PubMed · 2337566
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K R Postlethwaite. 1990. Small plate osteosynthesis.. https://doi.org/10.1016/0266-4356(90)90144-a
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Open reduction and rigid fixation with maxillomandibular fixation at least intraoperatively is the method of choice for treatment of mandibular fractures. We report an effective method of internal temporary fixation which significantly facilitates fracture reduction and stabilization. The technique is used in combination with special FAMI screws and a monocortical miniplates system according to Champy, which eliminates in most cases the need for maxillomandibular fixation. Our results in 78 patients with mandibular fractures confirmed the reliability and the efficiency of the internal temporary fixation.
PURPOSE: Reduction and plate osteosynthesis of condylar fractures often require a wide extraoral approach with the risk of aesthetic impairment and possible facial nerve palsy. To avoid complications, the purpose of this pilot study was to use an endoscopic device for the treatment of condylar fractures also allowing for endoscopically assisted plate application. PATIENTS AND METHODS: Seven condylar fractures were operated under endoscopic control. In three patients, a newly developed device for endoscopically controlled plate application was clinically tested. The new device and the application technique is described in detail. RESULTS: In two of three cases using this approach, fracture healing was achieved with the condyle in the anatomically correct position. In the third case the plate had to be removed early because of insufficient screw fixation. CONCLUSION: This technique may be helpful to further minimize surgical trauma in head and neck fracture treatment. The newly developed plate application device may also be used to approach other regions of the skull eg, the skull base, the zygoma, or the orbit.
We undertook a retrospective study of all isolated mandibular fractures which had required active management over a 1-year period at the Maxillofacial Unit at Newcastle General Hospital. Patients with single or multiple fractures of the mandible were included in the study, if there were other simultaneous fractures of the facial skeleton, those patients were excluded. All case notes and radiographs were reviewed by a single operator. A total of 202 cases of fractured mandible were identified of which 115 fulfilled the selection criteria of: isolated fracture, no previous facial fracture, treatment by open reduction and internal fixation using titanium osteosynthesis miniplates, and all case notes and radiographs available to study. Sixty-six patients had their fractures reduced manually to obtain anatomical reduction without the use of peroperative intermaxillary fixation (IMF). Forty-nine were treated conventionally using peroperative IMF. The two groups were broadly similar in severity and type of fracture, and the method of reduction seemed to be decided by the operator according to their preference. IMF was not used routinely postoperatively. Overall there were significantly fewer occlusal discrepancies in the early postoperative period in those patients treated by anatomical reduction (6/66 compared with 16/49, P = 0.002) but there was no difference in the final outcome of the occlusion between the two methods of reduction. Avoidance of the use of peroperative IMF is more economical in time and cost, is safer for the operator, and more comfortable for the patient. As this technique produces comparable results in the long term with fewer early complications, we conclude that IMF is not usually necessary to reduce fractures confined to the mandibular bone.