- Email: [email protected]
Management of Mandibular Fractures Treated By Champy Technique Without Postoperative Maxillomandibular Fixation: A Retrospective Study
Poster Session old or more, of these, 18 (56.2%) were male and the average age was 74.2 (8.6). The most prevalent trauma was falling (16-50%), following by high level falling (5-15.6%), vehicle-related trauma (4-12.5%), motor vehicle accidents (2-6.2%), physical aggression (1-3.1%) and object collision (1-3.1%). Elderly people with soft tissues lesions are 24 (75%) and 21 (65.6%) with facial bone fractures. The two elderly patients who underwent high kinematic accidents died. Based on these results it can be concluded that prevalent etiology in elderly people was falling, suggesting the need of precocious diagnosis of pathologic causes (intrinsic) and extrinsic of the fall, creation of strategies to improve their life quality. The conclusion is that the elderly people who undergo high kinematic impact have the worst prognosis. References: 1. Arcuri PM, Ramos NB, Scabar LF. Pacientes geriatricos no Brasil. Revista Instituto Ci^encias da Sa ude; 24(1): 43-45, jan.-marc. 2006 2. Dias E. et al. Trauma no idoso. Revista de Cirurgia e Traumatologia Buco- Maxilo-Facial; Pernanbuco; 1(2): 7-12, jul.-dez. 2001 3. Maeshiro FL. et al. Capacidade Funcional e a Gravidade do Trauma em Idosos. Acta Paulista de Enfermagem; S~ao Paulo; 26(4): 389-94, 2013 4. Instituto de estudos de sa ude suplementar. Envelhecimento Populacional e os Desafios para o Sistema de Sa ude Brasileiro. S~ao Paulo. 2013
POSTER 60 The Use of 3D Strut Plates for the Management of Mandibular Angle Fractures: A Retrospective Analysis of 222 Patients F. H. Alotaibi: University of Miami/Jackson Memorial Hospital, Y. Sawatari, H. A. Marwan, J. W. Gannon, M. Peleg Purpose: This article evaluates the use of 3D strut plates for the surgical management of mandibular angle fractures and evaluates the subsequent postoperative complication rate. Material and Methods: Two hundred and twentytwo patients met the inclusion criteria for mandible angle fractures at Jackson Memorial/University of Miami Medical Center between 2009 and 2013 and were included in this research. Our treatment protocol for mandibular angle fractures included open reduction and internal fixation with the utilization of a 3D strut plate. Patients were not placed in postoperative intermaxillary fixation (IMF). Results: An evaluation of the cases revealed a complication rate of 16%, of which 7% were considered major complications requiring surgical intervention. We have found that the 3D strut plate has many advantages over monoplate techniques with respect to the stability of the fracture and the rate of complications. e-88
Conclusion: Based on the current data, 3D strut plates provide a predictable result in the treatment of mandibular angle fractures. References: 1. Al-Moraissi EA, El-Sharkawy TM, El-Ghareeb TI, & Chrcanovic BR. Three-dimensional versus standard miniplate fixation in the management of mandibular angle fractures: a systematic review and metaanalysis. International Journal of Oral and Maxillofacial Surgery 43, 708-716, http://dx.doi.org/10.1016/j.ijom.2014.02.002 (2014). 2. Ellis E, 3rd. Treatment methods for fractures of the mandibular angle. International Journal of Oral and Maxillofacial Surgery 28, 243-252 (1999).
POSTER 61 Management of Mandibular Fractures Treated By Champy Technique Without Postoperative Maxillomandibular Fixation: A Retrospective Study M. E. Bell: Nova Southeastern University, S. McClure, F. Sarmiento Champy technique has been well accepted as a treatment modality for surgical management of mandibular fractures. Placing monocortical plates along the ideal lines of osteosynthesis allows surgeons to meet ideal surgical goals. These goals include minimal invasiveness, early return to function, and avoidance of skin incisions. Studies have demonstrated that mandibular trauma patients produce reduced occlusal forces.2 Our hypothesis is that Champy technique allows for an earlier return to function and does not necessitate post-operative maxillomandibular fixation (MMF). A retrospective review was conducted at Nova Southeastern University’s Department of Oral and Maxillofacial Surgery from October 2007 to January 2015. Mandibular fractures reviewed for this study were treated by residents under the supervision of one attending surgeon. Inclusion criteria required that all fractures must have been treated exclusively by Champy technique without postoperative MMF. Patients were not excluded based on age, gender, systemic health, mechanism of injury, or severity of fracture displacement. Major postoperative complications are those that would require a return to the operating room, and occurred within two months of the original surgery date. The records of 254 patients with mandible fractures were reviewed and 69 were identified as meeting inclusion criteria with 78 fractures. Eleven were lost to follow up. Patient population included 49 males and 9 females with age ranges from 13 to 54. Location of fractures included 49 angles, 26 parasymphseal, and 3 symphyseal. All patients had at least 4 to 6 weeks of follow-up. Two patients had a nonunion that required plate removal, debridement of the mandible and application of an AAOMS 2016
Poster Session inferior border plate with bicortical screws. Two patients with poor oral hygiene had a minor dehiscence, two had a slight (1 mm) open bite that was managed with elastics, and one had a subperiosteal infection managed with antibiotics. Major complication rate given this data is 3.4%, and minor complications amounted to 8.6%. Today’s healthcare is centric around patient satisfaction, which requires surgeons to provide high quality care while simultaneously being judicious with hospital resources. By avoiding postoperative MMF, patient care can further be enhanced by allowing an earlier return to function and earlier jaw physiotherapy. Furthermore, comorbidities that can be associated with MMF such as poor oral hygiene, caries, weight loss, and restricted jaw mobility are minimized. Our results show that major complication rates remain very low with patients treated exclusively via Champy plating technique without postoperative maxillomandibular fixation. References: 1. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg, 6:14–21, 1978 2. Kshirsagar R, Jaggi N, Halli, R; Bite force measurements in mandibular parasymphyseal fractures: A preliminary study, Craniomaxillofacial Trauma Reconstruction, 4:241-244, 2011
reconstruction plate were designed virtually, fabricated and used to reconstruct the mandible. Results: The patient was successfully treated with open reduction and internal fixation of her bilateral atrophic mandible fractures utilizing virtual surgical planning, custom cutting guides and custom reconstruction plate. Function was restored and the mandible was re-projected. Conclusion: ORIF of the atrophic, edentulous mandible fracture with the help of virtual surgical planning can not only decrease surgical time as reported in the literature,but also makes the operation more predicable and can re-create mandibular projection. References: 1. Clayman L, Rossi E: Fixation of atrophic edentulous mandible fractures by bone plating at the inferior border. J Oral Maxillofac Surg 70:883-889, 2012 2. Van Sickels J, DDS, Cunningham L: Management of atrophic mandible fractures: Are bone grafts necessary? J Oral Maxillofac Surg 68:1392-1395, 2010
POSTER 63 Subgaleal Hematoma from Hair-Combing J. C. Baker: Medical College of Wisconsin, K. D. Smith
POSTER 62 Open Reduction and Internal Fixation of Bilateral Atrophic Mandible Fractures Utilizing Virtual Surgical Planning, Custom Cutting Guides and Reconstruction Plate. a Case Report P. Kupfer: Oregon Health and Science University, N. Saadat, P. J. Hughes Purpose: The purpose of this abstract is to describe the reconstruction of a bilateral atrophic mandible fracture with malunion with the help of virtual surgical planning and custom cutting guides and reconstruction plate. Materials and Methods: A 73-year-old woman presented to the Oregon Health and Science University Department of Oral and Maxillofacial Surgery with a history of having suffered an atrophic, edentulous mandible fracture treated with circumandibular wires using her pre-existing dentures for reduction while vacationing outside the USA. She presented to our Department seven months later with a left sided malunion and right sided non-union and posterior displacement of the distal mandibular segment. A CT scan was obtained and virtual surgical planning was used determine the location of the osteotomy, and the patient’s mandible and B point was reprojected virtually. Custom cutting guides and a custom AAOMS 2016
Subgaleal hematomas have been reported to occur in the pediatric population particularly in neonates with incidence ranging from 4 to 59 per 10,000 births.1 Subgaleal hematoma occurrence beyond the neonatal period is most often associated with head trauma involving tangential or radial forces applied to the scalp in which emissary veins are ruptured.2,3 Children are predisposed to subgaleal bleeding due to a thinner scalp and more vascular subaponeurotic space than adults.4 A review of PubMed illustrated the rarity of subgaleal hematomas as only 12 cases were reported.3,5,6,7,8,9,10,11,12 Subgaleal hematoma was believed to result from hair-pull for the following reasons: the presence of thick hair that is difficult to pull, easily disrupted galeal-pericranial attachment, normal results of coagulopathy work-up, and no evidence of abuse or trauma.5 We report on a case of a 14-year-old male who presented to the emergency room with pain and swelling in the scalp of six days duration. Computed tomographic imaging revealed a 10.5 cm x 8.25 cm x 1.25 cm right frontotemporoparietal subgaleal hematoma. Following a thorough evaluation of the patient’s history—with no evidence of abuse or trauma—a detailed physical exam, and a normal hematology work-up, the swelling was determined to be secondary to hair-combing. The hematoma was drained three times: first, via an initial aspiration with drain and compression dressing application yielding 200cc of non-coagulated blood; second, via surgical e-89
POSTER 60 The Use of 3D Strut Plates for the Management of Mandibular Angle Fractures: A Retrospective Analysis of 222 Patients F. H. Alotaibi: University of Miami/Jackson Memorial Hospital, Y. Sawatari, H. A. Marwan, J. W. Gannon, M. Peleg Purpose: This article evaluates the use of 3D strut plates for the surgical management of mandibular angle fractures and evaluates the subsequent postoperative complication rate. Material and Methods: Two hundred and twentytwo patients met the inclusion criteria for mandible angle fractures at Jackson Memorial/University of Miami Medical Center between 2009 and 2013 and were included in this research. Our treatment protocol for mandibular angle fractures included open reduction and internal fixation with the utilization of a 3D strut plate. Patients were not placed in postoperative intermaxillary fixation (IMF). Results: An evaluation of the cases revealed a complication rate of 16%, of which 7% were considered major complications requiring surgical intervention. We have found that the 3D strut plate has many advantages over monoplate techniques with respect to the stability of the fracture and the rate of complications. e-88
Conclusion: Based on the current data, 3D strut plates provide a predictable result in the treatment of mandibular angle fractures. References: 1. Al-Moraissi EA, El-Sharkawy TM, El-Ghareeb TI, & Chrcanovic BR. Three-dimensional versus standard miniplate fixation in the management of mandibular angle fractures: a systematic review and metaanalysis. International Journal of Oral and Maxillofacial Surgery 43, 708-716, http://dx.doi.org/10.1016/j.ijom.2014.02.002 (2014). 2. Ellis E, 3rd. Treatment methods for fractures of the mandibular angle. International Journal of Oral and Maxillofacial Surgery 28, 243-252 (1999).
POSTER 61 Management of Mandibular Fractures Treated By Champy Technique Without Postoperative Maxillomandibular Fixation: A Retrospective Study M. E. Bell: Nova Southeastern University, S. McClure, F. Sarmiento Champy technique has been well accepted as a treatment modality for surgical management of mandibular fractures. Placing monocortical plates along the ideal lines of osteosynthesis allows surgeons to meet ideal surgical goals. These goals include minimal invasiveness, early return to function, and avoidance of skin incisions. Studies have demonstrated that mandibular trauma patients produce reduced occlusal forces.2 Our hypothesis is that Champy technique allows for an earlier return to function and does not necessitate post-operative maxillomandibular fixation (MMF). A retrospective review was conducted at Nova Southeastern University’s Department of Oral and Maxillofacial Surgery from October 2007 to January 2015. Mandibular fractures reviewed for this study were treated by residents under the supervision of one attending surgeon. Inclusion criteria required that all fractures must have been treated exclusively by Champy technique without postoperative MMF. Patients were not excluded based on age, gender, systemic health, mechanism of injury, or severity of fracture displacement. Major postoperative complications are those that would require a return to the operating room, and occurred within two months of the original surgery date. The records of 254 patients with mandible fractures were reviewed and 69 were identified as meeting inclusion criteria with 78 fractures. Eleven were lost to follow up. Patient population included 49 males and 9 females with age ranges from 13 to 54. Location of fractures included 49 angles, 26 parasymphseal, and 3 symphyseal. All patients had at least 4 to 6 weeks of follow-up. Two patients had a nonunion that required plate removal, debridement of the mandible and application of an AAOMS 2016
Poster Session inferior border plate with bicortical screws. Two patients with poor oral hygiene had a minor dehiscence, two had a slight (1 mm) open bite that was managed with elastics, and one had a subperiosteal infection managed with antibiotics. Major complication rate given this data is 3.4%, and minor complications amounted to 8.6%. Today’s healthcare is centric around patient satisfaction, which requires surgeons to provide high quality care while simultaneously being judicious with hospital resources. By avoiding postoperative MMF, patient care can further be enhanced by allowing an earlier return to function and earlier jaw physiotherapy. Furthermore, comorbidities that can be associated with MMF such as poor oral hygiene, caries, weight loss, and restricted jaw mobility are minimized. Our results show that major complication rates remain very low with patients treated exclusively via Champy plating technique without postoperative maxillomandibular fixation. References: 1. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg, 6:14–21, 1978 2. Kshirsagar R, Jaggi N, Halli, R; Bite force measurements in mandibular parasymphyseal fractures: A preliminary study, Craniomaxillofacial Trauma Reconstruction, 4:241-244, 2011
reconstruction plate were designed virtually, fabricated and used to reconstruct the mandible. Results: The patient was successfully treated with open reduction and internal fixation of her bilateral atrophic mandible fractures utilizing virtual surgical planning, custom cutting guides and custom reconstruction plate. Function was restored and the mandible was re-projected. Conclusion: ORIF of the atrophic, edentulous mandible fracture with the help of virtual surgical planning can not only decrease surgical time as reported in the literature,but also makes the operation more predicable and can re-create mandibular projection. References: 1. Clayman L, Rossi E: Fixation of atrophic edentulous mandible fractures by bone plating at the inferior border. J Oral Maxillofac Surg 70:883-889, 2012 2. Van Sickels J, DDS, Cunningham L: Management of atrophic mandible fractures: Are bone grafts necessary? J Oral Maxillofac Surg 68:1392-1395, 2010
POSTER 63 Subgaleal Hematoma from Hair-Combing J. C. Baker: Medical College of Wisconsin, K. D. Smith
POSTER 62 Open Reduction and Internal Fixation of Bilateral Atrophic Mandible Fractures Utilizing Virtual Surgical Planning, Custom Cutting Guides and Reconstruction Plate. a Case Report P. Kupfer: Oregon Health and Science University, N. Saadat, P. J. Hughes Purpose: The purpose of this abstract is to describe the reconstruction of a bilateral atrophic mandible fracture with malunion with the help of virtual surgical planning and custom cutting guides and reconstruction plate. Materials and Methods: A 73-year-old woman presented to the Oregon Health and Science University Department of Oral and Maxillofacial Surgery with a history of having suffered an atrophic, edentulous mandible fracture treated with circumandibular wires using her pre-existing dentures for reduction while vacationing outside the USA. She presented to our Department seven months later with a left sided malunion and right sided non-union and posterior displacement of the distal mandibular segment. A CT scan was obtained and virtual surgical planning was used determine the location of the osteotomy, and the patient’s mandible and B point was reprojected virtually. Custom cutting guides and a custom AAOMS 2016
Subgaleal hematomas have been reported to occur in the pediatric population particularly in neonates with incidence ranging from 4 to 59 per 10,000 births.1 Subgaleal hematoma occurrence beyond the neonatal period is most often associated with head trauma involving tangential or radial forces applied to the scalp in which emissary veins are ruptured.2,3 Children are predisposed to subgaleal bleeding due to a thinner scalp and more vascular subaponeurotic space than adults.4 A review of PubMed illustrated the rarity of subgaleal hematomas as only 12 cases were reported.3,5,6,7,8,9,10,11,12 Subgaleal hematoma was believed to result from hair-pull for the following reasons: the presence of thick hair that is difficult to pull, easily disrupted galeal-pericranial attachment, normal results of coagulopathy work-up, and no evidence of abuse or trauma.5 We report on a case of a 14-year-old male who presented to the emergency room with pain and swelling in the scalp of six days duration. Computed tomographic imaging revealed a 10.5 cm x 8.25 cm x 1.25 cm right frontotemporoparietal subgaleal hematoma. Following a thorough evaluation of the patient’s history—with no evidence of abuse or trauma—a detailed physical exam, and a normal hematology work-up, the swelling was determined to be secondary to hair-combing. The hematoma was drained three times: first, via an initial aspiration with drain and compression dressing application yielding 200cc of non-coagulated blood; second, via surgical e-89