- Email: [email protected]
A technical note on placement of the mandibular staple bone plate
J Oral Maxillofac 43225-226,
Surg
1985
A Technical Note on Placement of the Mandibular Staple Bone Plate I
CCI
IC
ucccc7
nhAn*
to secure the director rods and template has proved cumbersome and inefficient. This report describes two modifications of the technique that help to overcome this problem.
The mandibular staple bone plate is an implant that can be effectively used for the reconstruction of the atrophic edentulous mandible. The technique for insertion of the implant has been described in detail by Small and Stines.’ However, the maintenance of sterility at the time of placement of the director rods as described has been a problem-the need for an assistant to be removed from the sterile field and positioned underneath the surgical drapes
Technique
A moist throat pack is inserted intraorally and the mouth is prepared with a 20% solution of povidone and normal saline. The throat pack is then removed and replaced with another. An acrylic template, which has been relieved where the transosteal pins will penetrate the oral cavity. is positioned over the
* Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago. College of Dentistry, 801 South Paulina Street, Box 6998. Chicago, IL 60680. Address correspondence and reprint requests to Dr. Heffez.
FIGURE 1 Clefi). The acrylic template has been positioned under the Steri-drape. An excess amount of Steri-drape is then placed intraorally to form a sterile pocket. The director rods will be inserted in the acrylic template through small openings made in the Steridrape. FIGURE 2 (right).
The operator is able to maintain sterility while stabilizing both template and director rods.
225
226
MANDIBULAR
mandibular alveolar ridge. The skin in the submental region is then prepared. The oral cavity is isolated from the sterile field by placing an eye Steri-drape@ with the opening over the submental region. The excess Steri-drape from the periphery of the field is then placed intraorally, which permits the assistant to manipulate the template while remaining sterile. Two l-mm slits are cut in the Steridrape directly over the template to accommodate the director rods, and the rods are positioned (Fig. 1). The assistant, shielded from the oral cavity by the Steri-drape (Fig. 2), may then stabilize the template and director rods. When the drill guide rack is disassembled, the template can easily be manipulated out of the oral cavity without contaminating the field. Summary The technical modifications suggested for placement of the mandibular staple bone plate include
J Oral Maxillofac 43:226-228,
STAPLE BONE PLATE
the positioning of the acrylic template at the onset of the procedure and the insertion of an excess amount of Steri-drape intraorally at the time the patient is draped. The assistant can then manipulate the acrylic template and director rods from a sterile field. The perception of when the drill bit has completely traversed the alveolar bone is improved by relieving the acrylic template at the site at which the transosteal pins penetrate into the oral cavity. The advantages of these modifications are threefold: the entire surgical team remains sterile, the risk of contaminating the surgical field is reduced, and the procedure is rendered more time-efficient.
References 1. Small IA, Stines AV: Mandibular Staple Bone Plate-A Reconstructive Operation for the Atrophic Edentulous Mandible. Surgical Technique, Zimmer, Inc., 1976.
Surg
1985
Functional Therapy for Fractures of the Condyloid Process in Adults RODERICK B. THIELE, DDS,* 4ND RALPH M. MARCOOT, DDSt
The most common unilateral mandibular fracture is one of the condyloid process, and the most common bilateral mandibular fracture is a condyloid fracture associated with a fracture on the contralateral side.’ The treatment of such fractures in adults is controversial. One approach calls for open surgical reduction and fixation2-3 for the selected cases that involve severely dislocated fractures with gross malalignment of the segments, severe pain, or decreased function. A second approach is closed reduction using maxillomandibular fixation. The usual course of treatment is to maintain fixation for * Captain, Dental Corps, United States Army, Smith Dental Clinic, Fort Leavenworth, Kansas. t Colonel, Dental Corps, United States Army, Chief, Department of Dentistry, 97th General Hospital, Germany. The opinion or assertions contained herein are the private views of the authors and are not to be construed as offkial or as reflecting the views of the Department of the Army or the Department of Defense. Address correspondence and reprint requests to Cpt. Thiele: 2315 S. 16th Terrace, Leavenworth, KS 66048.
approximately three weeks to prevent ankylosis.4 A third approach is functional therapy, which is frequently used for the treatment of condyloid fractures in children.s-8 Review of Cases Unilateral fractures of the condyloid process, one with a concomitant parasymphyseal fracture, were treated without maxillomandibular fixation in four adults aged 15, 19,20, and 49 years. All patients were evaluated clinically and radiographically and observed for 24 to 48 hours for the first one to two weeks and then weekly for eight weeks. The patient who sustained the parasymphyseal fracture had that problem treated by closed reduction using a clear acrylic lingual splint wired interdentally. In all cases, the patients were initially placed on liquid diets, which gradually changed to soft and then to regular diets as was individually tolerated. Analgesics were initially prescribed as indicated. Mandibular function was allowed within the limits that pain allowed. As pain subsided and function increased, mandibular exercises were prescribed to preclude abnormal mandibular deviation. The mandibular lingual splint for the concomitant parasymphyseal
Surg
1985
A Technical Note on Placement of the Mandibular Staple Bone Plate I
CCI
IC
ucccc7
nhAn*
to secure the director rods and template has proved cumbersome and inefficient. This report describes two modifications of the technique that help to overcome this problem.
The mandibular staple bone plate is an implant that can be effectively used for the reconstruction of the atrophic edentulous mandible. The technique for insertion of the implant has been described in detail by Small and Stines.’ However, the maintenance of sterility at the time of placement of the director rods as described has been a problem-the need for an assistant to be removed from the sterile field and positioned underneath the surgical drapes
Technique
A moist throat pack is inserted intraorally and the mouth is prepared with a 20% solution of povidone and normal saline. The throat pack is then removed and replaced with another. An acrylic template, which has been relieved where the transosteal pins will penetrate the oral cavity. is positioned over the
* Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago. College of Dentistry, 801 South Paulina Street, Box 6998. Chicago, IL 60680. Address correspondence and reprint requests to Dr. Heffez.
FIGURE 1 Clefi). The acrylic template has been positioned under the Steri-drape. An excess amount of Steri-drape is then placed intraorally to form a sterile pocket. The director rods will be inserted in the acrylic template through small openings made in the Steridrape. FIGURE 2 (right).
The operator is able to maintain sterility while stabilizing both template and director rods.
225
226
MANDIBULAR
mandibular alveolar ridge. The skin in the submental region is then prepared. The oral cavity is isolated from the sterile field by placing an eye Steri-drape@ with the opening over the submental region. The excess Steri-drape from the periphery of the field is then placed intraorally, which permits the assistant to manipulate the template while remaining sterile. Two l-mm slits are cut in the Steridrape directly over the template to accommodate the director rods, and the rods are positioned (Fig. 1). The assistant, shielded from the oral cavity by the Steri-drape (Fig. 2), may then stabilize the template and director rods. When the drill guide rack is disassembled, the template can easily be manipulated out of the oral cavity without contaminating the field. Summary The technical modifications suggested for placement of the mandibular staple bone plate include
J Oral Maxillofac 43:226-228,
STAPLE BONE PLATE
the positioning of the acrylic template at the onset of the procedure and the insertion of an excess amount of Steri-drape intraorally at the time the patient is draped. The assistant can then manipulate the acrylic template and director rods from a sterile field. The perception of when the drill bit has completely traversed the alveolar bone is improved by relieving the acrylic template at the site at which the transosteal pins penetrate into the oral cavity. The advantages of these modifications are threefold: the entire surgical team remains sterile, the risk of contaminating the surgical field is reduced, and the procedure is rendered more time-efficient.
References 1. Small IA, Stines AV: Mandibular Staple Bone Plate-A Reconstructive Operation for the Atrophic Edentulous Mandible. Surgical Technique, Zimmer, Inc., 1976.
Surg
1985
Functional Therapy for Fractures of the Condyloid Process in Adults RODERICK B. THIELE, DDS,* 4ND RALPH M. MARCOOT, DDSt
The most common unilateral mandibular fracture is one of the condyloid process, and the most common bilateral mandibular fracture is a condyloid fracture associated with a fracture on the contralateral side.’ The treatment of such fractures in adults is controversial. One approach calls for open surgical reduction and fixation2-3 for the selected cases that involve severely dislocated fractures with gross malalignment of the segments, severe pain, or decreased function. A second approach is closed reduction using maxillomandibular fixation. The usual course of treatment is to maintain fixation for * Captain, Dental Corps, United States Army, Smith Dental Clinic, Fort Leavenworth, Kansas. t Colonel, Dental Corps, United States Army, Chief, Department of Dentistry, 97th General Hospital, Germany. The opinion or assertions contained herein are the private views of the authors and are not to be construed as offkial or as reflecting the views of the Department of the Army or the Department of Defense. Address correspondence and reprint requests to Cpt. Thiele: 2315 S. 16th Terrace, Leavenworth, KS 66048.
approximately three weeks to prevent ankylosis.4 A third approach is functional therapy, which is frequently used for the treatment of condyloid fractures in children.s-8 Review of Cases Unilateral fractures of the condyloid process, one with a concomitant parasymphyseal fracture, were treated without maxillomandibular fixation in four adults aged 15, 19,20, and 49 years. All patients were evaluated clinically and radiographically and observed for 24 to 48 hours for the first one to two weeks and then weekly for eight weeks. The patient who sustained the parasymphyseal fracture had that problem treated by closed reduction using a clear acrylic lingual splint wired interdentally. In all cases, the patients were initially placed on liquid diets, which gradually changed to soft and then to regular diets as was individually tolerated. Analgesics were initially prescribed as indicated. Mandibular function was allowed within the limits that pain allowed. As pain subsided and function increased, mandibular exercises were prescribed to preclude abnormal mandibular deviation. The mandibular lingual splint for the concomitant parasymphyseal