Subtarsal Versus Transconjunctival Approach-Esthetic and Functional Long-Term Experience.

PURPOSE: In addition to the transconjunctival approach, the subtarsal incision is one of the most commonly used procedures for surgical exploration of the orbital floor and infraorbital rim. However, available data are limited regarding validity and long-term esthetic and functional outcomes. The aim of this study was to verify the favorable clinical results of the subtarsal approach and compare these results with the transconjunctival procedure. MATERIALS AND METHODS: Forty-five patients (subtarsal group, n = 30; transconjunctival group, n = 15) were examined 6 to 30 months after surgical intervention using a standardized follow-up. Clinically noted complications, such as paresthesia, epiphora, or ocular foreign body sensation, were scored. Postoperative scar formation was investigated using the modified Vancouver Scar Scale (mVSS) and recorded according to standardized photographic documentation procedures. Photographic images were evaluated in a blinded manner by experts and nonexperts according to fixed criteria. Concomitant photographic evaluation was performed by age- and gender-matched healthy controls. Recorded data analyzed by χ2 test and unrelated samples analyzed by the Wilcoxon-Mann-Whitney test were statistically significant (P = .05). RESULTS: Comparable complication rates were found for the 2 approaches without any significant differences (P = .29). Using the subtarsal approach, discrete scar formation was discerned in 7 of 30 cases. Moreover, categorization by the mVSS showed that, in 93.3% of cases, the scar was measured as unremarkable hyper- or hypotrophy (mean, 1.7 of 10 possible points). No statistically significant differences in conspicuous scars and asymmetries were observed between the 2 approaches in the nonexpert and expert groups (P > .05). CONCLUSION: The results of the present study confirm that the subtarsal approach is a safe and esthetically favorable method.

The Volume Behavior of Autogenous Iliac Bone Grafts After Sinus Floor Elevation: A Clinical Pilot Study.

Iliac crest is still regarded as one of the most viable source of autogenous graft materials for extensive sinus floor elevation. Three-dimensional resorption behavior has to be taken into account in anticipation of the subsequent insertion of dental implants. We performed 3-dimensional volume measurements of the inserted bone transplants in 11 patients (6 women and 5 men; mean age = 2.3 years) who underwent bilateral sinus floor elevation with autogenous iliac crest grafts. In order to determine the respective bone graft volumes, cone-beam computerized tomography studies of the maxillary sinuses were carried out directly after the operation (T0), as well as 3 months (T1) and 6 months (T2) postoperatively. The acquired DICOM (Digital Imaging and Communications in Medicine) data sets were evaluated using suitable analysis software. We evaluated statistical significance of graft volumes changes using a linear mixed model with the grouping factors for time, age, side, and sex with a significance level of P = .05. 38.9% of the initial bone graft volume, which amounted to 4.2 cm(3), was resorbed until T1. At T2, the average volume again decreased significantly by 18.9 % to finally reach 1.8 cm(3). The results show neither age nor side dependency and apply equally to both sexes. Without functional load, iliac bone grafts feature low-volume stability in sinus-augmentation surgery. Further clinical and animal studies should be done to detect the optimal timing for implant placement.

Evaluation of computer-assisted mandibular reconstruction with vascularized iliac crest bone graft compared to conventional surgery: a randomized prospective clinical trial.

BACKGROUND: Computer-assisted surgery plays an increasingly important role in mandibular reconstruction, ensuring the best possible masticatory function and aesthetic outcome. METHODS: Twenty patients were randomly assigned to computer-assisted or conventional mandibular reconstruction with vascularized iliac crest bone graft in a prospective study design.Virtual surgical planning was based on preoperative CT-data using specific surgical planning software. A rapid prototyping guide transferred the virtual surgery plan to the operation site. During surgery the transplant ischemic time, reconstruction time, time for shaping the transplant and amount of bone removed were measured. Additionally, the difference in the intercondylar distance before and after surgery was calculated. RESULTS: Computer-assisted surgery shortened the time of transplant ischemia (P < 0.005) and defect reconstruction (P < 0.001) compared to conventional surgery. The time to saw and shape the transplant at the donor site was shorter using conventional surgery (P < 0.005); therefore, the overall time for surgery didn't change (P = 0.527). In the computer-assisted group, the amount of bone harvested equaled the defect size, whereas the transplant size in the conventional group exceeded the defect site by 16.8 ± 5.6 mm (P < 0.001) on average. The intercondylar distance before compared to after surgery was less affected in the computer-assisted than in the conventional group (P < 0.001). CONCLUSIONS: The presented study shows that computer-assisted surgery can help reduce the time for mandibular defect reconstruction and consequently the transplant ischemic time. In the computer-assisted group, the iliac crest donor site defect was downsized and the postoperative condyle position was less altered, reducing possible risks of postoperative complications and donor site morbidity. TRIAL REGISTRATION: DRKS00005181.

Computer-assisted zygoma reconstruction with vascularized iliac crest bone graft.

BACKGROUND: The reconstruction of zygoma is a challenge with regard to aesthetic and reconstructive demands. METHODS: Pre-operative CT data were imported into specific surgical planning software. The mirror-imaging technique was used. A surgical guide transferred the virtual surgery plan to the operation site, whereby it fitted uniquely to the iliac donor site. A postoperative CT scan was obtained for comparing the actual postoperative graft position and shape with the pre-operative virtual simulation. RESULTS: A mean difference of 0.71 mm (SD ± 1.42) for the shape analysis and 3.53 mm (SD ± 3.14) for the graft position was determined. The calculation of the closest point distance showed a surface deviation of < 2 mm for the shape analysis with 83.6% of values and for the graft position with 35.7% of values. CONCLUSION: Virtual surgical planning is a suitable method for zygoma reconstruction with vascularized iliac crest bone graft, with good accuracy for restoring the three-dimensional anatomy.

Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks.

The iliac bone crest is one of the most valuable regions for harvesting bone grafts, both vascularized and nonvascularized. Since the first commendable description of this region as a possible source for vascularized bone flaps by Taylor, little relevant information concerning the variations of the deep circumflex iliac vessels and their relationship to the neighboring structures has been published. The purpose of the current study was to examine this region clinically and anatomically, taking into consideration the former description by Taylor. We gathered all our findings on 216 iliac regions and proposed a new classification. In addition we measured the relationships between the deep circumflex iliac artery and important surgical landmarks. A comparison of our finding with other studies showed similarities and differences but was far more complete. Generally (92%) the deep circumflex iliac artery (DCIA) originated from external iliac artery (EIA) behind the inguinal ligament (IL) and passed cranio-laterally toward the anterior superior iliac spine, where it divided into two important branches. Four variations were observed of the DCIA. The deep circumflex iliac vein (DCIV) ran over (82.5%) or under (17.5%) the EIA. The superficial circumflex iliac vein (SCIV) was observed draining into the DCIV in some dissections. Three different variations of the superficial circumflex iliac artery (SCIA) were observed. The anatomical knowledge of these variations and their correlation to important surgical landmarks can help in harvesting the DCIA flap more safely and thus increasing the success rate while reducing donor site morbidity.

The intraoral approach to lateral osteotomy: the role of a diamond burr.

UNLABELLED: Lateral osteotomy is one of the most traumatic but critical steps in rhinoplasty and can dictate the aesthetic and functional outcomes. Many techniques and instruments to perform it have been suggested, with the objectives of increasing predictability, reliability, and easiness of this invasive approach. We used a 1.5-mm diamond burr via an intraoral approach to thin out the base of the nasal wall along the nasofacial crease in 24 patients. This technique was performed in patients seeking primary rhinoplasty (n = 6), correction of cleft nose deformities (n = 4), deformities due to trauma (n = 9), and secondary nose correction (n = 5). A high mucosal incision paranasally allowed easy access to the osteotomy line. The digital in-fracturing could be performed with light pressure and without extensive manipulation at any time during the rhinoplasty. The osteotomy took on average of 14.5 min (range = 11.00-19.80) and endoscopic examination showed no mucosal tearing. Postoperative swelling and hematoma were comparable to those of other techniques. Using a diamond burr via an intraoral approach is an easy, safe, and reliable method leading to predictable outcomes. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Microsurgical free flap reconstructions of head and neck region in 406 cases: a 13-year experience.

PURPOSE: The reconstruction of extended soft tissue and bony defects in the maxillofacial region with microsurgical flaps is considered to be the therapy of first choice. The aim of this retrospective study was to detect different influencing factors concerning flap survival. MATERIALS AND METHODS: We examined the data of 406 patient cases (121 female and 285 male cases; mean age, 57 years) undergoing reconstruction with a microsurgical flap in our facility between 1998 and 2010. In these cases 326 soft tissue flaps (radial forearm flap, scapula flap, latissimus dorsi flap, anterolateral thigh flap, lateral arm flap, and jejunum flap) and 80 bony flaps (fibula flap and deep circumflex iliac artery flap) were examined. Evaluated parameters were, among others, the timing of reconstruction, defect localization, and recipient vessels used (external vs internal jugular system), as well as anticoagulative management. We statistically analyzed data by means of a χ(2) test, taking account of the odds ratio with P < .05, which was deemed significant. RESULTS: The overall flap survival rate was approximately 92%, without any gender- or age-specific differences. Primary reconstructions proceeded distinctly more successfully than secondary reconstructions (P < .01). Likewise, the defect localization exerted a significant effect on the survival rate (P = .01), with a more caudal localization affecting flap survival positively. Finally, neither the anticoagulation regimen nor the choice of recipient vein system exercised an influence on the survival rate. CONCLUSIONS: Microsurgical tissue transfer is a convenient and reliable method in maxillofacial surgery, provided that one is aware of the determining factors for success.

Functional long-term results after the harvest of vascularised iliac bone grafts bicortically with the anterior superior iliac spine included.

The aim of this study was to evaluate the postoperative morbidity at the donor site and the long-term outcome after the harvest of bicortical iliac bone grafts, including the iliac crest and the anterior superior iliac spine (ASIS), by using a confirmed score. We retrospectively examined 54 consecutive patients who had had vascularised iliac bone grafts harvested to reconstruct different parts of the mandible. We used the Harris Hip Score to evaluate objectively the long-term postoperative morbidity at the donor site. Of 54 patients, 20 were female (37%) and 34 male (63%), with a mean age of 49 years (range 12-81). The causes of the bony defects were malignancy (n=37, 69%), benign tumours (n=7, 13%), osteomyelitis (n=9, 17%), and atrophy of the alveolar ridge (n=1, 2%). All transplants healed adequately. A total of 38/52 patients (73%) had a score of more than 80 points, which defines clinical success. Vascularised iliac bone grafts offer excellent bony dimensions with optimal shape to be used for reconstruction of different parts of the mandible. They can be harvested bicortically, including the iliac crest and the ASIS, with acceptable morbidity at the donor site. The Harris Hip Score is an appropriate tool for the evaluation of long-term impairment at the donor site after the harvest of vascularised iliac bone grafts, and it could be used to compare the results of different studies.

Carotid sinus syndrome as the presenting symptom of cystadenolymphoma.

Carotid sinus syndrome is a serious manifestation of head and neck malignancy. The purpose of this study was to clarify the presence of carotid sinus syndrome in a patient with cystadenolymphoma. To our knowledge carotid sinus syndrome secondary to cystadenolymphoma has not been reported to date. A 45-year-old woman with one-week-old swelling in the left mandibular angle having disturbing symptoms of vertigo, consciousness and sinus arrest. Holter monitoring revealed several episodes of sinus arrest. Ultrasonography showed a well-defined space-occupying lesion of about 31 mm in length and 17 mm in width located in the deep lobe of the left parotid gland. Computerized tomography (CT) showed a large mass extending into the carotid space and protruding into the parapharyngeal space. Parotidectomy was performed. Surgical removal of the tumor resulted in complete amelioration of symptoms and disappearance of electrocardiogram abnormalities. Here we report on a clinical case of carotid sinus syndrome associated with cystadenolymphoma. To our knowledge carotid sinus syndrome secondary to cystadenolymphoma has not been reported to date, and is made more remarkable as a possible differential diagnosis after clarification of all possible causes. Early diagnosis and immediate management can minimize complications.

Radiologic and facial morphologic long-term results in treatment of orbital floor fracture with flexible absorbable alloplastic material.

PURPOSE: Although orbital floor fractures are frequently treated by the Ethisorb patch or polydioxanone foil, the utility of these treatments in extensive fractures remains controversial. The purpose of this study was to examine objectively the extent to which such flexible absorbable materials can restore orbital geometry in comminuted and defect fractures. MATERIALS AND METHODS: Twenty-one patients with isolated comminuted or defect fractures of the orbital floor (mean, 4.32 cm(2)) were recruited for this retrospective study. Using an infraorbital approach, 15 patients received an Ethisorb patch, whereas polydioxanone foil (0.25 mm) was used in the remaining cases. Follow-up examinations with cone-beam computed tomography and 3-dimensional facial scanning occurred on average 27.4 months postoperatively. Orbital heights and volumes were measured on the fracture side and compared with the unaffected side. Based on 3-dimensional facial scan data, the ocular bulb position was assessed in the sagittal and vertical directions. For all parameters, the difference between the left and right sides was calculated, which was statistically significant compared with the side difference of an age- and gender-matched control group using unpaired t test (P < .05). RESULTS: No statistically significant differences were observed in any variable between the surgical and control cohorts. A decreased diplopia rate of 38.14% was attained by the surgical intervention. CONCLUSION: The reconstruction of moderate to extensive orbital floor fractures can be provided with polydioxanone foil or the Ethisorb patch without significant changes in orbital geometry.

Computer-assisted mandibular reconstruction with vascularized iliac crest bone graft.

BACKGROUND: The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. METHODS: We compared five computer-assisted mandibular reconstructions with 15 conventional mandibular reconstructions performed using vascularized iliac crest bone grafts. Based on preoperative cone beam computed tomography (CBCT) or CT data imported into the specific surgical planning software, a surgical guide was designed by rapid prototyping that helped to exactly translate the virtual surgery plan into the operation site whereby it fit uniquely to the iliac donor site. The ischemic time of the graft was measured intraoperatively and the difference between the amount of bone removed and the amount of bone required was determined. In addition, 3 months after surgery patients had to score the esthetics of their outer appearance using a visual analog scale. RESULTS: In all patients the graft fit perfectly into the mandibular defect without major adjustments. The time for the shaping process of the transplant and the ischemic time were shorter than in the conventional grafting procedure. The virtual plan reduced the amount of bone removed to the required volume. The patients who underwent computer-assisted reconstruction had a higher degree of satisfaction with their outer appearance. CONCLUSION: Our clinical experience and the collected data suggest that the described method is very promising for optimizing the surgical result of mandibular reconstructions using iliac crest bone grafts and achieving an excellent esthetic outcome. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Evaluation of computer-assisted jaw reconstruction with free vascularized fibular flap compared to conventional surgery: a clinical pilot study.

BACKGROUND: The introduction of computer-assisted surgery was a milestone in functional reconstructions of facial skeletal defects. PATIENTS AND METHODS: We compared five computer-assisted and five conventional reconstructions with fibular grafts in the course of a pilot study. A rapid prototyping guide translated the computer-assisted surgery plan into intraoperative utilizable models. We intraoperatively measured the time needed for shaping the graft to the recipient site and the ischaemic time. Furthermore, the size of donor site defect compared to the required transplant length was evaluated. RESULTS: Shaping procedure and ischaemic time turned out significantly shorter when compared to conventional surgery without cutting guide (p = 0.014). Using surgical guides, there was no change between the defect size of the fibula and the necessary transplant size. In conventional surgery, a mean change of 1.92 cm occurred (p = 0.001). CONCLUSION: The surgical guide significantly reduced shaping time and consequently ischaemic time. These factors can influence flap survival. The fibular donor site defect was downsized.

Anteriorly pedicled retroauricular flap for repair of auricular defects.

The reconstruction of the auricle is aesthetically very demanding. Various techniques have been used depending on the defect size, the defect location, and tissue involved. For better wound control and result predictability, we developed an anteriorly pedicled retroauricular flap. We used this modified double-full-thickness skin graft in three patients. This anteriorly pedicled flap provides a visible wound surface which makes wound dressing easy. The aesthetic outcome is good and predictable. No major complications were encountered during surgery or the healing phase. All patients were satisfied with the outcome. The described method offers a good option for reconstructing larger auricular defects with local tissue.

Verification of nerve integrity after surgical intervention using quantitative sensory testing.

PURPOSE: The aim of this study was to apply a standardized Quantitative Sensory Testing (QST) approach in patients to investigate whether oral surgery can lead to sensory changes, even if the patients do not report any sensory disturbances. Furthermore, this study determines the degree and duration of possible neuronal hyperexcitability due to local inflammatory trauma after oral surgery. PATIENTS AND METHODS: Orofacial sensory functions were investigated by psychophysical means in 60 patients (30 male, 30 female) in innervation areas of infraorbital nerves, mental nerves and lingual nerves after different interventions in oral surgery. The patients were tested 1 week, 4 weeks, 7 weeks, and 10 weeks postoperatively. As controls for bilateral sensory changes after unilateral surgery, tests were additionally performed in 20 volunteers who did not have any dental restorations. RESULTS: No differences were found between the control group and the control side of the patients. Although not 1 of the patients reported paresthesia or other sensory changes postoperatively, QST detected significant differences between the control and the test side in the mental and lingual regions. Test sides were significantly less sensitive for thermal parameters (cold, warm, and heat). No differences were found in the infraorbital region. Patients showed significantly decreased pain pressure thresholds on the operated side. QST monitored recovery over time in all patients. CONCLUSIONS: The results show that oral surgery can lead to sensory deficits in the mental and lingual region, even if the patients do not notice any sensory disturbances. The applied QST battery is a useful tool to investigate trigeminal nerve function in the early postoperative period. In light of the increasing forensic implication, this tool can serve to objectify clinical findings.

Exact three-dimensional skull-related repositioning of the maxilla during orthognathic surgery.

The LeFort I osteotomy is standard for corrective repositioning of the maxilla, but intraoperative, skull-related, three-dimensional repositioning of the maxilla remains unsolved. Different ways of improving the accuracy of intraoperative, preoperatively planned, skull-related, correcting movements have been described, including the measurement of vertical maxillary shift, use of positioning devices (such as a face bow or a halo frame), and computer-assisted navigation. Nevertheless, intraoperative three-dimensional control of maxillary shift is not standard. Intraoperatively adjusted positioning pins define an exactly reproducible skull-related position for a reference splint. Skull-related repositioning of the maxilla after osteotomy can be done precisely in combination with two further splints, each allowing for different, well-defined repositioning of the reference splint in relation to the maxillary dental arch. The positioning device can be inserted using the standard intraoral approaches of the Le Fort I osteotomy. It does not result in further radiation exposure for the patient besides that usually necessary for preoperative planning. Three-dimensional imaging and expensive, computer-assisted navigational systems are not required. In contrast to previous procedures, the new device allows for intraoperative, three-dimensional, skull-related repositioning of the maxilla exactly according to the position planned preoperatively.

Three-dimensional evaluation of postoperative swelling after third molar surgery using 2 different cooling therapy methods: a randomized observer-blind prospective study.

PURPOSE: In most cases, the removal of third molars leads to a significant degree of tissue trauma, resulting in common postoperative symptoms and signs of pain, facial swelling, dysfunction, and limited mouth opening (trismus). The beneficial effects of cold treatment on postoperative swelling, edema, pain, and inflammation, as well as the reduction in bleeding and hematomas, have been described. The aim of the present study was to compare postoperative cooling therapy using cooling compresses with that using the water-circulating cooling face mask by Hilotherm. We recorded the beneficial effects on postoperative facial swelling, pain, trismus, and neurologic complaints. PATIENTS AND METHODS: A total of 30 patients were scheduled to undergo third molar surgery and were divided randomly into 2 groups for treatment with either the Hilotherm or conventional cooling with cooling compresses. Cooling was performed one time for 45 minutes immediately after surgery. Facial swelling was quantified using a 3-dimensional optical scanning technique. The pain and neurologic scores and the degree of mouth opening were observed for each patient. RESULTS: Patients receiving cooling therapy using Hilotherm demonstrated less facial swelling, less pain, a tendency toward fewer neurologic complaints, and were more satisfied than the patients who had received conventional cooling. CONCLUSION: The results of our study have shown that the Hilotherm is more efficient for managing postoperative swelling and pain after the removal of third molars than conventional cooling using compresses.

Orthodontic treatment after autotransplantation.

Autotransplantation is an alternative method to replace a missing tooth. This study reports a 17-year-old man who had autotransplantation of the left upper third molar with the congenitally missing left lower second premolar. No signs of inflammation, root resorption, ankylosis, mobility, sensitivity, pocket problems, or pulp destructions were found after 2-year follow up. Autotransplantation can lead to shorter treatment time and an improved treatment result in certain cases. It also eliminates the need for implants or prosthetic therapy.

Effect of the sequence of lateral osteotomy and hump removal on the aesthetic outcome.

BACKGROUND: The authors hypothesized that by modifying the sequence of the rhinoplasty procedure they could avoid comminuted fractures resulting in suboptimal cosmetic results. METHODS: Percutaneous perforated lateral nasal osteotomies were performed in 36 fresh human cadaver heads. In the first group of 19 cadaver heads with big nasal humps, the perforations of the lateral wall were done before and digital infracturing after hump removal in 10 cases (subgroup A1). In the remaining 9 noses with big humps, the perforations and digital infracturing were performed after hump removal (subgroup group A2). In a second group of 17 cadaver heads with small humps, perforations were performed before hump removal in 8 cases (subgroup B1), and in the remaining 9 cases, the lateral walls were perforated after hump removal (subgroup B2). The number of fractured nasal bones was counted. In addition, the size and shape of the nasal bone fragments were described in a blinded fashion. RESULTS: Analysis of the number of fractured nasal bones yields higher rates for "osteotomies after" (8.44 vs. 5.83) and hump size "big" (8.37 vs. 5.76), with some influence of age and gender. CONCLUSIONS: The pattern of fractures after perforations of the lateral wall seems to be more regular if the perforations are done before the removal of bigger humps. In noses with small humps or no hump, no difference is seen regarding the sequence of the perforations in relation to hump removal.

Analysis of trigeminal nerve disorders after oral and maxillofacial intervention.

BACKGROUND: Quantitative sensory testing (QST) is applied to evaluate somatosensory nerve fiber function in the spinal system. This study uses QST in patients with sensory dysfunctions after oral and maxillofacial surgery. METHODS: Orofacial sensory functions were investigated by psychophysical means in 60 volunteers (30 patients with sensory disturbances and 30 control subjects) in innervation areas of the infraorbital, mental and lingual nerves. The patients were tested 1 week, 4 weeks, 7 weeks and 10 weeks following oral and maxillofacial surgery. RESULTS: QST monitored somatosensory deficits and recovery of trigeminal nerve functions in all patients. Significant differences (p < 0.05) between control group and patients were shown for cold, warm and mechanical detection thresholds and for cold, heat and mechanical pain thresholds. Additionally, QST monitored recovery of nerve functions in all patients. CONCLUSION: QST can be applied for non-invasive assessment of sensory nerve function (Aß-, Aδ- and C-fiber) in the orofacial region and is useful in the diagnosis of trigeminal nerve disorders in patients.

In vitro study of adhesive polymethylmethacrylate bone cement bonding to cortical bone in maxillofacial surgery.

PURPOSE: In the treatment of midface fractures, the fragments are immobilized using screws and plates for osteosynthesis until reunion has occurred. This method involves drilling holes for the insertion of the screws, which can be associated with additional fracturing of the corresponding bone owing to the complex architecture and thin layers of facial bone. To alleviate this problem, new adhesive techniques for fixing the plates for osteosynthesis have been investigated, mitigating the detrimental effects of screw hole drilling. In the present experimental study, the strength of this adhesive bond and its resistance to hydrolysis were investigated. MATERIALS AND METHODS: To determine the adhesive bonding strength, a tension test was implemented. Osteosynthesis plates with screw holes 1.3 mm in diameter were fixed to cortical bone samples of bovine femur using ultraviolet (UV) light-curing polymethylmethacrylate bone cement. To facilitate bonding, the surface of the bone was conditioned with an amphiphilic bonding agent before cementing. UV light curing was implemented using either a conventional UV unit, such as is used in dentistry, or with a specialized UV unit with a limited emission spectrum but high luminosity. Reference control samples were prepared without application of the bone bonding agent. After this procedure, the samples were stored for 1 to 7 days at 37°C submerged in 0.9% saline solution before being subjected to the tension test. RESULTS: Without the bone bonding agent, the bonding strength was 0.2 MPa. The primary average bonding strength at day 0 was 8.5 MPa when cured with the conventional UV unit and 14 MPa for the samples cured with the specialized UV unit. An almost constant average bond strength of 8 and 16 MPa was noted for all samples stored up to 7 days after curing with the conventional and specialized UV unit, respectively. CONCLUSION: With the development of a new bone bonding agent, a method is now available to promote the bonding between the hydrophilic bone surface and the hydrophobic polymethylmethacrylate bone cement by creating an interlayer that is beneficial for adhesion. In the present in vitro study, the strength of this bond and its resistance to hydrolysis were investigated. This new method could have clinical bearing in cases in which conventional fixation with screws and plates is limited, such as can occur in comminuted fractures. The observed average bonding strengths of 8 to 16 MPa support the implementation of this technique in nonload-bearing regions such as the midface, facilitating immobilization until the bone reunion is complete.