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A new technique for rapid splint localisation
British Journal of Oral and Maxillofacial Surgery (1988) 26, 155-156 0 1988 The British Association of Oral and Maxillofacial Surgeons
A NEW TECHNIQUE GLYN WREAKES, ALEX BABAJEWS,
FOR RAPID
SPLINT
LOCALISATION
B.Ch.D.,F.D.S.R.C.S., D.Orth.R.C.S., and F.D.s.R.c.~., F.F.D.R.c.~.(I), F.R.c.s.(Ed).
Department of Orthodontics and Department of Oral & Maxillofacial Surgery, Royal Surrey County Hospital, Guildford, Surrey GU2 5LX Summary. The locking bar is an inherent element of cap splint jaw localisation and fixation technique. The modified method described facilitates relocalisation: potentially reducing operating theatre and technician time.
Introduction
The use of the silver cap splint for jaw immobilisation was described over a century ago. The fracture displacement as mirrored by the occlusal discrepancy was reduced on the plaster model so that the jaw fragments could be fitted subsequently into a one piece splint. Kelsey Fry et al. (1942) later developed the connecting bar technique for the reduction and fixation of fractures of the facial skeleton. In the post-war years this technique was adapted for segmental orthognathic procedures to hold the jaw fragments in the corrected position as planned on the models. However, complex multi-directional movements can be subject to planning error or operative complications so that the preformed bar does not fit. In this unfortunate circumstance either relocalisation is required at the time of operation, or more commonly, after temporary fixation the relocation is carried out in the early post operative period. In the original localisation technique described by Conroy (1985), soft metal wire loops are soldered to locking plates which are screwed to the sectional cap splints which have been placed in the planned position. The wire loops are approximated and the terminal portions are covered with quick setting plaster. This assembly is then removed and given to the technician for the construction of a rigid connecting bar. The method we describe offers an expeditious alternative. Case history
An 1%year-old male patient had a large dentigerous cyst associated with the upper left canine tooth removed as a child. Subsequently a lateral open bite developed in the upper left buccal segment. In order to restore the occlusion and reduce the edentulous space anteriorly, surgical mobilisation and repositioning of the upper left buccal segment was felt to be the treatment of choice. At operation the connecting bar did not reproduce the planned position and relocation was required. Method
The original locking bar was divided and the sections serrated with an abrasive disc to provide keying. A length of clear naso-gastric tube of 5 mm internal (Received
3 February
1987; accepted
15.5
16 February
1987)
156
BRITISH
JOURNAL
Fig.
Figure
OF ORAL
& MAXILLOFACIAL
1
l-Schematic
Fig. 2 representation
Figure
SURGERY
2-The
of the components
completed
composite
with the light gun tip applied. locking
bar in situ.
diameter was selected to span between the locking plates (Fig. 1). The tube was then filled with the type of composite anterior tooth filling material’” which is activated by visible blue spectrum lightt. This is supplied in a pressure activated cartridge and can be simply extruded into the tubing. The ends of the sectioned bar then were inserted into the tubing and the walls gently squeezed to ensure the flow of material into and around the serrations before the assembly was returned to the mouth and the locking plates screwed into position. The composite material was then set by first traversing the tip of the light gun along the buccal surface and then repeating the process on the other accessible aspects of the tubing to ensure a total set. The completed rigid bar is shown in Fig. 2. Our observations of this composite material over the period whilst the conventional locking bar was being fabricated led us to believe that this new style bar might be durable enough to act as a definitive fixation. This indeed proved to be the case over the six-week fixation period. Discussion
Composite filling materials have great hardness, but without the structural rigidity of metal and therefore the technique described is best considered as an efficient and accurate Gay of providing short term localisation. However, with the advances currently being made with command-set materials it is felt that this approach may be extended to other aspects of surgical fixation in the future. Acknowledgements We would
like to thank Mr Ian Heslop. Consultant Oral & Maxillofacial Surgeon at the Royal Surrey County Hospital, Guildford. Surrey for allowing us to report this case. Mr M. Duffy. Medical Artist, Queen Mary’s Hospital, Roehampton. and Mr S. Archibald, Medical Photographer at St. Luke’s Hospital, Guildford, for illustrative assistance. References
Kelsey Fry, W. & Ward, T. (1956). The Dental Treatment of Maxillo-facial Injuries. Oxford: Blackwell Scientific Publications. Conroy, B. (1985). Maxillo facial prosthetics and technology. In: Rowe, N. L. & Williams, J. Ll. (editors). Maxillo-facial Injuries. Edinburgh & London: Churchill Livingstone. ” Helioset. Vivadent, i- Optilux Light Gun.
Kavo Supradent U.K. Orthomax. Bradford, U.K.
A NEW TECHNIQUE GLYN WREAKES, ALEX BABAJEWS,
FOR RAPID
SPLINT
LOCALISATION
B.Ch.D.,F.D.S.R.C.S., D.Orth.R.C.S., and F.D.s.R.c.~., F.F.D.R.c.~.(I), F.R.c.s.(Ed).
Department of Orthodontics and Department of Oral & Maxillofacial Surgery, Royal Surrey County Hospital, Guildford, Surrey GU2 5LX Summary. The locking bar is an inherent element of cap splint jaw localisation and fixation technique. The modified method described facilitates relocalisation: potentially reducing operating theatre and technician time.
Introduction
The use of the silver cap splint for jaw immobilisation was described over a century ago. The fracture displacement as mirrored by the occlusal discrepancy was reduced on the plaster model so that the jaw fragments could be fitted subsequently into a one piece splint. Kelsey Fry et al. (1942) later developed the connecting bar technique for the reduction and fixation of fractures of the facial skeleton. In the post-war years this technique was adapted for segmental orthognathic procedures to hold the jaw fragments in the corrected position as planned on the models. However, complex multi-directional movements can be subject to planning error or operative complications so that the preformed bar does not fit. In this unfortunate circumstance either relocalisation is required at the time of operation, or more commonly, after temporary fixation the relocation is carried out in the early post operative period. In the original localisation technique described by Conroy (1985), soft metal wire loops are soldered to locking plates which are screwed to the sectional cap splints which have been placed in the planned position. The wire loops are approximated and the terminal portions are covered with quick setting plaster. This assembly is then removed and given to the technician for the construction of a rigid connecting bar. The method we describe offers an expeditious alternative. Case history
An 1%year-old male patient had a large dentigerous cyst associated with the upper left canine tooth removed as a child. Subsequently a lateral open bite developed in the upper left buccal segment. In order to restore the occlusion and reduce the edentulous space anteriorly, surgical mobilisation and repositioning of the upper left buccal segment was felt to be the treatment of choice. At operation the connecting bar did not reproduce the planned position and relocation was required. Method
The original locking bar was divided and the sections serrated with an abrasive disc to provide keying. A length of clear naso-gastric tube of 5 mm internal (Received
3 February
1987; accepted
15.5
16 February
1987)
156
BRITISH
JOURNAL
Fig.
Figure
OF ORAL
& MAXILLOFACIAL
1
l-Schematic
Fig. 2 representation
Figure
SURGERY
2-The
of the components
completed
composite
with the light gun tip applied. locking
bar in situ.
diameter was selected to span between the locking plates (Fig. 1). The tube was then filled with the type of composite anterior tooth filling material’” which is activated by visible blue spectrum lightt. This is supplied in a pressure activated cartridge and can be simply extruded into the tubing. The ends of the sectioned bar then were inserted into the tubing and the walls gently squeezed to ensure the flow of material into and around the serrations before the assembly was returned to the mouth and the locking plates screwed into position. The composite material was then set by first traversing the tip of the light gun along the buccal surface and then repeating the process on the other accessible aspects of the tubing to ensure a total set. The completed rigid bar is shown in Fig. 2. Our observations of this composite material over the period whilst the conventional locking bar was being fabricated led us to believe that this new style bar might be durable enough to act as a definitive fixation. This indeed proved to be the case over the six-week fixation period. Discussion
Composite filling materials have great hardness, but without the structural rigidity of metal and therefore the technique described is best considered as an efficient and accurate Gay of providing short term localisation. However, with the advances currently being made with command-set materials it is felt that this approach may be extended to other aspects of surgical fixation in the future. Acknowledgements We would
like to thank Mr Ian Heslop. Consultant Oral & Maxillofacial Surgeon at the Royal Surrey County Hospital, Guildford. Surrey for allowing us to report this case. Mr M. Duffy. Medical Artist, Queen Mary’s Hospital, Roehampton. and Mr S. Archibald, Medical Photographer at St. Luke’s Hospital, Guildford, for illustrative assistance. References
Kelsey Fry, W. & Ward, T. (1956). The Dental Treatment of Maxillo-facial Injuries. Oxford: Blackwell Scientific Publications. Conroy, B. (1985). Maxillo facial prosthetics and technology. In: Rowe, N. L. & Williams, J. Ll. (editors). Maxillo-facial Injuries. Edinburgh & London: Churchill Livingstone. ” Helioset. Vivadent, i- Optilux Light Gun.
Kavo Supradent U.K. Orthomax. Bradford, U.K.