COMPUTER-ASSISTED SURGERY IN MANAGEMENT OF MANDIBULAR FRACTURE USING A CUSTOM-MADE TITANIUM MESH TRAY

Abstract

Introduction: The mandible is the second most common facial fracture due to its prominence and position. Continuous clinical and biomechanical studies implemented in order to improve the techniques and materials used, leading to reduction in the immobilization period and augmentation of rigid fixation. Computer assisted surgery technology, greatly plays an important role in designing the surgery, facilitating adaptation and fixation. Objectives: To evaluate clinical and radiographic outcomes of fixation of mandibular fractures using custom-made titanium mesh adapted on 3D model by virtual planning. Materials and methods: Fifteen patients with recent mandibular fracture were treated using custom-made titanium mesh on 3D model. Clinical follow up was conducted after 24-hours, one, four, six, twelve weeks and six months. In addition, a radiographic investigation was performed immediately postoperatively and after six months to estimate the mean bone density across the fracture line. Results:All cases showed normal lower lip sensation both preoperatively and postoperatively with no statistical significance, improved occlusal and intercuspal relation in addition to stabilized intrafragmentary mobility. A statistically significant decrease in intensity of pain was detected based on the Visual Analogue Scale (VAS). Two cases showed disturbed wound healing. The mean bone density after twelve weeks showed a statistically significant increase in its values when compared to the immediately postoperative values (p < 0.001). Conclusions: The use of custom-made titanium mesh adapted on a 3D model resulted in a satisfactory outcome, in terms of achieving adequate reduction and fixation.