ABSTRACT
RESUMEN: El objetivo de este artículo es presentar un caso clínico con la utilización de un innovador sistema de osteosíntesis basado en la mezcla de hidroxiapatita (HA) y acido poliláctico (PLLA). La paciente fue admitida en el Hospital Abraham González Peña de Lautaro (Chile) debido a una deformidad facial que exigió realizar una cirugía ortognática monomaxilar para avance y aumento transversal del maxilar; se utilizaron placas de tipo L y tornillos de HA/PLLA de 5 mm para la fijación maxilar, realizando la cirugía sin complicaciones; el proceso técnico y alta hospitalaria se ejecutó de forma convencional. Se realizó un análisis de la literatura donde se analiza la versatilidad, la seguridad y la estabilidad de segmentos cuando se utiliza este innovador material y se concluye que este tipo de osteosíntesis es aplicable a cirugía maxilofacial, exigiendo una curva de aprendizaje por parte del cirujano, necesaria para obtener resultados adecuados.
ABSTRACT: The aim of this paper is to show a clinical case, where was used an innovative osteosynthesys system based on the mixture of hidroxiapatite (HA) and polilactic acid (PLLA). The patient was admitted into Abraham González Peña Hospital (Chile), showing a facial deformity to treat with monomaxillary orthognathic surgery for advance and transversal increase of the maxilla.; were used type L plates and 5 mm screws of HA/PLLA for the internal fixation, performing the surgery without complications; the technical process and the ALTA hospital was realized in a conventional strategy. Was realized a literature review showing the versatility, safe and stability of bone segment when used this innovative material and it´s concluded that this osteosynthesis system can be used normally in maxillofacial surgery; a learning curve to learn about this material is needed by surgeons.
Subject(s)
Humans , Female , Osteotomy, Le Fort , Absorbable Implants , Maxilla/surgery , Bone Regeneration/physiology , Chile , DurapatiteABSTRACT
PURPOSE: Absorbable bone fixation materials for operation of facial bone fracture are composed of poly- lactic acid(PLA) & poly-glycolic acid(PGA). These materials are absorbed after facial bone healing period. Therefore, these materials are harmless in human body. But because of it's radioopacity, the number and the location of the materials are not checked in follow-up X-ray examination. We studied absorbable bone fixation materials checked radiological examination. So, we made the absorbable plate composed of PLA, Hydroxyapatite (HA) and Gold(Au). METHODS: Plate 1 was consisted of pure PLA. Plate 2 was consisted of PLA(50%) and HA(50%). Plate 3-7 were consisted of PLA(50%), and variable composition of HA & Au. The ratio of Au was as following. From the plate 3 to plate 7, the Au ratio was 1%, 5%, 10%, 17%, and 25%, respectively. Total 3 examinations were used -naked eye examination, simple X-ray examination, and Haunsfield unit of plate in CT examination. RESULTS: Naked eye examination found out that the color of plate 1 was most white. As the Au ratio increases, the color of plate was getting close to khaki color. the radioopacity of plate 2 was similar cortical bone of face in simple X-ray. The Haunsfield unit of cortical bone of face was 1000 HU. Haunsfield unit of titanium plate was 2900 HU. Haunsfield unit of plate 1 through plate 7 were -242, 1489, 1776, 3052, 3092, 3095, and 3095, respectively. CONCLUSION: Radioopacity of plate 2 was similar to cortical bone of face. In CT examination, Hanusfield unit of plate 2 was similar to Hanusfield unit of cortical bone of face. Hanusfield unit of plate 4-7 were similar to Hanusfield unit of titanium plate. So to trace bone fixation materials after facial bone surgery, the best ratio of Au is about 1-5%. If this study is applied to facial bone surgery, radiologic follow up would be easy after facial bone surgery.
Subject(s)
Humans , Durapatite , Eye , Facial Bones , Follow-Up Studies , Human Body , TitaniumABSTRACT
There are various surgical fixation techniques for fractures of the mandible angle due to traumatic facial injuries. Among those surgical treatment modalities, fixation methods using plates, screws, lag screws and wires have been commonly used. With the introduction of absorbable plates, the plate fixation technique has been popularized. However, plate fixation requires an external incision or an external approach using trochar for the direction of screw fixation to be perpendicular to the mandible. The external approach has disadvantages in that it leaves a scar and involves some risk to damage the marginal mandibular branch of the facial nerve. To overcome these disadvantages, the authors used a plate platform formation technique on the fractured mandible angle. The result was satisfactory with no complications. Plate platform formation technique, as performed by the authors, can be a new and simple surgical technique for stable fixation and with minimal postoperative complication by an internal approach to avoid an external scar and nerve injury.
Subject(s)
Cicatrix , Facial Injuries , Facial Nerve , Mandible , Postoperative ComplicationsABSTRACT
Rigid fixation techniques with absorbable plates and screws are recently utilized for the repair of craniofacial skeletal injuries or congenital anomalies. But no domestic literature are presented in treatments of mandible fracture. We present our early experience of absorbable plates and screws in fixation of mandible fracture. Eleven patients underwent fixation procedures for mandible fracture with absorbable plates and screws. Intraoperative stability was satisfactory in all cases. Significant problems, such as nonunion, malunion, delayed union and malocclusion from the use of absorbable plating system were not found, but there were two cases of localized inflammation. We also experienced advantages of absorbable plating system which are biodegradation, radiolucency and enough stability for reduction state. The use of absorbable plating system would eliminate potential effects on skeletal growth- restriction in child, problems associated with long- term palpability and visibility in X-ray, and cold sensitivity caused by traditional metal plating system. There are also several disadvantages of absorbable plates and screws. This plating system takes increased operative time and needs delicate technique relative to the traditional metal plating system. Nevertheless we concluded that absorbable plates and screws are good fixatives for mandibular fracture.