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Wang YC, Wu YC, Chen RF, Cheng NC, Lee SS. Simplified Fabrication of a Lingual Splint for Management of Mandibular Fractures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5919. [PMID: 38903138 PMCID: PMC11186805 DOI: 10.1097/gox.0000000000005919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/01/2024] [Indexed: 06/22/2024]
Abstract
Lingual splints have been used to treat mandibular fractures, particularly in cases of complicated mandibular fractures, and serve as a noninvasive adjunctive procedure for reduction and fixation. Furthermore, when used in conjunction with open reduction and internal fixation, the lingual splint provides feasible external fixation against displacing forces exerted by the robust musculature of the mandible. However, the conventional method for lingual splint fabrication is performed preoperatively, and the procedure is time-consuming. This technical note describes a simplified and efficient technique for the intraoperative manufacture of a lingual splint for mandibular fractures using a thermoplastic material, polycaprolactone. Our results demonstrated satisfactory fixation outcomes, reduced lingual splint fabrication time, and superior cost-effectiveness, offering an alternative option for adjunctive external fixation of mandibular fractures.
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Affiliation(s)
- Yu-Chi Wang
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Chia Wu
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rong-Fu Chen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Nai-Chen Cheng
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Su-Shin Lee
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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Approaching patients with panfacial fractures by using an anatomical reference. A novel concept and preliminary study. J Plast Reconstr Aesthet Surg 2022; 75:4249-4253. [DOI: 10.1016/j.bjps.2022.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 11/19/2022]
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Repairing Facial Fractures with Interrupted Maxillary-mandibular Arches by Computer-assisted Reverse Planning Model Surgery. Plast Reconstr Surg Glob Open 2022; 10:e4149. [PMID: 35211367 PMCID: PMC8860334 DOI: 10.1097/gox.0000000000004149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
Abstract
Background: Management of comminuted facial fractures with maxillary-mandibular arch interruption is difficult, resulting in inadequate bone reduction and malocclusion. Traditionally, a good quality dental splint is helpful, but difficult to obtain in acute trauma. We apply a computer-assisted design and three-dimensional printing technology to improve splint fabrication and utilization, thus facilitating restoration of dental occlusion and facial fracture. Methods: We retrospectively reviewed patients who suffered from facial fractures with interruption of the maxillary-mandibular arches. We developed the “computer-assisted reverse planning and three-dimensional printing model surgery” algorithm and applied it in selected patients. An occlusal splint was created as a surgical guide to enhance the maxilla-mandibular unit repair by taking care of the bone reduction and occlusion. All included patients were followed up to assess the functional outcome and patients suitable for this method. Results: From Jan 2015 to Aug 2020, 10 patients (eight men and two women) with comminuted facial fractures were included. The average time of surgery was 9.2 days. The average follow-up time was 8.6 months. There was no patient who needed major revision to correct malocclusion or facial asymmetry. Conclusions: A computer-assisted design splint decreases intraoperative inaccuracies and difficulty in comminuted maxillo-mandibular fractures. It is a useful and reliable alternative. Collaboration with an experienced engineer and patient selection are indispensable in delivering successful outcomes. Patients who have more than three bone fragments in a single dental arch or more than four bone fragments in the entire maxillary-mandibular unit appear to be excellent candidates for this method.
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Treatment of Gunshot-Related Mandibular Fracture with Splint-Guided Reduction: Case Report. BALKAN JOURNAL OF DENTAL MEDICINE 2021. [DOI: 10.2478/bjdm-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Background/Aim: Gunshot injury-related mandibular fractures often have a complex pattern, characterized by comminution, bone loss, and soft-tissue avulsion. The management is difficult and varies between individual cases.
Case Report: A 41-year-old male patient presented with marked swelling and ecchymosis in the left mandibular region. Intraorally, he had a deviated open bite on the left side. A unilateral comminuted mandibular fracture was diagnosed by panoramic radiograph and computed tomography. An acrylic dental splint-guided open reduction and internal fixation, including intermaxillary fixation through brackets and intermaxillary elastics, was planned. No complications were observed throughout the healing period, and healing at the fracture site was satisfactory. The occlusion returned to the preinjury position and was stable.
Conclusions: This case report shows that successful functional and esthetic results can be achieved with a strict patient-specific treatment protocol for a comminuted mandibular fracture due to gunshot injury.
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Many Moving Pieces: Virtual Preoperative Surgical Planning for Traumatic Occlusal Splints. J Craniofac Surg 2021; 33:1037-1041. [PMID: 34690316 DOI: 10.1097/scs.0000000000008282] [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
INTRO Achieving anatomic reduction and re-establishing premorbid occlusion in patients with complex maxillomandibular fractures is challenging even for seasoned surgeons. Historically, surgeons have utilized occlusal splints to help establish occlusal relationships before fracture reduction and fixation. These acrylic splints are fabricated from dental impressions and require manual repositioning of tooth bearing segments along the fracture line to reapproximate premorbid occlusion. The process is laborious, requires a dental lab, and is less efficacious in edentulous patients or those with significantly comminuted fractures; as such it has largely fallen out of practice. Recently, with advances in virtual 3D modeling and printing, we demonstrate that occlusal splints can be designed from computed tomography scans, manipulated virtually, and printed without obtaining impressions from the patient. METHODS/RESULTS In our series of 3 patients with complex maxillomandibular fractures, occlusal splints were created by 1) obtaining maxillofacial computed tomography scans, 2) reducing the fractures virtually, and 3) using orthognathic virtual surgery software to create the splint. The time between planning and delivery of the splint was 4 to 7 days. These splints were successfully utilized to help establish premorbid occlusion in conjunction with maxillomandibular fixation and aided in expeditious intraoperative fracture reduction and fixation. CONCLUSIONS In the treatment of complex facial fractures, occlusal splints can be a useful adjunct in the operative reduction and fixation of fractures. With the advent of virtual preoperative surgical planning via 3D modeling and 3D printing, these occlusal splints can be created of a sufficient fidelity to avoid the strict need for dental impressions.
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Kongsong W, Sittitavornwong S. Utilization of Virtual Surgical Planning for Surgical Splint-Assisted Comminuted Maxillomandibular Fracture Reduction and/or Fixation. Craniomaxillofac Trauma Reconstr 2020; 13:334-341. [PMID: 33456705 DOI: 10.1177/1943387520948677] [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: 11/17/2022] Open
Abstract
Study Design This article was a technical note. Objective To demonstrate the utilization of virtual surgical planning for surgical splint (VSPSS) fabrication. The VSPSS was used as an intraoperative assisting and guiding tool for reduction and/or fixation of treatment of comminuted maxillomandibular fractures. Methods The presented technical note showed the fabrication process that began with data acquisition and presurgical planning using virtual surgical planning (VSP). The VSPSS was designed and fabricated after the fractures were reduced digitally in VSP. In the operating room, the VSPSS was seated to guide reduction and/or allow satisfactory fixation in three different situations. Results Postoperative radiographs showed an acceptable reduction of the fractures. All patients had stable and repeatable occlusion postoperatively. Conclusions The VSPSS is a feasible tool for surgeons to assist in the comminuted maxillomandibular fracture management, decrease operating time, and improve fracture stability.
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Affiliation(s)
- Wichuda Kongsong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Alabama, USA
| | - Somsak Sittitavornwong
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama at Birmingham, Alabama, USA
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Ramanathan M, Panneerselvam E, Krishna Kumar Raja V. 3D planning in mandibular fractures using CAD/CAM surgical splints — A prospective randomized controlled clinical trial. J Craniomaxillofac Surg 2020; 48:405-412. [DOI: 10.1016/j.jcms.2020.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/18/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022] Open
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Yazdani J, Hajizadeh S, Ghavimi MA, Pourghasem Gargari B, Nourizadeh A, Kananizadeh Y. Evaluation of changes in anthropometric indexes due to intermaxillary fixation following facial fractures. J Dent Res Dent Clin Dent Prospects 2016; 10:247-250. [PMID: 28096951 PMCID: PMC5237672 DOI: 10.15171/joddd.2016.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background. One of the treatment modalities for facial fractures is closed reduction technique, but treatment with intermaxillary fixation (IMF) interferes with normal nutrition, and malnutrition can affect the patient’s recovery. Anthropometric measurements such as skinfold thickness and body mass index (BMI) are universal indexes for diagnosing malnutrition. Therefore, in this study we explain how treatment with IMF changes the anthropometric indexes. Methods. In this study 60 patients were treated with 4 weeks of IMF. Skinfold thickness and BMI of these patients were measured and compared before and after the treatment. Results. Patients’ weight, BMI and skinfold thickness decreased during the IMF period, and this decrease was statistically significant (P < 0.01). Conclusion. Although no severe and acute malnutrition was seen among our patients, IMF led to mild to moderate malnutrition in some cases, making it necessary to use nutritional supplements.
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Affiliation(s)
- Javad Yazdani
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Hajizadeh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Ghavimi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Amin Nourizadeh
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Kananizadeh
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Susarla S, Gordon PE, Attarpour AR, Winograd JM, Peacock ZS. Use of a mandibular plate to maintain intergonial width in a partially edentulous patient undergoing mandibular symphysis reconstruction. Craniomaxillofac Trauma Reconstr 2014; 6:281-4. [PMID: 24436775 DOI: 10.1055/s-0033-1349207] [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: 11/12/2012] [Accepted: 11/18/2012] [Indexed: 10/25/2022] Open
Abstract
One of the most challenging and essential aspects of management of patients with traumatic or ablative deformities involving the mandibular symphysis is maintenance of intergonial width. Classically, the use of occlusal splints has been a simple and cost-effective solution to this problem. Patients who are edentulous, the use of Gunning splints with circummandibular wires is an alternative strategy. In the present report, we describe the use of a mandibular fixation plate for maintenance of intergonial width in an edentulous patient with a postablative mandibular symphysis defect.
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Affiliation(s)
- Srinivas Susarla
- Department of Oral-Maxillofacial Surgery, Massachusetts General Hospital
| | - Paul E Gordon
- Department of Oral-Maxillofacial Surgery, Massachusetts General Hospital
| | - Ali R Attarpour
- Department of Oral-Maxillofacial Surgery, Massachusetts General Hospital
| | - Jonathan M Winograd
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Zachary S Peacock
- Department of Oral-Maxillofacial Surgery, Massachusetts General Hospital
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Koshy JC, Feldman EM, Chike-Obi CJ, Bullocks JM. Pearls of mandibular trauma management. Semin Plast Surg 2012; 24:357-74. [PMID: 22550460 DOI: 10.1055/s-0030-1269765] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mandibular trauma is a common problem seen by plastic surgeons. When fractures occur, they have the ability to affect the patient's occlusion significantly, cause infection, and lead to considerable pain. Interventions to prevent these sequelae require either closed or open forms of reduction and fixation. Physicians determining how to manage these injuries should take into consideration the nature of the injury, background information regarding the patient's health, and the patient's comorbidities. Whereas general principles guide the management of the majority of injuries, special consideration must be paid to the edentulous patient, complex and comminuted fractures, and pediatric patients. These topics are discussed in this article, with a special emphasis on pearls of mandibular trauma management.
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Affiliation(s)
- John C Koshy
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Abstract
PURPOSE OF REVIEW Gunshot wounds to the head and neck result in significant bone and soft tissue loss. These defects pose a challenge to the facial reconstructive surgeon. This paper reviews the current literature on the management of ballistic injuries to the head and neck and outlines a treatment algorithm. RECENT FINDINGS With recent advances in free tissue transfer, early definitive reconstruction of bone and soft tissue deficits with vascularized flaps has become the treatment of choice. Computed tomography angiography of the neck has been shown to be a sensitive, specific, and safe technique in screening for vascular injuries. SUMMARY Management of ballistic injuries to the head and neck begins with advanced trauma life support protocols. Computed tomography angiography is now widely available and provides an accurate and rapid evaluation of head and neck vasculature. The initial operation aims to establish occlusion, stabilize bone and close soft tissue defects. Serial debridement of wounds with delayed reconstruction has given way to early definitive repair with vascularized tissue. This has led to improved function, fewer operations, and shorter hospital stays.
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Affiliation(s)
- Vishal S Doctor
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
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Futran ND, Farwell DG, Smith RB, Johnson PE, Funk GF. Definitive management of severe facial trauma utilizing free tissue transfer. Otolaryngol Head Neck Surg 2005; 132:75-85. [PMID: 15632913 DOI: 10.1016/j.otohns.2004.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Severe ballistic or avulsion injuries to the face create complex, composite defects. We report the results of an aggressive management algorithm to optimize facial form and function: (1) the initial encounter, (2) definitive reconstruction with vascularized tissue, and (3) aesthetic and prosthetic refinement. STUDY DESIGN AND SETTING Retrospective case series of 49 patients in 2 tertiary care institutions. Patients were evaluated for age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, and functional outcomes. RESULTS Forty defects were gunshot wounds, 9 resulted from major avulsive trauma. Involved sites included 13 oromandibular, 21 midface/upper face, and 15 combined sites; 54 free flaps were utilized, 21 were soft tissue and 33 contained bone. No flap failures occurred. Function and cosmesis were best in the oromandibular only group, and worst in the combined group with nasal and/or orbital tissue loss. CONCLUSION Treatment of severe facial trauma requires early tissue debridement with bony repair and/or stenting to minimize scar contracture. Free tissue transfer techniques allow simultaneous reconstruction of the bony framework and overlying tissues. Multiple secondary procedures are frequently required for optimal aesthetic restoration. EBM RATING C.
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Affiliation(s)
- Neal D Futran
- University of Washington School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seattle 98195-6515, USA.
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