Una miniplaca de titanio en comparación a dos miniplacas de titanio para fracturas de ángulo mandibular favorables y aisladas / One miniplate or two mini plates in the fixation of favorable and isolated mandibular angle fractures

RESUMEN: Introducción: Las fracturas mandibulares producen serias comorbilidades, alteraciones en la función, calidad de vida entre otros. Existen distintas alternativas quirúrgicas en las fracturas favorables de ángulo mandibular, siendo las más utilizadas las técnicas de estabilización mediante miniplacas de titanio. No existe consenso sobre si es más efectivo y seguro utilizar una o dos miniplacas de titanio. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 7 revisiones sistemáticas que en conjunto incluyeron 17 estudios primarios, de los cuales 3 son ensayos aleatorizados. Concluimos que el tratamiento de estabilización mediante una miniplaca de titanio probablemente disminuye el riesgo de paresia facial. Por otro lado, el uso de una miniplaca podría aumentar el riesgo de dehiscencia de la herida quirúrgica, disminuir el riesgo de reintervención quirúrgica y podría resultar en poca o nula diferencia en el riesgo de maloclusión, pero la certeza de la evidencia es baja. No está claro si el uso de una en comparación con dos miniplacas de titanio reduce el riesgo de infección y parestesia ya que la certeza de la evidencia disponible es muy baja.

ABSTRACT: Introduction: Mandibular fractures produce severe comorbidities, functional alterations, changes in the quality of life, among others. There are different surgical alternatives for favorable mandibular angle fractures; the most used is the stabilization techniques using titanium miniplates. There is no consensus on which it is more effective and safe; use one or two titanium miniplates. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified seven systematic reviews that included 17 primary studies, in which three were randomized trials. We conclude that stabilization treatment with a titanium miniplate probably reduces the risk of facial paresis. On the other hand, the use of a miniplate could increase the risk of dehiscence of the surgical wound, decrease the risk of reoperation, and could result in little or no difference in the risk of malocclusion, but the certainty of the evidence is low. It is not clear whether the use of one compared to two titanium miniplates reduces the risk of infection and paresthesia since the certainty of the available evidence is very low.

Clinical efficacy of miniplates anchorage between the maxilla and the mandible for maxillary hypoplasia in cleft patients / 中华医学美学美容杂志

Objective To investigate the effects of titanium miniplates used for anchorage between the maxilla and the mandible for maxilly hypoplasia in cleft patients.Methods Miniplates were inserted into the infrazygomatic crests and between the canine and lateral incisor in the mandible on both the right and left sides in 6 subjects (mean age,11.3 years).Maxillomandibular elastics were attached between the upper and lower miniplates on each side.Cephalometric radiographs of each patient were evaluated at the beginning of treatment and at the end of active protraction treatment.Results A-point movement was increased mean 3.67 mm,SNA angle and ANB angle were increased by 2.75° and 3.1° respectively.Wit's appraisal was increased by 4.52 mm,and upper lip to E-plane was decreased mean 2.8 mm in a mean of 15 months and the significant difference was found (P＜0.05).Miniplates stability was excellent in all patients throughout treatment.Conclusions Remarkable advancement in the middle face and consequent fullness in the soft-tissue profile can be achieved by using titanium miniplates protraction for maxilly hypoplasia in cleft patients in the late mixed-dentition and initial stage of permanent dentition period.

Surgical Technique and Long-term Follow-up of Cervical Laminoplasty using Titanium Miniplates

OBJECTIVE: The authors report a simple and reliable method for cervical open-door laminoplasty secured by titanium miniplate. METHODS: Sixteen patients with cervical myelopathy secondary to multilevel cervical spondylosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty using titanium miniplates to stabilize the posterior elements described by O'Brien et al between February 1998 and June 2002, and all had a minimum of 6 months of follow-up(mean 22.5months) review. Plain radiographs were used to measure sagittal canal diameter and monitor construct integrity. The neurological outcome was evaluated before and after operation using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. RESULTS: Only 1 titanium miniplate construct was failed out of 69 levels in 16 patients during follow-up period, but decompression was maintained. After surgery, in 15 patients(93.7%) different levels of clinical improvement were demonstrated, and in four of them(25%) full recovery was observed. The sagittal canal diameter and JOA score increased from 13.3+/-2.2mm and 9.19 preoperatively to 20+/-2.4mm and 12.88 postoperatively(p<0.01). CONCLUSION: The use of titanium miniplate to stabilize the posterior elements after laminoplasty is a simple, durable, and effective technique to maintain the increased sagittal canal diameter of the spinal canal and have another advantage of compatability of magnetic resonance imaging.

Outcome of the Expansive Open-door Laminoplasty with Titanium Miniplate in Cervical Stenosis

OBJECTIVE: The purpose of this study is to introduce a simple yet effective technique to secure the posterior elements in the open position after expansive open-door laminoplasty and to evaluate factors contributing to surgical results after laminoplasty. METHODS: Twenty two myelopathic or radiculopathic patients with multilevel cervical canal stenosis or ossification of the posterior longitudinal ligament were treated with an expansive open-door laminoplasty. Thirteen patients were cervical spinal stenosis and the other 9 patients were diagnosed as the ossification of the posterior longitudinal ligament. The posterior elements were stabilized in the open position with titanium miniplates without spacers. Morphometric analysis was performed on preoperative and postoperative plain radiographs to obtain spinal canal dimensions and to monitor construct integrity. RESULTS: The mean preoperative sagittal canal diameter was 10.3+/-2.2mm. These dimensions increased to 17.4+/-2.8mm after surgery. Most patients improved from the myelopathy or the radiculopathy and the mean recovery rate was 52.4+/-17.1%. The titanium miniplate constructs did not fail during the follow-up period (mean, 38.5 months) and the decompression was maintained. Serious complications such as instability and kyphosis did not develop in any cases. There were no significant factors that predict surgical outcome. CONCLUSION: Expansive open-door laminoplasty using titanium miniplates can be easily performed and is effective technique for decompression and maintenance of the spinal canal diameter.

Cervical Laminoplasty Using Titanium Miniplate

The expansive open-door laminoplasty is an effective, simple and reliable method in decompression of posterior spinal elements, but this technique also has some pitfalls such as progressive narrowing of the opened spinal canal and collapse of the laminae leadin to deterioration of clinical status. To prevent these complications, the author as performed open-door laminoplasty using titanium miniplate in eight patients of multiple cervical canal stenosis with myelopathy and/or myeloradiculopathy. The clinical outcomes were evaluated according to the Japanese Orthopaedic Association(JOA) score and the postoperative sagittal diameter of the cervical spinal canal on plain radiography were measured. The clinical outcomes were excellent in 25.5% and good n 50.0% on 3 months after the operation and the average postoperative sagittal diameters of the spinal canal were 18.3mm(43% larger than preoperative diameters) 1 month after the operation and 18.1mm(42% larger than preoperative diameters) 3months after operation. Despite limited cases and short follow-up periods, the open-door laminoplasty using titanium miniplate is thought to be simple, durable and effective technique for maintaining increased sagittal diameter of the spinal canal. The titanium plates are easy to apply, and have advantage of the magnetic resonance imaging compatibility in the postoperative examination.

Cervical Laminoplasty Using Titanium Miniplate

The expansive open-door laminoplasty is an effective, simple and reliable method in decompression of posterior spinal elements, but this technique also has some pitfalls such as progressive narrowing of the opened spinal canal and collapse of the laminae leadin to deterioration of clinical status. To prevent these complications, the author as performed open-door laminoplasty using titanium miniplate in eight patients of multiple cervical canal stenosis with myelopathy and/or myeloradiculopathy. The clinical outcomes were evaluated according to the Japanese Orthopaedic Association(JOA) score and the postoperative sagittal diameter of the cervical spinal canal on plain radiography were measured. The clinical outcomes were excellent in 25.5% and good n 50.0% on 3 months after the operation and the average postoperative sagittal diameters of the spinal canal were 18.3mm(43% larger than preoperative diameters) 1 month after the operation and 18.1mm(42% larger than preoperative diameters) 3months after operation. Despite limited cases and short follow-up periods, the open-door laminoplasty using titanium miniplate is thought to be simple, durable and effective technique for maintaining increased sagittal diameter of the spinal canal. The titanium plates are easy to apply, and have advantage of the magnetic resonance imaging compatibility in the postoperative examination.