Efficacy and safety of biodegradable osteofixation devices in oral and maxillofacial surgery: a systematic review.

J Dent Res. 2006 Nov;85(11):980-9

Authors: Buijs GJ, Stegenga B, Bos RR

The use of osteofixation devices should be evidence-based if uncomplicated bone healing is to be achieved. Numerous studies describe and claim the advantages of biodegradable over titanium devices as a bone fixation method. Here, we systematically review the available literature to determine the clinical efficacy and safety of biodegradable devices compared with titanium devices in oral and maxillofacial surgery. In addition, related general aspects of bone surgery are discussed. We conducted a highly sensitive search in the databases of MEDLINE (1966-2005), EMBASE (1989-2005), and CENTRAL (1800-2005) to identify eligible studies. Eligible studies were independently evaluated by two assessors using a quality assessment scale. The study selection procedure revealed four methodologically 'acceptable' articles. Owing to the different outcome measures used in the studies, it was impossible to perform a meta-analysis. Therefore, the major effects regarding the stability and morbidity of fracture fixation using titanium and biodegradable fixation systems were qualitatively described. Any firm conclusions regarding the fixation of traumatically fractured bone segments cannot be drawn, due to the lack of controlled clinical trials. Regarding the fixation of bone segments in orthognathic surgery, only a few controlled clinical studies are available. There does not appear to be a significant short-term difference between titanium and biodegradable fixation systems regarding stability and morbidity. However, definite conclusions, especially with respect to the long-term performance of biodegradable fixation devices used in maxillofacial surgery, cannot be drawn.

PMID: 17062736 [PubMed - indexed for MEDLINE]

Dentoalveolar and mandibular body fractures caused by a horse kick: report of a case.

J Contemp Dent Pract. 2006 May 1;7(2):137-44

Authors: Martins WD, Fávaro DM, Ribas Mde O, Martins G

A rare case of multiple mandibular fractures and severe facial laceration is presented. The cause was a horse hoof kick to an unmounted equestrian. The pertinent literature is reviewed and the maxillofacial injuries associated with animal interaction are discussed.

PMID: 16685305 [PubMed - indexed for MEDLINE]

Mandibular mechanics following osteotomy and appliance placement II: Bone strain on the body and condylar neck.

J Oral Maxillofac Surg. 2006 Apr;64(4):620-7

Authors: Rafferty KL, Sun Z, Egbert MA, Baird EE, Herring SW

PURPOSE: The purpose of this investigation was to determine if the mechanical environment of the mandible is changed by osteotomy and fixation, as assessed by the measurement of bone strain on the condylar neck and mandibular corpus. MATERIALS AND METHODS: Immediately following unilateral mandibular osteotomy and distractor placement, strain gauges were attached directly to the corpus and condylar neck in a sample of domestic pigs. Bone strains were recorded during mastication and muscle stimulation. Comparisons of principal strain magnitudes and orientations were made between sides and between the osteotomy sample and a control database. RESULTS: The animals preferred to chew on the non-osteotomy side. Corpus strains were higher for osteotomy-side chewing but were comparable to the control database, regardless of chewing side. For the condyle, compared with the control database and the non-osteotomy side, the osteotomy side was underloaded in compression. Furthermore, the orientation of compressive strain was highly variable and more horizontally oriented than that of control and non-osteotomy condyles. Stimulation of the masseter and medial pterygoid loaded the mandible to normal levels. CONCLUSION: Masticatory behavior was altered, probably as a combined result of disruption of the occlusion, changes in muscle recruitment, and probable loss of sensory feedback. However, neither these changes nor damage to the muscles explain the decrease and reorientation of compressive strain on the condylar neck. Alternatively, the modified strain pattern could have arisen from positional instability of the proximal bone fragment.

PMID: 16546641 [PubMed - indexed for MEDLINE]

Mandibular mechanics after osteotomy and distraction appliance placement I: Postoperative mobility of the osteotomy site.

J Oral Maxillofac Surg. 2006 Apr;64(4):610-9

Authors: Sun Z, Rafferty KL, Egbert MA, Herring SW

PURPOSE: Fixation at the osteotomy site for mandibular distraction osteogenesis (DO) is probably not rigid, especially during mastication. Micromotion may affect the course of DO. This study aimed to measure the mobility of the fresh distractor-fixed osteotomy site in response to mastication and masticatory muscle stimulation. MATERIALS AND METHODS: Twenty-eight domestic pigs, 6 to 8 weeks old, underwent osteotomy of the right mandible and placement of a distractor appliance. Immediately after surgery, displacement at 3 different locations (superior-lateral, inferior-lateral, and inferior-medial) of the osteotomy site was assessed using ultrasound piezoelectric crystals or differential variable reluctance transducers (DVRTs). The amount of lengthening or shortening at each location was measured during mastication and muscle stimulation. Displacement was also measured for bilateral osteotomy during muscle stimulation from a subgroup of 12 pigs. RESULTS: The osteotomy site demonstrated significant mobility during power strokes of mastication with an average magnitude of 0.3 to 0.4 mm. Distinct patterns of displacement were associated with different locations, and the patterns varied between chewing sides. The most common pattern was lengthening at the superior-lateral and shortening at both inferior sites. Similar amounts of displacement were observed during the stimulation of jaw-closers (masseter and medial pterygoid), but the patterns produced by these muscles did not completely explain the masticatory pattern. Opening the osteotomy to 1.5 mm did not alter the displacements observed during muscle stimulation. Bilateral osteotomy tended to decrease displacement. CONCLUSIONS: The study demonstrates that during mastication and masticatory muscle stimulation, an acute mandibular osteotomy site is mobile despite fixation by a distractor appliance.

PMID: 16546640 [PubMed - indexed for MEDLINE]

Mandibular fracture reduction without intraoperative intermaxillary fixation: a technique using two modified reduction forceps.

J Contemp Dent Pract. 2006 Feb 15;7(1):150-6

Authors: Shinohara EH, Mitsuda ST, Miyagusko JM, Horikawa FK

This case report demonstrates a technique that is useful for precompressing mandibular fractures and obtaining anatomical reduction of the fracture edges without the use of peroperative intermaxillary fixation (IMF) in a mandibular fracture by using two modified reduction forceps. The first forcep is positioned at the inferior mandibular border and the other in the neutral zone where it is an ideal location to place a fixation plate in mandibular fractures. This technique is indicated for the anatomic reduction in mandibular fractures of the partial dentate patient.

PMID: 16491158 [PubMed - indexed for MEDLINE]

Fracture of the alveolar process in a 2-year-old child: a report of an unconventional immobilization.

J Contemp Dent Pract. 2005 Aug 15;6(3):134-8

Authors: Martins WD, Fávaro DM

This is a report of fracture of the maxillary anterior segment of the alveolar process of an energetic 2-year-old child. The fracture was reduced under general anesthesia, and the fractured segment was immobilized using only 2-0 chromic gut in order to avoid a second surgical episode to remove traditional fixation after healing. The patient was followed for one year and healed well with no evidence of the lack of vitality of the involved teeth.

PMID: 16127482 [PubMed - indexed for MEDLINE]

Frey's syndrome after condylar fracture: case report.

Braz Dent J. 2004;15(2):159-62

Authors: Sverzut CE, Trivellato AE, Serra EC, Ferraz EP, Sverzut AT

Frey's syndrome is the occurrence of hyperesthesia, flushing and warmth or sweating over the distribution of the auriculotemporal nerve and/or greater auricular nerve while eating foods that produce a strong salivary stimulus. Frey's syndrome is also known as auriculotemporal syndrome and gustatory sweating. We present a case of Frey's syndrome after a condylar fracture and its treatment by internal rigid fixation. A review of the literature is provided along with mention of a simple test (Minor's test) that can help in the diagnosis of this syndrome.

PMID: 15776201 [PubMed - indexed for MEDLINE]

[Study on the changes of TMJ stress before and after sagittal split ramus osteotomy by 3D finite element method]

Shanghai Kou Qiang Yi Xue. 2004 Feb;13(1):51-5

Authors: Fang B, Zhou Q, Shen GF, Cai Z

PURPOSE: To investigate the characteristic changes of the TMJ stress distributions, before and after SSRO for treating the skeletal class III malocclusion, being during centric occlusion. METHODS: CT scan was used to obtain 2-D transverse image of maxilla and mandible. Finite element models were established before and after SSRO. An analysis of the stress, strain, and displacement of TMJ configurations was done by three-finite element method. Paired t test was used to compare the stress before and after operation. RESULTS: The Von Mises stress on TMJ configurations was found to decrease significantly after mandibular set-back SSRO; The maximal and minimal principal stress and maximal displacement were also found to decrease after surgery; The stress of both sides of the TMJ was found to distribute symmetrically. CONCLUSION: Oral and maxillofacial deformity was treated by orthognathics surgery, jaws were repositional that induce the changes of the TMJ stress, the upper and lower further study should be done to determine the stress changes effecting the function and health of TMJ.

PMID: 15007483 [PubMed - indexed for MEDLINE]

Moulding of the generate to control open bite during mandibular distraction osteogenesis.

Eur J Orthod. 2002 Dec;24(6):639-45

Authors: Peltomäki T, Grayson BH, Vendittelli BL, Katzen T, McCarthy JG

Distraction osteogenesis of the craniofacial skeleton has become a widely accepted, safe, and effective means of craniofacial reconstructive surgery. Despite excellent results in general, there are still some uncertainties related to the procedure, such as development of an anterior open bite (AOB) during mandibular distraction. The aim of this study was to examine whether 'moulding of the generate', i.e. use of intermaxillary elastics during the active distraction phase is possible to close the mandibular plane angle and open bite. Three subjects, 13- and 15-year-old males and a 7-year-old female, underwent mandibular linear and angular bilateral distraction osteogenesis with moulding of the generate. Lateral cephalograms were obtained before the introduction of elastics and following distraction, once the activation was stopped and the patients were ready for the consolidation phase. Conventional cephalometric measurements were used to assess possible changes in the mandibular plane angle and incisor position. Three different anchorage systems (dental, orthopaedic, and skeletal) were used for placement of the intermaxillary elastics. Cephalometric examination showed that the mandibular plane angle was decreased during active distraction osteogenesis with the introduction of elastics and angulation of the distraction device. Depending on the type of elastic anchorage system, smaller or greater amounts of extrusion of the incisors were noted. Moulding of the generate during active distraction can be performed to reduce the mandibular plane angle and open bite. To prevent unwanted dentoalveolar changes from occurring during elastic traction, skeletal rather than dental fixation of the elastics is recommended. Intrusive mechanics may be incorporated into the orthodontic appliances to balance extrusive force by the moulding elastics.

PMID: 12512781 [PubMed - indexed for MEDLINE]

Post-operative stability of the maxilla treated with Le Fort I and horseshoe osteotomies in bimaxillary surgery.

Eur J Orthod. 2002 Oct;24(5):471-6

Authors: Harada K, Sumida E, Enomoto S, Omura K

In this study, the post-operative change of the maxilla in six non-cleft patients who underwent combination (Le Fort I and horseshoe) osteotomy for superior repositioning of the maxilla was investigated. In all patients, the maxilla was first osteotomized and fixed with four Luhr plates. No iliac bone graft was applied to the maxilla. A bilateral sagittal split ramus osteotomy of the mandible (BSSRO) was then carried out and titanium screw fixation was performed. No maxillo-mandibular fixation (MMF) with stainless steel wire was used post-operatively in any patient. Lateral cephalograms were obtained pre-operatively, 5 days post-operatively, and 3, 6, and 12 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisor (U1), and point of maxillary tuberosity (PMT) were examined. The maxillae in the six subjects were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and horseshoe osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy is comparatively stable.

PMID: 12407942 [PubMed - indexed for MEDLINE]

Effects of intermaxillary fixation during orthognathic surgery on respiratory function after general anesthesia.

Anesth Prog. 2001;48(4):125-9

Authors: Yamaguchi H

I examined the relationship between preoperative breathing route (nasal and/or oral) and respiratory status in 29 patients who underwent orthognathic surgery and intermaxillary fixation (IMF) with general anesthesia and in 14 healthy, adult control volunteers who received IMF without surgery or anesthesia. The tidal volume (VT), minute respiratory volume (MV), respiratory rate, and end-tidal carbon dioxide concentration were measured for both nasal and oral breathing before and after IMF. Pulse oximetry recordings were also taken. There was no significant effect of IMF on any parameter in the volunteers. Fifteen patients engaged in nasal breathing only both before and after surgery with IMF (group pN), and 7 patients had combined nasal and oral breathing before but only nasal breathing after IMF (group pNO). VT and MV decreased (536-357 mL and 7.84-5.40 L, respectively) in group pNO after IMF. These results suggest that assessment of the preoperative breathing status is helpful in predicting postoperative respiratory function after IMF and indicate that patients with preoperative mouth breathing require greater respiratory care after general anesthesia with IMF.

PMID: 11724220 [PubMed - indexed for MEDLINE]

Skeletal and dento-alveolar stability after surgical-orthodontic treatment of anterior open bite: a retrospective study.

Eur J Orthod. 2001 Oct;23(5):547-57

Authors: Swinnen K, Politis C, Willems G, De Bruyne I, Fieuws S, Heidbuchel K, van Erum R, Verdonck A, Carels C

The aim of this investigation was to assess skeletal and dento-alveolar stability after surgical-orthodontic correction of skeletal anterior open bite treated by maxillary intrusion (group A) versus extrusion (group B). The cephalometric records of 49 adult anterior open bite patients (group A: n = 38, group B: n = 11), treated by the same maxillofacial surgeon, were examined at different timepoints, i.e. at the start of the orthodontic treatment (T1), before surgery (T2), immediately after surgery (T3), early post-operatively (+/- 20 weeks, T4) and one year post-operatively (T5). A bimaxillary operation was performed in 31 of the patients in group A and in six in group B. Rigid internal fixation was standard. If maxillary expansion was necessary, surgically assisted rapid palatal expansion (SRPE) was performed at least 9 months before the Le Fort I osteotomy. Forty-five patients received combined surgical and orthodontic treatment. The surgical open bite reduction (A, mean 3.9 mm; B, mean 7.7 mm) and the increase of overbite (A, mean 2.4 mm; B, mean 2.7 mm), remained stable one year post-operatively. SNA (T2-T3), showed a high tendency for relapse. The clockwise rotation of the palatal plane (1.7 degrees; T2-T3), relapsed completely within the first post-operative year. Anterior facial height reduction (A, mean -5.5 mm; B, mean -0.8 mm) occurred at the time of surgery. It can be concluded that open bite patients, treated by posterior Le Fort I impaction as well as with anterior extrusion, with or without an additional bilateral sagittal split osteotomy (BSSO), one year post-surgery, exhibit relatively good clinical dental and skeletal stability.

PMID: 11668874 [PubMed - indexed for MEDLINE]

Open bite: stability after bimaxillary surgery--2-year treatment outcomes in 58 patients.

Eur J Orthod. 2000 Dec;22(6):711-8

Authors: Fischer K, von Konow L, Brattström V

Stability after bimaxillary surgery to correct open bite malocclusion and mandibular retrognathism was evaluated on lateral cephalograms before surgery, 8 weeks post-operatively, and after 2 years. The 58 consecutive patients were treated to a normal occlusion and good facial aesthetics. Treatment included the orthodontic alignment of teeth by maxillary and mandibular fixed appliances, Le Fort I osteotomy, and bilateral sagittal split ramus osteotomy. Twenty-six patients also had a genioplasty. Intra-osseous wires or bicortical screws were used for fixation. Twenty-three patients had maxillo-mandibular fixation (MMF) for 8 weeks or more, six for 4-7 weeks, 14 for 1-3 weeks, and 15 had no fixation. At follow-up 2 years later, the maxilla remained unchanged and the mandible had rotated on average 1.4 degrees posteriorly. Seventeen patients had an open bite. Among them, eight patients had undergone segmental osteotomies. The relapse was mainly due to incisor proclination. The most stabile overbite was found in the group with no MMF after surgery.

PMID: 11212606 [PubMed - indexed for MEDLINE]

Resorbable implants (plates and screws) in orthognathic surgery.

J Orthod. 2000 Jun;27(2):198-9

Authors: Mohamed-Hashem IK, Mitchell DA

PMID: 10867078 [PubMed - indexed for MEDLINE]

Cortical bone screws for maxillomandibular fixation in orthognathic surgery.

Br J Orthod. 1999 Dec;26(4):325

Authors: Thota LG, Mitchell DA

PMID: 10592161 [PubMed - indexed for MEDLINE]

Multi-bracket appliance in management of mandibular reconstruction with vascularized bone graft.

Jpn J Clin Oncol. 1999 Mar;29(3):119-26

Authors: Takushima A, Susami T, Nakatsuka T, Harii K, Takato T

BACKGROUND: The most commonly used tool for maxillo-mandibular fixation to the patient who underwent reconstruction using a vascularized bone graft after mandibular resection is a dental arch-bar. However, the occlusal relationship achieved by this method is not ideal. Different from the dental arch-bar, the multi-bracket appliance which is frequently used in orthodontic treatment can control the position of each individual tooth three dimensionally. Thus, this appliance was applied for maxillo-mandibular fixation to patients who underwent mandibular reconstruction using a vascularized bone graft. METHODS: A multi-bracket appliance was applied to three patients. Prior to the surgery, standard edgewise brackets were bonded to the teeth in the maxilla and in the remaining mandible. After mandibular resection, wires for maxillo-mandibular fixation were applied. The harvested bone was then carefully fixed with miniplates to maintain the occlusion. The multi-bracket appliance was worn for 3 months when the wound contraction became mild. RESULTS: All three cases demonstrated stable and good occlusion. They also demonstrated satisfactory post-surgical facial appearance. CONCLUSIONS: Compared to conventional dental arch-bars, a multi-bracket appliance offers improved management of mandibular reconstruction. Firstly, its properties are helpful in maintaining occlusion of the remaining dentition accurately in bone grafting procedure as well as protecting against postsurgical wound contraction. Secondly, the multi-bracket appliance keeps the oral cavity clean without periodontal injury. As a result, stable occlusion of the residual teeth and good facial appearance were obtained.

PMID: 10225693 [PubMed - indexed for MEDLINE]

Comparing prospective and retrospective evaluations of temporomandibular disorders after orthognathic surgery.

J Am Dent Assoc. 1997 Jul;128(7):999-1003

Authors: Scott BA, Clark GM, Hatch JP, van Sickels J, Rugh JD

The authors conducted a study to document agreement between prospective examinations performed by trained clinical trial examiners and retrospective surgical chart reviews in identifying signs and symptoms of temporomandibular disorders, or TMD. Only a small fraction of the signs and symptoms identified by clinical trial examiners were documented in the surgical charts. Studies relying on retrospective chart reviews may seriously underestimate signs and symptoms of TMD.

PMID: 9231604 [PubMed - indexed for MEDLINE]