Rapid prototyping and patient-specific pre-contoured reconstruction plate for comminuted fractures of the mandible

doi:10.1016/j.bjoms.2015.06.018

British Journal of Oral and Maxillofacial Surgery

Volume 53, Issue 10, December 2015, Pages 1035-1037

https://doi.org/10.1016/j.bjoms.2015.06.018 Get rights and content

Abstract

The clinical use of rapid prototype, 3-dimensional models and pre-bent reconstruction plates is recognised for mandibular reconstruction after resection of cancer. We describe a new approach using similar techniques in the management of complicated mandibular fractures.

Introduction

To maintain dental occlusion, spatial position, and bony contour after extensive injuries to the mandible and continuity defects, proper adaptation of reconstruction plates is essential. For mandibular reconstruction after resection of cancer, the use of rapid-prototyping to construct 3-dimensional stereolithographic models for patient-specific, pre-bent reconstruction plates has been well described and is now common.1, 2, 3, 4, 5, 6, 7 We describe what may be the first reported use of a rapid-prototype model and patient-specific, pre-bent reconstruction plate in a patient with a complex mandibular injury.

Section snippets

Case history

A 41-year-old man presented with a bilateral fracture of the mandible after a seizure. He was well known to the department, and had been treated about 4 months earlier for a fracture of the right parasymphysis of the mandible. Clinical and radiological examination showed a comminuted fracture of the left mandibular ramus and condyle, and a displaced fracture of the right parasymphysis, and we suspected non-union from the previous fracture. There was an osteosynthesis plate at the left angle of

Discussion

The patient's extensive mandibular injuries could have been managed using more traditional techniques. Prolonged immobilisation for intermaxillary fixation was deemed unsafe given his medical history, together with his excessive alcohol consumption and drug use. The use of load-bearing plates is well understood in comminuted mandibular fractures, so multiple miniplates were deemed inappropriate.

The benefits of rapid prototyping5, 6 and precontoured reconstruction plates have been well-described,

Conflict of interest

We have no conflicts of interest.

Ethics statement/confirmation of patient's permission

All personal or identifying patient details have been removed.

References (7)

B.T. Kernan et al.
Use of a stereolithography model for accurate, pre-operative adaptation of a reconstruction plate
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M.M. Hanasono et al.
Computer-assisted design and rapid-prototype modeling in microvascular mandble reconstruction
Laryngoscope
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F. Wilde et al.
Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods
Int J Comput Assist Radiol Surg
(2015)

There are more references available in the full text version of this article.

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Citation Excerpt :
Previous studies showed that comminuted mandibular fractures can be successfully treated by a number of methods, including ORIF, closed treatment with IMF, or external pin fixation, when applied under the appropriate circumstances.1,2 Many new methods and techniques, such as rapid prototyping and a low-profile locking mandibular reconstruction plate system, also have been applied to improve the surgical effects in recent years.8,9 However, many complications, including infection, malocclusion, and bone nonunion, have been reported in cases of comminuted mandibular fractures.10
Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures.
Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction–internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up.
Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis.
We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology.
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Short communicationRapid prototyping and patient-specific pre-contoured reconstruction plate for comminuted fractures of the mandible

Abstract

Introduction

Section snippets

Case history

Discussion

Conflict of interest

Ethics statement/confirmation of patient's permission

J Oral Maxillofac Surg

Computer-assisted design and rapid-prototype modeling in microvascular mandble reconstruction

Laryngoscope

Mandible reconstruction using patient-specific pre-bent reconstruction plates: comparison of standard and transfer key methods

Int J Comput Assist Radiol Surg

Short communication
Rapid prototyping and patient-specific pre-contoured reconstruction plate for comminuted fractures of the mandible