• Archives of Craniofacial Surgery
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• v.21 no.5
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• pp.301-304
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• 2020

Orthognathic surgeries often utilize rigid fixation for stabilization of the osteotomy site. The longterm fate of rigid fixations is still under investigation, and whether they should be routinely removed is under debate despite their low complication rates. Here, we report a case where a 26-year-old man suffered high-velocity trauma to his face 7 years after a two-jaw surgery. Computed tomography examination revealed a zygomaticomaxillary complex fracture, and open reduction and internal fixation was performed along with anterior maxillary wall reconstruction using absorbable mesh. Intraoperative examination revealed a broken L-shaped titanium plate near the fracture site with multiple bony fragments near each titanium screw. The rigid titanium system may have caused comminution of the fracture pattern, worsening the severity of the fracture.

• Archives of Craniofacial Surgery
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• v.16 no.2
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• pp.96-98
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• 2015

Maxillomandibular fractures usually require intermaxillary fixation as a means to immobilize and stabilize the fracture and to re-establish proper occlusion. Arch bars or intermaxillary fixation screws cannot be used for edentulous patients or for patients who have poor dental health. Here, we present a case of repeated intermaxillary fixation failure in a patient weak alveolar rigidity secondary to multiple dental implants. Because single-point fixation screws were not strong enough to maintain proper occlusion, we have used Y-shaped plates to provide more rigid anchoring points for the intermaxillary wires. We suggest that this method should be considered for patients in whom conventional fixation methods are inappropriate or have failed.

• Archives of Craniofacial Surgery
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• v.15 no.2
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• pp.53-58
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• 2014

Background: Maxillomandibular fixation (MMF) is usually used to treat double mandibular fractures. However, advancements in reduction and fixation techniques may allow recovery of the premorbid dental arch and occlusion without the use of MMF. We investigated whether anatomical reduction and microplate fixation without MMF could provide secure immobilization and correct occlusion in double mandibular fractures. Methods: Thirty-four patients with double mandibular fractures were treated with open reduction and internal fixation without MMF. Both fracture sites were surgically treated. For bony fixations, we used microplates with or without wire. After reduction, each fracture site was fixed at two or three points to maintain anatomical alignment of the mandible. Interdental wiring was used to reduce the fracture at the superior border and to enhance stability for 6 weeks. Mouth opening was permitted immediately. Results: No major complications were observed, including infection, plate exposure, non-union, or significant malocclusion. Five patients experienced minor complications, among whom the only one patient experienced a persistant but mild malocclusion with no need for additional management. Conclusion: This study showed that double mandibular fractures correction with two-or three-point fixation without MMF simplified the surgical procedure, increased patient comfort, and reduced complications, due to good stability and excellent adaptation.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.12-16
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• 2011

Purpose: This study examined the biomechanical stability of four different plating techniques in the experimental model of mandibular subcondyle fracture. Methods: Twenty standardized bovine tibia bone samples ($7{\times}1.5{\times}1.0cm$) were used for this study. Each of the four sets of tibia bone was cut to mimic a perpendicular subcondyle fracture in the center area. The osteotomized tibia bone was fixed using one of four different fixation groups (A,B,C,D). The fixation systems included single 2.0 mm 4 hole mini adaption plate (A), single 2.0 mm 4 hole dynamic compression miniplate (B), double fixation with 2.0 mm 4 hole mini adaption plate (C), double fixation with a 2.0 mm 4 hole mini adaption plate and 2.0 mm 4 hole dynamic compression miniplate (D). A bending force was applied to the experimental model using a pressure machine (858 table top system, $MTS^{(R)}$) until failure occurred. The load for permanent deformation, maximum load of failure were measured in the load displacement curve with the chart recorder. Results: Double fixation with a 2.0 mm 4 hole mini adaption plate and a 2.0 mm 4 hole dynamic compression miniplate (D) applied to the anterior and posterior regions of the subcondyle experimental model showed the highest load to failure. Conclusion: From this study, double fixation with an adaption plate and dynamic compression miniplate fixation technique produced the greatest biomechanical stability. This technique may be considered a useful means of fixation to reduce the postoperative internal maxillary fixation period and achieve early mobility of the jaw.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.301-308
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• 2012

In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.

• Archives of Craniofacial Surgery
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• v.23 no.1
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• pp.23-28
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• 2022

Background: Intermaxillary fixation (IMF) is a technique that allows for the reduction and stabilization of mandibular fractures. Several methods of IMF, such as self-tapping screws or arch bars, have been developed. This study aimed to validate the usefulness of IMF with a self-tapping screw compared to IMF with arch bars with focus on the patients' perspective. Methods: We retrospectively reviewed the medical records of all patients who were treated for mandibular fractures at our hospital between August 2014 and February 2021. A total of 57 patients were enrolled in this study. Thirteen patients were excluded from the analysis: three patients were lost to follow-up, and 10 patients did not undergo IMF. Finally, 44 patients were analyzed, of which 31 belonged to the arch bar group, and 13 belonged to the screw group. Patient discomfort and pain during IMF application and removal were analyzed using a patient self-assessment questionnaire. The surgeon also assessed oral hygiene, IMF stability, and occlusion. Results: We applied IMF to 34 men (77%) and 10 women (23%). The mean age of the patients was 37.3 years. The most common fracture site was the angle (30%), followed by the parasymphysis (25%), the body (23%), the condyle (11%), and the ramus (11%). Patient discomfort and oral hygiene were statistically favorable in the screw group. The IMF application time was statistically shorter in the screw group (p< 0.001). IMF stability was not statistically different between the two groups. The pain score during IMF removal was lower in the screw group (p< 0.001). Conclusion: Compared to arch bars, IMF screws provide more comfort during the IMF period, help maintain favorable oral hygiene, and have a shorter application time. From the patient's perspective, IMF screws are an excellent alternative to conventional arch bars when applicable.

• The Journal of Advanced Prosthodontics
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• v.7 no.3
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• pp.264-270
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• 2015

This report describes the case of an edentulous patient with an atrophic maxilla and severe class III malocclusion. Prosthetic rehabilitation was performed using CAD/CAM techniques for manufacturing an implant-supported overdenture with horizontal insertion. A vestibulo-lingual insertion overdenture is a precision prosthesis with a fixation system affording a good fit between the primary and secondary structure. Both structures exhibit passive horizontal adjustment. This treatment option requires the same number of implants as implant-supported fixed dentures. The horizontal assembly system prevents the prosthesis from loosening or moving in response to axial and non-axial forces. The technique was used to rehabilitate a patient presenting an atrophic upper maxilla, with the insertion of 8 implants. No complications were reported at follow-up 3, 6 and 12 months after fitting of the prosthesis. This system offers solutions to the clinical and laboratory complications associated with hybrid prostheses, concealing emergence of the chimneys and improving implant-prosthesis hygiene.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.2
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• pp.77-82
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• 2017

Objectives: The aim of this study was to compare the mechanical resistance of four different osteosyntheses modeled in two different sagittal split ramus osteotomy (SSRO) designs and to determine the linear loading in a universal testing machine. Materials and Methods: An in vitro experiment was conducted with 40 polyurethane hemimandibles. The samples were divided into two groups based on osteotomy design; Group I, right angles between osteotomies and Group II, no right angles between osteotomies. In each group, the hemimandibles were distributed into four subgroups according to the osteosynthesis method, using one 4-hole 2.0 mm conventional or locking plate, with or without one bicortical screw with a length of 12.0 mm (hybrid technique). Each subgroup contained five samples and was subjected to a linear loading test in a universal testing machine. Results: The peak load and peak displacement were compared for statistical significance using PASW Statistics 18.0 (IBM Co., USA). In general, there was no difference between the peak load and peak displacement related to osteotomy design. However, when the subgroups were compared, the osteotomy without right angles offered higher mechanical resistance when one conventional or locking 2.0 mm plate was used. One locking plate with one bicortical screw showed higher mechanical resistance ($162.72{\pm}42.55N$), and these results were statistically significantly compared to one conventional plate with monocortical screws (P=0.016) and one locking plate with monocortical screws (P=0.012). The difference in peak displacement was not statistically significant based on osteotomy design or internal fixation system configuration. Conclusion: The placement of one bicortical screw in the distal region promoted better stabilization of SSRO. The osteotomy design did not influence the mechanical behavior of SSRO when the hybrid technique was applied.