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Venugopalan V, Satheesh G, Jain V, Hemnaath R, Sakthi. Re: New method of arch bar fixation. Br J Oral Maxillofac Surg 2024; 62:387. [PMID: 38565490 DOI: 10.1016/j.bjoms.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 04/04/2024]
Affiliation(s)
- V Venugopalan
- Oral and maxillofacial surgery, Adiparashakthi Dental College and Hospital, India.
| | - G Satheesh
- Oral and maxillofacial surgery, Adiparashakthi Dental College and Hospital, India.
| | - Vijaykumar Jain
- Oral and maxillofacial surgery, Adiparashakthi Dental College and Hospital, India.
| | - R Hemnaath
- Oral and maxillofacial surgery, Adiparashakthi Dental College and Hospital, India.
| | - Sakthi
- Oral and maxillofacial surgery, Adiparashakthi Dental College and Hospital, India.
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Kalluri MH, Edalatpour A, Thadikonda KM, Blum JD, Garland CB, Cho DY. Patient outcomes and complications following various maxillomandibular fixation techniques: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 92:151-176. [PMID: 38520780 DOI: 10.1016/j.bjps.2024.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Currently, there are several methods of achieving maxillomandibular fixation (MMF), each with its unique operative considerations and subsequent patient outcomes and complications. In this study, we reviewed the literature to evaluate and compare all MMF methods. METHODS A systematic review of all MMF types was conducted and post-operative outcome data were analyzed and compared among the different types. Conventional Erich arch bars were compared to hybrid arch bars, MMF screws, and eyelet interdental wiring. A random-effects meta-analysis was used to determine the mean differences, and 95% confidence intervals (CIs) with a statistical significance of P < 0.05. RESULTS Among the 4234 articles identified, 24 were included, and 17 were meta-analyzed. Time to achieve MMF (-43.38 min; 95% CI, -58.20 to -28.56; P < 0.001), total operative time (-30.33 min; 95% CI, -61.05 to 0.39; P = 0.05), incidence of wire puncture injuries and glove perforations (0.11; 95% CI, 0.04 to 0.30; P < 0.001), and incidence of poor oral hygiene (0.08; 95% CI, 0.02 to 0.28; P < 0.001) were lower for alternative MMF interventions compared to those of the conventional Erich arch bars. CONCLUSIONS Alternative MMF methods required shorter operative time to achieve MMF and demonstrated other increased efficiencies of practice such as shorter total operative time and decreased glove perforations, when compared to conventional Erich arch bars. If a patient is a candidate for MMF, the presented alternative MMF techniques should be considered depending on the clinical context and availability of institutional resources.
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Affiliation(s)
- Manasa H Kalluri
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Armin Edalatpour
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kishan M Thadikonda
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica D Blum
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Catharine B Garland
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Y Cho
- Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Madhu SK, Dominic S, Baptist J, Shetty P. Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024; 25:289-291. [PMID: 38690704 DOI: 10.5005/jp-journals-10024-3650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
AIM This clinical technique aims to retighten intermaxillary fixation (IMF) wires when loosened intra/postoperatively. BACKGROUND Intermaxillary fixation is one of the most important steps to obtain stable and functional occlusion in maxillofacial trauma. However, IMF wires tend to loosen over time. This loosened wire is generally removed and a new wire is used for IMF. Removal and refixation is time-consuming for surgeon and unconformable for the patient. TECHNIQUE We recommend a simple technique for re-tightening IMF wires without breakage, with the use of shepherd's crook explorer by making a small circular loop. CONCLUSION This technique of re-tightening by looping further stretches and tightens the wire to regain stabilized occlusion with maximal intercuspation. CLINICAL SIGNIFICANCE This technique eliminates the need for removal and refixation of IMF wires, thereby improving patient comfort, yet obtaining stable occlusion over a long period of time. How to cite this article: Madhu SK, Dominic S, Baptist J, et al. Simple Method for Re-tightening IMF Wires without Breakage. J Contemp Dent Pract 2024;25(3):289-291.
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Affiliation(s)
- Sandeep K Madhu
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Orcid: https://orcid.org/0000-0002-6167-0388
| | - Shiney Dominic
- Department of Oral and Maxillofacial Surgery, Government Dental College, Thrissur, Kerala, India, Orcid: https://orcid.org/0000-0002-1977-9646
| | - Joanna Baptist
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Phone: +91 9480528512, e-mail: , Orcid: https://orcid.org/0000-0003-1075-8950
| | - Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India, Orcid: https://orcid.org/0000-0002-3474-1726
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Satpute AS, Mohiuddin SA, Doiphode AM, Kulkarni SS, Qureshi AA, Jadhav SB. Comparison of Erich arch bar versus embrasure wires for intraoperative intermaxillary fixation in mandibular fractures. Oral Maxillofac Surg 2018; 22:419-428. [PMID: 30302602 DOI: 10.1007/s10006-018-0723-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Intermaxillary fixation (IMF) is a fundamental principle in the management of mandibular fractures but with recent advent of open reduction and internal fixation (ORIF), use of IMF is almost limited intraoperatively. Therefore, we compared the efficacy of Erich arch bar versus embrasure wires for intraoperative IMF in mandibular fractures. METHOD This prospective study was comprised of 50 patients with mandibular fractures who required ORIF with intraoperative IMF. Patients were categorized into two groups of 25 patients each: Erich arch bar technique was used for group A and embrasure wire technique for group B. Parameters were time taken for IMF, needle stick injury, occlusal stability, iatrogenic complications, and periodontal status of patients. STATISTICAL ANALYSIS Chi-squared test and unpaired t test analyses was run on IBM SPSS 21.0 version (2015) software. RESULT Mean time for placing embrasure wire (3.48 min) was significantly less than that for Erich arch bar (48.08 min). Needle stick injury rates to the operator as well as the assistants were significantly less when using the embrasure wire than the Erich arch bar. The Erich arch bar had significantly superior postoperative occlusion stability. Iatrogenic injury was more common when placing the Erich arch bar than the embrasure wire. Postoperative oral hygiene status was good in patients that received the embrasure wire. CONCLUSION Embrasure wire technique is a quick, easy, and reliable technique for minimally or moderately displaced fractured mandible and had better clinical outcomes than did patients that underwent the Erich arch bar technique.
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Affiliation(s)
- Ashish Shrikant Satpute
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India.
| | - Syed Ahmed Mohiuddin
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Amol Madhukar Doiphode
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Sujay Sanjay Kulkarni
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Ahtesham Ahmad Qureshi
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
| | - Swapnil Bharat Jadhav
- Maharashtra Institute of Dental Sciences & Research, Dental College, M.I.T Medical Campus, Vishnathpurum, Latur, 413512, India
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Huang TT, Cheng KH, Chang CJ, Chen KC, Liu JK, Wong TY. Transoral vertical ramus osteotomy fixed with Kirschner pins. Br J Oral Maxillofac Surg 2018; 56:841-846. [PMID: 30293802 DOI: 10.1016/j.bjoms.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022]
Abstract
Transoral vertical ramus osteotomy (VRO) has been condemned because the condyle has the potential to sag, and because it needs lengthy maxillomandibular fixation. We have therefore introduced a simple method of fixation, and examined its effectiveness and complications. After the osteotomy, the proximal and distal segments are trimmed to adapt to each other. Four Kirschner (K) pins 0.9mm in diameter are inserted percutaneously from the proximal to the distal segment while the condyle is positioned in the glenoid fossa. This is followed by a brief period of maxillomandibular fixation. We have reviewed the records of 95 patients who had unilateral or bilateral vertical ramus osteotomy fixed with K pins, after which the mean (SD) period of fixation was 19 (11) days. Fixation failed in two patients because excursion of the jaw was either too heavy or too early. The fixations were redone. All other fixations remained stable, including the 20 dual-jaw procedures in which VRO preceded maxillary osteotomy. The mean (SD) maximal mouth opening at final follow-up was 44 (7) mm, and in only one patient was it less than 30mm. Numbness of the lip or chin developed in seven patients, five of whom had other anterior mandibular procedures. Four patients had discomfort on palpation of the site of the pins, and one required removal. The new method was effective, and resulted in few complications within its limitations.
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Affiliation(s)
- T T Huang
- Division of Oral and Maxillofacial Surgery, Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - K H Cheng
- Division of Oral and Maxillofacial Surgery, Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - C J Chang
- Division of Orthodontics, Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - K C Chen
- Division of Oral and Maxillofacial Surgery, Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - J K Liu
- Division of Orthodontics, Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - T Y Wong
- Division of Oral and Maxillofacial Surgery, Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Baker SB, Reid RR, Burkey B, Bartlett SP. Rapid Maxillary Distraction Protocol Utilizing the Halo Distraction System and Rigid Internal Fixation. Cleft Palate Craniofac J 2017; 44:476-81. [PMID: 17760481 DOI: 10.1597/06-040.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To shorten head frame wear time associated with external halo distraction (HD), we have adapted a protocol for maxillary distraction with the halo system that integrates plate fixation. Participants: All patients had a history of cleft lip and/or palate and maxillary retrusion ≥8 mm. Five patients treated with this protocol and followed for at least 1 year were included in this study. Interventions: The protocol included a 3-day latency period, variable maxillary distraction, and removal of the halo device with simultaneous rigid internal fixation. Two patients had a variable period of maxillomandibular fixation (MMF), which maintained the maxillary advancement and idealized intercuspal position while permitting further callus maturation. Cephalographs were obtained preoperatively, immediately following distractor removal, and 1 year after rigid internal fixation. Results: The mean age at time of surgery was 18.7 years. The maxillary deficiency ranged from 8 to 15 mm (mean = 10.6 mm). All five patients demonstrated excellent occlusion. Cephalometric analysis 1-year post rigid internal fixation revealed minimal (<1 mm) skeletal relapse. Conclusions: Rapid maxillary distraction followed by MMF to maintain maxillary advancement may reduce halo device wear to 1 to 2 weeks. MMF optimizes occlusion by forcing the maxillary teeth into maximal intercuspal position. Rigid fixation is not only associated with less long-term relapse compared to nonrigid forms of fixation, but also minimizes the incidence of nonunion. This treatment protocol provides the advancement possible with distraction osteogenesis and the accuracy of orthognathic surgery, thereby minimizing external head frame wear.
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Affiliation(s)
- Anshul Rai
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anuj Jain
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
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Abstract
INTRODUCTION The use of intermaxillary fixation (IMF) in the treatment of faciomaxillary fractures is the key factor for reduction and immobilization. Various techniques of IMF have been described in the past and recently IMF screws have been introduced. This technique has various advantages, including ease of use, less time consumption, less trauma to the surrounding soft tissues, and relatively reduced risk of needle stick injury. This study evaluates the efficacy of IMF screws over arch bar IMF before definitive fixation of facial fractures. MATERIALS AND METHODS This study is a randomized clinical study. Study population consists of 20 patients with mandibu-lar fractures requiring IMF with open reduction and reported to Department of Oral Surgery, Modern Dental College and Research Centre, Indore, Madhya Pradesh, India between September 2012 and April 2015. Two groups were formed with 10 patients in each group. In the first group, IMF was achieved using the Erich's arch bar and wires. In the second group, IMF was achieved using self-tapping IMF screw. The patients were assessed for various parameters, such as the time required in minutes for the IMF stability of fixation, postoperative occlusion, postoperative pain, periodontal health, oral hygiene, and incidence of needle stick injury. RESULTS All the cases had stable IMF in both groups. At the end of 14th day, overall oral hygiene was poor in group I and good in group II, significant statistically (p = 0.031). Iatrogenic injury to tooth was absent in group I and present in 1 case in group II, not significant statistically (p = 0.305). Average time taken for the IMF in group I was 74.9 minutes, with the range of 58 to 88 minutes, and in group II was 16.1 minutes, with the range of 11 to 22 minutes, which is highly significant statistically (p = 0.001). Needle stick injuries were taken as positive if glove perforation was present and these were reported in four cases in group I, whereas in group II, no case had incidence of needle stick injuries, which shows significant statistically (p = 0.025). CONCLUSION After this study, we can conclude that IMF self-tapping screw is a proven useful technique of IMF. Intermaxillary fixation is a safe and less time-consuming method but with various shortcomings and complications, which the surgeon must be aware of while providing treatment. CLINICAL SIGNIFICANCE Keywords: Erich's arch bar, Intermaxillary fixation, Self-tapping intermaxillary fixation screws.
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Affiliation(s)
- Animesh Barodiya
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rishi Thukral
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, Phone: +919406536836, e-mail:
| | - S M Agrawal
- Department of Oral and Maxillofacial Surgery, Modern Dental College & Research Centre, Indore, Madhya Pradesh, India
| | - Anil S Chouhan
- Department of Oral and Maxillofacial Surgery, Modern Dental College & Research Centre, Indore, Madhya Pradesh, India
| | - Sidharth Singh
- Department of Oral and Maxillofacial Surgery, Hitkarni Dental College & Hospital, Jabalpur, Madhya Pradesh, India
| | - Yogesh Loksh
- Department of Dentistry, Amaltas Institute of Medical Sciences Dewas, Madhya Pradesh, India
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Abstract
The use of osteofixation devices should be evidence-based if uncomplicated bone healing is to be achieved. Numerous studies describe and claim the advantages of biodegradable over titanium devices as a bone fixation method. Here, we systematically review the available literature to determine the clinical efficacy and safety of biodegradable devices compared with titanium devices in oral and maxillofacial surgery. In addition, related general aspects of bone surgery are discussed. We conducted a highly sensitive search in the databases of MEDLINE (1966–2005), EMBASE (1989–2005), and CENTRAL (1800–2005) to identify eligible studies. Eligible studies were independently evaluated by two assessors using a quality assessment scale. The study selection procedure revealed four methodologically ‘acceptable’ articles. Owing to the different outcome measures used in the studies, it was impossible to perform a meta-analysis. Therefore, the major effects regarding the stability and morbidity of fracture fixation using titanium and biodegradable fixation systems were qualitatively described. Any firm conclusions regarding the fixation of traumatically fractured bone segments cannot be drawn, due to the lack of controlled clinical trials. Regarding the fixation of bone segments in orthognathic surgery, only a few controlled clinical studies are available. There does not appear to be a significant short-term difference between titanium and biodegradable fixation systems regarding stability and morbidity. However, definite conclusions, especially with respect to the long-term performance of biodegradable fixation devices used in maxillofacial surgery, cannot be drawn. Abbreviations: CENTRAL, Cochrane Central Register of Controlled Trials; MeSH, Medical Subject Heading; VAS, Visual Analogue Scale; and W, weight.
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Affiliation(s)
- G J Buijs
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Hsueh WD, Schechter CB, Tien Shaw I, Stupak HD. Comparison of intraoral and extraoral approaches to mandibular angle fracture repair with cost implications. Laryngoscope 2015; 126:591-5. [PMID: 26154627 DOI: 10.1002/lary.25405] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to analyze outcomes of intraoral and extraoral approaches to mandibular angle fractures and provide cost estimates for comparison. STUDY DESIGN A retrospective review from January 2005 to June 2013 was performed of patients who underwent open reduction internal fixation of mandibular angle fractures at a level I trauma center. METHODS Patients were treated by three surgical specialties: otolaryngology-head and neck surgery, oral and maxillofacial surgery, and plastic and reconstructive surgery. Inpatient and outpatient medical records were reviewed for pertinent data including age, gender, duration of follow-up, presence of other mandible fractures, surgical approach, surgical team, operative time, and postoperative complications. RESULTS Of the 155 patients with mandibular angle fractures, 74% underwent open reduction internal fixation through an intraoral approach, whereas 26% of patients were treated with an extraoral approach. The occurrence of any complication was 69.6% in the extraoral group and 39% in the intraoral group (P = 0.009). In propensity-weighted analysis, however, the occurrence of any complication was less frequent in intraoral cases but no longer statistically significant (odd ratio 0.28; 95% confidence interval, 0.08 to 1.02; P = 0.053). Operating room time was significantly shorter with the intraoral approach. We estimate that the intraoral approach directly saves at least $2,900 per case. CONCLUSION We recommend the use of an intraoral approach for the repair of mandibular angle fractures when clinically appropriate. This can result in a comparable rate of success, however, with significant cost savings to the health care system. LEVEL OF EVIDENCE 4. Laryngoscope, 126:591-595, 2016.
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Affiliation(s)
- Wayne D Hsueh
- Department of Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Clyde B Schechter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - I Tien Shaw
- Department of Oral and Maxillofacial Surgery, Jacobi Medical Center, Bronx, New York, U.S.A
| | - Howard D Stupak
- Department of Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, U.S.A
- Department of Otolaryngology, Jacobi Medical Center, Bronx, New York, U.S.A
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Gelesko S, Wahlstrom D, Engelstad M. Routine Screening Radiography for Retained Wire Following Arch Bar Removal Is Not Indicated. J Oral Maxillofac Surg 2015; 74:796.e1-4. [PMID: 25936941 DOI: 10.1016/j.joms.2015.03.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To estimate the screening test value of routine radiography after arch bar wire removal by assessing the incidence of retained wires and the importance of their sequelae. MATERIALS AND METHODS This was a retrospective medical record review. Records of arch bar removal procedures were examined and divided into those screened with radiography after removal (screen group) and those that were not screened (comparison group). The incidence of retained wire was calculated for each group. Study variables included wire-related radiographic or clinical findings. RESULTS Records of 546 mandible fractures were reviewed; 95 met the study criteria. Most exclusions were due to lack of arch bars, missing postoperative radiographs, or insufficient postoperative documentation. Of the 55 records in the screen group, 1 wire was detected (2%); of the 40 records in the comparison group, 1 wire was detected (3%). The total incidence of retained wire findings was not statistically different between the 2 groups and there were no adverse wire-related sequelae reported by any of the 95 patients. CONCLUSION Because of the low incidence of retained wires and wire-related sequelae, routine imaging after wire removal is probably not an effective screening test for retained wire and should be limited to situations in which there is clinical suspicion of retained wire.
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Affiliation(s)
- Savannah Gelesko
- Resident, Department of Oral and Maxillofacial Surgery, Oregon Health & Science University, Portland, OR
| | - Devin Wahlstrom
- Dental Student, School of Dentistry, Oregon Health & Science University, Portland, OR
| | - Mark Engelstad
- Associate Professor, Departments of Oral and Maxillofacial Surgery and Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.
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Attishia R, Van Sickels JE, Cunningham LL. Incidence of bracket failure during orthognathic surgery: a comparison of two techniques to establish interim maxillomandibular fixation. Oral Maxillofac Surg 2014; 19:143-7. [PMID: 25260536 DOI: 10.1007/s10006-014-0468-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/15/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this study is to review the frequency of bracket failure using two different techniques for establishing interim fixation during orthognathic surgery. METHODS AND MATERIAL The first group (standard technique) had a maxillomandibular fixation (MMF) established during surgery by ligating splints to orthodontic appliances. The second group of patients had an interim fixation established using maxillomandibular screws (alternative technique). Preoperative and immediate postoperative panoramic radiographs were examined for loose and or missing brackets in both groups. Intraoperative observations were also recorded in the second group. The type of surgery (one- or two-jaw) and whether or not cemented bands on the molars were present were noted. A Pearson's chi-square analysis was done comparing the two groups. RESULTS There were 210 patients in the first group and 104 in the second. The overall incidence of missing or loose brackets following surgery in the standard technique group was 16%; 172 of them had a cemented band on either the first or on the first and second molars. There was a higher incident of lost or loose bonded brackets when the patients had no cemented brackets or underwent a two-jaw surgery. In the second group of 104 patients, there was one loose or missing brackets caused by the application of MMF (Pearson's chi-square value = 15.84, p < 0.0001). CONCLUSIONS When using orthodontic brackets to establish interim fixation, the incidence of missing or loose brackets during orthognathic surgery was dramatically higher in two-jaw cases and in cases where only bonded brackets were placed by the orthodontist. When using maxillomandibular screws to establish interim fixation, the problem has been greatly diminished.
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Affiliation(s)
- Reed Attishia
- University of Kentucky, D508 Chandler Medical Center University of Kentucky, 800 Rose Street, Lexington, KY, 40536-0297, USA
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Bhanji AH, Graham RM. Technique tips--tips on a maxillofacial toolbox. ACTA ACUST UNITED AC 2014; 41:557. [PMID: 25195492 DOI: 10.12968/denu.2014.41.6.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kokuryo S, Habu M, Miyamoto I, Uehara M, Kodama M, Iwanaga K, Yoshioka I, Tominaga K. Predictability and accuracy of maxillary repositioning during bimaxillary surgery using a three-dimensional positioning technique. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:187-93. [PMID: 25047927 DOI: 10.1016/j.oooo.2014.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/04/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Shinya Kokuryo
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Manabu Habu
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuya Miyamoto
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Masataka Uehara
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Kodama
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Kenjiro Iwanaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
| | - Izumi Yoshioka
- Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan.
| | - Kazuhiro Tominaga
- Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan
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Fry AM, Orr RL, Patterson A, Doyle PT. Intermaxillary splint and positioning stents to guide mandibular reconstruction. Br J Oral Maxillofac Surg 2014; 52:473-4. [PMID: 24629453 DOI: 10.1016/j.bjoms.2014.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Affiliation(s)
- A M Fry
- Department of Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Calow, Chesterfield, Derbyshire S44 5BL, United Kingdom.
| | - R L Orr
- Department of Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Calow, Chesterfield, Derbyshire S44 5BL, United Kingdom
| | - A Patterson
- Department of Oral and Maxillofacial Surgery, Rotherham Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - P T Doyle
- Department of Oral and Maxillofacial Surgery, Chesterfield Royal Hospital, Calow, Chesterfield, Derbyshire S44 5BL, United Kingdom
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West GH, Griggs JA, Chandran R, Precheur HV, Buchanan W, Caloss R. Treatment outcomes with the use of maxillomandibular fixation screws in the management of mandible fractures. J Oral Maxillofac Surg 2013; 72:112-20. [PMID: 24075236 DOI: 10.1016/j.joms.2013.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this prospective randomized study was to assess whether uncomplicated mandible fractures could be treated successfully in an open or closed fashion using maxillomandibular fixation (MMF) screws. MATERIALS AND METHODS This was a prospective institutional review board-approved study involving 20 adult patients who presented to the university emergency department or oral and maxillofacial surgical clinic with uncomplicated mandible fractures. Patients who met the exclusion criteria consented to enter the study in the open reduction internal fixation (ORIF) or the closed (MMF) study group. Six to 8 MMF screws were used to obtain intermaxillary fixation (IMF) in the 2 groups. Screw failure was documented. All screws were removed at 5 to 6 weeks postoperatively. Insertional torque (IT) was measured at time of screw placement to assess primary stability. Clinical and photographic documentation was performed to assess fracture healing, occlusion, and gingival health. Ten-centimeter visual analog scales were used to assess patient-centered outcomes. Cone-beam computed tomography was performed to assess the long-term effects on the periodontium and roots. A cost comparison was performed to determine whether the use of screws was cost effective compared with arch bars. RESULTS Fifteen men and 5 women (mean age, 25.2 yr) entered the study. All patients displayed adequate fracture healing based on clinical examination. All patients had acceptable occlusion at 5 to 6 weeks postoperatively. Total screw failure was 27 of 106 screws (25.5%). Forty percent of screws placed in the MMF group failed compared with only 6% in the ORIF group. Gingival health scores were favorable. Factors that had a significant effect on screw failure included a lower IT (P = .002), use in closed (MMF) treatment (P < .001), and use in the posterior jaw (P = .012). Minimal pain was associated with the MMF screws and pre-existing occlusion was re-established based on patients' subjective responses. The MMF group reported a statistically significant lower quality of life (P < .001) compared with the ORIF group. There was only 1 screw site that had a facial cortical bone defect noted at 6-month follow-up CBCT examination. There were no discernible long-term root defects. Cost analysis showed that the use of MMF screws saved around $600 per patient in operating room usage cost alone compared with the estimated use of arch bars. CONCLUSIONS Uncomplicated mandible fractures were successfully treated using MMF screws in open and closed treatments. However, the utility in closed treatment was decreased because of significant screw failure and patient noncompliance. The screws were well tolerated by the patients. There was minimal long-term damage to the periodontium and dental roots. The cost of screws was more than offset by time savings.
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Affiliation(s)
- Griffin Harold West
- Resident, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS
| | - Jason Alan Griggs
- Professor, Department of Biomedical Materials Science, University of Mississippi Medical Center, Jackson, MS
| | - Ravi Chandran
- Assistant Professor, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS
| | - Harry Vincent Precheur
- Professor Emeritus, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS
| | - William Buchanan
- Professor, Department of Periodontics and Preventive Sciences, University of Mississippi Medical Center, Jackson, MS
| | - Ron Caloss
- Associate Professor, Interim Chairman and Program Director, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS.
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Saltaji H, Major MP, Altalibi M, Youssef M, Flores-Mir C. Long-term skeletal stability after maxillary advancement with distraction osteogenesis in cleft lip and palate patients. Angle Orthod 2012; 82:1115-1122. [PMID: 22506512 PMCID: PMC8813140 DOI: 10.2319/011212-27.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 02/01/2012] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To systematically review the long-term skeletal stability after maxillary advancement with distraction osteogenesis (DO) in cleft lip and palate (CLP) patients. MATERIALS AND METHODS Electronic databases, grey literature, and reference list searches were conducted. The inclusion criteria were stability of maxillary advancement with distraction osteogenesis assessed at the posttreatment follow-up ≥ 1 year in CLP patients. Full articles were retrieved from abstracts or titles that appear to meet the inclusion criteria or lacked sufficient detail for immediate exclusion. Once full articles were collected, they were again reviewed considering more detailed inclusion criteria for a final selection decision. A methodologic quality assessment tool was utilized. RESULTS Thirty abstracts/titles met the initial search criteria, and 13 articles were finally selected. Overall, methodologic quality scores were high in only one randomized clinical trial. After maxillary advancement with DO in CLP patients, the long-term horizontal relapse in A-point was less than 15% in eight studies and between 20% and 25% in four studies. The study that was judged as a high-quality study reported 8.2% horizontal relapse in A-point. The relapse rate was higher in DO with external distracter device than DO with internal distracter device. CONCLUSIONS Current evidence suggests maxillary advancement with DO has good stability in CLP patients with moderate and severe maxillary hypoplasia.
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Affiliation(s)
- Humam Saltaji
- Orthodontic Graduate Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Akadiri OA, Omitiola OG. Maxillo-mandibular fixation: utility and current techniques in modern practice. Niger J Med 2012; 21:125-133. [PMID: 23311177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND There appears to be a gradual relegation of maxillo-mandibular fixation (MMF) from the frontline of oral and maxillofacial surgical techniques because of the evolution and increasing sophistication of rigid internal fixation techniques, efficiency. AIM To highlight the residual relevance, utility, and current techniques of achieving MMF in modern practice. METHODS A rigorous search of the maxillofacial literature was undertaken to identify recent articles that discuss the techniques, usefulness, limitations, merits, demerits and cost effectiveness of MMF. A narrative review of the selected literature was done to provide concise and current evidence on MMF in modern maxillofacial surgery. The cost effectiveness of MMF as a modality in the treatment of maxillofacial fractures is also compared with that of open reduction and internal fixation (ORIF). RESULTS MMF is employed as temporary intraoperative adjunct to rigid fixation techniques or as a supplement for postoperative stabilization after semi-rigid fixation. It is a adequate and more cost effective method in some types of mandibular fractures. Other indications are patients' refusal of open surgery, refusal of hardware insertion and lack of medical fitness for extensive surgical operation. Many innovative techniques of achieving MMF are now available and are in this article, categorized into MMF with direct wiring techniques, MMF with inter-arch straight tie wires or elastics, and MMF with Special devices. CONCLUSION In spite of the growing enthusiasm for ORIF, MMF remains a relevant technique in maxillofacial surgery and in some cases are more cost effective than rigid internal fixation.
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Affiliation(s)
- O A Akadiri
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, University of Port Harcourt, Port Harcourt Rivers state, Nigeria.
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Brasileiro BF, Van Sickels JE. A modified sagittal split ramus osteotomy for hemimandibular hyperplasia and simultaneous inferior alveolar nerve repositioning. J Oral Maxillofac Surg 2011; 69:e533-41. [PMID: 22117710 DOI: 10.1016/j.joms.2011.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/20/2011] [Accepted: 07/26/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Bernardo Ferreira Brasileiro
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Federal University of Sergipe, Aracaju, Brazil.
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Bissada E, Abou-Chacra Z, Ahmarani C, Poirier J, Rahal A. Intermaxillary screw fixation in mandibular fracture repair. J Otolaryngol Head Neck Surg 2011; 40:211-215. [PMID: 21518642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
PURPOSE To be successful, mandibular fracture reduction requires restoring premorbid occlusion. Intermaxillary fixation (IMF) is a founding principle of accurate mandibular fracture repair. Although arch bars are currently the standard in securing IMF, IMF screws have many potential benefits and should therefore not be overlooked. The goals of this study were to evaluate the effectiveness of IMF screws in the management of mandibular fractures, describe the technique, and identify those who will benefit from it without compromising the end results. MATERIALS AND METHODS Thirty-six consecutive patients with single or multiple displaced fractures of the mandible were treated using screw IMF. Open reduction internal fixation was then accomplished in the usual fashion. Postoperative plain films were used to evaluate fracture reduction and screw placement. Data were collected prospectively from clinical and radiologic evaluations at regular follow-up appointments. RESULTS Thirty-five (97.2%) of 36 patients demonstrated normal occlusion at the follow-up examination 6 weeks postoperatively. One case of root fracture and four cases of root impingement by screws were observed at the follow-up examinations. CONCLUSIONS Cortical bone screws offer a reliable alternative to more traditional methods of obtaining IMF in the treatment of mandibular fractures and present many advantages to the surgeon and the patient. Their use may be limited to specific clinical situations and potential consequences, of which the surgeon must be aware. Adequate preoperative planning is therefore essential to maximize successful results.
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Affiliation(s)
- Eric Bissada
- Department of Otolaryngology-Head and Neck Surgery, University of Montreal, 5415 boulevard de l'Assomption, Montreal, QC H1T 2M4.
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Akram A, Collin J, Postlethwaite K, Sweeney G. Planned to perfection? Use of the model repositioning instrument to plan maxillary movements for orthognathic surgery. Orthodontics (Chic.) 2011; 12:130-133. [PMID: 21935506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Previous studies have reported significant discrepancies between the surgical treatment objectives and final surgical results in orthognathic surgery patients. When dealing with complex asymmetrical maxillary movements in bimaxillary osteotomy patients, it can often be difficult to reposition the maxilla with a desirable degree of accuracy at the planning stage. Inaccurate placement of the maxilla can result in an unwanted repositioning of the mandible, which can lead to less than ideal functional and esthetic outcomes. The use of a model respositioning frame for orthognathic surgical planning is demonstrated. This can be utilized to position the maxilla at the model surgery stage with increased accuracy in both the vertical and horizontal plane. This frame can be used on semiadjustable articulators.
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Affiliation(s)
- Ansa Akram
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom.
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van der Walt JC, Graewe FR, McIntosh C. Fixation of mandible fractures: a simplified method. SADJ 2010; 65:358-363. [PMID: 21133049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Many mandible fractures can be treated effectively with closed methods. The authors describe a simple method, with the use of commercial cable ties, to obtain maxillary-mandibular fixation (MMF). This technique can be effectively employed to treat certain mandible fractures. AIMS AND OBJECTIVES A simple, safe and cost-effective method for treating mandible fractures by employing commercial cable ties to obtain MMF was developed. A clinical prospective study was conducted to evaluate the feasibility of this technique. METHODS Twenty consecutive patients were enrolled into this study. MMF was obtained with cable ties. The study group was evaluated according to occlusion, clinical outcome, discomfort level and complications. RESULTS Ninety percent of patients had normal occlusion after treatment. All fractures were clinically united. Seventy percent described their discomfort level as moderate during placement of the cable ties. The majority of patients experienced minimal discomfort both during MMF (95%), and with the removal of the cable ties (90%). No major complications occurred. Early loosening of MMF occurred in three patients with resultant subjective malocclusion in two of these. CONCLUSIONS Employing commercial cable ties to obtain MMF for the treatment of certain mandible fractures is safe, simple, effective and cost-effective.
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Affiliation(s)
- J C van der Walt
- Plastic and Reconstructive Surgery Department, Port Elizabeth Hospital Complex.
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O'Fearraigh P. Review of methods used in the reconstruction and rehabilitation of the maxillofacial region. J Ir Dent Assoc 2010; 56:32-37. [PMID: 20337144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Maxillofacial and dental defects often have detrimental effects on patient health and appearance. A holistic approach of restoring lost dentition along with bone and soft tissue is now the standard treatment of these defects. Recent improvements in reconstructive techniques, especially osseointegration, microvascular free tissue transfer, and improvements in bone engineering, have yielded excellent functional and aesthetic outcomes. This article reviews the literature on these modern reconstructive and rehabilitation techniques.
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Affiliation(s)
- Pádraig O'Fearraigh
- Department of Oral and Maxillofacial Surgery, Altnagelvin Area Hospital, Derry.
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Fushima K, Kobayashi M, Konishi H, Minagichi K, Fukuchi T. Real-time orthognathic surgical simulation using a mandibular motion tracking system. ACTA ACUST UNITED AC 2010; 12:91-104. [PMID: 17487659 DOI: 10.3109/10929080701253881] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We developed a new orthognathic surgical simulation system able to predict both occlusal correction and mandibular repositioning in three dimensions. This system uniquely integrates the real motion of the dental cast model with the virtual motion of the reconstructed cranio-facial model. The skeletal change of the mandibular osteotomy is simulated on the PC monitor while the occlusal change is confirmed by checking the cast model on the simulator. The simulation process is easily repeated and the operator can make several attempts to determine the final mandibular position. The occlusal relationship at the simulated mandibular posture is registered and the occlusal wafer splint, which ensures intermaxillary fixation, is fabricated on the simulator. This surgical simulation system appears to satisfy clinical demands well and is an important facilitator of communication between orthodontists and surgeons. Here, we outline the system and apply it to a demonstration case of orthognathic surgery.
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Sugiyama K, Saitoh Y, Kohjitani A. [ S-shaped suction catheter for intraoperative intermaxillary fixation]. Masui 2009; 58:777-781. [PMID: 19522279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Orthognathic surgery for maxillofacial deformities and open reduction of mandibular fractures may require intermaxillary fixation during the surgical procedure. Extubation with intraoperative intermaxillary fixation is highly dangerous, because nasal bleeding and postoperative vomiting can cause airway obstruction and aspiration pneumonia. To prevent these complications, we routinely use an S-shaped suction catheter in patients with intraoperative intermaxillary fixation. The purpose of this study was to determine the optimal location for fixation of a catheter to allow effective suctioning. METHODS Fourteen adult volunteers participated in this study. A suction catheter was inserted into the oral cavity proper through the retromolar space in an intercuspal position. When the catheter could suction distilled water in the mouth, the distance from the tip of the catheter to the angle of the mouth was measured. RESULTS The distances of straight type catheters were 68+/-7 and 57+/-7 mm in males and females, respectively. The distances of angle type catheters were 72+/-10 and 58+/-7 mm in males and females, respectively. CONCLUSIONS The present study suggests that an S-shaped suction catheter is useful to suction oral secretions in patients with intraoperative intermaxillary fixation.
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Affiliation(s)
- Kazuna Sugiyama
- Department of Dental Anesthesiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima
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Abstract
The search for the ideal method of treatment for mandibular fractures has continued for thousands of years. These injuries have unique and problematic features for adequate reliable wound healing. Oral and maxillofacial surgeons must learn and master several techniques for mandibular fracture treatment. The age-old successful management of these injuries using closed reduction techniques always should be considered when mandibular trauma presents. The closed reduction remains a mainstay of mandibular fracture treatment. An adequate knowledge of anatomy, multiple closed reduction techniques, and the physiology of fracture healing must be adequately understood and technically mastered by the oral and maxillofacial surgical team for the present and future of mandibular fracture management.
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Affiliation(s)
- Meredith Blitz
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, 110 Bergen Street, Newark, NJ 07103-2400, USA.
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Abstract
Edentulous or atrophic mandible fractures are rare and potentially problematic for the oral and maxillofacial surgeon. With the loss of teeth, atrophy of the alveolar bony apparatus ensues, creating a mandible more prone to fracture. This article describes the management of edentulous/atrophic mandibular fractures.
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Affiliation(s)
- Shahid R Aziz
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, 110 Bergen Street, Newark, NJ 07103, USA.
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Abstract
The goal of bicortical fixation of mandibular fractures is to provide for undisturbed healing and immobility of fragments to facilitate primary bony union. This type of fixation should provide sufficient rigidity for fracture segments to resist any movement along the fracture line during normal function of the mandible. The decision of which technique to use for fixation of a particular mandible fracture depends on multiple factors, such as fracture location, favorability of fracture vectors, anatomic location of fractures, systemic health of the patient, timing of surgery, experience of the surgeon, age of the patient, and patient compliance. In this chapter, the authors discuss the indications and techniques of bicortical fixation of mandible fractures.
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Affiliation(s)
- Lawrence Gorzelnik
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, 110 Bergen Street, Newark, NJ 07103-2400, USA.
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Abstract
Oral and maxillofacial surgeons must constantly weigh the risks of surgical intervention for pediatric mandible fractures against the wonderful healing capacity of children. The majority of pediatric mandibular fractures can be managed with closed techniques using short periods of maxillomandibular fixation or training elastics alone. Generally, the use of plate- and screw-type internal fixation is reserved for difficult fractures. This article details general and special considerations for this surgery including: craniofacial growth & development, surgical anatomy, epidemiology evaluation, various fractures, the role rigid internal fixation and the Risdon cable in pediatric maxillofacial trauma. It concludes with suggestions concerning long-term follow-up care in light of the mobility, insurance obstacles, and family dynamics facing the patient population.
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Affiliation(s)
- George M Kushner
- Department of Surgical and Hospital Dentistry, School of Dentistry, The University of Louisville, Louisville, KY 40292, USA
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Abstract
External fixation of mandible fractures is a useful technique when an open treatment is contraindicated because of extensive comminution, bone or soft tissue loss, and infection. This technique can also be used temporarily until definitive treatment is delivered. A uniphasic or biphasic system can be placed to reduce and stabilize mandibular fractures. These systems use surgically placed threaded pins and different types of connectors that can be manipulated to optimize the reduction of fractures. External fixation remains a quick, safe, and simple method to treat mandible fractures in selected clinical situations, and it should be part of the armamentarium in surgeons treating these injuries and fractures.
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Affiliation(s)
- Hani F Braidy
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, 110 Bergen Street, Newark, NJ 07103-2400, USA.
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Bianchi A, Amadori S, Pironi M, Marchetti C. Maxillary expansion and stability in the orthodontic-surgical treatment of skeletal anterior open bites. Prog Orthod 2009; 10:26-37. [PMID: 20545089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVES Evaluation of the surgical/orthodontic treatment's stability using rigid internal fixation. METHODS AND MATERIALS Seventeen patients presenting an anterior skeletal openbite, analyzed retrospectively to evaluate stability of surgical-orthodontic treatment using rigid internal fixation: mini plates and screws for maxillary fixation and bicortical screws for the mandible. The surgical procedures were Le Fort I osteotomy and bilateral sagittal split mandibular osteotomy. The patients were classified into 4 groups according to the characteristics described by Ellis (date): Group 1a (n = 4): Class II dental and skeletal malocclusions treated with one piece Le Fort I intrusion osteotomy and bilateral sagittal split mandibular advancement. Group 1 b (n = 4): Class II dental and skeletal malocclusions treated with multisegmental Le Fort I to expand surgically the maxillary width, intrusion osteotomy and bilateral sagittal split mandibular advancement. Group 2a (n = 5): Class III dental and skeletal malocclusions treated with one piece Le Fort I intrusion with/without advancement and bilateral sagittal split mandibular set-back. Group 2b (n = 4): Class III dental and skeletal malocclusions treated with multisegmental Le Fort I, expanding surgically the maxillary width, with/without advancement.
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Affiliation(s)
- Alberto Bianchi
- Oral and Maxillofacial Surgery Unit, S. Orsola-Malpighi Hospital, Bologna.
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Abstract
BACKGROUND A large number of studies and clinical cases show that an ideal prognosis for mouth function cannot be obtained without sufficient and reasonable postsurgical functional exercise after jaw fracture. However, no unifying criteria exist on postsurgical functional exercise with jaw fracture. The study was designed to explore effective methods of postsurgical functional exercise of jaw fracture. MATERIALS AND METHODS One hundred seventeen inpatients with jaw fracture between August 2005 and August 2006 were subjects in this study. Sequential function exercise methods were used to recover patients' gape degree, chewing, and so on. Gape degree was recorded, and healing of the jaw was assessed using x-ray. RESULTS All 117 patients with jaw fracture who underwent surgery were involved in the analysis. After sequential function exercise, gape degree and chewing function improved; good occluding relations were retained. Gape degree was significantly improved at 8 or 12 weeks postsurgery compared with 1 or 4 weeks postsurgery (P < 0.01). However, no significant differences in gape degree were observed between 1 and 4 weeks postsurgery and between 8 and 12 weeks postsurgery (P > 0.05). CONCLUSIONS Sequential function exercise contributes much to patient recovery of mouth function. This method is effective for postsurgical functional recovery of jaw fracture.
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Affiliation(s)
- Zhiyuan Feng
- Department of Oral & Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Poore MC, Penna KJ. The use of resorbable hardware for fixation of pediatric mandible fracture. Case report. N Y State Dent J 2008; 74:58-61. [PMID: 18788183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The diagnosis and management of mandible fractures in the pediatric patient population can pose multiple challenges to the oral and maxillofacial surgeon. Resorbable plates and screws for fixation in this population are both well tolerated and effective. They enable realignment and stable positioning of rapidly healing fracture segments, while obviating any potential impediments to long-term metal retention.
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Affiliation(s)
- Matthew C Poore
- Department of Oral and Maxillofacial Surgery, Nassau University Medical Center, East Meadow, NY, USA
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Hashitani S, Maeda T, Okui S, Takaoka K, Honda K, Urade M. Allergy to metal caused by materials used for intermaxillary fixation: Case report. Br J Oral Maxillofac Surg 2008; 46:315-6. [PMID: 17662511 DOI: 10.1016/j.bjoms.2007.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2007] [Indexed: 11/27/2022]
Abstract
A 21-year-old man with no history of contact allergy developed eczema over his entire body 2 days after he had had intermaxillary fixation (IMF) of a mandibular fracture. Patch testing showed a strong reaction to nickel so the arch bars and wires that had been used for fixation were removed and replaced with resin brackets, elastic bands, and a chin cap. The eczema disappeared 2 days later.
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Affiliation(s)
- Susumu Hashitani
- Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
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Zix J, Lieger O, Iizuka T. Use of straight and curved 3-dimensional titanium miniplates for fracture fixation at the mandibular angle. J Oral Maxillofac Surg 2007; 65:1758-63. [PMID: 17719394 DOI: 10.1016/j.joms.2007.03.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 01/05/2007] [Accepted: 03/14/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this follow-up study was to evaluate the clinical usefulness of a new type of 3-dimensional (3D) miniplate for open reduction and monocortical fixation of mandibular angle fractures. PATIENTS AND METHODS In 20 consecutive patients, noncomminuted mandibular angle fractures were treated with open reduction and fixation using a 2 mm 3D miniplate system in a transoral approach. All patients were systematically monitored until 6 months postoperatively. Among the outcome parameters recorded were infection, hardware failure, wound dehiscence, and sensory disturbance of the inferior alveolar nerve. RESULTS The mean operation time from incision to wound closure was 65 minutes. Two patients had a mucosal wound dehiscence with no consequences. None developed an infection requiring a plate removal. All but 2 patients had normal sensory function 3 months after surgery. Plate fracture occurred in one patient in whom a preceding surgical removal of the third molar had been the reason for the mandibular fracture. In the absence of clinical symptoms, the patient declined plate removal. On final follow-up, fracture healing was considered clinically complete in all patients. CONCLUSIONS The 3D plating system described here is suitable for fixation of simple mandibular angle fractures and is an easy-to-use alternative to conventional miniplates. The system may be contraindicated in patients in whom insufficient interfragmentary bone contact causes minor stability of the fracture.
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Affiliation(s)
- Juergen Zix
- Department of Cranio-Maxillofacial Surgery, University of Bern, Bern, Switzerland.
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Landes CA, Stuckensen T, Jaquiéry C, Sader R. Bone and Plate Fixation Device for Transoral Osteofixation in the Mandibular Angle, Ramus, and Condyle Region. J Oral Maxillofac Surg 2007; 65:2115-8. [PMID: 17884551 DOI: 10.1016/j.joms.2006.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 12/23/2005] [Accepted: 04/06/2006] [Indexed: 11/26/2022]
Affiliation(s)
- Constantin A Landes
- Klinik für Kiefer-und Plastische Gesichtschirurgie, Frankfurt University Medical Center, Germany.
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Wang T, Zhou G, Tan X, Dong Y. Evaluation of force degradation characteristics of orthodontic latex elastics in vitro and in vivo. Angle Orthod 2007; 77:688-93. [PMID: 17605476 DOI: 10.2319/022306-76] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 08/01/2006] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the characteristics of force degradation of latex elastics in clinical applications and in vitro studies. MATERIALS AND METHODS Samples of 3/16-inch latex elastics were investigated, and 12 students between the ages of 12 and 15 years were selected for the intermaxillary and intramaxillary tractions. The elastics in the control groups were set in artificial saliva and dry room conditions and were stretched 20 mm. The repeated-measure two-way analysis of variance and nonlinear regression analysis were used to identify statistical significance. RESULTS Overall, there were statistically significant differences between the different methods and observation intervals. At 24- and 48-hour time intervals, the force decreased during in vivo testing and in artificial saliva (P < .001), whereas there were no significant differences in dry room conditions (P > .05). In intermaxillary traction the percentage of initial force remaining after 48 hours was 61%. In intramaxillary traction and in artificial saliva the percentage of initial force remaining was 71%, and in room conditions 86% of initial force remained. Force degradation of latex elastics was different according to their environmental conditions. There was significantly more force degradation in intermaxillary traction than in intramaxillary traction. The dry room condition caused the least force loss. CONCLUSIONS There were some differences among groups in the different times to start wearing elastics in intermaxillary traction but no significant differences in intramaxillary traction.
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Affiliation(s)
- Tong Wang
- Key Laboratory for Oral Biomedical Engineering of Ministry of Education, Department of Orthodontics, Hospital and School of Stomatology, Wuhan University,Wuhan, Hubei, China
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Coletti DP, Salama A, Caccamese JF. Application of Intermaxillary Fixation Screws in Maxillofacial Trauma. J Oral Maxillofac Surg 2007; 65:1746-50. [PMID: 17719392 DOI: 10.1016/j.joms.2007.04.022] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 04/06/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE The use of intermaxillary fixation (IMF) in the treatment of maxillofacial trauma represents the cornerstone of fracture reduction and immobilization. Many modalities of IMF have been described; recently IMF screws have been introduced into clinical practice, however, hardware failure can occur. We performed a retrospective study evaluating hardware-associated complications for self-drilling/tapping IMF screws. MATERIALS AND METHODS A retrospective study on 49 patients requiring IMF was performed. The diagnosis, duration of IMF, screw site, use of elastic or wire fixation, and associated complications were recorded. IMF screws were used to adjunct open reduction techniques, for definitive closed reduction, or fracture prevention following dentoalveolar surgery. Follow-up examinations were performed until fracture healing was complete (6 to 8 weeks). RESULTS A single adverse event occurred in 19 patients (39%) while 4 patients (8%) had more than 1 complication. The most common event was screw loosening; 29% of patients had at least 1 screw dislodged in the treatment period. Of the total number of screws placed (229), 15 (6.5%) became loose, and were equally distributed among the mandible and maxilla. The remaining complications noted were root fracture, 4% (2 of 49); loosened wires, 6% (3 of 49); screw shear, 2% (1 of 49); malocclusion, 2% (1 of 49); and ingested hardware, 2% (1 of 49). CONCLUSIONS Overall the IMF self-drilling/tapping screws have been shown to be a useful modality to establish maxillomandibular fixation. It is a safe, and time-sparing technique; however, it is not without limitations or potential consequences which the surgeon must be aware of in order to provide safe and effective treatment.
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Affiliation(s)
- Domenick P Coletti
- Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Unit, Baltimore College of Dental Surgery, Baltimore, MD 21201, USA.
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Hashiba Y, Ueki K, Marukawa K, Shimada M, Yoshida K, Shimizu C, Alam S, Nakagawa K. A comparison of lower lip hypoesthesia measured by trigeminal somatosensory-evoked potential between different types of mandibular osteotomies and fixation. ACTA ACUST UNITED AC 2007; 104:177-85. [PMID: 17448708 DOI: 10.1016/j.tripleo.2006.11.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Revised: 10/05/2006] [Accepted: 11/09/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to compare objectively, the recovery of hypoestheia of the lower lip following orthognathic surgery using different procedures (sagittal split ramus osteotomy [SSRO]) and intra-oral vertical ramus osteotomy (IVRO)) and fixation methods (monocortical plate fixation and bi-cortical plate fixation). Hypoesthesia was evaluated using the trigeminal somatosensory-evoked potential (TSEP). PATIENTS AND METHODS The subjects consisted of 174 patients (348 sides) with mandibular prognathism with or without asymmetry, who underwent mandibular ramus osteotomies using different fixation types. The patients were divided into 4 groups. The OAM group consisted of 128 sides who had SSRO using the Obwegeser method with mono-cortical absorbable plate fixation, the ODTM group consisted of 84 sides who had the Obwegeser-Dal Pont method with mono-cortical titanium plate fixation, the OTB group consisted of 32 sides who had the Obwegeser method with bi-cortical titanium plate fixation and the VO group consisted of 104 sides who underwent IVRO according to the Bell method without fixation. Trigeminal nerve hypoestheia at the region of the lower lip was assessed bilaterally by the TSEP method. An electroencephalograph recording system (Neuropack Sigma; Nion Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated pre-operatively and then post-operatively at 1 and 2 weeks, 1, 3, and 6 months, and 1 year. RESULTS The mean measurable period and standard deviation of TSEP of the lower lip in the OAM group was 5.2 +/- 9.9 weeks, 10.9 +/- 13.1 weeks in the ODTM group, 7.8 +/- 4.5 weeks in the OTB group, and 2.5 +/- 6.3 weeks in the VO group. There were significant differences between the OAM and ODTM groups (P < .0001), the ODTM and OTB groups (P = .0001), the OTB and VO groups (P = .0221), the OAM and VO groups (P < .0001), and the ODTM and VO groups (P < .0001). CONCLUSION This study proved using objective measurements that the recovery period from hypoesthesia of the lower lip following orthognathic surgery was dependent on the surgical procedure. Recovery in lower lip hypoesthesia after IVRO was significantly earlier than SSRO.
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Affiliation(s)
- Yukari Hashiba
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
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Abstract
The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented.
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Affiliation(s)
- Ceyda Kocabay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara,
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Ueki K, Marukawa K, Shimada M, Nakagawa K, Yamamoto E. The Use of an Intermaxillary Fixation Screw for Mandibular Setback Surgery. J Oral Maxillofac Surg 2007; 65:1562-8. [PMID: 17656284 DOI: 10.1016/j.joms.2006.10.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 06/28/2006] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess skeletal stability after mandibular setback surgery with and without an intermaxillary fixation (IMF) screw. PATIENTS AND METHODS The subjects were 40 patients with mandibular prognathism. The subjects underwent sagittal split ramus osteotomy with titanium plate fixation and were divided into 2 groups, 1 with and 1 without an IMF screw. A lateral cephalogram was done preoperatively, immediately after surgery, and 1 month, 3 months, and 6 months postoperatively. The 2 groups were then compared statistically. RESULTS In the comparison of the time-course change between the 2 groups with repeated measure analysis of variance, there were significant differences in occlusal plane (between subjects, F = 2.517; df = 4; P = .0437) and convexity (between subjects, F = 4.048; df = 4; P = .0038). However, there was no significant difference in the other measurements. CONCLUSION This study suggested that in most measurements, there was no significant difference between 2 groups with and without an IMF screw in time-course skeletal change. However, use of IMF screws was helpful for orthognathic surgery as a rigid anchor of IMF.
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Affiliation(s)
- Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
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Binahmed A, Sansalone C, Garbedian J, Sándor GKB. The lingual splint: an often forgotten method for fixating pediatric mandibular fractures. J Can Dent Assoc 2007; 73:521-4. [PMID: 17672958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Maxillofacial fractures are uncommon in the pediatric population, and their treatment is unique due to the psychological, physiological, developmental and anatomical characteristics of children. We present the case of a boy who was treated in an outpatient dental clinic using a lingual splint for the reduction, stabilization and fixation of a mandibular body fracture. This technique is a reliable, noninvasive procedure that dentists may consider in selected cases by referral to an oral and maxillofacial surgeon. It also limits the discomfort and morbidity that can be associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients.
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Affiliation(s)
- Abdulaziz Binahmed
- Pediatric Oral and Maxillofacial Surgery, The Hospital for Sick Children, University of Toronto, Toronto ON, Canada
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Gerressen M, Stockbrink G, Smeets R, Riediger D, Ghassemi A. Skeletal Stability Following Bilateral Sagittal Split Osteotomy (BSSO) With and Without Condylar Positioning Device. J Oral Maxillofac Surg 2007; 65:1297-302. [PMID: 17577492 DOI: 10.1016/j.joms.2006.10.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 05/10/2006] [Accepted: 10/17/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE The goal of this retrospective study was to investigate whether utilization of condylar positioning devices in comparison to the manual positioning technique has a favorable influence on skeletal stability after bilateral sagittal split osteotomy. PATIENTS AND METHODS Lateral cephalometric radiographs of 49 patients who had undergone bilateral sagittal split osteotomy or bimaxillary surgery at the Universitiy Hospital of Aachen between 1993 and 2003 were evaluated with the aid of analysis software (Adda Keph version 3.0, JR - datentechnik, Leipzig, Germany). As a criterion for skeletal stability the postoperative changes of SNB angle and Wits appraisal were determined. In 10 of 28 patients with mandibular advancement and in 10 of 21 individuals with mandibular setback, the Luhr positioning device was used intraoperatively to reproduce the condylar position. Mandibular joints of the remaining patients were positioned manually. The results were statistically worked up by means of unrelated t test at P = .05. RESULTS Neither in advancement nor in setback surgery did the positioning device technique result in better outcomes for postoperative changes of SNB angle and Wits appraisal. The confidence intervals rather suggest equivalence of the data in both groups. CONCLUSION The use of positioning appliances does not lead to an improvement of skeletal stability. With the manual technique, equally stable results can be attained in advancement as well as in setback surgery.
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Affiliation(s)
- Marcus Gerressen
- Department of Oral, Maxillofacial and Plastic Facial Surgery, Universitätsklinikum der RWTH Aachen, Aachen, Germany.
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Coombes D, Norris P, Collyer J, Sneddon K. Comment on letter to the editor by S. Whitley et al. Re: Wood GD. Inion biodegradable plates: The first century. Br J Oral Maxillofac Surg 2006;44:38-41. Br J Oral Maxillofac Surg 2007; 46:79. [PMID: 17590485 DOI: 10.1016/j.bjoms.2007.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2007] [Indexed: 11/23/2022]
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Korkmaz HH. Evaluation of different miniplates in fixation of fractured human mandible with the finite element method. ACTA ACUST UNITED AC 2007; 103:e1-13. [PMID: 17468022 DOI: 10.1016/j.tripleo.2006.12.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 11/21/2006] [Accepted: 12/15/2006] [Indexed: 11/30/2022]
Abstract
The objective of this study was to develop a 3-dimensional finite element model (FEM) to formulate biomechanical justification of the positioning of different plates to achieve stable fixation of a fractured mandible. Miniplate systems that give acceptable levels of rigidity were investigated, and recommendations about miniplate location, orientation, and type selection are made. A fracture near the body region was bridged with a variety of commonly used plate configurations. Number, positioning and type of the plate system parameters. The results of this fracture model support the advantage of 2-plate systems. Using a longer plate in the superior position and a shorter one in the inferior position produced a more stable condition. Number of screws or length of the miniplate had no significant effect on the stability of fractured segments. The results obtained from this study offer the choice of a particular plate size, thickness, design, or configuration for application and thus provide information for clinical use.
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Affiliation(s)
- Hasan Husnu Korkmaz
- Civil Engineering Department, Engineering and Architecture Faculty, Selcuk University, Konya, Turkey.
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Trost O, Kadlub N, Abu El-Naaj I, Danino A, Trouilloud P, Malka G. Traitement chirurgical des fractures du condyle mandibulaire de l'adulte en France en 2005. ACTA ACUST UNITED AC 2007; 108:183-8. [PMID: 17459440 DOI: 10.1016/j.stomax.2006.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 09/12/2006] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The authors had for aim to present the latest trends in the surgical management of mandibular condylar fractures in France, in 2005. MATERIAL AND METHODS One hundred maxillofacial surgeons were questioned on the surgical management of condylar fractures and indications. Results were presented at the 41st Congress of Stomatology and Maxillofacial surgery. RESULTS The overall reply rate was 70%. Condylar fractures are generally managed in teaching hospitals. Open reduction and fixation was deemed appropriate in low subcondylar fractures in 76% of the cases, in 10% for diacapitular fractures. Therapeutic details and indications were a matter of huge variability. DISCUSSION This survey highlighted the absence of any consensus as far as condylar fractures are concerned. It seems that the higher the fractures are, the lesser they are approached.
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Affiliation(s)
- O Trost
- Service de chirurgie maxillofaciale et stomatologie, plastique, esthétique et réparatrice, chirurgie de la main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France.
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Schupp W, Arzdorf M, Linke B, Gutwald R. Biomechanical testing of different osteosynthesis systems for segmental resection of the mandible. J Oral Maxillofac Surg 2007; 65:924-30. [PMID: 17448842 DOI: 10.1016/j.joms.2006.06.306] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 01/16/2006] [Accepted: 06/12/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE This investigation assessed the mechanical behavior of 3 different locking and nonlocking reconstruction systems-Unilock 2.4, Reconstruction 2.4, and Reconstruction 2.7-with regard to plate and screw fracture. MATERIALS AND METHODS Five different plate/screw configurations (Unilock 2.4-locking screws, Unilock 2.4 -conventional screws, Reconstruction 2.4-conventional screws, Reconstruction 2.7-conventional screws, and Unilock 2.4-locking screws with a 1-mm gap; Synthes, Umkirch, Germany) were tested on synthetic mandibles. All mandibles were resected on the left side between the canine and third molar, reconstructed, and loaded cyclically between 30 and 300 N up to 250,000 cycles or until screw or plate failure occurred. RESULTS No screw fractures were observed. All plates fractured close to the distal fragment. The Unilock plates fixed with locking screws withstood significantly more cycles until failure than the Reconstruction plates 2.4 fixed with conventional MF-Cortex screws. No significant differences were found in the other groups. Only 2 of the 34 plates tested, both of the Reconstruction 2.7 system, reached the runout limit. CONCLUSIONS Unilock plates fixed with locking screws have a higher long-term stability than the Reconstruction 2.4 system. A 1-mm gap between the plate and mandible does not lead to early screw failure in the Unilock 2.4 system with locking screws. The Reconstruction 2.7 system seems superior if well contoured, because 2 of those plates reached the runout limit; however, this system is not as easy to handle as the 2.4 systems, and good contouring is difficult to achieve. Therefore, we consider the Unilock 2.4 system with locking screws the best choice.
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Affiliation(s)
- Wiebke Schupp
- Senior Resident, Department of Oral and Maxillofacial Surgery, University Hospital of Freiburg, Freiburg, Germany.
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Gil JN, Claus JDP, Manfro R, Lima SM. Predictability of maxillary repositioning during bimaxillary surgery: accuracy of a new technique. Int J Oral Maxillofac Surg 2007; 36:296-300. [PMID: 17240117 DOI: 10.1016/j.ijom.2006.10.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 07/07/2006] [Accepted: 10/02/2006] [Indexed: 11/21/2022]
Abstract
The purpose of this retrospective study was to evaluate the predictability of maxillary repositioning following Le Fort I osteotomy during bimaxillary surgery using a new technique with splints to reposition the maxilla in the three planes of space. In order to assess the accuracy of horizontal and vertical maxillary movements of the maxilla, 32 consecutive patients who underwent bimaxillary surgery had their predictive tracings and model surgery measures compared to postoperative cephalograms taken 1 week after surgery. There was a strong positive correlation between model surgery and postoperative result: 53% of horizontal movements and 41% of vertical movements showed less than 0.2 mm variation. When predictive tracings were compared to postoperative results 44% of horizontal and 50% of vertical movements showed less than 0.2 mm variation. There was no significant difference (P>0.05) between the planned and actual maxillary positions in the sample evaluated. This technique for maxillary repositioning during two-jaw surgery proved to be effective and predictable, with strong agreement between predictive tracings, model surgery and postoperative results.
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Affiliation(s)
- J N Gil
- Department of Oral and Maxillofacial Surgery, University Hospital, College of Dentistry, Santa Catarina Federal University, Florianópolis, SC, Brazil.
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