Mini-plate fracture was found in a case of the bone grafting after the segmental mandibular excision, and a case of osteomyelitis in the radiographic follow-up examinations. It was emphasized that usefulness of mini-plate would be evaluated by modification in shape and number of mini-plate used for fixation or reconstruction

FURUSAWA KIYOFUMI

IGUCHI KOUSEI

YAMAMOTO MASAYA

YAMAOKA MINORU

YASUDA KOUICHI

English

application/pdfMini-plate fracture was found in a case of the bone grafting after the segmental mandibular excision, and a case of osteomyelitis in the radiographic follow-up examinations. It was emphasized that usefulness of mini-plate would be evaluated by modification in shape and number of mini-plate used for fixation or reconstruction.journal articl

YAMAMOTO, MASAYA

FURUSAWA, KIYOFUMI

YASUDA, KOUICHI

YAMAOKA, MINORU

IGUCHI, KOUSEI

Matsumoto Dental University Repository

(Clinical Report) Matsumoto Shigaku 21 1 57--61, 1995  key words : mini-plate fracture - reconstruction - fixationMini-Plate FractureMASAYA YAMAMOTO KIYOFUMI FURUSAWA KOUICHI YASUDA and MINORU YAMAOKAOral and Maxillofacial Surge7pu DePartment II, Matsumoto Dental College                   (Chief : Prof M. Yamaoha)DePartment of Dentist7fy,KOUSEI IGUCHIOral and Mexillofacial Surgery,   (Chief : K. Iguchi)Suwakohan HospitalSummary       Mini-plate fracture was found in a case of the bone grafting after the segmental   mandibular excision, and a case of osteomyelitis in the radiographic follow-up exami-   nations. It was emphasized that usefulness of mini-plate would be evaluated by modifica-   tion in shape and number of mini-plate used for fixation or reconstruction.                                    Introduction   Stabilization using mini-plate has been evaluated as routine method for treatment of fractureand bone defect since Champy et al') described mandibular osteosynthesis without intermaxillaryfixation. The concept that mini-plate has advantages in all cases has been praised. However, trialsof mini-plate is gave a serious consideration in bone graft after mandibulectomy and osteomyelitis.Fundamentally, usefulness of mini-plate could not be defined clearly in these cases. Therefore, therecognition that stabilizing could be realized in fixation of such cases is weakened. It is needed thatstability of mini-plate could be ascertained and use of mini-plate could be recognized to be the bestmethod of reconstruction of the mandible in the cause of its availability.   We are necessary to learn a lesson in order to recognize a risk to mini-plate and confirmusefulness of mini-plate in those cases from mini-plate fracture.                               Materials and Methods   Case 1. 0n March 13, 1986, a 51-year-old woman was seen with a 3-month history of progressiveand increasing ulcer of right tongue. The patient was diagnosed as carcinoma of the tongue and thefloor of the mouth. Preoperatively the patient received chemotherapy consisted of vincristine andpepleomycin. Partial resection of the tongue and floor of the mouth and combined marginalmandibulectomy and lingual split as well as radical block dissection of the neck were performed on(accepted for publication on February 28, 1995)58 Yamamoto, et al.:Mini-Plate FractureMay 7, 1986. The defect of the tongue, the floor of the rnouth and the alveolar region was recon-structed with a pectoralis major myocutaneous flap. On October 28, 1986 segmental mandibularexcision was performed because of chronic osteomyelitis of the mandibular margin remained inprevious surgical procedure, and the bone defect was reconstructed by use of a segment of the iliaccrest with intact periosteum. Ensuring proper occlusion during the surgical intervention, threestainless steel mini-plates with four, four and six holes (Martin Medizin Technik, Germany) weremanipulated with pliers to adapt onto the bone and applied to fix bone grafting to the remainingmandibular segment. The number of screws used was four, four and three in four, four and six holes,respectively (Fig. 1). The length of the screws was 7 mm in the mandible and 9 mm in the bonegrafting. And the patient had a fixed appliances which the pontic region extended to the rightcanine, using the lower left incisor, canine, premolar and molar teeth as abutments. At present thepatient is 7 years 6 months after mandibulectomy and remains free of recurrence, retainingmandibular arch configuration (Fig. 1).    Case 2. 0n June 26, 1993, a 66-year-old man was seen cemplaining retardation of wound healingafter removal of the right lower third molar. Lateral radiograph showed a fracture of the angle ofthe mandible though the wound. On July 15, 1993, reduction and fixation of the mandible wereperformed. Two titanium mini-plates with six and eight holes (Martin Medizin Technik, Germany)were contoured to the bone surface and were placed on it, after excision of fibrous tissue ac-companied with curettage of the wound, and freshening of the ends of the fracture. The number ofFig. 1 Above: Showing mini-plate fracture (arrow) 7years 5months after reconstruction ofmandible by use of the iliac crest.Below : A pectoralis major musculocutaneous flap 7 years 10 months after transplantationin the tongue, the floor of the mouth and the alveolar region,There is no inflammation and no functional disorders in the tongue movement andmastication,                                  kZk ztsi ca "=ff"!:' 21 (1) 1995 5,9screws used was two and three at either end of mini-plate with six and eight holes, respectively gFig.2). And the length of the screws was 7 mm. Proper occlusion was ensured during the surgicalprocedure. The postoperative course was uneventful and did not show wound dehiscence, retainingnormal occlusion   Records and radiograms in their progress were compared between case 1 and case 2.                                        Results    There has been no clinical evidence of inflammation around the mini-plates since surgicaloperations, and radiographic examinations performed every one year in case 1 and every two orthree months in case 2 have not shown any abnormalities although somewhat nonunion of the boneswere seen. However, mini-plates fractures were found in radiographic examinations at March 14,1994 in case 1 and January 25, 1994 in case 2. There were no distance between the bone ends andno elevation of fragment in both cases. Digital examination did not show evidence of mini-platefracture and nonunion of the bone. The period between osteosynthesis and mini-plate fracture wasIlig.2 Above : Orthopantornogram showing mini-plate fracture (arrow) 5 months after insertion.Middle : Showing mini-plates fixed to the bone grafting and the mandible after removalof fractured mini-plate, segmental mandibular excision and reconstruction by use of theiliac crest.Below : showing again mini-plate fracture at rim of the hole after 3 rnonths.60 Yamamoto, et al. : Mini-Plate Fracture7 years 5 months in case 1, and 6 months in case 2. In case 1 mini-plates were remained in placebecause of stability of the mandible. In case 2 mini-plates were removed and segmental mandibularexcision was performed on March 1, 1994. Mandibular defect was reconstructed by use of a segmentof the iliac crest. Four titanium mini-plates with four holes (Martin Medizin Technik, Germany)were bent in shape and applied to fix the bone grafting. The number of screws used was two ateither end of mandible and bone grafting (Fig. 2). The length of the screw was 7 mm in mandible and9 mm in the bone grafting. Intermaxillary fixation was also performed. However, mini-platefracture was again observed in radiographic examination on June 6, 1994. Mini-plate was remainedin place because of asymptom and stability of mandible. Its fracture was seen at rim of the hole ineach case.Discussion    Many cases have been treated with mini-plate since Champy et ali) noted of its usefulness. Itperforms rigid fixation because of its high stability, gives no compression damaging of the alveolarinferior nerve, no necessity of intermaxillary fixation, and does not give rise to an infection.Moreover, there is no problem of exposed plates due to affinity to bone tissue and due to beingcovered by regenerated bone in healthy condition. Indication of mini-plate is fixation of bonetransplants, and reconstruction of mandibular defects. Use of mini-plate is a simple and successfultechnique for shaping and stabilizing the bone component2'3}. Cesteleyn et al`} noted that mini-plateis useful to even dislocated and luxated fractures of the mandibular condyle. We found mini-platefractures in a case of bone grafting after segmental mandibular excision due to carcinoma of thetongue and the floor of the mouth and another case of osteomyelitis. This is a problem difficult topursue a benefit of mini-plate. Although it is very important to define which mini-plate should beused in shape and how mini-plate should be used in number in such cases in order to confirm itsusefulness, these cases possess considerable risk, because the presence of osteomyelitis has atendency to show a nonunion of the mandible, even if the plates was fixed solidly to control the pullof the muscles attached to the mandible and control the wedging force between the bone endsoccurred by the muscles. A significant amount of strain energy may be built up in the mini-platebecause of residual stress state at the bone ends which did not easily show bone production in suchstate. Causes of the mini-plate fracture might be a stress-induced fatigue crack, and the formedfracture of a mini-plate may require less energy for a fracture of another plate unless bone wouldbe regenerated. Differing rates of mechanical fatigue produced by temporary bent in the adaptationon the bone surface and permanent structural change stressed or strained by muscles could playimportant roles in occurring fracture of above and below in case 2 or below in case 1 out of twomini-plates. The effect of mechanical fatigue may have important implications to the life ofmini-plates under dynamic loading conditions accompanied with bone regeneration.   Our cases indicated that a• rim of hole is broken in each case, suggesting that assessment isnecessary in response to mechanical loading in the records of mechanical examination as well asmore cases. And mini;plate is too valuable to be spoiled because of its fracture. We shoUld definea reason that benefits which use mini-plates in these cases are justified, as use of mini-plate did notlead to unsatisfactory results in these cases. Indeed, it has been indicated to possess an ability tomake fixation without any functional disorders and any infections as shown als'o in our cases. Twoor more mini-plates seem to be indispensable to a bony fixation in mandibular osteomyelitis.Kameyama et al5). described that longitudinal strain of the mini-plate was small in the use of two松本歯学21(1)199561mini-platesinmechanicalexperiments.Itmayincreaseanabilityofrigidfixationandachieverehabilitationinevencasewhichhasariskoffibrosisordehiscencebetweentheboneends,ifmini-platestrengthenedatrimoftheholewouldbeapplied.References1)Champy,M.,Loddる,J.P.,Muster,D、,Wilk,A.andGastelo,L(1977)Lesosteosynthesisparplaquesviss6esminiaturis6esenchirurgiefacialeetcraniene.Indicatiens,R6sultatsaproposde400cas.Ann.Chir.Plast.22:261-264.2)Barnard,N.A.andVaughan,E.D.(1991)Osteosynthetictitaniummini-platefixationofcoエnpositeradialforearmflapsinmandibularreconstruction.J.Cranio・Max-Fac.Surg.19:243-248・3)Uglesic,V.,Virag,M.,Allino▽ic,N.andMacan,D.(1993)Evaluationofmandibularfracturetreatment.J.Cranio-Max-Fac.Surg.21=251-257.4)Cesteleyn,L.,Kovacs,B.,Brernerich,A.andAkuamoa・Boateng,E(1990)Differential-indicatievooroperativeverzorgingvanco11ummandibulae-fracturen.Acta.StomatoLBelg.87:167-187.5)Kameyama,T.,Sakamoto,E.,Takeshita,H.,Shimada,J.andYamarnoto,Y.(1989)Mechanicalstudyonthestabilityofmultiformmini-plates.1.Double-T-typeplate(90,regular,6・holes)inmandibularbodyfracture.MeikaiDaigakuShigakuZasshi,18:88-96.抄録:ミニープレートの破折山本雅也　古澤清文　安田浩一　山岡稔(松本歯大・口腔外科II)井口光世(諏 訪湖畔病院 ・歯科 口腔外科)ミニ プー レー トの破折が,下 顎骨離断術後の骨移植症例 と慢性下顎骨骨髄炎の治療後の症例で認 められた.こ れ らの ことか ら,ミ ニ プー レー トの有用性は,固 定や再建 のために付与 した形態や使用枚数 によって評価 されることが認識 された.

Mini-Plate Fracture

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ミニープレートの破折

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