[Fractures of the edentulous atrophic mandible. Fracture management and complications]

ArticleinMund- Kiefer- und Gesichtschirurgie 5(4):227-32 · August 2001with24 Reads
Source: PubMed
Abstract

Background: With increasing atrophy, fractures of the edentulous mandible tend to have a higher incidence of nonunion. However, the connection between disturbances of bony consolidation and inadequate primary stability is often insufficiently discussed. Fixation: Rigid internal fixation with 2.7 or now 2.4 AO compression and reconstruction plates is a safe procedure to achieve short-term rehabilitation in the mostly elderly patients by ensuring immediate function without intermaxillary fixation. With increasing atrophy, our concept suggests the use of stronger plates and fixation of screws in safe bony regions far from the fracture site. Results and discussion: This study reports the results of treatment of 40 fractures of the edentulous mandible in 25 patients from 1979 until 1996: 38 fractures (95%) showed primary healing, and only 1 nonunion was revealed after fracture of the plate. The criteria for choice of plates are discussed as well as fracture exposure and the question of primary and secondary bone grafting.

    • "But when teeth are absent, more of the force exerted may be transferred to other regions. Osteoporosis in the mandible is regarded as a possible factor influencing the complication rate, especially of non-unions in fractures of the mandible67686970. This may be due to less rigid fixation and a reduced contact area of bone in the edentulous mandible. "
    [Show abstract] [Hide abstract] ABSTRACT: Osteoporosis is a common problem in orthopedic surgery. The purpose of this review of the literature was to examine whether osteoporosis is also an important factor in patient treatment in the field of craniomaxillofacial surgery. Emphasis was given to the consequences of osteoporosis for the maxilla and mandible, the influence of osteoporosis on fracture treatment, the use of dental implants, the importance of soft tissues and the effect of osteoporosis therapies. It was found that osteoporosis does affect the bones of the skull. The effect of osteoporosis on treatment, however, is controversial and necessitates better ways of quantifying bone loss. Large inter-individual and site-specific differences in bone density, as well as other effects such as removal of teeth, periodontitis, implant insertion, augmentation procedures and altered loading with dystrophic consequences need to be considered in future studies. Special attention should be given to osteoporosis during fracture treatment.
    Full-text · Article · Mar 2006 · Osteoporosis International
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  • [Show abstract] [Hide abstract] ABSTRACT: Oddelek za maksilofacialno in oralno kirurgijo, Splošna bolnišnica Celje, Oblakova 5, 3000 Celje Glede na strokovno zavajajoč in žaljiv način pisanja v »Komentarju na članek Posebnosti zlomov obrazne-ga skeleta pri starostnikih« v 11.številki Zdravniškega vestnika iz l.2006 sem prisiljen nanj odgovoriti. Ko-mentator navaja načine zdravljenja poškodb obrazne-ga skeleta vseh starostnih obdobij, ki jih tudi slikovno dokumentira, žal pa so trditve brez podpore ustrezne literature, ki bi se nanašala na populacijo starostni-kov in njene posebnosti. Literatura je sicer navedena, vendar brez ustrezne citiranosti, hkrati pa obravnava v glavnem problematiko zlomov kondilarnega odrast-ka, prav tako pri vseh starostnih skupinah in ne po umestitvi v celotnem obraznem skeletu. Opisani načini zdravljenja na Oddelku za maksilofa-cialno in oralno kirurgijo celjske bolnišnice temeljijo na 25-letnih izkušnjah. 1 Pri tem moram poudariti, da pri poškodovancih starejše starostne skupine nismo imeli pomembnih med-in pooperativnih zapletov, pa tudi ne slabših rezultatov zdravljenja. Seveda pa smo pri operativnem zdravljenju upoštevali lastne izkuš-nje in uvedli tudi modificirane metode, ki so temeljile na izkušnjah z dobrimi rezultati naših bolnikov. Tako predvsem pri starostnikih odklanjamo vsako invaziv-no operativno tehniko, kot npr. ekstraoralne pristo-pe do zloma oziroma rez od ušesa do ušesa, kot to priporoča komentator. Ta rez je upravičen pri multi-plih poškodbah. Tako težkih poškodb, ki bi opraviče-vale omenjeni dostop, pri starostnikih v zadnjih 25 letih v naši ustanovi nismo imeli, zato ta pristop v pri-spevku ni bil omenjen. Žal nisem imel možnosti sočasnega odgovora v isti številki Zdravniškega vestnika, kljub temu pa bom sku-šal po delih odgovoriti na razhajajoča se mnenja. Bistvena sta mehanizem poškodbe in fizična sposob-nost poškodovanca, na kar je komentator povsem po-zabil. Zlomi maksile Iz izkušenj nam je znano, kakšne poškodbe zgornje čeljustnice dobi starostnik, kar si lahko predstavlja-mo, ko razčlenimo mehanizem poškodbe. Na podla-gi tega se tudi odločimo, katere rentgenske preiskave so potrebne. Zavedati se moramo, da so CT preiskave izredno drage in jih zato ne bomo zahtevali v vsakem primeru, kot priporoča komentator. Ne nazadnje bi navedel podatke obremenitve z RTG žarki, ki znašajo pri RTG posnetku po Watersu 0,005 do 0,025 mSv, pri CT pa 0,45 do 1,6 mSv. Cena RTG po Watersu je 12,85 EUR in CT od 122,40 do 244,80 EUR, kar tudi ni zanemarljivo. Zato menim, da je neupravičena uporaba CT pri vseh poškodbah maksile. Prav tako je mnogo večji odme-rek obsevanja pri sicer jasni klinični diagnozi, podpr-ti s klasično RTG sliko, nedopusten in za bolnika škod-ljiv. V prispevku so opisane indikacije in kontraindikacije tako za konzervativno kakor tudi za operativno zdrav-ljenje zlomov maksile pri starostnikih. Prav tako so omenjene prednosti enega v primerjavi z drugim na-činom zdravljenja. 2 Pri počeni maksili, ki je popolno-ma čvrsta, pa ni potrebno nobeno zdravljenje, ampak samo mehkejša prehrana poškodovanca.
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  • [Show abstract] [Hide abstract] ABSTRACT: The high rate of complications led us to develop a new osteosynthesis plate for the treatment of the fractured atrophied mandible. The development of the new so-called pencil-bone plate is based on the 2.0 mini-plate system manufactured by the Medartis Company. Finite elements (FE) analysis of the new plate as well as flexibility experiments were undertaken, and 14 patients with 16 fractures of the atrophied mandible were treated with the pencil-bone plate between October 2000 and November 2001. The results clearly show that the pencil-bone plate reacted in both the FE model and the static flexibility experiment in a more stable way than a standard 2.0 plate. In 13 patients, healing proceeded without serious complications; all of the patients showed subjective, nearly unchanged chewing, speaking, and swallowing abilities and no complications occurred when wearing dentures. One patient underwent surgical intervention after a new trauma. The clinical outcome of the treated fractures confirmed the experimental results, which proved the high stability of the plate in the area of the fracture site. Due to the mini-plate format the intraoral application of the plate is possible without problems. The intraoral access allows rapid operation followed by a minimum of morbidity. A great advantage of the small dimension system is the unrestricted wearing of dentures after the application.
    No preview · Article · Dec 2003 · Mund- Kiefer- und Gesichtschirurgie
    O Blume O Blume L Seper L Seper U Meyer U Meyer +1 more author... J Piffkó J Piffkó
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