COMPUTER-ASSISTED SURGERY IN MANAGEMENT OF MANDIBULAR FRACTURE USING A CUSTOM-MADE TITANIUM MESH TRAY | ||
| Alexandria Dental Journal | ||
| Article 8, Volume 45, Issue 3, December 2020, Pages 44-48 PDF (1.16 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/adjalexu.2020.82689 | ||
| Authors | ||
| Ahmed M. Helmy* 1; Nagy H. El Prince2; Riham M. Fliefel3 | ||
| 1Bachelor of Dental Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt | ||
| 2Professor of Oral and Maxillofacial Surgery Alexandria University, Alexandria, Egypt. | ||
| 3Lecturer at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt | ||
| Abstract | ||
| 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. | ||
| Keywords | ||
| Mandible; Fracture; Computer-assisted; Titanium mesh; 3D model | ||
| References | ||
|
1. Ghodke MH, Bhoyar SC, Shah SV. Prevalence of mandibular fractures reported at C.S.M.S.S Dental College, aurangabad from february 2008 to september 2009. J Int Soc Prev Community Dent. 2013;3:51-8.
2. Fasola A, Obiechina A, Arotiba J. Incidence and pattern of maxillofacial fractures in the elderly. Int J Oral Maxillofac Surg. 2003;32:206-8.
3. Singh S, Fry RR, Joshi A, Sharma G, Singh S. Fractures of angle of mandible: A retrospective study. J Oral Biol Craniofac Res. 2012;2:154-8.
4. Koshy JC, Feldman EM, Chike-Obi CJ, Bullocks JM. Pearls of mandibular trauma management. Semin Plast Surg. 2010;24:357-74.
5.El-Anwar MW, Sayed El-Ahl MA, Amer HS. Open reduction and internal fixation of mandibular fracture without rigid maxillomandibular fixation. Int Arch Otorhinolaryngo. 2015;19:314-8.
6.Bhatnagar A, Bansal V, Kumar S, Mowar A. Comparative analysis of osteosynthesis of mandibular anterior fractures following open reduction using 'stainless steel lag screws and mini plates'. J Maxillofac Oral Surg. 2013;12:133-9.
7.Marchetti C, Bianchi A, Bassi M, Gori R, Lamberti C, Sarti A. Mathematical modeling and numerical simulation in maxillofacial virtual surgery . J Craniofac Surg. 2007;18:826-32.
8. Pickering RS, Hattery RR, Hartman GW, Holley KE. Computed tomography of the excised kidney. Radiology. 1974;113:643-7.
9. Schug T, Rodemer H, Neupert W, Dumbach J. Treatment of complex mandibular fractures using titanium mesh. J Craniomaxillofac Surg. 2000;28:235-7.
10.Kuttenberger JJ, Hardt N. Long-term results following reconstruction of craniofacial defects with titanium micromesh systems. J Cranio Maxillofac Surg. 2001;29:75-81.
11.Kaur N, Kaur T, Kaur J, Kaur Y, Kapila S, Sandhu A. Efficacy of Titanium Mesh Osteosynthesis in Maxillofacial Fractures. J Maxillofac Oral Surg. 2018;17:417-24.
12.Novelli G, Tonellini G, Mazzoleni F, Bozzetti A, Sozzi D. Virtual surgery simulation in orbital wall reconstruction: integration of surgical navigation and stereolithographic models. J Craniomaxillofac Surg. 2014;42:2025-34.
13.Sadhwani BS, Anchlia S. Conventional 2.0 mm miniplates versus 3-D plates in mandibular fractures. Ann Maxillofac Surg. 2013;3:154-9.
14.Patel MF, Langdon JD. Titanium mesh (TiMesh) osteosynthesis: a fast and adaptable method of semi-rigid fixatio. Br J Oral Maxillofac Surg. 1991;29:316-24.
15. Mittal G, Dubbudu R, Cariappa K. Three dimensional titanium mini plates in oral & maxillofacial surgery: A prospective clinical trial. J Maxillofac Oral Surg. 2011;11:152-9.
16.Goyal M, Marya K, Chawla S, Pandey R. Mandibular osteosynthesis: A comparative evaluation of two different fixation systems using 2.0 mm titanium miniplates and 3-D locking plates. J Maxillofac Oral Surg. 2011;10:32-37.
17.Cobetto GA, McClary SA, Zallen RD. Treatment of mandibular fractures with malleable titanium mesh plates: a review of 120 cases. J Oral Maxillofac Surg. 1983;41:597- 600.
18.Chhabaria G, Halli R, Chandan S, Joshi S, Setiya S, Shah A. Evaluation of 2.0-mm titanium three-dimensional curved angle strut plate in the fixation of mandibular angle fractures – A prospective clinical and radiological analysis. Craniomaxillofac Trauma Reconstr. 2014;7:119-25.
19.Guimond C, Johnson JV, Marchena JM. Fixation of mandibular angle fractures with a 2.0-mm 3-dimensional curved angle strut plate. J Oral Maxillofac Surg. 2005;63:209-14.
20.Singh R, Pal U, Singh P, Singh G. Role of fixation in posttraumatic nerve injury recovery in displaced mandibular angle fracture. Natl J Maxillofac Surg. 2016;7:29-32.
21.Shridharani SM, Berli J, Manson PN, Tufaro AP, Rodriguez ED. The role of postoperative antibiotics in mandible fractures: A systematic review of the literature. Ann Plast Surg. 2015;75:353-7.
22.Pattar P, Shetty S, Degala S. A prospective study on management of mandibular angle fracture. J Maxillofac Oral Surg. 2014;13:592-8.
23.Doblar M, Garcia JM. Modelling bone tissue fracture and healing. Omez Engine Frac Mech 2004;71:1809-10.
24.Schulze D, Heiland M, Thurmann H, Adam G. Radiation exposure during midfacial imaging using 4-and 16-slice computed tomography, cone beam computed tomography systems and conventional radiography. Dentomaxillofac Radiol. 2004;33:83-6.
25.Ma J, Ma L, Wang Z, Zhu X, Wang W. The use of 3Dprinted titanium mesh tray in treating complex comminuted mandibular fractures. Medicine (Baltimore). 2017;96:e7250.
26.Schreiber JJ, Anderson PA, Rosas HG, Buchholz AL, Au AG. Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. JBJS. 2011;93:1057-63.
27.Hopper KD, Wang MP, Kunselman AR. The use of clinical CT for baseline bone density assessment. J Comput Assist Tomogr. 2000;24:896-9.
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