Clinical results of two different three-dimensional titanium plates in the treatment of condylar neck and base fractures: A retrospective study

Complications following miniplate insertion in maxillofacial fractures: a systematic review

Background

Maxillofacial fractures, frequently arising from road traffic incidents, falls, and acts of interpersonal aggression, are a considerable public health issue, exhibiting diverse epidemiological patterns according to demographic factors. The application of miniplates for fracture stabilization is a recognized technique, with innovative methods such as 3D plate systems emerging. Nonetheless, consequences including infections and hardware malfunctions persist. This systematic review seeks to present current evidence regarding the complications linked to miniplate placement in maxillofacial fractures over the last ten years.

Methods

A systematic review was performed in accordance with PRISMA principles. Databases such as the Cochrane Library, PubMed, and Scopus were examined from September 2014 to September 2024. Studies documenting problems related to miniplate placement were included, without language constraints. The ROBINS-I tool was utilized for non-randomized studies, whereas the Cochrane risk of bias tool was applied to randomized controlled trials.

Results

From 2,289 initially found studies, 56 satisfied the inclusion criteria. Among these, 28 employed interventional designs, whilst the remaining 28 were observational research. The predominant problems documented in several investigations encompassed infection, wound dehiscence, malocclusion, paraesthesia, malunion/non-union, segment movement, hardware failure, and palpable hardware. Advanced methodologies such as 3D plate systems and locking mechanisms were linked to diminished complication rates.

Conclusion

This systematic analysis presents a decade of updated research about problems associated with miniplate placement in maxillofacial fractures. Novel methodologies such as 3D plate systems and locking mechanisms demonstrate promise in mitigating problems relative to conventional techniques. These findings can facilitate informed decision-making in clinical practice. Additional study utilizing standardized outcomes and prospective designs is essential to enhance comprehension of the long-term effects of miniplate utilization.

Clinical Application of Digital Joint Guide in the Fracture of the Condyle Neck

PURPOSE

The purpose of this study is to use a digital guide plate for joint positioning to assist the reduction of condylar neck fractures and evaluate the accuracy of the reduction after surgery.

MATERIALS AND METHODS

In this study, 20 patients were selected from January 2016 to October 2020, and the reduction of the mandibular condyle neck fracture was designed virtual and digital based on the computed tomography data of the patients, based on the position of the condyle in the articular socket, the height of the ascending mandibular ramus, and the joints. The average value of the anterior space and the posterior space of the joint is these indicators, the position of the condyle is reconstructed, and the fracture reduction finger guide plate is designed. During the operation, the digital guide plate is used to assist the reduction of the condyle neck fracture. The postoperative follow-up was 4 to 12 months to check the accuracy of the reduction.

RESULTS

A total of 20 patients, all fractures achieved complete bone healing, the patients' mouth opening was normal, no obvious complications were found, and none of the patients had facial paralysis. In the postoperative evaluation and preoperative virtual design plan, the chromatographic error was within 2 mm, and the magnetic resonance of the temporomandibular joint showed no displacement of the articular disc.

CONCLUSION

The digital joint guide can reduce the fracture of the condyle neck while ensuring the position of the condyle in the joint socket, which is beneficial to reduce the occurrence of subsequent temporomandibular joint complications.

Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery.

The Use of Titanium 3D Mini-Plates in the Surgical Treatment of Fractures of the Mandibular Condyle: A Systematic Review and Meta-Analysis of Clinical Trials

Introduction: Fixing fractures of the base and neck of mandibular condyles is demanding due to the difficulties in surgical access and the various shapes of bone fragments. Classic fixation techniques assume the use of straight mini-plates, utilized for other craniofacial bone fractures. Three dimensional mini-plates may provide a reasonable alternative due to their ease of use and steadily improved mechanical properties. The multitude of different shapes of 3D mini-plates proves the need for their evaluation. Aim: This paper aims to summarize the clinical trials regarding the use of various types of 3D condylar mini-plates in terms of need for reoperation and the incidence of loosening and damage to the osteosynthetic material. Materials and Methods: A systematic review was conducted in accordance with PICOS criteria and PRISMA protocol. The risk of bias was assessed using ROBINS-I and RoB 2 Cochrane protocols. The obtained data series was analyzed for correlations (Pearson’s r) respecting statistical significance (Student’s t-test p > 0.05) and visualized using OriginLab. Results: 13 clinical trials with low overall risk of bias regarding 6 shapes of 3D mini-plates were included in the synthesis. The number of reoperations correlates with the number of fixations (r = 0.53; p = 0.015) and the total number of screw holes in the mini-plate (r = −0.45; p = 0.006). There is a strong correlation between the number of loosened osteosynthetic screws and the total number of fractures treated with 3D mini-plates (r = 0.79; p = 0.001 for each study and r = 0.99; p = 0.015 for each mini-plate shape). A correlation between the percentage of lost screws and the number of distal screw holes is weak regarding individual studies (r = −0.27; p = 0.000) and strong regarding individual mini-plate shape (r = −0.82; p = 0.001). Three cases of 3D mini-plate fractures are noted, which account for 0.7% of all analyzed fixation cases. Discussion: The reasons for reoperations indicated by the authors of the analyzed articles were: mispositioning of the bone fragments, lack of bone fragment union, secondary dislocation, and hematoma. The known screw loosening factors were poor bone quality, bilateral condylar fractures, difficulties in the correct positioning of the osteosynthetic material due to the limitations of the surgical approach, fracture line pattern, including the presence of intermediate fragments, and mechanical overload. Fractures of the straight mini-plates fixing the mandibular condyles amounts for up to 16% of cases in the reference articles. Conclusions: There is no convincing data that the number of reoperations depends on the type of 3D mini-plate used. The frequency of osteosynthetic screw loosening does not seem to depend on the 3D mini-plate’s shape. Clinical fractures of 3D mini-plates are extremely rare.

Comparison between 3D delta plate and conventional miniplate in treatment of condylar fracture: A randomised clinical trial

The aim of the study was to conduct a randomized clinical trial comparing the efficacy of standard non-compression miniplate and 3-dimensional (3D) titanium plate in the open reduction internal fixation (ORIF) of the mandibular condylar fractures. Patients who underwent open reduction of mandibular condylar fracture were recruited for the study. The patients satisfying the inclusion criteria were randomly assigned to two groups in a 1:1 ratio. Group A comprised patients treated using conventional miniplates, and Group B comprised patients treated using 3D Delta Plate. Informed consent was provided. All the patients underwent ORIF under GA via retromandibular approach. The sample size was set at 20 participants, with 10 participants in each group who were randomly allocated. Our study showed that patients in Group A had a significant statistical difference operating time (141.20 ± 2.59 min) than that of Group B (117.2 ± 9.63 min). Mouth opening was significantly greater in the 3^rd-month follow-up in Group B (mean = 42.40 ± 1.82) compared to Group A (mean = 35.80 ± 1.30). Biting efficiency in Group B was observed to be clinically and statistically better compared to Group A (P = 0.012). Wound dehiscence was managed efficiently by judicious use of antibiotics and wounds were free of any signs of infections or discharge in the consecutive follow-ups. No plate removal was required in either group. Patients treated with 3D delta plates have superior outcomes with regard to operation time, mouth opening, and biting efficiency compared with miniplates. Hence, it can be concluded that the triangular shape of the 3D Delta plate allows the stress distribution to be superior and multidimensional, leading to better post-operative stability, faster healing, and reduced complications.

Does Three-Dimensional Plate Offer Better Outcome and Reduce the Surgical Time Following Open Reduction and Internal Fixation of Adult Mandibular Unilateral Subcondylar Fractures. A Randomized Clinical Study

PURPOSE

The management of the condyle fractures continue to be a source of perineal controversy in the field of oral and maxillofacial trauma. The aim of this study was to compare the surgical feasibility, functional outcome, and stability of fixation between the conventional miniplate and 3-dimensional plate in the management of adult mandibular unilateral subcondylar fractures.

MATERIALS AND METHODS

A prospective randomized clinical study with well-structured inclusion and exclusion criteria was carried out. Patients were allocated into Group A (Miniplates) and Group B (3-D Plates). The primary outcome variables were time taken for fixation, maximum mouth opening, occlusal stability, increase in angulation, and increase in the gap between fractured segments in the radiograph. The secondary outcome variables were needed for intermaxillary fixation (IMF) with guiding elastics and jaw movements. Statistical analysis was done using χ² test and student's t test with P value less than 0.05 indicating statistical significance.

RESULTS

Forty-four patients (40 male and 4 female) were enrolled, with 22 patients in each group. Time taken for fixation using 3-D plates was significantly lower than conventional miniplates (9.6 ± 0.9 minutes with P value 0.001). Although clinical parameters showed improved results for Group B, there was no statistical significance. Radiological parameters ie increase in angulation, and increase in the gap, showed statistically significant results. Group A had significant increases in the angulation of the fractured condyle at the end of the third and sixth months with a P value of 0.008 and 0.0001, respectively. The gap between the fractured segments was significantly increased in Group A at the end of the first and third months, with a P value of 0.022 and 0.003, respectively.

CONCLUSIONS

Our results concluded that 3-D plate offers superior fracture fragment stability and less displacement of the fractured segments. It has an added advantage of the ease of adaptation and shorter operating time.