Fixation of Mandibular Fracture with Bioabsorbable Self-reinforced Poly(L/DL)-lactide(70/30%) Plate and Screw

Metal fixation device, titanium miniplate is commonly used in facial bone fixation. But metal fixation device requires secondary removal procedure because of such complications as bony atrophy, metallic corrosion, low carcinogenic risk, growth disturbance of craniofacial skeleton, and endocranial migration of device which may lead to pediatric craniofacial surgery. Bioabsorbable plates lose strength retention after a given period of time unlike metalic plates, are degraded and absorbed completely in human body. Because they yield no metalic complications nor risks, and require no secondary removal, their use has been recently increased in fixation of facial bone. Self-inforced(SR)-poly(L/DL) lactide(70/30%) plate is applied for the fixation of midfacial bone in adult. But its weak strength brings concern about the skeletal stability, and makes surgeons hesitate its application to mandibular fractures. SR-poly(L/DL) lactide are rarely used especially in mandibular fractures. The authors used Biosorb FX 2.0 plate in 58 patients of mandibular fractures by open reduction and internal fixation. The duration of intermaxillary fixation was 7 days in 12 patients of multiple fractures. Follow-up period was 4 to 16 months(mean; 12 months). Complications included 2 cases with malocclusion, 6 cases with sensory disturbance and no infection was reported. The malocclusion was solved by minimal occlusal grinding, and sensory disturbance was temporary. The authors applied bicortical fixation of two plate system(thickness 1.2mm) with long screws or large diameter screws to mandibular fractures and obtained sufficient skeletal stability. The risk of tissue reaction associated with possible postimplantative crystallization of SR-poly(L/DL) lactide(70/ 30%) could be reduced. They report their experiences with review of literature.

Mandibular Angle Reduction By Selective Extraoral Approach

For the aeshetic contouring of prominent mandibular angle, conventional resection of mandible angle through intraoral approach has been used commonly. And the sagittal resection of lateral cortex is being performed recently to reduce the lower width of square face in some cases. That is to say, the prominent mandibular angle is meant by not only posteroinferior projection as well as lateral bulging. But intraoral approach corrects the former more efficiently than the latter because of limited operation field. And sometimes, the conventional resection of the mandibular angle yields obtuse, unnatural angle. Still more, postoperative complications such as bleeding, swelling, pain are inescapable. Through extraoral approach, authors were simultaneously able to accomplish precise, sufficient resection of angle and sufficient burring of lateral cortical bone without difficulty and complication. With the incision along relaxed skin tension line and meticulous everted sutures, scars are acceptable. One patient needed scar revision afterward. And so it is reported with review of literatures.