RESUMO
We aimed to compare in vivo the stability of fixation of condylar fractures in sheep using sonic bone welding and standard titanium screws. We assessed stability of the osteosynthesis and maintenance of the height of the mandibular ramus. Height decreased slightly in both groups compared with the opposite side. The volume of the condyle increased considerably in both groups mainly because callus had formed. The results showed no significant disadvantages for pin fixation compared with osteosynthesis using titanium screws.
Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis , Pinos Ortopédicos , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Titânio , Animais , Antraquinonas , Materiais Biocompatíveis/química , Calo Ósseo/patologia , Cefalometria/métodos , Doxiciclina , Fluoresceínas , Corantes Fluorescentes , Consolidação da Fratura/fisiologia , Imageamento Tridimensional/métodos , Mandíbula/patologia , Côndilo Mandibular/patologia , Côndilo Mandibular/cirurgia , Fenóis , Polidioxanona/química , Distribuição Aleatória , Ovinos , Sulfóxidos , Titânio/química , Tomografia Computadorizada por Raios X/métodosRESUMO
Two groups of titanium dental implants, identical in geometry but different in the treatment of their surfaces, were tested in an in vivo minipig model of the mandible. The surfaces that were tested were, first, sandblasted and acid-etched; and secondly, sandblasted, acid-etched, and conditioned. The removal torque was assessed at 2, 4, and 8 weeks after implantation (n=6 animals in each healing period). The interfacial stiffness was also evaluated. All dental implants were well-integrated at the time of death. Removal torque values increased significantly over the course of 8 weeks. Removal torque and interfacial stiffness were increased for conditioned surfaces after 2 weeks, but there were no significant differences between the two surfaces. The sandblasted and acid-etched implants are the standard, and conditioning of the surface showed a tendency to increase early peri-implant formation of bone.
Assuntos
Implantes Dentários , Materiais Dentários/química , Hidróxidos/química , Titânio/química , Condicionamento Ácido do Dente/métodos , Animais , Fenômenos Biomecânicos , Corrosão Dentária/métodos , Implantação Dentária Endóssea/métodos , Planejamento de Prótese Dentária , Análise do Estresse Dentário/instrumentação , Módulo de Elasticidade , Mandíbula/cirurgia , Teste de Materiais , Osseointegração/fisiologia , Osteogênese/fisiologia , Rotação , Propriedades de Superfície , Suínos , Porco Miniatura , Fatores de Tempo , TorqueRESUMO
We evaluated the osteosynthesis of condylar fractures using resorbable mini plates and ultrasound-aided insertion of pins clinically and histologically. Stability was greater than that with resorbable screws because of the fusion of pin and plate. Long term evaluation showed complete resorption of the polymeric osteosynthesis material.
Assuntos
Implantes Absorvíveis , Pinos Ortopédicos , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Ultrassom , Animais , Materiais Biocompatíveis/química , Matriz Óssea/patologia , Remodelação Óssea/fisiologia , Parafusos Ósseos , Calo Ósseo/patologia , Consolidação da Fratura/fisiologia , Côndilo Mandibular/patologia , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/patologia , Osteoblastos/patologia , Osteócitos/patologia , Poliésteres/química , Ovinos , Fatores de Tempo , Titânio/químicaRESUMO
We describe the use of a resorbable mesh fixed by ultrasound-activated pins, and report the satisfactory outcome in the first 5 patients treated.
Assuntos
Implantes Absorvíveis , Fixação Interna de Fraturas/métodos , Fixadores Internos , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Telas Cirúrgicas , Fixação Interna de Fraturas/instrumentação , Humanos , Côndilo Mandibular/cirurgiaRESUMO
To assess the stability of osteosynthesis in diacapitular condylar fractures we compared fixation using ultrasound-aided resorbable pins with poly-(D,L)-lactide (SonicWeld® Rx, KLS Martin, Tuttlingen, Germany) with that of titanium screws in 20 pig mandibles, 10 in each group. Isolated diacapitular fractures were created using a surgical chisel. Ten fractures were each repositioned and fixed by two pins (17 and 11 mm long, 2.1mm in diameter), and 10 fractures were fixed by two titanium screws of equal length, 2.0mm in diameter. Shear tests were done immediately after treatment to measure the maximum force to disrupt the fixation. Fixation with pins resisted mean shear forces of 310N until the pins fractured, whereas fixation with titanium screws failed at 918N when the screws pulled out of the bone. Long-term stability and resorption of pins will have to be analysed in an in vivo study.
Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis , Pinos Ortopédicos , Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Poliésteres , Animais , Materiais Biocompatíveis/química , Fenômenos Biomecânicos , Parafusos Ósseos , Falha de Equipamento , Teste de Materiais , Osteotomia/métodos , Poliésteres/química , Resistência ao Cisalhamento , Estresse Mecânico , Suínos , Titânio/química , Resultado do Tratamento , UltrassomRESUMO
Data regarding the use of prophylactic antibiotics and infection rate following surgery for fractures of the zygomatic bone is scarce. Therefore an audit of the use and outcomes of antibiotic prophylaxis for surgery of fractures of the zygoma was undertaken. Following audit approval, four maxillofacial surgery units in the Yorkshire Region gathered prospective data for 134 patients undergoing surgery for fractures of the zygoma. Data was collected on four groups of patients undergoing surgery for fractures of the zygomatic bone: uncomplicated reductions of the zygomatic arch, reductions of the zygomatic complex without mini-plate fixation, reductions of the zygomatic complex using mini-plate fixation but excluding zygomatico-maxillary buttress, and fixation of the zygomatic complex with miniplates including the zygomatico-maxillary buttress. The choice and timing of any antibiotics given peri-operatively was recorded, and 30 days after the operation, the patients' notes were reviewed to identify any episodes of surgical site infection (SSI) requiring the prescription of antibiotics, or any instances of plate removal in the post-operative period. This data has demonstrated that the prescription of antibiotic prophylaxis for surgery for fractures of the zygomatic bone is extremely variable, and that the infection rate is low.
Assuntos
Antibioticoprofilaxia/estatística & dados numéricos , Fixação Interna de Fraturas/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Fraturas Zigomáticas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
A 41-year-old gentleman underwent surgical repair of the fractured right parasymphisis and left condyle of his mandible. Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapia's syndrome was made.
Assuntos
Dispneia/etiologia , Rouquidão/etiologia , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Doenças da Língua/etiologia , Adulto , Seguimentos , Humanos , Doenças do Nervo Hipoglosso/etiologia , Masculino , Côndilo Mandibular/cirurgia , Paralisia/etiologia , Síndrome , Paralisia das Pregas Vocais/etiologiaRESUMO
The aim of this study on the mandibles of minipigs was to compare the biomechanical stability of different methods of osteosynthesis that are used in the operative treatment of fractures of the base of the condyle. Ten different systems of osteosynthesis were used to fix 164 fractures, which were tested by a two-point bending test after repositioning and fixing. This stress test was applied in four directions: lateral to medial, anterior to distal, distal to anterior, and medial to lateral. The Eckelt lag screw, one or two 2.0mm miniplates, one miniplate with bar (KLS Martin), minicompression plates (Medicon), zygoma compression plates (Medartis), condylus fracture plates (Medartis), square 4-hole plates (KLS Martin), and either one or two resorbable 4-hole miniplates (Resorb-X, Martin) were used for osteosynthesis. A total of 164 tests were done using a universal test machine that measured forces until the osteosynthesis failed. Advantages in mechanical load capacity were also measured for the Eckelt lag screw when force was applied from medial to lateral. Fixation with one resorbable miniplate was not functionally stable. Irrespective of the direction of force applied, two miniplates were the most stable technique. There were pronounced differences depending on the direction of force applied. The results suggest that treatment with a single resorbable miniplate is not functionally stable.
Assuntos
Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Procedimentos Cirúrgicos Bucais/instrumentação , Animais , Placas Ósseas , Parafusos Ósseos , Força Compressiva , Análise do Estresse Dentário , Côndilo Mandibular/cirurgia , Suínos , Porco Miniatura , Resistência à TraçãoRESUMO
OBJECTIVES: The aim of this study was to determine the compound strength of the fixation between 2 blocks of synthetic bone using ultrasound activated resorbable pins (regarding drill hole diameter) and compare them to fixation with titanium miniscrews. Resorbable pins were up to 17 mm long. STUDY DESIGN: Two synthetic bone blocks (Sawbone) were fixed by either a resorbable pin or miniscrew osteosynthesis. Maximum tensile forces were determined mechanically. Pin lengths of 7 mm, 11 mm, and 17 mm were analyzed in relation to different drill hole diameters. RESULTS: The ideal drill hole configuration was a combination of diameters of 2.1/1.6 mm (in a lag screw configuration). Mean maximum tensile force was 80 N for 7 mm pins (105 N/11 mm, 69 N/17 mm). In comparison, tensile forces of titanium screws were 20 N (7 mm), 97 N (11 mm), and 135 N (17 mm). CONCLUSIONS: Osteosynthesis by resorbable pins reached equal compound strength levels compared with titanium miniscrews. This in vitro study was the basis for a clinical trial of ultrasound-guided resorbable pin osteosynthesis.
Assuntos
Implantes Absorvíveis , Pinos Ortopédicos , Fixação Interna de Fraturas/instrumentação , Ultrassom , Fenômenos Biomecânicos , Parafusos Ósseos , Substitutos Ósseos , Análise do Estresse Dentário , Fraturas Ósseas/cirurgia , Poliuretanos , Estatísticas não Paramétricas , Resistência à TraçãoRESUMO
We describe a new design of resorbable plate for use in the treatment of fractures of the condylar neck, and report the outcome of initial treatment in two patients.
Assuntos
Fixação Interna de Fraturas/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Procedimentos Cirúrgicos Bucais/instrumentação , Implantes Absorvíveis , Placas Ósseas , Desenho de Equipamento , Humanos , Côndilo Mandibular/cirurgia , MiniaturizaçãoRESUMO
Management of mandibular condylar fractures remains a source of ongoing controversy. While some condylar fractures can be managed non-surgically, recognition of fracture patterns that require surgical intervention and selection of an appropriate operative procedure are paramount to success in treating these injuries.The objective of this review is to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.
Assuntos
Fixação Interna de Fraturas/métodos , Côndilo Mandibular/lesões , Fraturas Mandibulares/classificação , Fraturas Mandibulares/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Fraturas Cominutivas/cirurgia , Humanos , Côndilo Mandibular/cirurgia , Articulação Temporomandibular/lesões , Articulação Temporomandibular/cirurgiaRESUMO
INTRODUCTION: A prospective study of postoperative oral and perineal pain experienced by a group of patients undergoing buccal mucosal graft harvest for urethral reconstruction. PATIENTS AND METHODS: A consecutive group of 24 male patients undergoing buccal mucosa graft harvest for urethral reconstruction of stricture disease was prospectively studied between June 2006 and December 2008. All patients were examined pre-operatively and entered into the study prospectively. After surgery, all patients were reviewed at 24 h and 48 h. On both occasions, they were asked to complete a proforma containing visual analogue pain scales for both the oral donor site as well as the perineum. RESULTS: A statistically significant higher level of pain was experienced from the perineum than the oral donor site on both the first and second postoperative days. CONCLUSIONS: Comparative analysis of visual analogue pain scale scores between oral donor site and perineum showed that patients experience significantly more pain from the latter postoperatively.
Assuntos
Mucosa Bucal/transplante , Dor Pós-Operatória/etiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Humanos , Masculino , Boca , Medição da Dor , Períneo , Estudos ProspectivosRESUMO
PURPOSE: This randomized, clinical multicenter trial investigated the treatment outcomes of displaced condylar fractures, and whether radiographic fracture level was a prognostic factor in therapeutic decision-making between open reduction and internal fixation (ORIF) versus closed reduction and mandibulomaxillary fixation (CRMMF). PATIENTS AND METHODS: Sixty-six patients with 79 displaced fractures (deviation of 10 degrees to 45 degrees, or shortening of the ascending ramus >or=2 mm) of the condylar process of the mandible at 7 clinical centers were enrolled. Patients were randomly allocated to CRMMF (n = 30 patients) or ORIF (n = 36 patients) treatment. The following parameters were measured 6 months after the trauma. Clinical parameters included mouth opening, protrusion, and laterotrusion. Radiographic parameters included level of the fracture, deviation of the fragment, and shortening of the ascending ramus. Subjective parameters included pain (according to a visual analogue scale), discomfort, and subjective functional impairment with a mandibular functional impairment questionnaire. RESULTS: The difference in average mouth opening was 12 mm (P
Assuntos
Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Técnicas de Fixação da Arcada Osseodentária/instrumentação , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Tomada de Decisões , Fixação Interna de Fraturas/instrumentação , Humanos , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/patologia , Dor Pós-Operatória , Estudos Prospectivos , Amplitude de Movimento Articular , Articulação Temporomandibular/lesões , Resultado do TratamentoRESUMO
We describe the fixation of bilateral comminuted diacapitular fractures of the mandibular condyle with ultrasound activated resorbable pins (KLS Martin SonicWeld Rx) by an open approach with primary fixation of the fractures using the resorbable osteosynthesis pins.