DOI:

10.37988/1811-153X_2018_1_44

Issues of clinical efficacy of modern technologies in osteosynthesis of the lower jaw

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Authors

  • A.S. Pankratov 1, PhD in Medical Sciences, full professor of the Maxillofacial dentistry Department
  • 1 Sechenov University, 119435, Moscow, Russia

Abstract

According to some authors, the real percentage of postsurgical complications with the use of modern technologies of osteosynthesis of the lower jaw remains at a fairly high level. According to the StAR clinical protocol dedicated to the treatment of patients with fractures of this bone, the overall incidence of complications is 15-19%, which in fact does not differ from the corresponding indicator of 25 years ago, i.е. the period when these technologies have not yet been widely introduced into domestic clinical practice. The purpose of this paper was to analyze the causes of the situation. At the first stage, a retrospective study of the history of the disease of 88 patients consulted for complications that developed after the surgical treatment of fractures of the lower jaw using osteosynthesis was conducted. At the same time, in 62.5% of cases, deviations from the requirements of operational technologies were revealed. Among the remaining 37.5% of patients, in most cases, the effectiveness of treatment can be improved by enhancing operational procedures. This is confirmed by the results of the second stage of the study, performed in 442 patients with different variants of mandibular fractures and their complications at various periods after the trauma. Operative treatment for them was carried out in strict accordance with the requirements of the osteosynthesis protocol developed by us earlier. The overall incidence of complications was 4.07%, of which clinically significant were 2.03%. Thus, there is a need to introduce regulatory rules for the operational treatment of this category of patients, based on evidence-based medicine.

Key words:

mandible, fractures, osteosynthesis

For Citation

[1]
Pankratov A.S. Issues of clinical efficacy of modern technologies in osteosynthesis of the lower jaw. Clinical Dentistry (Russia).  2018; 1 (85): 44—49. DOI: 10.37988/1811-153X_2018_1_44

References

  1. Аджиев К.С. Профилактика гнойно-воспалительных осложнений переломов нижней челюсти с помощью вибромассажа на собственных частотах сердечно-сосудистой системы пациентов: автореф. дис. … к.м.н. - М., 1991. - 16 с.
  2. Александров Н.М., Аржанцев П.З., Вихриев Б.С. и др. Травмы челюстно-лицевой области. - М.: Медицина, 1986. - 447 с.
  3. Александров Н.М. (ред.) Клиническая оперативная челюстно-лицевая хирургия: руководство для врачей. - Л.: Медицина, 1985. - 448 с.
  4. Клинические рекомендации (протоколы лечения). Перелом нижней челюсти. - URL: http://www.e-stomatology.ru/director/protocols/protocol_perelom.php. (дата обращения 21 июня 2017).
  5. Козлов В.А. Неотложная стационарная стоматологическая помощь. - Л.: Медицина, 1988. - 288 с.
  6. Медведев Ю.А., Сергеев Ю.Н., Бедирханлы Н.С., Хоаг Т.А. Опыт и перспективы хирургического лечения высоких переломов мыщелкового отростка нижней челюсти со смещением отломков. - Здоровье и образование в XXI веке. - 2009; 1: 64-7.
  7. Панкратов А.С. Совершенствование методов оперативного лечения больных с переломами нижней челюсти и их осложнениями: дис. … д.м.н. - М., 2005. - 365 с.
  8. Панкратов А.С., Притыко А.Г., Коркин В.В., Озолина Н.Г. Организация неотложной медицинской помощи больным с переломами костей лицевого скелета. - Российский медицинский журнал. - 2009; 4: 3-6.
  9. Панкратов А.С. Неотложная помощь в клинике челюстно-лицевой хирургии. Современное состояние вопроса. Вековые традиции. Новые технологии. - В сб.: Материалы юбилейной научно-практической конференции ГКБ № 1 им. Н.И. Пирогова. - М., 2012. - С. 320-332.
  10. Темерханов Ф.Т., Юрмазов Н.Б. Хирургическое лечение переломов мыщелковых отростков нижней челюсти с применением титановых устройств. - Бюллетень СО РАМН. - 2003; 3 (109): 102-7.
  11. Шаргородский А.Г., Стефанцов Н.М. Повреждения мягких тканей и костей лица. - М.: ВУНЦ, 2000. - 240 с.
  12. Bergh B., Heymans M.W., Duvekot F., Forouzanfar T. Treatment and complications of mandibular fractures: a 10-year analysis. - J CranioMaxillofac Surg. - 2012; 10 (4): 108-11.
  13. Boyne P.J. Free grafting of traumatically displaced or resected mandibular condyles. - J Oral Maxillofac Surg. - 1989; 47 (3): 228-32.
  14. Bui P., Demian N., Beetar P. Infection rate in mandibular angle fractures treated with a 2.0 mm 8-hole curved strut plate. - J Oral Maxillofac Surg. - 2009; 67: 804-8.
  15. Campbell A., Lin Y. Complication of rigid internal fixation. - Craniomaxillofac Trauma Reconstr. - 2009; 2 (1): 41-7.
  16. Champy M., Pape H.D., Gerlach K.L., Lodde J.P. The Strasbourg miniplate ostesynthesis. - In: Krüger E, Schilli W, Worthington P (eds.) Oral and maxillofacial traumatology. - Vol. 2. -Edinburgh: Quintessence, 1986. - Pp. 19-43.
  17. Feller K.U., Schneider M., Hlawitschka M. et al. Analysis of complications in fractures of the mandibular angle-a study with finite element computation and evaluation of data of 277 patients. - J CranioMaxillofac Surg. - 2003; 31 (5): 290-5.
  18. Fox A.J., Kellman R.M. Mandibular angle fractures: two-miniplate fixation and complications. - Arch Facial Plast Surg. - 2003; 5: 464-9.
  19. Haug R.H., Serafin B.L. Mandibular angle fractures: a clinical and biomechanical comparison-the works of Ellis and Haug. - Craniomaxillofac Trauma Reconstr. - 2008; 1 (1): 31-8.
  20. Iizuka T., Lindqvist C., Hallikainen D., Mikkonen P., Paukku P. Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures. A clinical and radiologic study of thirteen patients. - Oral Surg Oral Med Oral Pathol. - 1991; 72 (4): 400-7.
  21. Kroon F.H., Mathisson M., Cordey J.R., Rahn B.A. The use of miniplates in mandibular fractures. An in vitro study. - J Craniomaxillofac Surg. - 1991; 19: 199-204.
  22. Mansuri S., Abdulkhayum A.M., Gazal G., Hussain M.A. Treatment of mandibular angle fracture with a 2 mm, 3-dimensional rectangular grid compression miniplates: a prospective clinical study. - J Int Oral Health. - 2013; 5 (6): 93-100.
  23. Singh R.K., Pal U.S., Agrawal A., Singh G. Single miniplate osteosynthesis in angle fracture. - Natl J Maxillofac Surg. - 2011; 2 (1): 47-50.
  24. Winstanley R.P. The management of fractures of the mandible. - Br J Oral Maxillofac Surg. - 1984; 22 (3): 170-7.
  25. Winstanley R.P. Fractures of the mandible: the case for minimal intervention. - Oral Surg Oral Med Oral Pathol. - 1995; 80 (4): 380.

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Published on

March 1, 2018