Zur Osteosynthese bei Frakturen im zahnlosen atrophen Unterkiefer – Möglichkeiten zum Hardware Downsizing, Lingual Plating

Zusammenfassung

Die Frakturbehandlung im zahnlosen atrophen Unterkiefer ist problematisch. Dies hat seine Gründe in lokalen Faktoren, wie der reduzierten ossären Quantität und Qualität sowie in altersassoziierten Komorbiditäten. Die Therapiemöglichkeiten reichen von minimalistisch konservativen Ansätzen über die Applikation von Miniplatten unter Verwendung transoraler chirurgischer Zugänge bis hin zur aggressiven transfazial-submandibulären Dissektion mit Reposition und Montage von Makro- bzw. Rekonstruktionsplatten. Wenn Rekonstruktionsplattensysteme mit einem hochatrophen „Pencilbone“-Unterkiefer zusammentreffen, wird ein „Overengineering“ deutlich, da die Massivität des Osteosynthesematerials und der residuale Knochen in krassem Missverhältnis zueinander stehen. Wegen der hohen Stabilität der mit Rekonstruktionsplatten überbrückten Frakturen gelten diese jedoch nach wie vor als Referenz für Vergleiche mit anderen internen Fixationsverfahren bzw. Plattenvarianten und Konstrukten.

Abstract

The management of atrophic mandible fractures is challenging. This is attributed to local factors like impaired bone quality and quantity as well as to age-related comorbidities. Therapeutic options range from minimalistic non-operative approaches over the transoral application of miniplates to extended submandibular approaches with application of reconstruction plates. Stabilising a “pencil-bone” mandible with a large macroplate may appear like “over-engineering” due to the size discrepancy between bone and plate. However, treatment of atrophic mandible fractures with reconstruction plates can still be considered as the standard because of the high stability that is achievable.

• Literatur

• 1 Bruce RA, Strachan DS. Fractures of the edentulous mandible: the Chalmer J. Lyons Academy study. J Oral Surg 1976; 34: 973-979
• 2 Thaller SR. Fractures of the edentulous mandible: a retrospective review. J Craniofac Surg 1993; 4: 91-94
• 3 Amaratunga NA. A comparative study of the clinical aspects of edentulous and dentulous mandibular fractures. J Oral Maxillofac Surg 1988; 46: 3-5
• 4 Kunz C, Hammer B, Prein J. [Fractures of the edentulous atrophic mandible. Fracture management and complications]. Mund Kiefer Gesichtschir 2001; 5: 227-232
• 5 Bruce RA, Ellis 3rd E. The second Chalmers J. Lyons Academy study of fracture of the edentulous mandible. J Oral Maxillofac 1993; 51: 904-911
• 6 Xie Q, Ainamo A. Association of edentulousness with systemic factors in elderly people living at home. Community Dent Oral Epidemiol 1999; 27: 202-229
• 7 McGregor AD, MacDonald DG. Age changes in the human inferior alveolar artery–a histological study. Br J Oral Maxillofac Surg 1989; 27: 371-374
• 8 Bradley JC. Age changes in the vascular supply of the mandible. Br Dent J 1972; 132: 142-144
• 9 Bradley JC. Age changes of the inferior alveolar artery. Br J Oral Maxillofac Surg 1988; 26: 517-519
• 10 Härle F. Atlas der präprothetischen Operationen. München: Hanser Verlag; 1989
• 11 Luhr HG, Reidick T, Merten HA. Fractures of the atrophic mandible–a challenge for therapy. Fortschr Kiefer Gesichtschir 1996; a 41: 151-154
• 12 Luhr HG, Reidick T, Merten HA. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases. J Oral Maxillofac Surg 1996; b 54: 250-254
• 13 Carlsson GE, Ragnarson N, Astrand P. Changes in height of the alveolar process in edentulous segments. A longitudinal clinical and radiographic study of full upper denture cases with residual lower anteriors. Odontol Tidskr 1967; 75: 193-208
• 14 Wical KE, Swoope CC. Studies of residual ridge resorption. I. Use of panoramic radiographs for evaluation and classification of mandibular resorption. J Prosthet Dent 1974; 32: 7-12
• 15 Atwood DA. Bone loss of edentulous alveolar ridges. J Periodontol 1979; 50: 11-21
• 16 Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg 1988; 17: 232-236
• 17 Nasser M, Fedorowicz Z, Ebadifir A. Management of the fractured edentulous atrophic mandible. Cochrane Database of Systematic Review 2007; (1) CD006087
• 18 Cope MR. Spontaneous fracture of an atrophic endentulous mandible treated without fixation. Br J Oral Surg 1982; 20: 22-30
• 19 Wolfe SA, Lovaas M, McCafferty LR. Use of a miniplate to provide intermaxillary fixation in the edentulous patient. J Craniomaxillofac Surg 1989; 17: 31-33
• 20 Hori M, Nakada Y, Matsunaga S et al. Use of two miniplates for intermaxillary skeletal fixation in the treatment of jaw deformity and fracture. J Nihon Univ Sch Dent 1992; 34: 224-229
• 21 Pohl L. Extraoral splinting of the edentulous mandible. Lancet 1941; 2: 389-391
• 22 Ginestet G. Le „fixateur externe“ dans le traitement des fractures du maxillaire inférieur. Rev Odontol Stomatol Maxillo-Fac 1946; 10: 455-460
• 23 Kaufman Y, Cole P, Hollier L. Contemporary issues in facial gunshot wound management. J Craniofac Surg 2008; 19: 421-427
• 24 Alpert B, Tiwana PS, Kushner GM. Management of comminuted fractures in the mandible. Oral Maxillofac Surg Clin North Am 2009; 21: 185-192
• 25 Madsen MJ, Haug RH, Christensen BS et al. Management of atrophic mandible fractures. Oral Maxillofac Surg Clin North Am 2009; 21: 175-183
• 26 Ellis 3rd E, Miles BA. Fractures of the mandible: a technical perspective. Plast Reconstr Surg 2007; 120: 76S-89S
• 27 Michelet FX, Dessus B, Benoit JP et al. [Mandibular osteosynthesis without blocking by screwed miniature stellite plates]. Rev Stomatol Chir Maxillofac 1973; 74: 239-245
• 28 Champy M, Wilk A, Schneebelen JM. Die Behandlung der Mandibularfrakturen mittels Osteosynthese ohne intermaxilläre Ruhigstellung nach der Technik von F.X. Michelet. Zahn Mund Kieferheilk 1975; 63: 339-341
• 29 Champy M, Lodde JP, Jaeger JH et al. [Biomechanical basis of mandibular osteosynthesis according to the F.X. Michelet method]. Rev Stomatol Chir Maxillofac 1976; a 77: 248-251
• 30 Champy M, Lodde JP, Jaeger JH et al. [Mandibular osteosynthesis according to the Michelet technic. I. Biomechanical bases]. Rev Stomatol Chir Maxillofac 1976; b 77: 569-576
• 31 Champy M, Lodde JP, Jaeger JH et al. [Mandibular osteosynthesis according to the Michelet technic. II. Presentation of new material. Results]. Rev Stomatol Chir Maxillofac 1976; c 77: 577-582
• 32 Champy M, Lodde JP, Jaeger JH et al. [Mandibular osteosynthesis according to the Michelet technic. Justification of new material. Results]. Rev Stomatol Chir Maxillofac 1976; d 77: 252-255
• 33 Iatrou I, Samaras C. Theologie-Lygidakis N, Miniplate osteosynthesis for fractures of the edentulous mandible: a clinical study 1989–96. J Craniomaxillofac Surg 1998; 26: 400-404
• 34 Choi BH, Huh JY, Suh CH et al. An in vitro evaluation of miniplate fixation techniques for fractures of the atrophic edentulous mandible. Int J Oral Maxillofac Surg 2005; 34: 174-177
• 35 Mugino H, Takagi S, Oya R et al. Miniplate osteosynthesis of fractures of the edentulous mandible. Clin Oral Investig 2005; 9: 266-270
• 36 Pape HD, Gerlach KL, Champy M. Mandibular Fractures including atrophied Mandible. In: Härle F, Champy M, Terry BC, eds. Atlas of craniomaxillofacial Osteosynthesis. Miniplates, Microplates and Screws. Stuttgart, New York: Thieme; 1999: 31-39
• 37 Spiessl B, Schargus G, Schroll K. Die stabile Osteosynthese bei Frakturen des unbezahnten Unterkiefers. Schweiz Monatschr Zahnheilk 1971; 81: 39-45
• 38 Spiessl B. Osteosynthese des Unterkiefers, Manual der AO-Prinzipien. Berlin, Heidelberg, New York: Springer Verlag; 1988
• 39 Prein J. Invited Comment to Newman L: The role of autogenous rib grafts in treating fractures of the atrophic edentulous mandible. Br J Oral Maxillofac Surg 1990; 33: 386
• 40 Eyrich GK, Grätz KW, Sailer HF. Surgical treatment of fractures of the edentulous mandible. J Oral Maxillofac Surg 1997; 55: 1081-1087 discussion 1087 – 1088
• 41 Schilli W, Stoll P, Bähr W et al. Mandibular Fractures. In: Prein J, ed. Manual of internal Fixation in the cranio-facial Skeleton. Berlin, Heidelberg, New York: Springer; 1998: 86-87
• 42 Ellis 3rd E, Price C. Treatment protocol for fractures of the atrophic mandible. J Oral Maxillofac Surg 2008; 66: 421-435
• 43 Tiwana PS, Abraham MS, Kushner GM et al. Management of atrophic edentulous mandibular fractures: the case for primary reconstruction with immediate bone grafting. J Oral Maxillofac Surg 2009; 67: 882-887
• 44 Haug RH, Street CC, Goltz M. Does plate adaptation affect stability? A biomechanical comparison of locking and nonlocking plates. J Oral Maxillofac Surg 2002; 60: 1319-1326
• 45 Prein J, Rahn B. Scientific and technical Background. In: Prein J, ed. Manual of internal Fixation in the cranio-facial Skeleton. Berlin, Heidelberg, New York: Springer; 1998: 9
• 46 Gutwald R, Büscher P, Schramm A. Biomechanical stability of an internal mini-fixation-system in maxillofacial osteosynthesis. Med Biol Eng Comp 1999; 37 (Suppl. 02) 280
• 47 Gutwald R, Alpert B, Schmelzeisen R. Principle and stability of locking plates. Keio J Med 2003; 52: 21-24
• 48 Sikes jr. JW, Smith BR, Mukherjee DP. An in vitro study of the effect of bony buttressing on fixation strength of a fractured atrophic edentulous mandible model. J Oral Maxillofac Surg 2000; 58: 56-61
• 49 Alpert B, Gutwald R, Schmelzeisen R. New innovations in craniomaxillofacial fixation: the 2.0 lock system. Keio J Med 2003; 52: 120-127
• 50 Egol KA, Kubiak EN, Fulkerson E et al. Biomechanics of locked plates and screws. J Orthop Trauma 2004; 18: 488-493
• 51 Luhr HG. Fractures of the atrophic Mandible. In: Hausmann J-E, Ward Booth P, Schendel SA, eds. Maxillofacial Surgery. Edinburgh: Churchill Livingstone; 1999: 195-206
• 52 Levine PA. AO compression plating technique for treating fractures of the edentulous mandible. Otolaryngol Clin North Am 1987; 20: 457-477
• 53 Krebs 3rd FJ. Dynamic compression plating in treatment of the fractured, edentulous mandible. Laryngoscope 1988; 98: 198-201
• 54 Obwegeser HL, Sailer HF. Another way of treating fractures of the atrophic edentulous mandible. J Oral Maxillofac Surg 1973; 1: 213-221
• 55 Blume O, Seper L, Meyer U et al. Experimentelle und klinische Studie zur Stabilität einer Osteosyntheseplatte für den atrophen Unterkiefer. Mund Kiefer Gesichtschir 2003; 7: 323-329
• 56 Seper L, Piffko J, Joos U et al. Treatment of fractures of the atrophic mandible in the elderly. J Am Geriatr Soc 2004; 52: 1583-1584
• 57 Joos U, Piffko J, Meyer U. Neue Aspekte in der Versorgung von Unterkieferfrakturen. Mund Kiefer Gesichtschir 2001; 5: 2-16
• 58 Militsakh ON, Wallace DI, Kriet JD et al. Use of the 2.0 mm locking reconstruction plate in primary oromandibular reconstruction after composite resection. Otolaryngol Head Neck Surg 2004; 131: 660-665
• 59 Farwell DG, Kezirian EJ, Heydt JL et al. Efficacy of small reconstruction plates in vascularized bone graft mandibular reconstruction. Head Neck 2006; 28: 573-579
• 60 Ellis 3rd E, Graham J. Use of a 2.0 mm locking plate/screw system for mandibular fracture surgery. J Oral Maxillofac Surg 2002; 60: 642-645
• 61 Novelli G, Sconza C, Ardito E et al. Surgical treatment of the atrophic mandibular fractures by locked plates systems: our experience and a literature review. Craniomaxillofac Trauma Reconstr 2012; 5: 65-74
• 62 Van Sickels JE, Cunningham LL. Management of atrophic mandible fractures: are bone grafts necessary?. Journal Oral Maxillofac Surg 2010; 68: 1392-1395
• 63 Madsen MJ, Kushner GM, Alpert B. Failed fixation in atrophic mandibular fractures: The case against miniplates. Craniomaxillofacial Trauma and Reconstruction 2011; 4: 145-150
• 64 Aziz SR, Najjar T. Management of the edentulous/atrophic mandibular fracture. Atlas Oral Maxillofac Surg Clin North Am 2009; 17: 75-79
• 65 Spiessl B. Nonunion problems in fractures of the atrophied mandible. SSO Schweiz Monatsschr Zahnheilkd 1980; 90: 627-632
• 66 Buchbinder D. Treatment of fractures of the edentulous mandible, 1943 to 1993: a review of the literature. J Oral Maxillofac Surg 1993; 51: 1174-1180
• 67 Wittwer G, Adeyemo WL, Turhani D et al. Treatment of atrophic mandibular fractures based on the degree of atrophy–experience with different plating systems: a retrospective study. J Oral Maxillofac Surg 2006; 64: 230-234
• 68 Santos GS, de Assis Costa MD, de Oliveira Costa C et al. Failure of miniplate osteosynthesis for the management of atrophic mandibular/fracture. J Craniofac Surg 2013; 24: e415-e418
• 69 Vajgel A, Camargo IB, Willmersdorf RB et al. Comparative finite element analysis of the biomechanical stability of 2.0/fixation plates in atrophic mandibular fractures. J Oral Maxillofac Surg 2013; 71: 335-342
• 70 Madsen MJ, Haug RH. A biomechanical comparison of 2 techniques for reconstructing atrophic edentulous mandible fractures. J Oral Maxillofac Surg 2006; 64: 457-465
• 71 Madsen MJ, McDaniel CA, Haug RH. A biomechanical evaluation of plating techniques used for reconstructing mandibular symphysis/parasymphysis fractures. J Oral Maxillofac Surg 2008; 66: 2012-2019
• 72 Müller S, Burgers R, Ehrenfeld M et al. Macroplate fixation of fractures of the edentulous atrophic mandible: immediate function and masticatory rehabilitation. Clinical oral investigations 2011; 15: 151-156