INTRODUCTION: The mandible is the second most common facial fracture due to its prominence and position. Continuous clinical and biomechanical studies implemented in order to improve the techniques and materials used, leading to reduction in the immobilization period and augmentation of rigid fixation. Computer assisted surgery technology, greatly plays an important role in designing the surgery, facilitating adaptation and fixation. OBJECTIVES: To evaluate clinical and radiographic outcomes of fixation of mandibular fractures using custom-made titanium mesh adapted on 3D model by virtual planning. MATERIALS AND METHODS: Fifteen patients with recent mandibular fracture were treated using custom-made titanium mesh on 3D model. Clinical follow up was conducted after 24-hours, one, four, six, twelve weeks and six months. In addition, a radiographic investigation was performed immediately postoperatively and after six months to estimate the mean bone density across the fracture line. RESULTS: All cases showed normal lower lip sensation both preoperatively and postoperatively with no statistical significance, improved occlusal and intercuspal relation in addition to stabilized intrafragmentary mobility. A statistically significant decrease in intensity of pain was detected based on the Visual Analogue Scale (VAS). Two cases showed disturbed wound healing. The mean bone density after twelve weeks showed a statistically significant increase in its values when compared to the immediately postoperative values (p<0.001). CONCLUSIONS: The use of custom-made titanium mesh adapted on a 3D model resulted in a satisfactory outcome, in terms of achieving adequate reduction and fixation.
Background: The introduction of various open mesh and laparoscopic techniques has increased the interest in inguinal hernia surgery. But still controversy persists about the most effective inguinal hernia repair. The aim of this study was to compare the results of open Lichtenstein tension-free mesh technique and laparoscopic transabdominal preperitoneal (TAPP) repair for inguinal hernia.Methods: We considered 55 patients were enrolled between. Patients were divided into two groups, group A had open mesh repair and group B had laparoscopic TAPP repair of groin hernia. Time to full recovery and return to work, operative time, postoperative pain, hospital postoperative stay, complications and recurrence rate were recorded in both groups.Results: Significant difference was observed in the median time to return to normal activities in TAPP group versus in open approach. The mean hospital postoperative stay was 1-2 days in both groups. On follow up of our patients we found that in group A 3 patients had seroma, no haematoma discovered among our patients, 3 patients had wound infection, all previous complications were managed conservatively, in group B none of all 30 patients develop seroma, haematoma or infection. In group A 4 patients who were had bilateral hernia develop recurrence, while in group B we had no recurrence among the patients.Conclusions: Laparoscopic (TAPP) approach to inguinal hernia repair is considered safe and effective as excellent alternative to conventional surgery repair. It is associated with less postoperative pain, hospital postoperative stay, postoperative complications, and recurrence, earlier return to normal activities.
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