Comparison of titanium and biodegradable plates for treating midfacial fractures.

PURPOSE: The purpose of the present study was to evaluate the use of titanium plates and screws (TPSs) versus biodegradable plates and screws (BPSs) for fixation of midfacial fractures. In addition, complications related to the plates and rates of secondary surgery for plate removal were compared. PATIENTS AND METHODS: From March 2005 to March 2012, 109 patients were enrolled in this study. Fifty-six patients with TPSs implanted to fix midfacial fractures (group A) and 53 patients with BPSs to treat midfacial fractures (group B) were evaluated. Patients' histories of plate-related nonunion, infection, displacement, pain, and palpability and secondary surgery for plate removal were checked. RESULTS: None of the study participants developed nonunion issues related to the TPSs or BPSs. Six patients in group A developed complications associated with TPSs and 5 patients underwent secondary surgery for plate removal. One patient (1.8%) had a plate-related infection, 1 patient (1.8%) developed plate extrusion, 1 patient (1.8%) had plate-associated chronic pain, 2 patients (3.6%) complained of palpability, and 2 patients (3.6%) developed psychological problems (1 patient developed 2 complications). In contrast, only 1 patient in group B (2%) complained of temporary palpability, and this problem disappeared over time. None of the patients in group B complained of any other problems. CONCLUSIONS: The results indicated that BPSs and TPSs have the potential for successfully treating midfacial fractures. BPSs are suitable for treating midfacial fractures and could serve as an alternative for TPSs in selected cases.

Quality of life of patients with segmental mandibular resection and immediate reconstruction with plates.

PURPOSE: The surgical management of some head-and-neck pathology affects a patient's form and fundamental function and, eventually, the quality of the individual's daily life. Restoring mandibular continuity after resection will improve form, function, and eventually, quality of life (QOL). The aim of this study was to evaluate the effect of our limited restoration with immediate plate reconstruction after segmental mandibular resection on the QOL of patients. PATIENTS AND METHODS: A total of 13 patients were included in the study. They were treated for benign but aggressive mandibular pathology. Treatment included segmental mandibular resection with immediate plate reconstruction. A modified University of Washington QOL questionnaire was used to assess QOL. Data on clinico-dermographic variables were also collated. A total of 17 surgeries were undertaken, with 16 implants placed. RESULTS: Patients with smaller tumors seemed to have better QOL scores than those with larger tumors. The overall QOL scores for younger patients seemed better than those of older patients. Spontaneous regeneration of the mandible, occurring in our younger patients, was an added reason for this seemingly better QOL. CONCLUSIONS: Patients with segmental mandibulectomy and spontaneous mandibular regeneration tended to have a better QOL than those with no reconstruction and immediate plate reconstruction.

Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction.

OBJECTIVES: Segmental resection of the mandible causes functional, aesthetic and social problems affecting health-related quality of life (HRQoL). It is often assumed that reconstruction with composite free flaps guarantees better function and aesthetics than bridging the defect with reconstruction plates. METHODS: Using the European Organization for Research and Treatment of Cancer questionnaires (EORTC QLQ-C30 version 3.0 and EORTC QLQ-H&N35), we compared HRQoL in patients who received free fibula flaps versus reconstruction plates after segmental resection of the lateral mandible. RESULTS: Thirty-seven completed questionnaires (18 fibula reconstructions and 19 patients with reconstruction plates) were available. Reconstruction with a free fibula flap did not provide clear additional benefit to bridging the defect with a reconstruction plate after segmental resection of the lateral mandible. In particular aspects known to have the most impact on HRQoL like swallowing, speech and chewing were not influenced by the type of reconstruction. CONCLUSIONS: Reconstruction of segmental defects of the lateral mandible with free fibula flap and reconstruction plate resulted in comparable HRQoL. If dental rehabilitation by means of dental implants is not anticipated in the fibula, then plate reconstruction with adequate soft tissue remains a suitable technique for the reconstruction of segmental defects of the lateral mandible.

Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients.

Removal of miniplates is a controversial topic in oral and maxillofacial surgery. Originally, miniplates were designed to be removed on completion of bone healing. The introduction of low profile titanium miniplates has led to the routine removal of miniplates becoming comparatively rare in many parts of the world. Few studies have investigated the reasons for non-routine removal of miniplates and the factors that affect osteosynthesis after osteotomy in large numbers of patients. The aim of the present study was to investigate complications related to osteosynthesis after bilateral sagittal split osteotomy (BSSO) in a large number (n=153) of patients. In addition to the rates of removal, emphasis was placed on investigating the reasons and risk factors associated with symptomatic miniplate removal. The rate of plate removal per patient was 18.6%, the corresponding rate per plate being 18.2%. Reasons for plate removal included plate-related complications in 16 patients and subjective discomfort in 13 patients. Half of the plates were removed during the first postoperative year. Smoking was the only significant predictor for plate removal. Patients undergoing orthognathic surgery should be screened with regard to smoking and encouraged and assisted to cease smoking, at least perioperatively.

Removal of titanium plates coated with anodic titanium oxide ceramic: retrospective study.

Transformation of the surface of metallic titanium with titanium oxides prepared in various ways is a modern procedure. For more than 15 years, the authors have been utilizing fixing elements coated with titanium oxide ceramics, prepared by anodic oxidation and thermal treatment, for purposes of jawbone osteosynthesis. The aim of the authors' work was to assess the extent to which the titanium oxide ceramic coating influences the fate of the plates used for osteosynthesis within the human organism, in regard to the possible need for their removal. During a 5-year period, 108 of 1,396 plates coated with anodic titanium oxide had to be removed for various reasons: plate exposure (47), osteomyelitis (25), palpable swelling and tenderness (21), patient request for psychological reasons (13), or fracture of the plate (2). In none of these 108 cases was metallosis observed, which otherwise is reported relatively frequently in the vicinity of traditional titanium fixing elements, nor was any tissue damage connected with the surface of the plates. The results indicate the favorable properties of the titanium oxide ceramic surface.