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Herzog P, Rendenbach C, Turostowski M, Ellinghaus A, Prates Soares A, Heiland M, Duda GN, Schmidt-Bleek K, Fischer H. Titanium versus plasma electrolytic oxidation surface-modified magnesium miniplates in a forehead secondary fracture healing model in sheep. Acta Biomater 2024:S1742-7061(24)00376-3. [PMID: 39002920 DOI: 10.1016/j.actbio.2024.07.005] [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: 03/18/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
Magnesium as a biodegradable material offers promising results in recent studies of different maxillo-facial fracture models. To overcome adverse effects caused by the fast corrosion of pure magnesium in fluid surroundings, various alloys, and surface modifications are tested in animal models. In specified cases, magnesium screws already appeared for clinical use in maxillofacial surgery. The present study aims to compare the bone healing outcome in a non-load-bearing fracture scenario of the forehead in sheep when fixed with standard-sized WE43 magnesium fixation plates and screws with plasma electrolytic oxidation (PEO) surface modification in contrast to titanium osteosynthesis. Surgery was performed on 24 merino mix sheep. The plates and screws were explanted en-bloc with the surrounding tissue after four and twelve weeks. The outcome of bone healing was investigated with micro-computed tomography, histological, immunohistological, and fluorescence analysis. There was no significant difference between groups concerning the bone volume, bone volume/ total volume, and newly formed bone in volumetric and histological analysis at both times of investigation. The fluorescence analysis revealed a significantly lower signal in the magnesium group after one week, although there was no difference in the number of osteoclasts per mm2. The magnesium group had significantly fewer vessels per mm2 in the healing tissue. In conclusion, the non-inferiority of WE43-based magnesium implants with PEO surface modification was verified concerning fracture healing under non-load-bearing conditions in a defect model. STATEMENT OF SIGNIFICANCE: Titanium implants, the current gold standard of fracture fixation, can lead to adverse effects linked to the implant material and often require surgical removal. Therefore, degradable metals like the magnesium alloy WE43 with plasma electrolytic oxidation (PEO) surface modification gained interest. Yet, miniplates of this alloy with PEO surface modification have not been examined in a fracture defect model of the facial skeleton in a large animal model. This study shows, for the first time, the non-inferiority of magnesium miniplates compared to titanium miniplates. In radiological and histological analysis, bone healing was undisturbed. Magnesium miniplates can reduce the number of interventions for implant removal, thus reducing the risk for the patient and minimizing the costs.
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Affiliation(s)
- Paulina Herzog
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Carsten Rendenbach
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marta Turostowski
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Agnes Ellinghaus
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ana Prates Soares
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Georg N Duda
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katharina Schmidt-Bleek
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Heilwig Fischer
- Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health at Charité -Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany
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Balani A, Saroj P, Kharsan V, Karan A, Mazhar H, Awasthy A. Management of mandibular angle and body fractures using miniplates and 3D plates. Bioinformation 2024; 20:605-609. [PMID: 39131529 PMCID: PMC11312315 DOI: 10.6026/973206300200605] [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: 06/01/2024] [Revised: 06/30/2024] [Accepted: 06/30/2024] [Indexed: 08/13/2024] Open
Abstract
Mandibular angle fractures have the greatest recorded rate of postoperative complications of any mandibular location and hence they present an especially difficult task for surgeons. Therefore, it is of interest to compare the conventional miniplates and three dimensional (3D) plates in management of mandibular angle fracture and body fractures.60 patients with isolated non-comminuted mandibular angle fractures and body fractures were randomly assigned into two groups by lottery. Utilizing Champy's osteosynthesis standards, group one (n = 30) received treatment with 2-mm standard miniplate and group two (n = 30) had treatment with open reduction and internal fixation utilizing 2-mm 3D locking stainless steel plates. The mean operative time was greater in conventional miniplate category as compared to three dimensional plates. Need for postoperative occlusion correction was lesser n 3 dimensional plate category. The incidence of postoperative infection was comparable in both categories. Incidental tooth damage was lesser in three-dimensional plate's category three-dimensional locking plates are an alternate strategy that has a comparable result profile to miniplates.
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Affiliation(s)
- Abhishek Balani
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
| | - Praveen Saroj
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
| | - Vinay Kharsan
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
| | - Abhishek Karan
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
| | - Heena Mazhar
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
| | - Arunima Awasthy
- Department of Oral and Maxillofacial Surgery, New Horizon Dental College and Research Institute, Sakri, Bilaspur, Chhattisgarh, India
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Floros MC, Bortolatto JF, Lausch AJ, Valiente AJ, Sone ED, Santerre JP, Whyne C, Fialkov JA. BoneTape: A novel osteosynthetic device for the stabilization of zygomatic fractures. J Plast Reconstr Aesthet Surg 2024; 91:276-283. [PMID: 38432085 DOI: 10.1016/j.bjps.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/15/2023] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The study aims to assess the safety and effectiveness of BoneTape™, a new resorbable bone fixation device, using a zygomatic fracture model in rabbits. METHODS The study followed BoneTape™ samples and control (sham) groups over 2-, 6-, and 12-week periods post-zygomaticomaxillary (ZM) osteotomy and zygomaticofrontal (ZF) disarticulation. The osteotomized segments were analyzed for bone healing, inflammatory response, and tissue healing. µCT imaging and histological analysis were used to examine the axial alignment, offset, and quality of new bone formation. RESULTS BoneTape™ samples demonstrated enhanced maintenance of the initial intraoperative positioning, reduced axial offset, and better alignment when compared with the control group, enabling stable bone healing under physiological loading conditions. Complete union was observed at 12-weeks in both groups. The BoneTape™ group experienced minimal immune and tissue reactions, classically associated with wound healing, and showed an increased number of giant cells at 6 and 12-weeks. CONCLUSION BoneTape™ represents a promising advancement in osteosynthesis, demonstrating efficacy in maintaining stable zygomatic reconstruction and eliciting minimal immune response in a rabbit model. This study introduces BoneTape™ as a disruptive solution specifically designed for clinical application in cranio-maxillofacial fracture fixation, with the potential to eliminate the use of over-engineered solutions while offering benefits such as ease of application and fewer biologically disruptive steps.
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Affiliation(s)
| | | | | | | | - Eli D Sone
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada; Deparment of Materials Science and Engineering, University of Toronto, Toronto, Canada
| | - J Paul Santerre
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Canada; Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Cari Whyne
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada
| | - Jeffrey A Fialkov
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Surgery, University of Toronto, Toronto Canada.
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4
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Gazo Hanna E, Younes K, Roufayel R, Khazaal M, Fajloun Z. Engineering innovations in medicine and biology: Revolutionizing patient care through mechanical solutions. Heliyon 2024; 10:e26154. [PMID: 38390063 PMCID: PMC10882044 DOI: 10.1016/j.heliyon.2024.e26154] [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: 06/02/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
The overlap between mechanical engineering and medicine is expanding more and more over the years. Engineers are now using their expertise to design and create functional biomaterials and are continually collaborating with physicians to improve patient health. In this review, we explore the state of scientific knowledge in the areas of biomaterials, biomechanics, nanomechanics, and computational fluid dynamics (CFD) in relation to the pharmaceutical and medical industry. Focusing on current research and breakthroughs, we provide an overview of how these fields are being used to create new technologies for medical treatments of human patients. Barriers and constraints in these fields, as well as ways to overcome them, are also described in this review. Finally, the potential for future advances in biomaterials to fundamentally change the current approach to medicine and biology is also discussed.
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Affiliation(s)
- Eddie Gazo Hanna
- College of Engineering and Technology, American University of the Middle East, Egaila, 54200, Kuwait
| | - Khaled Younes
- College of Engineering and Technology, American University of the Middle East, Egaila, 54200, Kuwait
| | - Rabih Roufayel
- College of Engineering and Technology, American University of the Middle East, Egaila, 54200, Kuwait
| | - Mickael Khazaal
- École Supérieure des Techniques Aéronautiques et de Construction Automobile, ISAE-ESTACA, France
| | - Ziad Fajloun
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, 1352, Tripoli, Lebanon
- Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and Its Applications, EDST, Lebanese University, 1300, Tripoli, Lebanon
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Lee KC, Reynolds R, Recker MJ, Markiewicz MR. Rigid Fixation of the Pediatric Facial Skeleton. Oral Maxillofac Surg Clin North Am 2023; 35:529-541. [PMID: 37537081 DOI: 10.1016/j.coms.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Pediatric facial fractures are uncommon, and fortunately, the majority can be managed with conservative measures. Rigid fixation of the pediatric facial skeleton can potentially be associated with delayed hardware issues and growth inhibition. When appropriate, resorbable fixation is most commonly used for this purpose. Titanium plates and screws are advantageous when rigid fixation is a priority because properly placed hardware that respects natural suture lines is not thought to significantly inhibit growth. Furthermore, titanium fixation may be removed following healing.
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Affiliation(s)
- Kevin C Lee
- Department of Oral and Maxillofacial Surgery, University at Buffalo, 3425 Main Street 112 Squire Hall, Buffalo, NY 14214, USA; Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Renée Reynolds
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott Street, Buffalo, NY 14203, USA
| | - Matthew J Recker
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, 818 Ellicott Street, Buffalo, NY 14203, USA
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, University at Buffalo, 3425 Main Street 112 Squire Hall, Buffalo, NY 14214, USA.
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6
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Shaye DA, Nwosu O, Ncogoza I, Nyabyenda V, Tuyishimire G, Manana W, Taiwo AO. Cost Burden of Rigid Internal Fixation in Craniomaxillofacial Trauma Care in Low- and Middle-Income Countries. OTO Open 2023; 7:e92. [PMID: 37933273 PMCID: PMC10625666 DOI: 10.1002/oto2.92] [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: 08/19/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
Fractures of the craniomaxillofacial (CMF) skeleton cause significant morbidity and mortality in low- and middle-income countries (LMICs). Despite this, quality CMF trauma care is lacking for the majority of the world's population. There is a paucity of literature describing the costs of standard-of-care open reduction internal fixation (ORIF) for CMF fractures in LMICs. We consider the cost of a six-hole plate with six screws (SHPS), standard materials used in ORIF for CMF fractures, as a percentage of gross domestic product (GDP) per capita to ascertain the cost burden to patients. Hospital pricing catalog data at 14 LMIC institutions were queried. On average, the SHPS cost represented 10.2% of the GDP per capita in sampled LMICs. We highlight manufacturing costs, import taxes, and lack of subsidized health care as factors contributing to the significant cost burden of ORIF in these areas. Future work should characterize additional financial and socioeconomic barriers to optimal CMF care.
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Affiliation(s)
- David A. Shaye
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and EarHarvard Medical SchoolBostonMassachusettsUSA
- Department of SurgeryUniversity Teaching Hospital of KigaliKigaliRwanda
| | - Obinna Nwosu
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and EarHarvard Medical SchoolBostonMassachusettsUSA
| | - Isaie Ncogoza
- Department of SurgeryUniversity Teaching Hospital of KigaliKigaliRwanda
| | - Victor Nyabyenda
- Department of SurgeryUniversity Teaching Hospital of KigaliKigaliRwanda
| | | | - Wayne Manana
- Department of Oral and Maxillofacial Surgery, Faculty of Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Abdurrazaq Olanrewaju Taiwo
- Departments of Oral and Maxillofacial Surgery/Dental and Maxillofacial Surgery, Faculty of Dental SciencesUsmanu Danfodiyo University/Usmanu Danfodiyo University Teaching HospitalSokotoNigeria
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7
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Alostath HF, Chatzopoulou D, Holmes S, Gould D, Sukhorukov G, Cattell MJ. Synthesis of Novel Antimicrobial CHX-CaCl 2 Coatings on Maxillofacial Fixatures for Infection Prevention. Int J Mol Sci 2023; 24:9801. [PMID: 37372949 DOI: 10.3390/ijms24129801] [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: 05/11/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Maxillofacial surgery placement of fixatures (Leonard Buttons, LB) at close proximity to surgical incisions provides a potential reservoir as a secondary local factor to advanced periodontal disease, with bacterial formation around failed fixatures implicating plaque. To address infection rates, we aimed to surface coat LB and Titanium (Ti) discs using a novel form of chlorhexidine (CHX), CHX-CaCl2 and 0.2% CHX digluconate mouthwash as a comparison. CHX-CaCl2 coated, double-coated and mouthwash coated LB and Ti discs were transferred to 1 mL artificial saliva (AS) at specified time points, and UV-Visible spectroscopy (254 nm) was used to measure CHX release. The zone of inhibition (ZOI) was measured using collected aliquots against bacterial strains. Specimens were characterized using Energy Dispersive X-ray Spectroscopy (EDS), X-ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). SEM displayed copious dendritic crystals on LB/ Ti disc surfaces. Drug release from double-coated CHX-CaCl2 was 14 days (Ti discs) and 6 days (LB) above MIC, compared to the comparison group (20 min). The ZOI for the CHX-CaCl2 coated groups was significantly different within groups (p < 0.05). CHX-CaCl2 surface crystallization is a new drug technology for controlled and sustained CHX release; its antibacterial effectiveness makes this drug an ideal adjunct following clinical and surgical procedures to maintain oral hygiene and prevent surgical site infections.
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Affiliation(s)
- Hawraa F Alostath
- Centre for Oral Bioengineering, Bart's and the London, School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | - Domniki Chatzopoulou
- Centre for Oral Bioengineering, Bart's and the London, School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | - Simon Holmes
- Barts Health NHS Trust, Department of Oral and Maxillofacial Surgery, Queen Mary University of London, London E1 1FR, UK
| | - David Gould
- Centre for Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Gleb Sukhorukov
- Institute of Bioengineering, School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Michael J Cattell
- Centre for Oral Bioengineering, Bart's and the London, School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
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8
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Fischer H, Schmidt-Bleek O, Orassi V, Wulsten D, Schmidt-Bleek K, Heiland M, Steffen C, Rendenbach C. Biomechanical Comparison of WE43-Based Magnesium vs. Titanium Miniplates in a Mandible Fracture Model in Sheep. MATERIALS (BASEL, SWITZERLAND) 2022; 16:102. [PMID: 36614440 PMCID: PMC9821048 DOI: 10.3390/ma16010102] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
In fractures of the mandible, osteosynthesis with titanium plates is considered the gold standard. Titanium is an established and reliable material, its main disadvantages being metal artefacts and the need for removal in case of osteosynthesis complications. Magnesium, as a resorbable material with an elastic modulus close to cortical bone, offers a resorbable alternative osteosynthesis material, yet mechanical studies in mandible fracture fixation are still missing. The hypothesis of this study was that magnesium miniplates show no significant difference in the mechanical integrity provided for fracture fixation in mandible fractures under load-sharing indications. In a non-inferiority test, a continuous load was applied to a sheep mandible fracture model with osteosynthesis using either titanium miniplates of 1.0 mm thickness (Ti1.0), magnesium plates of 1.75 mm (Mg1.75), or magnesium plates of 1.5 mm thickness (Mg1.5). No significant difference (p > 0.05) was found in the peak force at failure, stiffness, or force at vertical displacement of 1.0 mm between Mg1.75, Mg1.5, and Ti1.0. This study shows the non-inferiority of WE43 magnesium miniplates compared to the clinical gold standard titanium miniplates.
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Affiliation(s)
- Heilwig Fischer
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Oskar Schmidt-Bleek
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Vincenzo Orassi
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Dag Wulsten
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Katharina Schmidt-Bleek
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Claudius Steffen
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Carsten Rendenbach
- Department of Oral and Maxillofacial Surgery, Charité—Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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9
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McCann A, Singerman K, Coxe J, Singletary J, Wang J, Collar R, Hsieh TY. Quantifying Aerosol Generation in Maxillofacial Trauma Repair Techniques. Craniomaxillofac Trauma Reconstr 2022; 15:362-368. [PMID: 36387309 PMCID: PMC9647378 DOI: 10.1177/19433875211059314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Study Design Cadaveric simulation study. Objective The novel coronavirus (COVID-19), which can be transmitted via aerosolized viral particles, has directed focus on protection of healthcare workers during procedures involving the upper aerodigestive tract, including maxillofacial trauma repair. This study evaluates particle generation at different distances from open reduction and internal fixation (ORIF) of maxillofacial injuries in the intraoperative setting to reduce the risk of contracting airborne diseases such as COVID-19. Methods Two cadaveric specimens in a simulated operating room underwent ORIF of midface and mandible fractures via intraoral incisions as well as maxillomandibular fixation (MMF) using hybrid arch bars. ORIF was performed with both self-drilling screws and with the use of a power drill for creating guide holes. Real-time aerosol concentration was measured throughout each procedure using 3 particle counters placed 0.45, 1.68, and 3.81 m (1.5, 5.5, and 12.5 feet, respectively) from the operative site. Results There was a significant decrease in particle concentration in all procedures at 1.68 m compared to 0.45 m, but only 2 of the 5 procedures showed further significant decrease in particle concentration when going from 1.68 to 3.81 m from the operative site. There was significantly less particle concentration generated at all distances when using self-drilling techniques compared to power drilling for ORIF. Conclusions Consideration of using self-drilling screwing techniques as well as maintaining physical distancing protocols may decrease risk of transmission of airborne diseases such as COVID-19 while in the intraoperative setting.
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Affiliation(s)
- Adam McCann
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kyle Singerman
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - James Coxe
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - John Singletary
- Department of Environmental and Public
Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jun Wang
- Department of Environmental and Public
Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Ryan Collar
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tsung-yen Hsieh
- Department of Otolaryngology - Head and
Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Sansgiri T, Prasad K, Kumar V, Ranganath K, Rajanikanth BR, Sejal KM, Sagar P, Prathibha G. Comparative Assessment of Microplates with Miniplates in the Fixation of Midface Fractures: A Prospective Study. J Maxillofac Oral Surg 2022; 21:396-404. [DOI: 10.1007/s12663-020-01453-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022] Open
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11
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Ngo HX, Bai Y, Sha J, Ishizuka S, Toda E, Osako R, Kato A, Morioka R, Ramanathan M, Tatsumi H, Okui T, Kanno T. A Narrative Review of u-HA/PLLA, a Bioactive Resorbable Reconstruction Material: Applications in Oral and Maxillofacial Surgery. MATERIALS (BASEL, SWITZERLAND) 2021; 15:150. [PMID: 35009297 PMCID: PMC8746248 DOI: 10.3390/ma15010150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022]
Abstract
The advent of bioresorbable materials to overcome limitations and replace traditional bone-reconstruction titanium-plate systems for bone fixation, thus achieving greater efficiency and safety in medical and dental applications, has ushered in a new era in biomaterial development. Because of its bioactive osteoconductive ability and biocompatibility, the forged composite of uncalcined/unsintered hydroxyapatite and poly L-lactic acid (u-HA/PLLA) has attracted considerable interest from researchers in bone tissue engineering, as well as from clinicians, particularly for applications in maxillofacial reconstructive surgery. Thus, various in vitro studies, in vivo studies, and clinical trials have been conducted to investigate the feasibility and weaknesses of this biomaterial in oral and maxillofacial surgery. Various technical improvements have been proposed to optimize its advantages and limit its disadvantages. This narrative review presents an up-to-date, comprehensive review of u-HA/PLLA, a bioactive osteoconductive and bioresorbable bone-reconstruction and -fixation material, in the context of oral and maxillofacial surgery, notably maxillofacial trauma, orthognathic surgery, and maxillofacial reconstruction. It simultaneously introduces new trends in the development of bioresorbable materials that could used in this field. Various studies have shown the superiority of u-HA/PLLA, a third-generation bioresorbable biomaterial with high mechanical strength, biocompatibility, and bioactive osteoconductivity, compared to other bioresorbable materials. Future developments may focus on controlling its bioactivity and biodegradation rate and enhancing its mechanical strength.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan; (H.X.N.); (Y.B.); (J.S.); (S.I.); (E.T.); (R.O.); (A.K.); (R.M.); (M.R.); (H.T.); (T.O.)
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12
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Evaluation of the Efficacy of Biodegradable Plates in Maxillofacial Fractures. J Craniofac Surg 2021; 33:1166-1169. [DOI: 10.1097/scs.0000000000008444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Joshi A, Dias G, Staiger MP. In silico modelling of the corrosion of biodegradable magnesium-based biomaterials: modelling approaches, validation and future perspectives. BIOMATERIALS TRANSLATIONAL 2021; 2:257-271. [PMID: 35836648 PMCID: PMC9255808 DOI: 10.12336/biomatertransl.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
Metallic biomedical implants based on magnesium, zinc and iron alloys have emerged as bioresorbable alternatives to permanent orthopaedic implants over the last two decades. The corrosion rate of biodegradable metals plays a critical role in controlling the compatibility and functionality of the device in vivo. The broader adoption of biodegradable metals in orthopaedic applications depends on developing in vitro methods that accurately predict the biodegradation behaviour in vivo. However, the physiological environment is a highly complex corrosion environment to replicate in the laboratory, making the in vitro-to-in vivo translation of results very challenging. Accordingly, the results from in vitro corrosion tests fail to provide a complete schema of the biodegradation behaviour of the metal in vivo. In silico approach based on computer simulations aim to bridge the observed differences between experiments performed in vitro and vivo. A critical review of the state-of-the-art of computational modelling techniques for predicting the corrosion behaviour of magnesium alloy as a biodegradable metal is presented.
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Affiliation(s)
- Aditya Joshi
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - George Dias
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Mark P. Staiger
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand,Corresponding author: Mark P. Staiger,
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Bonitz L, Wruck V, Peretti E, Abel D, Hassfeld S, Bicsák Á. Long-term evaluation of treatment protocols for isolated midfacial fractures in a German nation-wide craniomaxillofacial trauma center 2007-2017. Sci Rep 2021; 11:18291. [PMID: 34521960 PMCID: PMC8440643 DOI: 10.1038/s41598-021-97858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
An update on the trends in maxillofacial traumatology provides additional information on the actual and changing needs. This retrospective study aimed to review all patient records of patients treated for isolated midface fractures in the Department of Cranial- and Maxillofacial Surgery at the Dortmund General Hospital between 2007 and 2017. The patient radiographs and patient files were reviewed. The safety and efficacy of the applied methods were controlled by assessing complications based on the Clavien-Dindo classification system. The statistical analysis included descriptive methods including regression analysis and χ2-test. In eleven years, 3474 isolated midface fracture sites have been identified in 2868 patients. The yearly trend is slightly increasing, in elderly clearly worsening, in children and youth decreasing. The male-to-female ratio was 2.16:1 for the whole study population, in the age group 18-25 y.o. 6.95:1 while in elderly above 80 y.o. 1:2.51, the age group specific incidence reflects this result, too. The most common fractures were nasal bone fractures (1405), zygomatic fractures (832) and orbital floor fractures (700). The average hospital stay was 2.7 days, the most fractures were operated within 24 h. The complication rate was 2.02% (Clavien-Dindo class II-V). The incidence of midfacial fractures is increasing in the total population and especially in elderly, but decreasing in children. Development of injury prevention measures is needed in this population. The diagnostic and therapeutic procedures are appropriate, as there is a low complication rate and short inpatient stay observed.
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Affiliation(s)
- Lars Bonitz
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Vivienne Wruck
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Elena Peretti
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Dietmar Abel
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Stefan Hassfeld
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany
| | - Ákos Bicsák
- Clinic for Cranial- and Maxillofacial Surgery, Regional Plastic Surgery, Dortmund General Hospital, Chair of the University of Witten-Herdecke, Muensterstrasse 240, 44145, Dortmund, Germany.
- Health Faculty, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 45, 58453, Witten, Germany.
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Abstract
ABSTRACT Deformity and tissue loss involving the craniomaxillofacial region occurs frequently as a result of trauma, oncologic resection, or a congenital malformation. In order to maximize the patient's quality of life, reconstruction of the craniomaxillofacial skeleton must seek to restore aesthetics as well as function. Advances in diagnostic technology, surgical technique, instrumentation, and innovative biomaterials used have transformed the way reconstructive surgeons approach their patients' needs. From the advent of alloplastic reconstruction, surgeons have sought the ideal material for use in craniomaxillofacial surgery. Substances such as metals, ceramics, glasses, and more recently resorbable polymers and bioactive materials have all been utilized.While autologous bone has remained widely-favored and the gold standard, synthetic alternatives remain a necessity when autologous reconstruction is not readily available. Today, alloplastic material, autografting via microvascular tissue transfer, hormone and growth factor-induced bone formation, and computer-aided design and manufacturing of biocompatible implants represent only a fraction of a wide range of options used in the reconstruction of the craniomaxillofacial skeleton. We present a brief review of the materials used in the repair of deformities of the craniomaxillofacial skeleton as well as a look into the potential future direction of the field.
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Amjad S, Kalim Ansari MD, Ahmad SS, Rahman T. Comparative study of outcomes between locking plates and three-dimensional plates in mandibular fractures. Natl J Maxillofac Surg 2020; 11:263-269. [PMID: 33897192 PMCID: PMC8051647 DOI: 10.4103/njms.njms_53_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/03/2020] [Accepted: 05/09/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives The objective was to compare the efficiency and assess postoperative complications of 2.00 mm unicortical locking plates and three-dimensional (3D) plates in surgical correction of uncomplicated mandibular fracture. Materials and Methods A prospective cohort study of twenty patients of uncomplicated mandibular fractures, who were operated either by noncompression unicortical 2-mm locking mini-plate or by noncompression unicortical 2-mm 3D mini-plate, were enrolled and followed up for the study outcomes such as operative time, postoperative infection, and postoperative occlusion. Results Majority of the patients (90%) were male who had road traffic accident. In 80% of cases, mandibular fracture site was parasymphysis. The mean operating time for 3D plates (43.20 min) was significantly lower than that for locking plates (54.82 min), P < 0.001. All cases operated by 3D plates compared to 60% by locking mini-plates did not need intermaxillary fixation, P = 0.025. The 80% of cases operated by 3D plates did not require postoperative occlusion correction compared to 30% in another group, P = 0.01. For other parameters such as postoperative sensory disturbance, postoperative infection, incidence tooth damage, vertical displacement of mandible, feeling of plate after platting, and chewing efficiency after 1 week, there were no statistical significant differences between the two groups. Conclusions The outcome of 2.0mm 3D mini-plate is better in terms of operating time required, post-operative need of intermaxillary fixation and occlusal correction. While the outcome is similar to the use of non-compression unicortical 2.00mm locking miniplate in parameters like infection rate and incidence of tooth damage etc.
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Affiliation(s)
- Shaikh Amjad
- Department of Dentistry, Indian Institute of Medical Sciences and Research, Jalna, Maharashtra, India
| | - M D Kalim Ansari
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed S Ahmad
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Tabishur Rahman
- Department of Oral and Maxillofacial Surgery, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Jung BT, Kim WH, Park B, Lee JH, Kim B, Lee JH. Biomechanical evaluation of unilateral subcondylar fracture of the mandible on the varying materials: A finite element analysis. PLoS One 2020; 15:e0240352. [PMID: 33031474 PMCID: PMC7544122 DOI: 10.1371/journal.pone.0240352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
Fixation materials used in the surgical treatment of subcondylar fractures contribute to successful clinical outcomes. In this study, we simulated the mechanical properties of four fixation materials [titanium (Ti), magnesium alloy (Mg alloy), poly-L-lactic acid (PLLA), and hydroxyapatite/poly-L-lactide (HA-PLLA)] in a finite-element analysis model of subcondylar fracture. Two four-hole plates were fixed on the anterior and posterior surfaces of the subcondyle of the mandible. In the simulation model of a subcondylar fracture, we evaluated the stress distribution and mechanical deformation of fixation materials. The stress distribution conspicuously appeared on the condylar neck of the non-fractured side and the center of the anterior plate for all materials. More stress distribution to the biologic component appeared with HA-PLLA than with Ti or Mg alloy, but its effects were less prominent than that of PLLA. The largest deformation was observed with PLLA, followed by HA-PLLA, Mg alloy, and Ti. The results of the present study imply the clinical potential of the HA-PLLA fixation material for open reduction of subcondylar fractures.
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Affiliation(s)
- Bryan Taekyung Jung
- School of Dentistry, University of Detroit Mercy, Detroit, Michigan, United States of America
| | - Won Hyeon Kim
- Department of Mechanical Engineering, Sejong University, Seoul, Korea
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
| | - Byungho Park
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jong-Ho Lee
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Bongju Kim
- Clinical Translational Research Center for Dental Science, Seoul National University Dental Hospital, Seoul, Korea
- * E-mail: (BK); (JHL)
| | - Jee-Ho Lee
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
- * E-mail: (BK); (JHL)
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Graillon N, Guyot L, Sigaux N, Louvrier A, Trost O, Lutz JC, Foletti JM. Do mandibular miniplates increase the risk of complex fracture in facial trauma recurrence? Case series. J Craniomaxillofac Surg 2020; 49:613-619. [PMID: 33994291 DOI: 10.1016/j.jcms.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 11/17/2022] Open
Abstract
Whether to conserve or remove miniplates, widely used in oral and maxillofacial surgery, has not been agreed on in the literature. Complications such as pain, infection, and screw exposure or loosening have already been largely described. We present the consequences of a trauma recurrence on a mandible with miniplates. The data of 13 patients who had a mandibular fracture previously surgically treated with miniplates (ten mandibular fractures and three mandibular osteotomies) were analysed. All the patients were male; the average age was 32 years (range, 20-64 years). The mechanism of the second trauma was assault in most of the cases. The average time between the first osteosynthesis and the new fracture was 35 months (range, 6-128 months). The fractures occurred at a distance from the miniplates in all the cases except two. No plate fracture was reported. We hypothesised that miniplates reinforced the underlying bone, protecting it from fractures, and transmitted the forces to areas anterior or posterior to the miniplates or to the condyle. Thus, the risk of mandible trauma recurrence should be taken into account in the indication of plate removal, and the biomechanical consequences of the conservation of the miniplates should be studied.
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Affiliation(s)
- Nicolas Graillon
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, bd Pierre Dramard, 13916 Marseille, France.
| | - Laurent Guyot
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, bd Pierre Dramard, 13344 Marseille, France
| | - Nicolas Sigaux
- Department of Maxillofacial Surgery and Facial Plastic Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, 165, Chemin du Grand Revoyet, 69310 Pierre-Bénite, France; Claude Bernard Lyon 1 University, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbanne, France
| | - Aurélien Louvrier
- Department of Oral and Maxillofacial Surgery, Hospital Dentistry Unit, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25000 Besançon, France; University of Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur, Ingénierie Cellulaire et Génique, 8 Rue du Docteur JFX Girod, F-25000 Besançon, France
| | - Olivier Trost
- Department of Oral and Maxillofacial Surgery, CHU Rouen, Hôpital Charles-Nicolle, 1 Rue de Germont, 76000 Rouen, France; Laboratoire d'anatomie UFR Santé de Rouen, Université Rouen Normandie, 22, Boulevard Gambetta, 76183 Rouen, France
| | - Jean-Christophe Lutz
- Maxillo-Facial Surgery Department, Strasbourg University Hospital, 1, Avenue Molière, 67098 Strasbourg Cedex, France; University of Strasbourg, Faculty of Medicine, 8 Rue Kirschleger, 67000 Strasbourg, France; Laboratory of Engineering Science, Computer Science and Imaging, CNRS, ICUBE University of Strasbourg, 2 Rue Boussingault, 67000 Strasbourg, FMTS, France
| | - Jean-Marc Foletti
- Department of Oral and Maxillofacial Surgery, CHU Conception, APHM, 147 bd Baille, 13005 Marseille, France; Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, bd Pierre Dramard, 13916 Marseille, France
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19
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Andalib A, Etemadifar M, Yavari P. Clinical Outcomes of Intramedullary and Extramedullary Fixation in Unstable Intertrochanteric Fractures: A Randomized Clinical Trial. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:190-197. [PMID: 32490050 DOI: 10.22038/abjs.2019.34942.1919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The best method for repairing intertrochanteric fractures is still controversial. The fixation methods include extramedullary (EM) and intramedullary (IM). Studies that compare IM and EM fixations for unstable hip fractures are rare. In this study, our goal was to compare the efficacy of EM and IM fixation in treatment of unstable intertrochanteric fractures. Methods A total of 113 patients with unstable intertrochanteric were randomized in this cohort study between March 2016 and June 2018 in trauma center of Kashani and Alzahra Hospitals, Isfahan, Iran. The patients were followed for a period of 12 months with sequential clinical and imaging evaluations. Baseline data were recorded at the time of injury. Radiographs were evaluated immediately post-operatively and at the scheduled follow-up intervals. Results A total of 20 of patients were excluded during the study and finally 93 patients (43 males and 50 females) with mean age of 62.74±16.4 completed the follow-up sessions. Mann-Whitney test indicated a significant difference in tip-apex distance between the two groups. While the two groups were homogeneous in the baseline LEM score, it was not significantly different between two groups after 1 and 3 months of surgery as well. However, the LEM score was significantly higher in IM group after 6 and 12 months of surgery. Conclusion According to our findings, IM nails (such as the cephalomedullary nail) afforded more advantages over EM devices (such as the DHS and DCS) in the treatment of unstable intertrochanteric fractures. Our results indicated that the final LEM scores as well as the time to union were better in IM fixation group.
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Affiliation(s)
- Ali Andalib
- Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Etemadifar
- Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pedram Yavari
- Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Guastaldi FPS, Martini AP, Rocha EP, Hochuli-Vieira E, Guastaldi AC. Ti-15Mo Alloy Decreases the Stress Concentration in Mandibular Angle Fracture Internal Fixation Hardware. J Maxillofac Oral Surg 2020; 19:314-320. [PMID: 32346246 DOI: 10.1007/s12663-019-01251-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/29/2019] [Indexed: 10/26/2022] Open
Abstract
Objectives Comparison of the mechanical stability of 2.0 plates made of commercially pure titanium (cpTi) and a titanium-molybdenum (Ti-15Mo) alloy and two methods of internal fixation employed mandibular angle fractures, using 3D finite element analysis. Materials and Methods Four groups were evaluated. For the cpTi: group Eng 1P, one 4-hole plate and 4 screws 6 mm long, in the tension zone of the mandible; group Eng 2P, two 4-hole plates, one in the tension zone of the mandible and the other in the compression zone, both were fixed with 8 screws 6 mm long. The same groups were created for the Ti-15Mo alloy. A 100 N compressive load was applied to the occlusal surface of the mandibular first molar on the plated side. Results When considering the von Mises equivalent stress (σ vM) values for the comparison between both groups with one plate, a decrease of 10.5% in the plate and a decrease of 29.0% in the screws for the Ti-15Mo group was observed. Comparing the same groups with two plates, a decrease of 28.5% in the screws was shown for the Ti-15Mo alloy group. No significant differences were observed when considering maximum and minimum principal stresses (σ max, σ min), and maximum principal strain (ε max) to the mandibular bone. The Ti-15Mo alloy plates substantially decreased the stress concentration in the screws for both internal fixation techniques and in the plate for the Ti-15Mo 1 plate group. Conclusion From a clinical standpoint, the use of Ti-Mo alloy with reduced stiffness will decrease the stress shielding between the hardware and bone, influencing the outcome of the treatment.
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Affiliation(s)
- F P S Guastaldi
- 1Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Humaitá Street, 1680, Araraquara, SP 14801-903 Brazil
| | - A P Martini
- 2Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP Brazil
| | - E P Rocha
- 2Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (Unesp), Araçatuba, SP Brazil
| | - E Hochuli-Vieira
- 1Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (Unesp), Humaitá Street, 1680, Araraquara, SP 14801-903 Brazil
| | - A C Guastaldi
- 3Department of Physical Chemistry, Institute of Chemistry, São Paulo State University (Unesp), Araraquara, SP Brazil
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21
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Kang JM, Kalin-Hajdu E, Idowu OO, Vagefi MR, Kersten RC. Nasolacrimal Obstruction Following the Placement of Maxillofacial Hardware. Craniomaxillofac Trauma Reconstr 2020; 13:32-37. [PMID: 32642029 DOI: 10.1177/1943387520906004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose This article reviews cases of nasolacrimal obstruction (NLO) secondary to maxillofacial hardware placement. Methods A retrospective review was performed at a single institution from 2012 to 2017 of patients with NLO following maxillofacial reconstruction. The study was approved by the Institutional Review Board of the University of California, San Francisco, adhered to the tenets of the Declaration of Helsinki, and was Health Insurance Portability and Accountability Act compliant. Patients were included if external dacryocystorhinostomy (DCR) confirmed previously placed maxillofacial hardware as the primary contributor to lacrimal outflow obstruction and had at least 3 months of follow-up. Results Of 420 patients who underwent external DCR, 6 cases of implant-related NLO were identified. The mean age was 47.3 ± 9.6 years and 66.7% of patients were male. All patients presented with epiphora and 50% also had chronic dacryocystitis. Patients had prior maxillofacial hardware placement for paranasal sinus tumors (66.7%) or facial fractures (33.3%). In addition to external DCR, all patients had revision or removal of implants that were impeding lacrimal outflow by 2 mechanisms: (1) an orbital implant impinging the lacrimal sac or nasolacrimal duct (NLD) and/or (2) maxillofacial screws placed into the bony NLD or nasolacrimal fossa. Five of the 6 patients (83.3%) had complete resolution of symptoms and patency of the nasolacrimal system at their last follow-up visit (range 3-30 months). Conclusion NLO secondary to hardware placement, though infrequent, is underreported. Two mechanisms of hardware-induced NLO were encountered in this case series. Specific attention to nasolacrimal anatomy at the time of maxillofacial reconstruction may help minimize implant-induced NLO.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada
| | - Oluwatobi O Idowu
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Robert C Kersten
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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22
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Pimenta de Melo L, Contessi Negrini N, Farè S, de Mello Roesler CR, de Mello Gindri I, Salmoria GV. Thermomechanical and in vitro biological characterization of injection-molded PLGA craniofacial plates. J Appl Biomater Funct Mater 2019; 17:2280800019831599. [PMID: 30841778 DOI: 10.1177/2280800019831599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE: To evaluate the thermomechanical and in vitro biological response of poly(lactic-co-glycolic acid) (PLGA) plates for craniofacial reconstructive surgery. METHODS: PLGA 85/15 craniofacial plates were produced by injection molding by testing two different temperatures (i.e., 240°C, PLGA_lowT, and 280°C, PLGA_highT). The mechanical properties of the produced plates were characterized by three-point bending tests, dynamic mechanical analysis, and residual stress. Crystallinity and thermal transitions were investigated by differential scanning calorimetry. Finally, in vitro cell interaction was evaluated by using SAOS-2 as cell model. Indirect cytotoxicity tests (ISO 10-993) were performed to prove the absence of cytotoxic release. Cells were then directly seeded on the plates and their viability, morphology, and functionality (ALP) checked up to 21 days of culture. RESULTS: A similar performance of PLGA_lowT and PLGA_highT plates was verified in the three-point bending test and dynamic mechanical analyses. Also, the two processing temperatures did not influence the in vitro cell interaction. Cytotoxicity and ALP activity were similar for the PLGA plates and control. Cell results demonstrated that the PLGA plates supported cell attachment and proliferation. Furthermore, energy-dispersive X-ray spectroscopy revealed the presence of sub-micron particles, which were identified as inorganic mineral deposits resulting from osteoblast activity. CONCLUSION: The present work demonstrated that the selected processing temperatures did not affect the material performance. PLGA plates showed good mechanical properties for application in craniofacial reconstructive surgery and adequate biological properties.
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Affiliation(s)
- Liliane Pimenta de Melo
- 1 Biomechanics Engineering Laboratory, University Hospital (HU), Federal University of Santa Catarina, Florianópolis, SC, Brazil.,2 NIMMA Laboratory, Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil.,3 Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Milan, Italy
| | - Nicola Contessi Negrini
- 3 Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Milan, Italy.,4 INSTM, Consorzio Nazionale di Scienza e Tecnologia dei Materiali, Milan, Italy
| | - Silvia Farè
- 3 Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Milan, Italy.,4 INSTM, Consorzio Nazionale di Scienza e Tecnologia dei Materiali, Milan, Italy
| | - Carlos Rodrigo de Mello Roesler
- 1 Biomechanics Engineering Laboratory, University Hospital (HU), Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Izabelle de Mello Gindri
- 1 Biomechanics Engineering Laboratory, University Hospital (HU), Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Gean Vitor Salmoria
- 1 Biomechanics Engineering Laboratory, University Hospital (HU), Federal University of Santa Catarina, Florianópolis, SC, Brazil.,2 NIMMA Laboratory, Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Knoops PGM, Borghi A, Ruggiero F, Badiali G, Bianchi A, Marchetti C, Rodriguez-Florez N, Breakey RWF, Jeelani O, Dunaway DJ, Schievano S. A novel soft tissue prediction methodology for orthognathic surgery based on probabilistic finite element modelling. PLoS One 2018; 13:e0197209. [PMID: 29742139 PMCID: PMC5942840 DOI: 10.1371/journal.pone.0197209] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/27/2018] [Indexed: 12/02/2022] Open
Abstract
Repositioning of the maxilla in orthognathic surgery is carried out for functional and aesthetic purposes. Pre-surgical planning tools can predict 3D facial appearance by computing the response of the soft tissue to the changes to the underlying skeleton. The clinical use of commercial prediction software remains controversial, likely due to the deterministic nature of these computational predictions. A novel probabilistic finite element model (FEM) for the prediction of postoperative facial soft tissues is proposed in this paper. A probabilistic FEM was developed and validated on a cohort of eight patients who underwent maxillary repositioning and had pre- and postoperative cone beam computed tomography (CBCT) scans taken. Firstly, a variables correlation assessed various modelling parameters. Secondly, a design of experiments (DOE) provided a range of potential outcomes based on uniformly distributed input parameters, followed by an optimisation. Lastly, the second DOE iteration provided optimised predictions with a probability range. A range of 3D predictions was obtained using the probabilistic FEM and validated using reconstructed soft tissue surfaces from the postoperative CBCT data. The predictions in the nose and upper lip areas accurately include the true postoperative position, whereas the prediction under-estimates the position of the cheeks and lower lip. A probabilistic FEM has been developed and validated for the prediction of the facial appearance following orthognathic surgery. This method shows how inaccuracies in the modelling and uncertainties in executing surgical planning influence the soft tissue prediction and it provides a range of predictions including a minimum and maximum, which may be helpful for patients in understanding the impact of surgery on the face.
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Affiliation(s)
- Paul G. M. Knoops
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- * E-mail:
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Federica Ruggiero
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giovanni Badiali
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alberto Bianchi
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery Unit, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Naiara Rodriguez-Florez
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Department of Biomedical Engineering, Mondragon University, Mondragón, Spain
| | - Richard W. F. Breakey
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - David J. Dunaway
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
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Abstract
The goal of maxillofacial surgery is to restore the shape and functionality of maxillofacial region. In the past years, there has been a tremendous progress in this field because of significant advances in biotechnology that provided innovative biomaterials to efficiently reconstruct the maxillofacial injured region. By using appropriate selection of the implant biomaterial, it is possible to reconstruct the native tissue, both in form and function. The ideal biomaterial should mimic native tissues regarding density, strength, and modulus of elasticity. Autografts are currently the gold standard for replacement of missing tissues, but synthetic biomaterials have been widely used because they eliminate the discomfort to take the replacement tissue from the donor site. Among synthetic biomaterials, different metals may be utilized to efficiently reconstruct the maxillofacial injured region. This article makes an effort to summarize the most important metals in use in maxillofacial surgery, and point out advantages and disadvantage of each type.
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Affiliation(s)
- L Pacifici
- Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, Rome, Italy
| | - F DE Angelis
- Department of Oral and Maxillofacial Science, "Sapienza" University of Rome, Rome, Italy
| | | | - A Cielo
- Private Practice, Rome, Italy
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Abstract
BACKGROUND Resorbable osteosynthesis systems are used to treat craniofacial fractures. However, conventional synthetic polyester materials are potentially associated with inflammatory reaction and negative host response and may result in incomplete bone remodeling. The authors have developed a resorbable silk fibroin-based osteosynthesis system and propose that silk screws loaded with bone morphogenetic protein-2 (BMP-2) may exhibit biocompatibility and promote bone remodeling. METHODS Resorbable silk screws were prepared and loaded with BMP-2. The BMP-2-loaded and nonloaded silk screws were inserted into the distal femora in 15 Sprague-Dawley rats by self-tapping, similar to conventional metal systems. Animals were euthanized after 1, 3, and 6 months. The femora were explanted at the designated time points, dissected for histologic evaluation, and compared regarding osteoid formation and inflammatory response. RESULTS Increasing organization of newly formed bone tissue was observed over time in both groups. No appreciable difference in inflammation was noted between the BMP-2-loaded and nonloaded silk screws. Notably, mineralized collagen around the periphery of the screw appears to be greatest and more organized in the BMP-2-loaded samples. There was greater recruitment of osteoclasts and osteoblasts around the perimeter of the BMP-2-loaded screws at 3 and 6 months. CONCLUSIONS The BMP-2-loaded silk-based fixation device in this study exhibited characteristics comparable to the current nonloaded silk screws with regard to integration and biocompatibility. However, functionalization of silk screws with BMP-2 appeared to allow for more organized collagen and osteoid deposition after 3 and 6 months and may increase the potential of successful remodeling.
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Peltola EM, Mäkelä T, Haapamäki V, Suomalainen A, Leikola J, Koskinen SK, Kortesniemi M, Koivikko MP. CT of facial fracture fixation: an experimental study of artefact reducing methods. Dentomaxillofac Radiol 2016; 46:20160261. [PMID: 27786546 DOI: 10.1259/dmfr.20160261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to determine the optimal post-operative CT imaging method that enables best visualization of facial bony structures in the vicinity of osteosynthesis material. METHODS Conducted at Töölö Hospital (Helsinki, Finland), this study relied on scanning a phantom with CBCT, 64-slice CT and high-definition multislice CT with dual-energy scan (providing monochromatic images of 70-, 100-, 120- and 140-keV energy levels) and iterative reconstruction (IR) methods. Two radiologists assessed the image quality, and the assessments were analyzed. In addition, a physicist performed a semi-quantitative analysis of the metal-induced artefacts. RESULTS The three subjects most easily assessed were the loose screw and both the bone structure and the fracture further away from the screw and the plate. Soft tissues adjacent to the screw and the plate remained more difficult for assessment. Both image interpreters agreed that the artefacts disturbed their assessments under dual energy. Metal artefacts disturbed the least under multislice CT with IR [adaptive statistical iterative reconstruction (ASiR) and VEO]. Neither interpreter found metal suppression helpful in CBCT. CONCLUSIONS CBCT with or without a metal artefact reduction algorithm was not optimal for post-operative facial imaging compared with multislice CT with IR. Multislice CT with ASiR filtering offered good image quality performance with fast image volume reconstruction, representing the current sweet spot in post-operative maxillofacial imaging.
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Affiliation(s)
- Elina M Peltola
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Mäkelä
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Haapamäki
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anni Suomalainen
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- 2 Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Seppo K Koskinen
- 3 Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden
| | - Mika Kortesniemi
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika P Koivikko
- 1 Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Surface characterization, in vitro and in vivo biocompatibility of Mg-0.3Sr-0.3Ca for temporary cardiovascular implant. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 67:72-84. [DOI: 10.1016/j.msec.2016.04.108] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/10/2016] [Accepted: 04/27/2016] [Indexed: 11/18/2022]
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Upson SJ, Partridge SW, Tcacencu I, Fulton DA, Corbett I, German MJ, Dalgarno KW. Development of a methacrylate-terminated PLGA copolymer for potential use in craniomaxillofacial fracture plates. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:470-7. [PMID: 27612737 DOI: 10.1016/j.msec.2016.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/28/2016] [Accepted: 06/05/2016] [Indexed: 11/17/2022]
Abstract
We synthesised methacrylate-terminated PLGA (HT-PLGA, 85:15 LA:GA, 169kDa), for potential use as an adhesively attached craniomaxillofacial fracture fixation plate. The in vitro degradation of molecular weight, pH and flexural modulus were measured over 6weeks storage in PBS at 37°C, with commercially available high (225kDa, H-PLGA) and low (116kDa, L-PLGA) molecular weight 85:15 PLGAs used as comparators. Molecular weights of the materials reduced over 6weeks, HT-PLGA by 48%, H-PLGA by 23% and L-PLGA by 81%. HT-PLGA and H-PLGA exhibited a near constant pH (7.35) and had average flexural moduli in excess of 6GPa when produced, similar to that of the mandible. After 1week storage both exhibited a significant reduction in average modulus, however, from weeks 1-6 no further significant changes were observed, the average modulus never dropped significantly below 5.5GPa. In contrast, the L-PLGA caused a pH drop to below 7.3 by week 6 and an average modulus drop to 0.6 from an initial 4.6GPa. Cell culture using rat bone marrow stromal cells, revealed all materials were cytocompatible and exhibited no osteogenic potential. We conclude that our functionalised PLGA retains mechanical properties which are suitable for use in craniofacial fixation plates.
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Affiliation(s)
- Sarah J Upson
- School of Mechanical and Systems Engineering, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Simon W Partridge
- School of Mechanical and Systems Engineering, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Ion Tcacencu
- Department of Dental Medicine, Karolinska Institutet, 14104 Huddinge, Sweden
| | - David A Fulton
- Chemical Nanoscience Laboratory, School of Chemistry, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Ian Corbett
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Matthew J German
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Kenneth W Dalgarno
- School of Mechanical and Systems Engineering, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Caballero M, Morse JC, Halevi AE, Emodi O, Pharaon MR, Wood JS, van Aalst JA. Juvenile Swine Surgical Alveolar Cleft Model to Test Novel Autologous Stem Cell Therapies. Tissue Eng Part C Methods 2016; 21:898-908. [PMID: 25837453 DOI: 10.1089/ten.tec.2014.0646] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Reconstruction of craniofacial congenital bone defects has historically relied on autologous bone grafts. Engineered bone using mesenchymal stem cells from the umbilical cord on electrospun nanomicrofiber scaffolds offers an alternative to current treatments. This preclinical study presents the development of a juvenile swine model with a surgically created maxillary cleft defect for future testing of tissue-engineered implants for bone generation. Five-week-old pigs (n=6) underwent surgically created maxillary (alveolar) defects to determine critical-sized defect and the quality of treatment outcomes with rib, iliac crest cancellous bone, and tissue-engineered scaffolds. Pigs were sacrificed at 1 month. Computed tomography scans were obtained at days 0 and 30, at the time of euthanasia. Histological evaluation was performed on newly formed bone within the surgical defect. A 1 cm surgically created defect healed with no treatment, the 2 cm defect did not heal. A subsequently created 1.7 cm defect, physiologically similar to a congenitally occurring alveolar cleft in humans, from the central incisor to the canine, similarly did not heal. Rib graft treatment did not incorporate into adjacent normal bone; cancellous bone and the tissue-engineered graft healed the critical-sized defect. This work establishes a juvenile swine alveolar cleft model with critical-sized defect approaching 1.7 cm. Both cancellous bone and tissue engineered graft generated bridging bone formation in the surgically created alveolar cleft defect.
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Affiliation(s)
- Montserrat Caballero
- 1 Plastic Surgery, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Justin C Morse
- 2 Plastic and Reconstructive Surgery, The University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | | | - Omri Emodi
- 4 Oral and Maxillofacial Surgery, Rambam Medical Center , Haifa, Israel
| | - Michael R Pharaon
- 5 Plastic Surgery, Kapiolani Hospital for Women and Children , Honolulu, Hawaii
| | - Jeyhan S Wood
- 2 Plastic and Reconstructive Surgery, The University of North Carolina School of Medicine , Chapel Hill, North Carolina
| | - John A van Aalst
- 1 Plastic Surgery, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
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Chemical and structural analyses of titanium plates retrieved from patients. Int J Oral Maxillofac Surg 2015; 44:1005-9. [DOI: 10.1016/j.ijom.2014.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the trends in management of preadolescent facial fractures - a challenging population because of the need to consider growth, dynamic changes in dentition, and evolving fracture patterns. RECENT FINDINGS Recent findings are a more thorough understanding of fracture patterns and distribution because of recent comprehensive studies isolating the preadolescent age cohort; the role of rigid internal fixation for significantly displaced fractures; and the potential applications and indications for the use of resorbable hardware for fracture fixation in the preadolescent. SUMMARY As preadolescent fractures occur in a period of growth and evolving dentition in the facial skeleton, it is mandatory for the treating surgeon to have a thorough knowledge of standard and alternative treatment options to optimally manage these patients.
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Kumar BP, Kumar KAJ, Venkatesh V, Mohan AP, Ramesh K, Mallikarjun K. Study of Efficacy and the Comparison Between 2.0 mm Locking Plating System and 2.0 mm Standard Plating System in Mandibular Fractures. J Maxillofac Oral Surg 2014. [PMID: 26225079 DOI: 10.1007/s12663-014-0718-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and comparison between 2.0 mm locking plate system and 2.0 mm Champy's titanium mini plating system in mandible fractures. MATERIALS AND METHODS A total of 20 patients with mandibular fractures were selected and divided into two groups A and B on randomized basis. Group A was treated with open reduction internal fixation using 2.0 mm locking plates and group B with 2.0 mm Champy's titanium miniplates. All patients were followed up for 12 weeks postoperatively. RESULTS Results of the study show less screw loosening, less precision in plate adaptation and less alteration of the osseous or occlusal relationship upon screw tightening in group A. Chi square test was applied to compare the results between the two groups. Statistical analysis did not show significant difference of incidence of malocclusion between the two groups (p value = 0.606). Statistical analysis using un-paired t test showed significant difference of working time between the two groups (p value = 0.00296). When comparing the overall complication rates according to plates used, the χ(2) test showed no statistically significant difference between the locking and nonlocking plates (p > 0.05). CONCLUSION It is observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. The precise adaptation required for using conventional plates is not needed when this locking plate/screw system is used. Locking plate/screw system provides better stability than the conventional plate/screw system.
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Affiliation(s)
- B Pavan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - K A Jeevan Kumar
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - V Venkatesh
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - A P Mohan
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - K Ramesh
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
| | - K Mallikarjun
- Oral and Maxillofacial Surgery, Kamineni Institute of Dental Sciences, Sreepuram, Narketpally, Nalgonda (Dist.), 508254 Andhra Pradesh India
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Nallathamby V, Lee H, Lin YY, Lim J, Ong WC, Lim TC. Retained broken implants in the craniomaxillofacial skeleton. Craniomaxillofac Trauma Reconstr 2014; 7:154-7. [PMID: 25045419 DOI: 10.1055/s-0034-1371551] [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: 05/19/2013] [Accepted: 05/27/2013] [Indexed: 10/25/2022] Open
Abstract
Facial fracture patients are seen in a Level 1 trauma hospital. In our institution, we manage many patients with facial fractures and carry out more than 150 surgical procedures every year. Open reduction and internal fixation is our management of choice. All surgical procedures involve drilling of bone and implant insertion to keep the fractured bones in an anatomically reduced position to aid healing. Occasionally, drill bits used to create the pilot hole break and are embedded in the bone. We present a situation in which such an incident occurred and review the literature on retained broken implants and devices.
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Affiliation(s)
- Vigneswaran Nallathamby
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Hanjing Lee
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Yap Yan Lin
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Jane Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Wei Chen Ong
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Thiam-Chye Lim
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
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Computed Tomography Imaging Manifestations of Commonly Used Materials in Posttraumatic Craniofacial Repair. J Comput Assist Tomogr 2014; 38:890-7. [PMID: 25119065 DOI: 10.1097/rct.0000000000000138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chou DT, Hong D, Saha P, Ferrero J, Lee B, Tan Z, Dong Z, Kumta PN. In vitro and in vivo corrosion, cytocompatibility and mechanical properties of biodegradable Mg-Y-Ca-Zr alloys as implant materials. Acta Biomater 2013; 9:8518-33. [PMID: 23811218 DOI: 10.1016/j.actbio.2013.06.025] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 06/14/2013] [Accepted: 06/18/2013] [Indexed: 11/19/2022]
Abstract
This study introduces a class of biodegradable Mg-Y-Ca-Zr alloys novel to biological applications and presents evaluations for orthopedic and craniofacial implant applications. Mg-Y-Ca-Zr alloys were processed using conventional melting and casting techniques. The effects of increasing Y content from 1 to 4 wt.% as well as the effects of T4 solution treatment were assessed. Basic material phase characterization was conducted using X-ray diffraction, optical microscopy and scanning electron microscopy. Compressive and tensile tests allowed for the comparison of mechanical properties of the as-cast and T4-treated Mg-Y-Ca-Zr alloys to pure Mg and as-drawn AZ31. Potentiodynamic polarization tests and mass loss immersion tests were used to evaluate the corrosion behavior of the alloys. In vitro cytocompatibility tests on MC3T3-E1 pre-osteoblast cells were also conducted. Finally, alloy pellets were implanted into murine subcutaneous tissue to observe in vivo corrosion as well as local host response through H&E staining. SEM/EDS analysis showed that secondary phase intermetallics rich in yttrium were observed along the grain boundaries, with the T4 solution treatment diffusing the secondary phases into the matrix while increasing the grain size. The alloys demonstrated marked improvement in mechanical properties over pure Mg. Increasing the Y content contributed to improved corrosion resistance, while solution-treated alloys resulted in lower strength and compressive strain compared to as-cast alloys. The Mg-Y-Ca-Zr alloys demonstrated excellent in vitro cytocompatibility and normal in vivo host response. The mechanical, corrosion and biological evaluations performed in this study demonstrated that Mg-Y-Ca-Zr alloys, especially with the 4 wt.% Y content, would perform well as orthopedic and craniofacial implant biomaterials.
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Affiliation(s)
- Da-Tren Chou
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
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