Management of facial fractures

Clinical and radiographic assessment of patient-specific transantral reconstruction of orbital floor fractures: A case series

To clinically and radiographically evaluate patient-specific titanium meshes via a trans-antral approach for correction of enophthalmos and orbital volume in patients with recent unilateral orbital floor fracture. Seven patients with unilateral orbital floor fractures received patient-specific titanium meshes that were designed based on a mirror-image of the contralateral intact orbit. The patient-specific implants (PSIs) were inserted via a trans-antral approach without endoscopic assistance. The patients were evaluated clinically for signs of diplopia and restricted gaze as well as radiographically for enophthalmos and orbital volume correction. Diplopia was totally resolved in two of the three patients who reported diplopia in the upward gaze. Whereas enophthalmos significantly improved in all but two patients, with a mean value of 0.2229 mm postoperatively compared to 0.9914 mm preoperatively. CT scans showed excellent adaptation of the PSIs to the orbital floor with a mean reduction of the orbital volume from 29.59 cc to 27.21 cc, a mean of 0.6% smaller than the intact orbit. It can be concluded that the proposed PSI can offer good reconstruction of the orbital floor through an isolated intraoral transantral approach with minimal complications. It could of special benefit in extensive orbital floor fractures.

Are Biodegradable Osteosyntheses Still an Option for Midface Trauma? Longitudinal Evaluation of Three Different PLA-Based Materials

The aim was to evaluate three different biodegradable polylactic acid- (PLA-) based osteosynthesis materials (OM). These OM (BioSorb, LactoSorb, and Delta) were used in 64 patients of whom 55 (85.9%) had fractures of the zygoma, five (7.8%) in the LeFort II level, two of the frontal bone (3.1%), and two of the maxillary sinus wall (3.1%). In addition to routine follow-up (FU) at 3, 6, and 12 months (m) (T1, T2, and T3) all patients were finally evaluated at a mean FU after 14.1 m for minor (e.g., nerve disturbances, swelling, and pain) and major (e.g., infections and occlusal disturbances) complications. Out of all 64 patients 38 presented with complications; of these 28 were minor (43.8%) and 10 major (15.6%) resulting in an overall rate of 59.4%. Differences in minor complications regarding sensibility disturbance at T1 and T3 were statistically significant (P = 0.04). Differences between the OM were not statistically significant. Apart from sufficient mechanical stability for clinical use of all tested OM complications mostly involved pain and swelling probably mainly related to the initial bulk reaction attributable to the drop of pH value during the degradation process. This paper includes a review of the current aspects of biodegradable OM.

Mechanical strength and stiffness of biodegradable and titanium osteofixation systems

PURPOSE

To present relevant mechanical data to simplify the selection of an osteofixation system for situations requiring immobilization in oral and maxillofacial surgery.

MATERIALS AND METHODS

Seven biodegradable and 2 titanium osteofixation systems were investigated. The plates and screws were fixed to 2 polymethylmethacrylate (PMMA) blocks to simulate bone segments. The plates and screws were subjected to tensile, side bending, and torsion tests. During tensile tests, the strength of the osteofixation system was monitored. The stiffness was calculated for the tensile, side bending, and torsion tests.

RESULTS

The 2 titanium systems (1.5 mm and 2.0 mm) presented significantly higher tensile strength and stiffness compared with the 7 biodegradable systems (2.0 mm, 2.1 mm, and 2.5 mm). The 2.0 mm titanium system showed significantly higher side bending and torsion stiffness than the other 8 systems.

CONCLUSION

Based on the results of the current study, it can be concluded that the titanium osteofixation systems were (significantly) stronger and stiffer than the biodegradable systems. The BioSorb FX (Linvatec Biomaterials Ltd, Tampere, Finland), LactoSorb (Walter Lorenz Surgical Inc, Jacksonville, FL), and Inion (Inion Ltd, Tampere, Finland) 2.5 mm systems have high mechanical device strength and stiffness compared with the investigated biodegradable osteofixation systems. With the cross-sectional surface taken into account, the Biosorb FX system (with its subtle design) proves to be the far more superior system. The Resorb X (Gebrüder Martin GmbH & Co, Tuttlingen, Germany) and MacroPore (MacroPore Biosurgery Inc, Memphis, TN) systems present to be, at least from a mechanical point of view, the least strong and stiff systems in the test.