Use of a single 2.0-mm locking AO reconstruction titanium plate in linear, non-comminuted, mandible fractures

Neurosensory Recovery Following Mental Nerve Skeletonization in Intraoral Open Reduction and Internal Fixation of Mandible Fractures

PURPOSE

The purpose of this study was to evaluate neurosensory recovery after mental nerve skeletonization in open reduction and internal fixation (ORIF) of mandible fractures.

METHODS

This was a prospective nonrandomized observation study of adult subjects treated at a Level I trauma center between April 1, 2016 and December 31, 2019, with mental nerve skeletonization for ORIF of mandible fractures. Age, sex, and mandibular injury severity score (MISS), and functional sensory recovery (FSR) and subjective neurosensory recovery of skeletonized mental nerve were recorded at preoperative and regularly scheduled follow-up appointments. Uninomial and multinomial logistic regressions were conducted with a significance level of < 0.05.

RESULTS

Twenty-six subjects (all male) completed all the postoperative protocol requirements and were included in this study. All subjects had a loss of FSR (S0) and subjective neurosensation immediately after surgery. Half of the subjects achieved FSR (S3) and subjective neurosensory recovery (VAS < 4) an average of 42 days after surgery. All subjects improved FSR (S4) by 57 days and subjective neurosensory recovery by 90 days after surgery. These were independent of MISS but had decreased recovery time with increased age. No incidences of mental nerve neuropathic pain during the trial period were found.

CONCLUSIONS

FSR and subjective neurosensory recovery from mental nerve skeletonization in intraoral ORIF of mandible fractures was achieved in all subjects by the end of this study. Neurosensory recovery was independent of MISS but decreased with increased age. Initial inverse correlations between objective and subjective neurosensory assessments were insignificant at study completion. No incidences of neuropathic pain were identified during the time of this study. Mental nerve skeletonization in ORIF of mandible fracture may be performed with an anticipated return of functional and subjective neurosensory recovery within 3 months of surgery.

Evaluation of different stable internal fixation in unfavorable mandible fractures under finite element analysis

INTRODUCTION

The mandibular angle fracture is the most common fracture between this type of injury in jaw bone and also is the type of fracture treatment that presents a larger number of complications, and a series different osteosynthesis types have been studied over the years by the world literature. The finite element method is a form of mathematical analysis, which is based on dividing a structure into a finite number of small areas. It has the ability tomathematically model structures, making it possible to apply forces anywhere.

MATERIAL AND METHODS

For this study, a three-dimensional mandible with an unfavorable angle fracture was simulated. Five different types of fixations were evaluated: group 1, Champy technique with one 4-holes miniplate, 2.0 system; group 2, technique with two parallel 4-holes conventional miniplates, 2.0 system; group 3, technique with two parallel 4-holes locking miniplates, 2.0 system; group 4, technique with one reconstruction 6-holes plate, 2.8 system in base jaw; and group 5, technique with one reconstruction 6-holes plates, 2.8 system in jaw body + one parallel 4-holes conventional miniplate, 2.0 system.

RESULTS

The results showed that strains are better distributed through the locking miniplate and screws system and presented less stress concentration when compared with the conventional ones. The Champy technique had the worst results about of all groups. The use of the locking system shows less stress compared to the non-locking system, and the presence of a reconstruction plate associated with a mini plate does not lead to increased stability compared with an isolated reconstruction plate.

Study of Efficacy and the Comparison Between 2.0 mm Locking Plating System and 2.0 mm Standard Plating System in Mandibular Fractures

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.