The Use of Microplates for Internal Fixation of Comminuted Mandibular Fractures

Abstract

Background Although clinical trials have successfully applied microplates for the internal fixation of single or double isolated mandibular fractures, the use of microplate systems in comminuted mandibular fractures is not widely accepted. This study aimed to evaluate the use of microplates for internal fixation of comminuted mandible fractures and to discuss their applicability. Methods Fourteen patients with comminuted mandibular fractures (10 at a single region, 3 at 2 regions, and 1 at 4 regions) were treated with open reduction and internal fixation using 0.5- or 0.6-mm-thick titanium microplates and 1.0-, 1.2-, or 1.3-mm monocortical microscrews. Three-level fixation at the lower border, upper border (as interdental wiring), and middle of the mandible was performed. Maxillomandibular fixation was applied only when premature occlusal contact was observed after fracture fixation. Results During the follow-up period (3–55 months), all fractures showed favorable and complete bone healing. Six patients experienced minor complications, including minimal malocclusion (n = 5) and a localized infection (n = 1). Most of these complications were managed with conservative treatment. No major complications that required further orthodontic treatment or reoperation occurred. Conclusions These results suggest that 3-level fixation using microplates is appropriate for the reconstruction of comminuted mandibular fractures without bony defects. The small size and malleability of these devices facilitate accurate anatomical reduction for complete contact of the comminuted bony segments by multiple fixation. Furthermore, microplates allow for preservation of sufficient periosteal blood supply and restoration of premorbid occlusion (by occlusal self-adjustment) while providing sufficient stability.

Three-Dimensional Finite Element Analysis on Mandibular Biomechanics Simulation under Normal and Traumatic Conditions

“…It was shown by Choi et al that the outer surface of the mandible must be divided into at least 30,000 finite elements to obtain an analysis with a high degree of precision [23]. While the number of elementary tetrahedra described by Gallas Torreira et al was 30,119 and only a few thousand by Tanaka et al the models created for this research comprised 231,353 such elements, resulting in significant discrepancies in values for the sizes desired [14,42].…”

“…Two different zones of the jaw should be defined on a biomechanical simulation of mandibular fractures: the elastic deformation zone and the plastic zone. The bone fracture movements are also influenced by the occlusal contacts, muscle insertions, and characteristics of the impact [22][23][24].…”

OCCS Classification and Treatment Algorithm for Comminuted Mandibular Fractures Based on 109 Patients and 11 Years Experiences: A Retrospective Study

“…CMFs mainly result from high-energy impacts, directly or indirectly, to a localized area of the mandible [ 13 , 14 ] and may lead to a series of unfavorable consequences, such as airway obstruction, malocclusion, mouth-opening limitation, infection or bone nonunion, and secondary dento-maxillofacial deformities [ 2 ]. The treatment methods include MMF, external fixation [ 6 ], ORIF with micropletes [ 15 ], mini-plates, reconstruction plates [ 16 ] or titanium mesh [ 7 ]. ORIF with load-bearing reconstruction plates is advocated by AO/ASIF and is regarded as the first place internationally for the treatment of CMFs.…”

Le Fort I İlerletme Osteotomisi Sonrası Farklı Fiksasyon Sistemlerinin Biyomekanik Olarak Karşılaştırması: İn Vitro Çalışma

“…Also, to our knowledge no in vitro study has been conducted to explore the stability of microplate systems which have been reported to be a reliable modality used for internal fixation in cranio-maxillofacial region, after Le Fort I osteotomy. 9,13,20,33 Thus we planned an in vitro study to explore an effective fixation pattern that could provide adequate stability and overcome the shortcomings of the conventional system. To achieve this goal we tested 5 different fixation patterns on 3D polyurethane skull models to simulate clinical conditions of maxillary advancement and loading.…”