Duration Of Intermaxillary Fixation Research Articles

THE USE OF FIXING DEVICES WITH SHAPE MEMORY EFFECT IN FRACTURES OF THE MANDIBLE

The study was devoted to the evaluation of the effectiveness of the osteosynthesis using titanium nickelide clamps with shape memory in angular fractures of the mandible. Clinical and radiological examination was done in 70 patients. The volume of surgery included open reduction and rigid internal fixation of the bony fragments. The choice of fixing devices, their number was based on the pattern of bone damage and configuration of the fracture line. In early postoperative period, the dynamics of restoration of the function of the lower jaw, duration of intermaxillary fixation, as well as general time of hospitalization were evaluated. In the long-term period, control checkups were performed with mandatory x-ray imaging of the mandible. According to the data obtained during examination of the local status and radiographic data, the correct position of bone fragments and fixation structures in all operated patients were noted. There were no symptoms of infection, malocclusion or nonunion. Thus, the use of a personified approach in the selection of fixation devices in patients with fractures of the lower jaw allowed to improve the quality of surgical treatment, as well as to shorten timeframe of the rehabilitation.

MAXILLOMANDIBULAR FIXATION USING ORTHODONTIC MINI-IMPLANTS IN MANAGEMENT OF MANDIBULAR FRACTURES

INTRODUCTION: 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, to overcome the cumbersome procedure of tooth borne appliances, miniimplants have been introduced into clinical practice. OBJECTIVES: To evaluate the effectiveness of using mini-implants for IMF for the treatment of mandibular fractures. MATERIALS AND METHODS: This clinical trial was performed on ten patients with mandibular fractures. The diagnosis, duration of IMF, miniimplants site, bite force recovery, bone density around the fracture line and any associated complications were recorded. Clinical and radiographic follow-up examinations were performed immediately, 3 and 6 months post-operatively until fracture healing was complete. CONCLUSIONS: The use of mini-implants for IMF has shown to be a useful and safe modality to establish maxillo-mandibular fixation following mandibular fractures.

Prevalence of Surgical Site Infections Following Orthognathic Surgery: A Double-Blind, Randomized Controlled Trial on a 3-Day Versus 1-Day Postoperative Antibiotic Regimen

The purpose of this study was to determine the effect of a 3- versus 1-day antibiotic regimen on the rate of surgical site infection (SSI) in patients undergoing orthognathic surgery at a department of oral and maxillofacial surgery in Halifax, Nova Scotia, Canada. A prospective, randomized controlled trial was conducted. All patients received 1day of intravenous antibiotics after surgery. Then, patients were randomly distributed into groups that received 2days of additional antibiotics (group A) or placebo (group B). The primary outcome measured was the presence of SSI. The operating surgeon, concomitant extraction of teeth, surgical procedures performed, duration of intermaxillary fixation, and length of hospital stay were analyzed for an effect on SSI. Patients were followed for 1year after surgery to identify SSIs that might have been diagnosed outside the hospital. The trial started with 288 patients, and 117 patients were lost to follow-up. Statistical analyses were ultimately performed on those 171 patients who were adherent to the study medication regimen. Group A (n= 86) and B (n= 85) SSI rates were 7.0 and 17.6% (number needed to treat= 10; P= .04), respectively. Mandibular bilateral sagittal split osteotomy (BSSO) was involved in 71% of SSIs. Intra- and postoperative surgical variables did not have a relevant effect on the SSI rate. Patients were followed for 1year after surgery, and group A (n= 46) and group B (n= 44) had SSI rates of 4 and 25% (P < .05), respectively. Three days of postoperative cefazolin and cephalexin markedly decreases SSI rates compared with 1day. However, the number needed to treat of 10 suggests that the benefits of the extended regimen might not outweigh the risks. The high prevalence of SSIs at the mandibular BSSO incisions might have been caused by contamination, with more saliva and reception of a lower blood supply, than maxillary Le Fort I incisions. Mandibular osteotomies could benefit from an extended antibiotic regimen to minimize SSIs and associated complications. Other surgical variables might not require special consideration for antibiotic therapy.

A multi-centre retrospective study of mandibular fractures: do occlusal support and the mandibular third molar affect mandibular angle and condylar fractures?

This retrospective study was performed to investigate the influence of occlusal support and the presence, state, and position of mandibular third molars on the incidence of mandibular angle and condylar fractures. The following variables were investigated: age, sex, cause of fracture, presence and state (impaction, angulation, and the number of roots) of the mandibular third molars, site of the mandibular fracture, presence of occlusal support, duration of intermaxillary fixation, and postoperative complications. Various risk factors for mandibular angle and condylar fractures were investigated by univariate analysis. The risk of mandibular angle fracture was significantly higher in patients with occlusal support and mandibular third molars. The risk of condylar fracture was significantly higher in patients without occlusal support or mandibular third molars. The position and angulation of the mandibular third molars were not significant risk factors in mandibular angle and condylar fractures. This study demonstrated the influence of occlusal support and the presence of mandibular third molars on the incidence of mandibular angle and condylar fractures. The presence of occlusal support may be a more important factor affecting mandibular angle or condylar fractures than the position of the mandibular third molars.

Effectiveness of 2.0 mm Standard and 2.0 mm Locking Miniplates in Management of Mandibular Fractures: A Clinical Comparative Study

To compare and evaluate the effectiveness of 2.0mm locking miniplates versus 2.0mm standard miniplates in treatment of mandible fractures. Sixty randomly selected patients who sustained mandibular fractures were selected for this study. The fractured fragments were stabilized using 2.0mm locking miniplates in 30 cases and in the remaining 30 cases the fractured fragments were fixed with conventional 2.0mm miniplates. Post-operative stability was assessed with radiographs at 7thday, 1st, and 3rdmonths. The stability of the reduced fracture was assessed clinically and both the types of plates were assessed with an OPG or conventional radiographs. This study shows favorable results on use of locking miniplates in mandibular fractures. The results show that there were no significant differences in the post-operative complications between the conventional and the locking plate/screw mandibular systems. The locking plate/screw system was more rigid than conventional plate/screw system, thereby reducing the need and duration of intermaxillary fixation (IMF).

Computer-assisted surgical planning and simulation for condylar reconstruction in patients with osteochondroma

We describe the use of computer-assisted three-dimensional surgical planning in condylar reconstruction by vertical ramus osteotomy for patients with osteochondroma, and its clinical effects. Seventeen patients with osteochondroma of the mandibular condyle who were seen from March 2005 to March 2009 were divided into 2 groups treated by condylectomy and condylar reconstruction using vertical sliding osteotomy of the mandibular ramus with and without three-dimensional simulation using Surgicase CMF Materialise software. Clinical examination, radiographs, photographs, and details of operation and outcome were used postoperatively to evaluate the clinical effects of the technique. Satisfactory mouth opening was achieved in all cases. Mean (SD) osteotomy and fixation time, duration of intermaxillary fixation, and degree of postoperative numbness of the lower lip were considerably reduced among patients who had three-dimensional simulation. The combined use of computer-assisted three-dimensional surgical planning and simulation with vertical ramus osteotomy to reconstruct the condyle for patients with osteochondroma after excision of the tumour makes the operation more accurate and more convenient, and avoids damage to vital structures.

A comparison between 2.0-mm standard and 2.0-mm locking miniplates in the management of mandibular fractures

The purpose of this clinical study was to compare effectiveness of 2.0-mm locking miniplates and screws with 2.0-mm standard miniplates and screws in treating mandible fractures. A randomized prospective study comprising of 40 samples, where 20 patients (group 1) were treated with locking plates and 20 patients (group 2) were treated with standard miniplates. All the cases were evaluated for the type of fracture, need for the Intermaxillary Fixation (IMF) and its duration, duration of surgery, anatomic reduction, paresthesia / neurosensory changes, occlusal discrepancies, infection at the fracture site and any need for the removal of the plates and screws. In our study Road Traffic Accidents (RTA) accounted for the majority of patients 30 (70%). RTA was more prevalent (52.5%) in 21-30 age group, with assault being more common (67%) in 25-35 years. There was a significant difference between group 1 and 2 in postoperative occlusal discrepancy and need for IMF (p=0.008). There was no significant difference in complication rates between group 1 and group 2 patients. Locking plate/screw system proved to be more rigid than conventional plate/ screw system, thereby reducing the need and duration of IMF. However there was no significant difference in complication rates.

Application of Intermaxillary Fixation Screws in Maxillofacial Trauma

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. 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). 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). 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.

Randomized controlled clinical trial on internal fixation for fracture of mandible with super-high molecular weight PDLLA plates and screws

目的 评价国产超高分子量聚D,L乳酸(PDLLA)小夹板螺钉在下颌骨骨折内固定中的疗效.方法采用随机抽样的方法,将57例下颌骨单纯性线性骨折分为两组,分别行PDLLA小夹板螺钉内固定和小型钛板内固定.术后观察骨折段复位、咬合关系、咀嚼效能、伤口愈合及局部组织反应等情况.并采用B超观察PDLLA小夹板在患者体内的降解过程.结果PDLLA夹板组内固定术后骨折段的稳定性好,骨折愈合正常,咬合关系恢复良好,无一例出现无菌性炎症,与小型钛板组的疗效相似(P＞0.05).术后2个月咀嚼效能与小型钛板组差异无显著意义(P＞0.05).术后4个月在B超图像上观察到PDLLA夹板开始降解,术后6个月可见夹板断裂,术后1年夹板已基本吸收,仅剩少许残留.结论在下颌骨单纯性线性骨折治疗中,PDLLA小夹板螺钉是一种比小型钛板更理想的骨折内固定系统。

Experiences with intraoral trans-osseous wiring of mandibular fractures

Summary After a survey of our indications for the intra-oral approach for placing wires in treating mandibular fractures, our experience with 148 patients, treated with 178 wiring sites, is described. The total number of complications amounted to 7% of the wiring sites. A re-operation was necessary in 4 cases. Middle segment fractures and fractures in the edentulous mandible are especially difficult to treat. Overall, however, the results were good. With an uncomplicated course of healing, the duration of intermaxillary fixation may be reduced to 4 weeks with satisfactory results. Our results may be favourably compared with the results in patients treated with bone plates for fracture reduction.