External pin fixation for stabilization of the mandible—comeback of a method: historical review and first experiences with the ‘mandible external fixator’

Abstract

The market-release of a modified 'mandible external fixator' appliance prompted us to reconsider the issues of pin fixation. The first product line of the 'mandible external fixator set-Phase1' (Synthes Maxillofacial, Paoli, USA) contains the three classical basic components: percutaneous pins, clamps, and pre-bent connecting rods. The innovative features are a lightweight titanium construct and the snap-on design of the clamps. The framework is assembled by a single connecting bar (monofixator) in the so-called visor-style technique. The indication was restricted to: (1) pathological fractures, e.g., in infected osteoradionecrosis; (2) resectional defects; and (3) emergency care of mandible fractures in a multi-piece, heavy comminution, or defect pattern. The mandible external fixator was used in a series of ten patients (all male, 39-73 years), for head and neck tumor sequelae in eight cases (n = 5-curatively, n = 3-palliation) and in two polytrauma cases. All patients had benefited from the functional restitution of the mandibular continuity avoiding major surgical exposure and additional soft tissue damage. The application using a 'visor-style technique' was appropriate for bridging defects or single comminution zones (n = 9). In the emergency care of a polytraumatized patient with multifragmentation all over the mandible divisions, it did not contribute to an adequate realignment. In curative tumor treatment (patients n = 5), a conversion either to internal fixation (n = 2) or revascularized bone grafting (n = 3) ensued after prolonged intervals of 40-170 days. Pin track infections or loosening did not occur. The hallmark of external pin fixation is its atraumatic soft tissue management. Hence, it offers peculiar options in singular comminution or defect areas associated with bone pathology and/or soft tissue alterations.