polyglycolic acid, and the ratio of these biodegradable polymers is used to control the longevity of the plates. Degradation rate of absorbable plate is closely related to the chance of infection. Low degradation is associated with increased accumulation of plate debris, which in turn can increase the chance of infection. Predisposing factors for absorbable plate-related infection include the presence of maxillary sinusitis, plate proximity to incision site, and use of tobacco and significant amount of alcohol. Using short screws in fixating maxillary fracture accompanied maxillary sinusitis will increase the rate of infection. Avoiding fixating plates near the incision site will also minimize infection. Close observation until complete absorption of the plate is crucial, especially those who are smokers or heavy alcoholics. The management of plate infection is varied depending on the clinical situation. Severe infections require plate removal. Wound culture and radiologic exam are essential in treatment planning.
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Affiliation(s)
- Seung Hyup Choi
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Jang Hyun Lee
- Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Are Biodegradable Osteosyntheses Still an Option for Midface Trauma? Longitudinal Evaluation of Three Different PLA-Based Materials. BIOMED RESEARCH INTERNATIONAL 2015; 2015:621481. [PMID: 26491680 PMCID: PMC4600553 DOI: 10.1155/2015/621481] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
Abstract
The aim was to evaluate three different biodegradable polylactic acid- (PLA-) based osteosynthesis materials (OM). These OM (BioSorb, LactoSorb, and Delta) were used in 64 patients of whom 55 (85.9%) had fractures of the zygoma, five (7.8%) in the LeFort II level, two of the frontal bone (3.1%), and two of the maxillary sinus wall (3.1%). In addition to routine follow-up (FU) at 3, 6, and 12 months (m) (T1, T2, and T3) all patients were finally evaluated at a mean FU after 14.1 m for minor (e.g., nerve disturbances, swelling, and pain) and major (e.g., infections and occlusal disturbances) complications. Out of all 64 patients 38 presented with complications; of these 28 were minor (43.8%) and 10 major (15.6%) resulting in an overall rate of 59.4%. Differences in minor complications regarding sensibility disturbance at T1 and T3 were statistically significant (P = 0.04). Differences between the OM were not statistically significant. Apart from sufficient mechanical stability for clinical use of all tested OM complications mostly involved pain and swelling probably mainly related to the initial bulk reaction attributable to the drop of pH value during the degradation process. This paper includes a review of the current aspects of biodegradable OM.
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Romero-Ruiz MM, Mosquera-Perez R, Gutierrez-Perez JL, Torres-Lagares D. Flapless implant surgery: A review of the literature and 3 case reports. J Clin Exp Dent 2015; 7:e146-52. [PMID: 25810827 PMCID: PMC4368003 DOI: 10.4317/jced.51985] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/07/2014] [Indexed: 12/31/2022] Open
Abstract
Since the 1970s, modern Implantology is based on a concept of surgery with flap elevation. Gradually, several clinical trials demonstrated that a mid-crestal incision gives similar success rates compared to those obtained using the classical protocol. However, over the past decade in medicine it has been established the concept of minimally invasive surgery, consisting in taking advantage of advancements experienced in diagnostic techniques and specific surgical instruments, to perform surgical procedures infringing as less damage as possible to the patient The present work aims to produce a thorough review of the literature published on the field of Implantology with flapless surgery, to determine the current scientific evidence of the technique, along with illustrating the results with different clinical cases. After presenting the clinical cases, and the review of literature, we can say that flapless surgeries should be restricted to well-selected cases in which a proper clinical and radiological planning has been made. Patients treated with anticoagulant drugs or medically compromised equally can get benefitted by this minimal invasion technique. Key words:Flapless, minimally invasive surgery, dental implant.
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Lim HY, Jung CH, Kim SY, Cho JY, Ryu JY, Kim HM. Comparison of resorbable plates and titanium plates for fixation stability of combined mandibular symphysis and angle fractures. J Korean Assoc Oral Maxillofac Surg 2014; 40:285-90. [PMID: 25551093 PMCID: PMC4279974 DOI: 10.5125/jkaoms.2014.40.6.285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/29/2014] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We compared resorbable plates with titanium plates for treatment of combined mandibular angle and symphyseal fractures. MATERIALS AND METHODS Patients with mandibular angle and symphysis fractures were divided into two groups. The control (T) group received titanium plates while the experimental (R) group received resorbable plates. All procedures were carried out under general anesthesia using standard surgical techniques. We compared the frequency of wound dehiscence, development of infection, malocclusion, malunion, screw breakage, and any other technical difficulties between the two groups. RESULTS Thirteen patients were included in the R group, where 39 resorbable plates were applied. The T group consisted of 16 patients who received 48 titanium plates. The mean age in the R and T groups was 28.29 and 24.23 years, respectively. Primary healing of the fractured mandible was obtained in all patients in both groups. Postoperative complications were minor and transient. Moreover, there were no significant differences in the rates of various complications between the two groups. Breakage of 3 screws during the perioperative period was seen in the R group, while no screws or plates were broken in the T group. CONCLUSION Resorbable plates can be used to stabilize combined mandibular angle and symphysis fractures.
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Affiliation(s)
- Ho-Yong Lim
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Chang-Hwa Jung
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Seong-Yong Kim
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin-Yong Cho
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae-Young Ryu
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyeon-Min Kim
- Department of Oral and Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Kim DH, Kim RH, Lee J, Chee YD, Kwon KH, Kwon KH. Evaluation of soft tissue asymmetry using cone-beam computed tomography after open reduction and internal fixation of zygomaticomaxillary complex fracture. J Korean Assoc Oral Maxillofac Surg 2014; 40:103-10. [PMID: 25045636 PMCID: PMC4095814 DOI: 10.5125/jkaoms.2014.40.3.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 05/18/2014] [Accepted: 05/19/2014] [Indexed: 01/25/2023] Open
Abstract
Objectives In this study, we assessed soft tissue asymmetry that occurred after open reduction of unilateral zygomaticomaxillary complex (ZMC) fractures. We proposed a simple method to assess soft tissue asymmetry after reduction surgery by evaluating the symmetry between the affected and the unaffected sides. The factors affecting soft tissue contour after surgery were also analyzed. Materials and Methods Subjects included patients admitted to Wonkwang University Dental Hospital from 2008 to 2013. Cone-beam computed tomography (CBCT) images of asymmetric patients who underwent open reduction at least 3 months prior were compared with healthy patients. Results The degree of asymmetry was measured in both the open reduction and control groups. Landmarks that showed a statistically significant difference between the two groups were zygion (1.73±0.24 mm), bucclae (1.08±0.26 mm), point of cheek (2.05±0.33 mm) and frontozygomatic point (1.30±0.31 mm). Conclusion When compared with the normal group, asymmetry can occur in the affected side, which usually shows depression of overlying soft tissue and is statistically significantly different. Evaluation of soft tissue asymmetry with CBCT images after open reduction of ZMC fracture is useful.
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Affiliation(s)
- Dong Hyuck Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, Korea. ; Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Wonkwang University, Iksan, Korea
| | - Rae Hyong Kim
- Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Wonkwang University, Iksan, Korea
| | - Jun Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, Korea. ; Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
| | - Young Deok Chee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, Korea. ; Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
| | - Kyung Hwan Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, Korea. ; Wonkwang Dental Research Institute, Wonkwang University, Iksan, Korea
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Bali RK, Sharma P, Jindal S, Gaba S. To evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures: A prospective study. Natl J Maxillofac Surg 2014; 4:167-72. [PMID: 24665170 PMCID: PMC3961889 DOI: 10.4103/0975-5950.127645] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: The present study was undertaken to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures and to study the morbidity associated with the use of biodegradable plates and screws. Materials and Methods: This prospective study consisted of 10 patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection, comminuted and pathological fractures were excluded. All were plated with biodegradable system (Inion CPS) using standard plating principles and observed for a total period of 24 weeks. Characteristics of the fractures, ease of use of bioresorbable plate/screw system and post operative complications were assessed. Results: Of total 10 patients, eight patients were of midface fracture and two pediatric patients with mandibular fracture, with nine male and one female. The mean age was 32.8 years. Out of 20 plates and 68 screws applied to the 10 fractures sites; there were three incidences of screw breakage with no other intraoperative difficulties. Paresthesia of the infraorbital nerve was present in two patients, and recovered completely in four weeks after surgery. Fracture reduction was considered to be satisfactory in all cases. One patient developed postsurgical infection and was managed with oral antibiotics and analgesics. Conclusions: Favorable healing can be observed through the use of biodegradable plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood, however further studies with more sample size are required.
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Affiliation(s)
- Rishi K Bali
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Shalu Jindal
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
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Kang IG, Jung JH, Kim ST, Choi JY, Sykes JM. Comparison of titanium and biodegradable plates for treating midfacial fractures. J Oral Maxillofac Surg 2014; 72:762.e1-4. [PMID: 24529570 DOI: 10.1016/j.joms.2013.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/27/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the use of titanium plates and screws (TPSs) versus biodegradable plates and screws (BPSs) for fixation of midfacial fractures. In addition, complications related to the plates and rates of secondary surgery for plate removal were compared. PATIENTS AND METHODS From March 2005 to March 2012, 109 patients were enrolled in this study. Fifty-six patients with TPSs implanted to fix midfacial fractures (group A) and 53 patients with BPSs to treat midfacial fractures (group B) were evaluated. Patients' histories of plate-related nonunion, infection, displacement, pain, and palpability and secondary surgery for plate removal were checked. RESULTS None of the study participants developed nonunion issues related to the TPSs or BPSs. Six patients in group A developed complications associated with TPSs and 5 patients underwent secondary surgery for plate removal. One patient (1.8%) had a plate-related infection, 1 patient (1.8%) developed plate extrusion, 1 patient (1.8%) had plate-associated chronic pain, 2 patients (3.6%) complained of palpability, and 2 patients (3.6%) developed psychological problems (1 patient developed 2 complications). In contrast, only 1 patient in group B (2%) complained of temporary palpability, and this problem disappeared over time. None of the patients in group B complained of any other problems. CONCLUSIONS The results indicated that BPSs and TPSs have the potential for successfully treating midfacial fractures. BPSs are suitable for treating midfacial fractures and could serve as an alternative for TPSs in selected cases.
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Affiliation(s)
- Il Gyu Kang
- Professor, Department of Otolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Joo Hyun Jung
- Professor, Department of Otolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Seon Tae Kim
- Professor, Department of Otolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Ji Yun Choi
- Professor, Department of Otolaryngology-Head and Neck Surgery, Chosun University College of Medicine, Gwangju, South Korea
| | - Jonathan M Sykes
- Director, Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, University of California-Davis Medical Center, Sacramento, CA.
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Tripathi N, Goyal M, Mishra B, Dhasmana S. Zygomatic complex fracture: A comparative evaluation of stability using titanium and bio-resorbable plates as one point fixation. Natl J Maxillofac Surg 2013; 4:181-7. [PMID: 24665173 PMCID: PMC3961892 DOI: 10.4103/0975-5950.127648] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The malar bone represents a strong bone on fragile support and its processes - frontal, orbital, maxillary and zygomatic are frequently the site of fracture. Current study was done to compare the stability of zygomatic complex fracture using Biodegradable plates and titanium miniplates with one point fixation. MATERIALS AND METHODS Twenty patients of zygomatic complex fracture were randomly selected and divided in two groups which were further divided into two subgroups (A, B). Group I patients were treated with titanium miniplate at zygomatic buttress and Group II was treated by bio-resorbable plates. One point fixation was done either at zygomatic buttress or at frontozygomatic suture and it was observed that both the site have been the most favored site of rigid internal fixation in terms of stability, aesthetics and prevention of rotation of the fracture segment in either vertical or horizontal axis. CONCLUSION There is no significant difference in post operative outcomes between two groups, but still bioresorbable system has some advantage over titanium system as these plates resorbs over a period of time and does not cause any interference with growth and post operative radiotherapy. However application of biodegradable system demands highly précised technique.
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Affiliation(s)
- Nalini Tripathi
- Department of Dentistry, Hind Institute of Medical Sciences, Barabanki, Lucknow, Uttar Pradesh, India
| | - Manoj Goyal
- Department of Oral and Maxillofacial Surgery, Santosh Dental College, Ghaziabad, Uttar Pradesh, India
| | - Brijesh Mishra
- Department of Plastic Surgery, King Georges Medical University, Lucknow, Uttar Pradesh, India
| | - Satish Dhasmana
- Department of Anesthesiology, King Georges Medical University, Lucknow, Uttar Pradesh, India
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Yang L, Xu M, Jin X, Xu J, Lu J, Zhang C, Tian T, Teng L. Complications of absorbable fixation in maxillofacial surgery: a meta-analysis. PLoS One 2013; 8:e67449. [PMID: 23840705 PMCID: PMC3696084 DOI: 10.1371/journal.pone.0067449] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/18/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The use of titanium during maxillofacial fixation is limited due to its palpability, mutagenic effects and interference with imaging, which lead to the requirement for subsequent removal. The use of a biologically absorbable fixation material will potentially eliminate these limitations. In this meta-analysis, we analyzed the complications of absorbable fixation in maxillofacial surgery. METHODS We performed a systematic search of PubMed, Embase, Cochrane Central Register of Systematic Reviews and Cochrane Central Register of Controlled Trials for trials published through December 2012. Data extracted from literature were analyzed with Review manager 5.0.24. RESULTS Relevant data was extracted from 20 studies (1673 participants) and revealed that patients in the absorbable group had significantly more complications than those in the titanium group (RR = 1.20; 95% CI: 1.02-1.42; P = 0.03) in all enrolled maxillofacial surgeries. For bimaxillary operation subgroup, the absorbable fixation group did not have a significant increase in complications when compared with the titanium group (RR = 1.89; 95% CI: 0.85-4.22; P = 0.12). There was no significant difference observed between the absorbable and titanium groups receiving a bilateral sagittal split ramus osteotomy (BSSRO) (RR = 1.45; 95% CI: 0.84-2.48; P = 0.18) and Le Fort I osteotomy (RR = 0.65; 95% CI: 0.34-1.23; P = 0.18). The combined results of the five trials revealed that the absorbable group had a significantly lower rate of complications compared to the titanium group (RR = 0.71; 95% CI: 0.52-0.97; P = 0.03) in fracture fixation. CONCLUSION This meta-analysis shows that absorbable fixation systems used for fixation in maxillofacial surgery do not have adequate safety profiles. Subgroup indicated the safety of absorbable fixation systems was superior during fracture fixation. The absorbable fixation systems tend to have a similar favorable safety profile as titanium fixation during Le Fort I, bimaxillary operation and BSSRO.
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Affiliation(s)
- Liya Yang
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Meibang Xu
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaolei Jin
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jiajie Xu
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jianjian Lu
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Chao Zhang
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Tian Tian
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Li Teng
- Department 2 of Cranio-maxillo-facial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- * E-mail:
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Menon S, Choudhury CSKR. Resorbable implants in maxillofacial surgery: a reality check. J Maxillofac Oral Surg 2012; 11:132-7. [PMID: 23730058 PMCID: PMC3386407 DOI: 10.1007/s12663-011-0177-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Stability is the main feature of fixation techniques in fracture management modalities, in vogue today. One of the most significant landmarks in the armamentarium of maxillofacial fracture management has been the introduction of rigid internal fixation (RIF). The biomaterials used in RIF have seen a gradual change from Stainless steel to titanium due to the evidence based advantages of the latter. However, the inherent problems with metallic implants led to the introduction of resorbable polymers in RIF. MATERIALS AND METHOD This article evaluates the efficacy of these polymers in fixation of bone segments as compared to titanium fixation implants in 40 patients of zygomatic complex fractures. The study compared the clinical efficacy, technique, cost and time factors in the use of these two biomaterials. RESULTS The results showed very little difference after the use of these two biomaterials in spite of the increased time, technique sensitivity and cost of the resorbable system. CONCLUSION The argument for use of the resorbable fixation implants as a better alternative to titanium in maxillofacial fracture management seems overstated considering the insignificant differences in the results obtained but significant differences in the time taken and economics of the two biomaterials. The resorbabale system should ideally be restricted for use in pediatric craniofacial surgery.
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Affiliation(s)
- Suresh Menon
- Department of Oral & Maxillofacial Surgery, Vydehi Institute of Dental Sciences, 82 # EPIP Area, Whitefield, Bangalore, 560066 India
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Yoshioka I, Igawa K, Nagata J, Yoshida M, Ogawa Y, Ichiki T, Yokota R, Takamori K, Kashima K, Sakoda S. Comparison of Material-Related Complications After Bilateral Sagittal Split Mandibular Setback Surgery: Biodegradable Versus Titanium Miniplates. J Oral Maxillofac Surg 2012; 70:919-24. [DOI: 10.1016/j.joms.2011.02.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 02/22/2011] [Accepted: 02/23/2011] [Indexed: 11/26/2022]
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Abstract
The material used for osteosynthesis plays a crucial role in the management of facial fractures. Plates need to be flexible enough to be bent and should not be palpable through the skin, while ensuring stable fixation und adequate biocompatibility. Although stainless steel was initially the material of choice, titanium has become the standard material due to its superior biocompatibility. While the explantation of titanium plates and screws appears unnecessary in general, it should be considered in cases of dislocation, cosmetic concerns, pain and infection. Due to their limited initial stability and a potential increase in local complications, resorbable materials based on polymeric lactose are used with caution in midfacial fractures in adults. Our own retrospective study comparing the postoperative complications after fixation of lateral midfacial fractures with titanium and resorbable systems demonstrated a low complication rate for both systems (7-8%) and no statistically significant difference between the two. The appropriate material for fixation should be selected based on the localization and severity of the fracture, the experience of the surgeon as well as on the age and overall condition of the patient.
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Singh V, Sharma B, Bhagol A. Evaluating the Applicability of a Biodegradable Osteosynthesis Plating System in the Management of Zygomatico-Maxillary Complex Fractures. Otolaryngol Head Neck Surg 2011; 145:924-9. [DOI: 10.1177/0194599811421750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. The present study was undertaken to evaluate and analyze the efficacy of bioresorbable plates and screws in internal fixation of zygomatico-maxillary complex (ZMC) fractures and to evaluate the incidence of complications associated with the procedure. Study Design. Case series with planned data collection. Setting. Pt BD Sharma University of Health Sciences. Subject and Methods. A total of 14 patients with isolated ZMC fractures were included, and exclusion of grossly comminuted, pathological, and infected fractures was done. Open reduction internal fixation was done with biodegradable plates and screws. All patients were reviewed clinically and radiographically at regular follow-up. Occlusion, stability of fracture segments, anesthesia or paresthesia of the infraorbital nerve region, and various complications were assessed periodically. Results. Fourteen patients with 34 fracture sites were included in the study. Intraoperatively, there were 2 incidences of screw head fracture. As observed clinically, there was complete stability of fracture segments, and no maxillomandibular fixation was required postoperatively. Paresthesia of the infraorbital nerve was present in 5 patients, but the sensation recovered completely in the first 3 months after surgery. The mean pain score was 3 on a visual analogue scale. In 1 case, ectropion developed, and dehiscence occurred in another patient in the early postoperative period. Postoperative radiographs were evaluated for the accuracy of fracture reduction and stability of fixation. Conclusion. The biodegradable osteosynthesis system exhibits adequate strength and has negligible complications. This system is technique sensitive with satisfactory results in the management of mild to moderately displaced ZMC fractures.
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Affiliation(s)
- Virendra Singh
- Department of Oral and Maxillofacial Surgery, Government Dental College, Pt BD Sharma University of Health Sciences, Haryana, India
| | - Bindu Sharma
- Department of Oral and Maxillofacial Surgery, Government Dental College, Pt BD Sharma University of Health Sciences, Haryana, India
| | - Amrish Bhagol
- Department of Oral and Maxillofacial Surgery, Government Dental College, Pt BD Sharma University of Health Sciences, Haryana, India
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Fractured Facial Bone Reduction and Resorbable Plate Fixation Using Tapper. J Craniofac Surg 2011; 22:1215-8. [DOI: 10.1097/scs.0b013e31821c0d84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
A 48-year-old man who had received a bioresorbable plate fixation for a zygomatic bone fracture 13 months earlier visited our clinic complaining of sudden facial swelling. The facial computed tomographic scan showed the soft tissue swelling without any bony abnormality, and the symptoms did not improve after 1 week of antibacterial therapy. The patient had a diagnosis of a late infection caused by unresorbed plates, and exploratory surgery was performed. Partially resorbed plates and screws were seen, and we removed the remnants of such completely. The symptoms were relieved after the operation, and there was no recurrence during 8 months of follow-up.
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Choi JY, Kim JW, Yoo CK, Yun PY, Baek SH, Kim YK. Evaluation of post-surgical relapse in maxillary surgery using resorbable plate. J Craniomaxillofac Surg 2011; 39:578-82. [PMID: 21300552 DOI: 10.1016/j.jcms.2010.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 11/01/2010] [Accepted: 12/27/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study was carried out to evaluate the vertical and horizontal changes after maxillary surgery using resorbable plates made of an l-lactic acid and d-lactic acid copolymer of PLA (P(L/DL)LA), and to analyze factors of skeletal pattern and surgical movement affecting the post-surgical change. MATERIALS AND METHODS The subjects consisted of 20 patients who underwent bimaxillary surgery using P(L/DL)LA resorbable plate (Inion CPS, Inion Ltd., Tampere, Finland). Lateral cephalograms were taken at 1 month before (T0), 1 month after (T1) and 6 months after surgery (T2). They were divided into two groups, one showing less relapse (LR) and one more relapse (MR) using K-means clustering analysis of post-surgical relapse (T2-T1). In terms of linear and angular variables of maxillary relapse, the two groups were compared with measurements at the pre-surgical stage (T0), the surgical change obtained (T1-T0) and post-surgical relapse (T2-T1) using Mann-Whitney test. RESULTS Because Frankfort horizontal (FH) to anterior nasal spine (ANS) showed the largest variance in post-surgical relapse of the maxilla, it was used for clustering analysis to define the MR and LR groups. Comparison between the MR and LR groups showed that a short preoperative anterior facial height (AFH) was a significant factor in maxillary relapse. The AFH of the MR group was significantly shorter pre-surgically (p<0.01) and was significantly increased postoperatively (p<0.05) when compared to the LR group. In post-surgical relapse, AFH, FH to A, FH to ANS and the palatal plane angle of the MR group were significantly decreased. CONCLUSIONS In the case of a short AFH, P(L/DL)LA resorbable plates may not provide enough vertical stability in the maxillary position due to the muscle force. Facial height might be an important factor when deciding to use P(L/DL)LA resorbable plates for maxillary surgery.
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Affiliation(s)
- Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
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Effect of in vitro aging on the stiffness of bioabsorbable fixation plates. J Craniofac Surg 2010; 22:110-2. [PMID: 21187765 DOI: 10.1097/scs.0b013e3181f6f7dc] [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] Open
Abstract
The purpose of this study was to investigate the effect of in vitro aging on the stiffness of bioabsorbable fixation plates. Twenty-four polylactic/polyglycolic acid plates (LactoSorb; Lorenz, Jacksonville, FL) were divided in 3 groups of 8 specimens each. Group A served as control, and groups B and C were immersed in 0.1 M lactic acid for 15 and 30 days, respectively. All specimens were subjected to a 3-point bending test, using a universal testing machine, and the stiffness of each specimen was estimated. When analyzed with one-way analysis of variance, no difference was observed for the control and in vitro-aged specimens with regard to stiffness. Long-term (30 d) in vitro aging of poly-L-lactic acid bioabsorbable fixation plates does not seem to significantly affect the stiffness of the material as derived from a 3-point bending test.
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Hollweck T, Marschmann M, Hartmann I, Akra B, Meiser B, Reichart B, Eblenkamp M, Wintermantel E, Eissner G. Comparative analysis of adherence, viability, proliferation and morphology of umbilical cord tissue-derived mesenchymal stem cells seeded on different titanium-coated expanded polytetrafluoroethylene scaffolds. Biomed Mater 2010; 5:065004. [PMID: 20924136 DOI: 10.1088/1748-6041/5/6/065004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Umbilical cord tissue comprises an attractive new source for mesenchymal stem cells. Umbilical cord tissue-derived mesenchymal stem cells (UCMSC) exhibit self-renewal, multipotency and immunological naivity, and they can be obtained without medical intervention. The transfer of UCMSC to the ischemic region of the heart may have a favorable impact on tissue regeneration. Benefit from typical cell delivery by injection to the infarcted area is often limited due to poor cell retention and survival. Another route of administration is to use populated scaffolds implanted into the infarcted zone. In this paper, the seeding efficiency of UCMSC on uncoated and titanium-coated expanded polytetrafluoroethylene (ePTFE) scaffolds with different surface structures was determined. Dualmesh (DM) offers a corduroy-like surface in contrast to the comparatively planar surface of cardiovascular patch (CVP). The investigation of adherence, viability and proliferation of UCMSC demonstrates that titanium-coated scaffolds are superior to uncoated scaffolds, independent of the surface structure. Microscopic images reveal spherical UCMSC seeded on uncoated scaffolds. In contrast, UCMSC on titanium-coated scaffolds display their characteristic spindle-shaped morphology and a homogeneous coverage of CVP. In summary, titanium coating of clinically approved CVP enhances the retention of UCMSC and thus offers a potential cell delivery system for the repair of the damaged myocardium.
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Affiliation(s)
- Trixi Hollweck
- Department of Cardiac Surgery, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany
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Abstract
Different methods of internal fixation of simple displaced zygomatic fracture, such as wiring, miniplate, and screw fixation, were compared for postreduction rotational stability caused by muscular forces. This study was performed to evaluate the minimally invasive therapy in cases of zygomatic bone fracture. Seventeen patients were treated by percutaneous hook reduction and miniplate fixation along the frontozygomatic suture. Postoperatively, repositioning of aesthetic and stability and also bone ends approximation were assessed clinically and radiologically. The patients were followed up for 6 to 49 months. Preoperative symptoms were subsided except the infraorbital sensitivity disturbances in one of the patients. Postoperative complications such as diplopia and hematoma were minimal and subsided by time. In this study, orbitozygomatic, commuted, and zygomatic bone fractures simultaneously with diplopia were excluded. We showed that treatment of an isolated zygomatic bone fracture according to aesthetic and functional requirements may be achieved by insertion of a single miniplate at the lateral rim of the orbit.
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Comparison of titanium and biodegradable miniplates for fixation of mandibular fractures. J Oral Maxillofac Surg 2010; 68:2065-9. [PMID: 20096981 DOI: 10.1016/j.joms.2009.08.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 08/11/2009] [Accepted: 08/20/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the present study was to compare the use of biodegradable miniplates and titanium miniplates for the fixation of mandibular fractures. PATIENTS AND METHODS BioSorb FX biodegradable plates and screws and titanium miniplates were used in 91 patients (65 males and 26 females; age range 11 to 69 years) for the treatment of mandibular fractures. The clinical and radiographic findings were recorded at 1, 3, 6, and 12 months after surgery. RESULTS The overall complication rate was 4.41%. In the biodegradable plate group, infection occurred in 2 cases (4.26%) and was resolved by incision and drainage and antibiotics. In the titanium plate group, infection occurred in 1 case and plate fracture in 1 case (4.56%). The fractured plate was removed, and a new titanium miniplate was applied using a trocar. The infection was resolved with antibiotics. No adverse tissue reactions, malocclusions, or malunions occurred during the observation period. CONCLUSIONS Our results have shown that the rate of morbidity is very low with the use of biodegradable plates and titanium plates, suggesting that biodegradable and titanium plates have the potential for successful use in the fixation of mandibular fractures.
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Ahn YS, Kim SG, Baik SM, Kim BO, Kim HK, Moon SY, Lim SH, Kim YK, Yun PY, Son JS. Comparative study between resorbable and nonresorbable plates in orthognathic surgery. J Oral Maxillofac Surg 2010; 68:287-92. [PMID: 20116697 DOI: 10.1016/j.joms.2009.07.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 04/15/2009] [Accepted: 07/25/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the clinical application of resorbable and nonresorbable plates for correction of facial asymmetry. PATIENTS AND METHODS A total of 272 patients who had undergone orthognathic surgery were enrolled. The site of osteotomy was fixed using a nonresorbable plate in group I (n = 152) and using a resorbable plate in group II (n = 120). The postoperative complications included postoperative anterior open bite, infection, temporomandibular joint dysfunction, and postoperative relapse. The incidence of all complications was examined. RESULTS The surgical outcome was successful in 269 patients (98.89%). Of the 152 patients with a titanium plate, 13 (8.6%) developed complications. Of the 120 patients with a resorbable plate, 22 (18.3%) developed complications. A greater degree of postoperative open bite and a trend toward relapse were observed in patients' cases in which an absorbable fixation plate was used. Postoperative infection occurred in patients with an absorbable fixation plate. CONCLUSION On the basis of these data, we have concluded that an absorbable fixation plate should be used instead of a titanium fixation plate in indicated patients.
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Affiliation(s)
- Yu-Seok Ahn
- Department of Oral and Maxillofacial Surgery, Chosun University School of Dentistry, Gwang Ju City, South Korea
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Is Transfacial Kirschner Wire Fixation Still Indicated in Isolated Zygomaticomaxillary Complex Fractures? J Craniofac Surg 2009; 20:1231-9. [DOI: 10.1097/scs.0b013e3181acde63] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
BACKGROUND Rigid internal fixation of the jaw bones is a routine procedure for the management of facial fractures. Titanium plates and screws are routinely used for this purpose. The limitations of this system has led to the development of plates manufactured from bioresorbable materials which, in some cases, omits the necessity for the second surgery. However, concerns remain about the stability of fixation and the length of time required for their degradation and the possibility of foreign body reactions. OBJECTIVES To compare the effectiveness of bioresorbable fixation systems with titanium systems for the management of facial fractures. SEARCH STRATEGY We searched the following databases: The Cochrane Oral Health Group's Trials Register (to 20th August 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1950 to 20th August 2008), EMBASE (from 1980 to 20th August 2008), http://www.clinicaltrials.gov/ and http://www.controlled-trials.com (to 20th August 2008). SELECTION CRITERIA Randomised controlled trials comparing resorbable versus titanium fixation systems used for facial fractures. DATA COLLECTION AND ANALYSIS Retrieved studies were independently screened by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS The search strategy retrieved 53 potentially eligible studies. None of the retrieved studies met our inclusion criteria and all were excluded from this review. One study is awaiting classification as we failed to obtain the full text copy. Three ongoing trials were retrieved, two of which were stopped before recruiting the planned number of participants. In one study, the excess complications in the resorbable arm was declared as the reason for stopping the trial. AUTHORS' CONCLUSIONS This review illustrates that there are no published randomised controlled clinical trials relevant to this review question. There is currently insufficient evidence for the effectiveness of resorbable fixation systems compared with conventional titanium systems for facial fractures. The findings of this review, based on the results of the aborted trials, do not suggest that resorbable plates are as effective as titanium plates. In future, the results of ongoing clinical trials may provide high level reliable evidence for assisting clinicians and patients for decision making. Trialists should design their studies accurately and comprehensively to meet the aims and objectives defined for the study.
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Affiliation(s)
- Mojtaba Dorri
- Department of Epidemiology & Public Health, University College London (UCL), 1-19 Torrington Place, London, UK, WC1E 6BT.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the common signs, symptoms, and treatment options for zygomatic fractures. 2. Answer basic questions on therapy for zygomatic fractures. SUMMARY This maintenance of certification article on zygomatic fractures attempts to review the current approaches to the treatment of these fractures. Although the article does not deal with extended approaches to treatment, it does in a general sense present the preoperative, intraoperative, and postoperative thinking for the plastic surgeon approaching these patients in general practice. A further in-depth review can be obtained through the references at the end of the article.
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Kojima T, Freitas PHL, Ubaidus S, Suzuki A, Li M, Yoshizawa M, Oda K, Maeda T, Kudo A, Saito C, Amizuka N. Histochemical examinations on cortical bone regeneration induced by thermoplastic bioresorbable plates applied to bone defects of rat calvariae. ACTA ACUST UNITED AC 2007; 28:219-29. [PMID: 17878602 DOI: 10.2220/biomedres.28.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We aimed to histologically elucidate whether bioresorbable plates (DeltaSystem) can induce cortical bone formation, which is essential for long-lasting bone augmentation. Standardized bone defects in rat calvariae were covered with a convexly-shaped DeltaSystem plate, and then processed for histological observations. At 1 week, alkaline phosphatase-positive osteoblasts were seen in the newly-formed bone extending from the cavity's bottom, indicating accelerated osteogenesis. A thick layer of soft connective tissue positive for periostin, a hallmark of periosteum, covered this new bone. At 2 weeks, a spongy bone had filled the cavity up to half its height. The inner layer of the soft tissue facing the spongy bone revealed abundant periostin and osteopontin, and had many tartrate-resistant acid phosphatase-positive osteoclasts. At 4 weeks, this layer had given rise to thin new bony matrices without relation to the spongy bone arising from the cavity. These bone matrices had been thickened by 8 weeks, and turned into a thick cortical bone outlining the regenerated bone at 12 weeks. Thus, our study has provided histological evidences of cortical osteogenesis when DeltaSystem plates are used for bone augmentation procedures.
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Affiliation(s)
- Taku Kojima
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences, Japan
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Maeda M, Hirose M, Ohgushi H, Kirita T. In vitro Mineralization by Mesenchymal Stem Cells Cultured on Titanium Scaffolds. ACTA ACUST UNITED AC 2007; 141:729-36. [PMID: 17383975 DOI: 10.1093/jb/mvm077] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Titanium has been utilized in the field of orthopaedic and dental reconstructive surgery, but mineralization through osteogenic differentiation of osteogenic cells on titanium surfaces has not been fully investigated. Here we cultured rat mesenchymal stem cells (MSCs) on the surfaces of titanium dishes in osteogenic media containing calcein which is a calcium-binding fluorescence dye. On titanium dishes, MSCs showed high viability to adhere to the surfaces and excellent proliferation. At day 14 of culture, MSCs differentiated into osteoblasts to form mineralized matrices on titanium dishes as well as tissue culture polystyrene (TCPS) dishes which are widely recognized as optimal culture substrates. Calcein was incorporated into the bone minerals fabricated by MSCs cultured on both substrates to show green emission under fluorescence microscopy. The fluorescence intensity was quantified with an image analyser during culture periods. These results indicate that the surfaces of titanium showed a high adhesion/proliferation potential to MSCs and that the titanium effectively supported the osteogenic differentiation of MSCs comparable to TCPS dishes. Therefore, the titanium is an effective scaffold that is applicable in bone reconstruction surgery.
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Affiliation(s)
- Masahiko Maeda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan
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Kojima T, Amizuka N, Suzuki A, de Freitas PHL, Yoshizawa M, Kudo A, Saito C, Maeda T. Histological examination of bone regeneration achieved by combining grafting with hydroxyapatite and thermoplastic bioresorbable plates. J Bone Miner Metab 2007; 25:361-73. [PMID: 17968488 DOI: 10.1007/s00774-007-0763-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 04/10/2007] [Indexed: 10/22/2022]
Abstract
In this study, we present a novel guided bone regeneration (GBR) concept that consists of combining Boneject, a bone substitute containing atelocollagen and bovine hydroxyapatite particles, with thermoplastic, bioresorbable plates (DeltaSystem) known to resist mechanical loading. In rat calvariae, standardized bone defects were filled with Boneject and covered with a convex DeltaSystem plate. Tissue from rats at 1, 2, 4, 8, and 12 weeks postoperation were fixed with an aldehyde solution, and the new bone formed at the defects was histologically assessed. At 1 week, alkaline phosphatase (ALP)-negative cells deriving from the bottom region of the defect could be found up to half the height of the cavity. Boneject particle surfaces in the bottom region revealed an intense osteopontin immunopositivity whereas those in the upper region did not. Tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts accumulated on the surfaces of osteopontin-coated particles. A newly formed, woven-like bone featuring ALP-positive osteoblasts extended from the native bone. At the second week, the newly formed woven bone had surrounded the Boneject particles. Cement lines, which indicate active bone remodeling, could be observed in the new bone despite its immaturity. Four weeks after surgery, the new bone had reached the height of the DeltaSystem plate, and just beneath it a periostin-positive fibrous layer covered the mix of new bone and Boneject particles. By then, despite having acceptable histological features, electron probe microanalyzer (EPMA) and transmission electron microscope (TEM) analyses revealed that the new bone could not be regarded as compact bone. At 8 and 12 weeks, the new bone showed compact bone-like features according to TEM and EPMA assessments. Summarizing, the combination of a bone substitute such as Boneject and a rigid, bioresorbable plate appears to be osteoconductive and to promote bone remodeling, leading to the genesis of a tissue similar to the one that is regarded as the "gold standard" for bone regeneration: the compact bone.
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Affiliation(s)
- Taku Kojima
- Division of Reconstructive Surgery for Oral and Maxillofacial Region, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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