External Pin Fixation for Stabilization of the Mandible--comeback of a Method: Historical Review and First Experiences with the 'mandible External Fixator'

Overview

Journal Oral Maxillofac Surg

Specialties Dentistry
General Surgery

Date 2008 Dec 4

PMID 19050945

Citations 8

Authors

Carl-Peter Cornelius

Jens Bolko Augustin

Leif-Konradin Sailer

Affiliations

Soon will be listed here.

Abstract

Background: The market-release of a modified 'mandible external fixator' appliance prompted us to reconsider the issues of pin fixation.

Materials And Methods: The first product line of the 'mandible external fixator set-Phase1' (Synthes Maxillofacial, Paoli, USA) contains the three classical basic components: percutaneous pins, clamps, and pre-bent connecting rods. The innovative features are a lightweight titanium construct and the snap-on design of the clamps. The framework is assembled by a single connecting bar (monofixator) in the so-called visor-style technique.

Indications: The indication was restricted to: (1) pathological fractures, e.g., in infected osteoradionecrosis; (2) resectional defects; and (3) emergency care of mandible fractures in a multi-piece, heavy comminution, or defect pattern.

Patients: The mandible external fixator was used in a series of ten patients (all male, 39-73 years), for head and neck tumor sequelae in eight cases (n = 5-curatively, n = 3-palliation) and in two polytrauma cases.

Results: All patients had benefited from the functional restitution of the mandibular continuity avoiding major surgical exposure and additional soft tissue damage. The application using a 'visor-style technique' was appropriate for bridging defects or single comminution zones (n = 9). In the emergency care of a polytraumatized patient with multifragmentation all over the mandible divisions, it did not contribute to an adequate realignment. In curative tumor treatment (patients n = 5), a conversion either to internal fixation (n = 2) or revascularized bone grafting (n = 3) ensued after prolonged intervals of 40-170 days. Pin track infections or loosening did not occur.

Conclusion: The hallmark of external pin fixation is its atraumatic soft tissue management. Hence, it offers peculiar options in singular comminution or defect areas associated with bone pathology and/or soft tissue alterations.

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