PubMed · 5150713
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J J Comtet, R Rozier, R Vassal, J M Arene, L Fischer. 1971. [Osteosynthesis by plate].. https://pubmed.ncbi.nlm.nih.gov/5150713/
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OBJECTIVES: To evaluate and to compare rates and timing of exposure of alloplastic mandibular plates by plate type and tissue reconstruction technique. DESIGN: A retrospective review series of 92 consecutive patients for 4 years (mean follow-up, 30 months). SETTING: National Cancer Institute-designated comprehensive cancer center in a freestanding cancer hospital. PATIENTS: Seventy-nine patients received alloplastic mandibular plates for segmental defects, and 13 patients received compression plates for mandibular osteotomies following ablative cancer surgery, including 21 titanium hollow osseointegrating reconstruction, 41 Storz, 16 Synthes, and 5 AO/ASIF (Arbeitsgemein schott fur Ostcosynthese fragen/Association for the Study of Internal Fixation) plates. Primary flap repair was provided by 71 pedicled soft tissue and 19 osseocutaneous free flaps, with primary closure in the remaining 2. INTERVENTION: Most of the reconstructions of the mandibular defect was with an alloplastic plate with musculocutaneous flap or revascularized bone graft. OUTCOME MEASURES: Clinically apparent intraoral or extraoral plate exposure. RESULTS: Plate exposure occurred in 25 cases. Nine plates were exposed extraorally, at a mean postoperative interval of 40 weeks. The remaining 16 plates were exposed intraorally at a mean postoperative interval of 16 weeks. There was no significant difference in the exposure rates of different plate types or methods of reconstruction. The titanium hollow osseointegrating reconstruction plate had a similar exposure rate compared with the other plates. Size and site of the defect were the only significant predictors of plate exposure Radiotherapy and postoperative complications did not affect the rate of exposure. CONCLUSIONS: Extraoral plate exposure occurs less commonly and later in the postoperative period than intraoral exposure, suggesting different causes. Plate type and type of flap reconstruction do not affect the rate of exposure. This may reflect long follow-up.
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STUDY DESIGN: The authors present the results of an anatomic study of the human occiput to delineate appropriate screw placement sites. OBJECTIVES: Occipital bone morphologic characteristics were evaluated to determine whether significant variability exists and to determine the position of greatest bone thickness for safe and effective internal fixation. SUMMARY OF BACKGROUND DATA: New instrumentation and techniques for occipital fixation are being developed in response to concerns about occipital bone variability. Thirty cadaveric occiputs were evaluated to determine if such variability exists and the location of greatest bone thickness. Radial thickness, occipital locations, and gender differences, were determined. METHODS: Twenty-six skulls were sectioned sagittally to determine the contributions of the inner, middle, and outer tables to overall occipital thickness. The angle required to gain maximal cortical purchase was determined. Mean values and variance were analyzed statistically to determine variability and thickness. Data was plotted in three dimensions. Variability in morphologic features was minimal. RESULTS: The internal occipital protuberance-external occipital protuberance was thickest at 17.55 mm (SD = 3.18 mm) and was consistently located on the superior nuchal line 43 degrees from the horizontal skull base line. Bone thickness decreased radially from the central internal occipital protuberance position. Bone thickness above the superior nuchal line exceeded that below by 2.74 mm (P < 0.05) vertically and at the oblique positions (P < 0.05). Bone to the right of the midline was only 1 mm thicker than that to the left. Gender differences were minimal. The inner table contributed only 10% to overall occipital thickness. As occipital thickness decreased, the optimal purchase angle increased. CONCLUSIONS: Unicortical purchase at and above the superior nuchal line is warranted with a low risk of intracranial venous penetration. Internal fixation devices developed in response to occipital bone variability should be considered with respect to occipital bone thickness distributions. Attention to cervical morphologic characteristics should result in higher success rates in occipitocervical arthrodesis.