A Prospective Randomized Clinical Trial Comparing 3D and Standard Miniplates in Treatment of Mandibular Symphysis and Parasymphysis Fractures

Purpose

To compare the efficacy of the 3D miniplates to standard miniplates in the osteosynthesis of mandibular symphysis and parasymphysis fractures on the basis of clinical parameters and radiographic evaluation.

Patients and Methods

A prospective randomized clinical trial was conducted to treat consecutive mandibular symphysis and parasymphysis fractures. The patients were randomly divided into 2 groups. The patients underwent osteosynthesis in group A with 3D titanium miniplates and in group B with conventional titanium miniplates. The cause of trauma, the number of days from injury to surgery, average age and gender were all reviewed. The assessment of the patients was done at 1, 3, and 6 weeks and 3 months using the clinical parameters and radiographic evaluation.

Results

Eighty patients with isolated symphysis or parasymphysis fracture met the inclusion criteria. In our study, a statistically significant difference was not found in the clinical parameters such as pain, swelling, infection, paresthesia, hardware failure, and mobility between the fracture segments. Similarly Radiological evaluation did not show any statistically significant difference in reduction between the 2 groups. 3D plates are difficult to adapt and use sometimes, but operative time is less with them in treatment of symphysis and parasymphysis fractures.

Conclusion

The use of 3D miniplates for symphysis and parasymphysis fracture fixation was efficacious enough to bear the masticatory load during osteosynthesis of the fracture. Although 3D miniplate system is difficult to adapt and difficult to use in cases of fractures involving the mental nerve, they provide the advantage of less operative time and less implant material in treatment of symphysis and parasymphysis fracture, with clinical results almost similar to those seen with conventional miniplate osteosynthesis.     

Comparison Between Two Techniques for the Treatment of Mandibular Subcondylar Fractures: Closed Treatment Technique and Transoral Endoscopic-Assisted Open Reduction

Purpose

The endoscopic-assisted technique for the treatment of subcondylar fractures has been used successfully and its acceptance develops as more surgeons gain experience. We present the short term results of this technique in a randomized prospective clinical trial.

Methods and Materials

A total of 40 patients with mandibular subcondylar fracture were included in our study in two groups randomly. Patients of first group were treated by closed treatment technique and patients of second group by transoral endoscopic-assisted open reduction. All patients were followed for minimum of 12 weeks and occlusion, Mandibular Anterior Opening (MAO), mandibular deviation, and posterior ramal height were assessed.

Results

In the endoscopic group the MAO was significantly greater and mandibular deviation was lesser at 2nd and 4th week of follow up. Posterior ramal height showed significant increase in the endoscopic group rather than closed treatment group.

Conclusion

The transoral endoscopic-assisted technique is a reliable and successful technique to address subcondylar fractures. The patients who were treated by this technique showed better results in the fields of mandibular function and patient satisfaction and comfort, although it is time consuming and needs expensive instruments.     

Evaluation of Mechanical Resistance After Fixation of Mandibular Condylar Fracture with Single and Double Miniplates: A Comparative In Vitro Study

Objectives

1. To evaluate the efficacy of two plating system in comparison with single plating system
2. To study the biomechanical behaviour of single and two plating system when compression load is applied.

Materials and Methods

Twenty hemimandibles were divided into two groups A and B of ten each. A subcondylar fracture was created. Group A was stabilized by single adaptation plating technique and group B by double adaptation plating technique and both the groups were tested for stability by using universal testing machine.

Results

Higher mean displacement was observed in Group A compared to Group B, but the difference in mean displacement between the two groups was not statistically significant (p > 0.05). Higher mean load was recorded in group B compared to group A and the difference in mean load between them was found to be statistically significant (p < 0.001).

Conclusion

The present study demonstrated that double adaptation plating technique had greater resistance to compression load than single adaptation plating technique and it shows more favorable biomechanical behavior.     

髁突与生长板软骨发育早期组织学特征的比较研究

目的探讨髁突软骨与生长板软骨发育早期组织学特征上的异同,进一步了解髁突软骨的发育过程和生长特点,为临床上功能矫形的治疗提供理论依据。方法选用胚胎SD大鼠的髁突软骨与生长板软骨作为研究对象,建立发育早期的动物模型,对两种软骨进行组织切片染色观察,比较它们组织学特征上的异同。结果胎龄14~19 d,髁突软骨与生长板软骨的组织结构大体相似,但存在一定的差异。两种软骨分层不同,细胞形态不同,生长板增殖层和前肥大层软骨细胞更为扁平;细胞排列不同,生长板软骨细胞平行于长骨呈柱状排列,髁突软骨细胞分层排列,无细胞柱;另外,生长板软骨中肥大软骨细胞的出现较髁突软骨早。结论发育早期,髁突软骨与生长板软骨组织结构大体相似,但在软骨细胞分层、形态及排列方式方面存在一定差异。     

A Comparative Study of 3-Dimensional Titanium Versus 2-Dimensional Titanium Miniplates for Open Reduction and Fixation of Mandibular Parasymphysis Fracture

Introduction

Three dimensional titanium plating system was developed by Farmand in 1995 to meet the requirements of semi rigid fixation with lesser complication. The purpose of this in vivo prospective study was to evaluate and compare the clinical effectiveness of three dimensional and two dimensional Titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture.

Materials and Methods

Thirty patients with non-comminuted mandibular parasymphysis fractures were divided randomly into two equal groups and were treated with 2 mm 3D and 2D miniplate system respectively. All patients were systematically monitored at 1st, 2nd, 3rd, 6th week, 3rd and 6th month postoperatively. The outcome parameters recorded were severity of pain, infection, mobility, occlusion derangement, paresthesia and implant failure. The data so collected was analyzed using independent t test and Chi square test (α = .05).

Results

The results showed that one patient in each group had post-operative infection, occlusion derangement and mobility (p > .05). In Group A, one patient had paresthesia while in Group B, two patients had paresthesia (p > .05). None of the patients in both the groups had implant failure. There was no statistically significant difference between 3D and 2D miniplate system in all the recorded parameters at all the follow-ups (p > .05).

Conclusion

3D miniplates were found to be better than 2D miniplates in terms of cost, ease of surgery and operative time. However, 3D miniplates were unfavorable for cases where fracture line was oblique and in close proximity to mental foramen, where they were difficult to adapt and more chances for tooth-root damage and inadvertent injury to the mental nerve due to traction.

     

Orthopaedic Protraction of the Maxilla with Miniplates: Treatment of Midface Deficiency

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, resulting in an anterior crossbite and a concave profile. Early class III malocclusion treatment with reverse pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavourable dentoalveolar effects. Titanium miniplates used as temporary anchorage device might permit equivalent favourable skeletal changes without unwanted dentoalveolar effects. We report two cases having class III malocclusion with maxillary deficiency treated by using titanium miniplates. Cephalometric tracings were done pre and post treatment to determine the anatomic changes during the course of treatment.     

Mandibular coronoid fractures: Treatment options

Fractures of the coronoid process are uncommon and can easily be missed. The purpose of this study was to classify the fracture patterns and explore the treatment options. This retrospective study included 39 patients with fractures of the mandibular coronoid process. Treatment protocols were developed based on the time of fracture, degree of mouth opening, location of the coronoid fracture, types of fracture, and other concomitant fractures. All patients were followed up for 12–60 months. Sixteen patients underwent conservative management and four of these patients developed progressive trismus, which improved significantly after removal of the coronoid process. Twenty-three patients underwent open reduction and internal fixation (ORIF) via the modified retromandibular approach. Follow-up data showed significant improvement in maximum mouth opening and symptoms (diet and pain) compared to their preoperative status. In summary, conservative management is first recommended for fractures of the coronoid process with minimal displacement or restriction of mouth opening. For patients with significant fracture displacement and limited mouth opening, or with concomitant fractures of the zygoma, zygomatic arch, or mandibular ramus, ORIF via the modified retromandibular approach through the anterior border of the parotid gland is an alternative treatment method.     

手术辅助微波治疗下颌骨肿瘤的初步报道

目的 评价微波与手术结合治疗下颌骨肿瘤及保存下颌骨功能的疗效。方法 选择下颌骨恶性肿瘤及易复发性肿瘤患者7例，按肿瘤手术原则切除肿瘤，保留部分下颌骨。再以铜网保护周围组织，对病变下颌骨进行微波照射。结果 治疗后，面部形态、功能恢复良好。术后并发症少，除1例感染外，伤口均一期愈合。术后随访21/2a病变均未复发。结论 对下颌骨恶性肿瘤或易复发性肿瘤，手术辅以微波照射可迅速、有效杀灭残存细胞，为预防肿瘤治疗后复发，保存面部形态与功能，提供了一种有效的辅助手段。