Screw-wire combination technique in the reconstruction of anterior mandible fractures

AMAÇ Mandibula kırıkları sıkça karşılaşılan yüz yaralanmalarından biridir ve tedavileri özellik arz eder. Bu çalışmanın amacı basit ve yer değiştirmiş simfizis ve parasimfizis mandibula kırıklarının tedavisinde vida-tel osteosentez tekniğinin etkinliğini göstermektir. GEREÇ VE YÖNTEM Basit ve yer değiştirmiş simfizis ve parasimfizis mandibula kırıklarının tedavisinde 9 hastaya vida-tel kombine osteosentez tekniği kullanılarak onarım gerçekleştirildi. Ağız içinden girilerek kırık hatlarının her iki yanına, kırık hatlarından 5 mm uzaklıkta, kırık hattının her iki tarafına, ikisi altta ikisi üstte 4 adet vida yerleştirildi. Vidaların alttaki iki tanesi bikortikal, üstteki iki tanesi unikortikal olarak yerleştirildi. Vidaların telin etrafından geçebilmesi için vidalar tam sıkılmadı. Kırığın şekli, yeri, ihtiyacı ve kırık segmentleri arasındaki dikey eşitsizliğe göre değişik tiplerde vida tel ile kemik tespiti yapıldı. Tel(ler) vidaların etrafından geçirildikten sonra kırık hatlarını karşılıklı düzgün bir şekilde oturtacak şekilde sıkılaştırıldı. Vidalar 1-2 tur daha çevrilerek vida başlarının konik şekli sayesinde ek bir sıkılaştırılma sağlandı. Hastaların tamamına operasyon esnasında intermaksiller fiksasyon yapıldı ve 7 ila 10 gün intermaksiller fiksasyon uygulandı. BULGULAR Sekiz ay-3 yıl arasında değişen takiplerinde enfeksiyon, kaynamama , geç kaynama veya tel ile vidaların çıkartılmasını gerektiren şikayetlerle karşılaşılmadı. SONUÇ Bu yöntemin özellikle anterior mandibula kırıklarında ucuz, basit, hızlı ve etkin bir yöntem olduğunu düşünmekteyiz.BACKGROUND Fractures of the mandible are among frequently seen facial injuries and their reconstruction requires unique procedures. The purpose of this study is to demonstrate the efficacy of screw-wire combination osteosynthesis technique in the treatment of simple and displaced, symphisis and parasymphisis mandible fractures. METHODS In our clinic 9 simple and displaced, symphysis and parasymphysis fractures of mandible were treated with screw-wire combination osteosynthesis technique. By intraoral approach 4 screws were applied to both sides of the fracture site 5 mm away from either side placed at superior (n = 2) and inferior (n = 2) localizations. Lower and upper wires were placed bicortically, and unicortically respectively . In order to surround them with wire, the screws were not fully tightened. After surrounding the screws, the wires were tightened in a manner that would properly face the fracture sites mutually. Intermaxillary fixation was applied for 7 to 10 days in all patients. RESULTS During follow up period we did not encounter infection, malunion, nonunion, delayed union and patient discomfort necessitating extirpation of the materials fixed . CONCLUSION We think that screw-wire combination technique is an easy and effective method with low cost and fast healing especially in reconstruction of anterior mandible fractures

Detection of Meatal Stenosis with Uroflowmetry in Cases of Distal Hypospadias that are Operated with the TIPU Technique

Objective: Meatal stenosis after hypospadias surgery causes difficulty in urination and intermittent cessation in urinary stream at the early postoperative period. Increasing the duration of catheterization, meatotomy, and meatal revision surgeries are among the procedures applied for meatal stenosis. If the diagnosis of meatal stenosis is made at an earlier stage, it is easier to manage it, especially in the younger age group. We aimed to determine whether the uroflowmetry technique can be a guide for detecting and following meatal stenosis. Material and Methods: Forty-one cases with distal hypospadias operated with the Tubularized Incised Plate Urethroplasty (TIPU) technique were involved in this study. At the postoperative 1st month, all the patients with or without complaints of meatal stenosis had uroflowmetries with an effort to provide an objective data for diagnosing stenosis at the early stages. The results of uroflowmetries were compared with the clinical signs of meatal stenosis. Results: The average maximum flow rate was found to be 11.3 mL/s (6.7–31.6), and the average voided quantity of urine was detected as 181.7 mL/s (71–283) as result of uroflowmetry. Ureteral stenosis was clinically diagnosed in three patients with intermittent urination, prolonged urination with poor flow, and with difficulty in starting urination. All patients were found to be similar. The uroflowmetry results were parallel to the clinical outcome in all patients. Conclusion: In the early stages, uroflowmetry can assist clinical observation as a non-invasive method. In addition, it makes it possible to perform earlier therapeutic interventions