R C Edwards1, K D Kiely, B L Eppley. 1. University of Rochester School of Medicine, Oral and Maxillofacial Surgery Associates, NY, USA.
Abstract
PURPOSE: This study evaluated the potential effectiveness of resorbable plate and screw fixation for skeletal stabilization of simultaneously performed maxillary and mandibular osteotomies. PATIENTS AND METHODS: Twenty consecutive patients underwent simultaneous maxillary and mandibular osteotomies that were fixed using copolymeric poly L-lactic acid/polyglycolic acid (PLLA/PGA) plates and screws. Prefabricated acrylic intermediate and final splints were used as guides and then removed at completion of the surgery. Guidance elastics were applied at 2 weeks postoperatively. RESULTS: The LeFort I osteotomies included segmentalizations with and without bone grafts (7/20), impactions (4/20), advancements (8/20), and unilateral downgrafting with a bone graft (2/20)- one of which was segmental. The mandibular sagittal split osteotomies involved advancements (11/20), setbacks (5/20), and asymmetric rotation (4/20). Three patients had simultaneous genioplasties, which were also stabilized with resorbable fixation. All maxillae were fixed with four 2.0-mm L-shaped plates and screws. The mandibular rami were maintained with three 2.5-mm bicortical screws per side. The mandibular symphyseal segments were held in position with two or three 2.5 mm bicortical screws. All surgeries were accomplished uneventfully, and no problems in the immediate postoperative stability of the occlusion were encountered. Follow-up ranged from 12 to 25 months. CONCLUSIONS: The initial clinical findings suggest that this form of bone fixation is a viable alternative to standard metallic fixation techniques for certain maxillomandibular deformities in which excessive bony movements are not performed. Differences exist in both intraoperative application and postoperative management of masticatory function. This is partially a US government work. There are no restrictions on its use.
PURPOSE: This study evaluated the potential effectiveness of resorbable plate and screw fixation for skeletal stabilization of simultaneously performed maxillary and mandibular osteotomies. PATIENTS AND METHODS: Twenty consecutive patients underwent simultaneous maxillary and mandibular osteotomies that were fixed using copolymeric poly L-lactic acid/polyglycolic acid (PLLA/PGA) plates and screws. Prefabricated acrylic intermediate and final splints were used as guides and then removed at completion of the surgery. Guidance elastics were applied at 2 weeks postoperatively. RESULTS: The LeFort I osteotomies included segmentalizations with and without bone grafts (7/20), impactions (4/20), advancements (8/20), and unilateral downgrafting with a bone graft (2/20)- one of which was segmental. The mandibular sagittal split osteotomies involved advancements (11/20), setbacks (5/20), and asymmetric rotation (4/20). Three patients had simultaneous genioplasties, which were also stabilized with resorbable fixation. All maxillae were fixed with four 2.0-mm L-shaped plates and screws. The mandibular rami were maintained with three 2.5-mm bicortical screws per side. The mandibular symphyseal segments were held in position with two or three 2.5 mm bicortical screws. All surgeries were accomplished uneventfully, and no problems in the immediate postoperative stability of the occlusion were encountered. Follow-up ranged from 12 to 25 months. CONCLUSIONS: The initial clinical findings suggest that this form of bone fixation is a viable alternative to standard metallic fixation techniques for certain maxillomandibular deformities in which excessive bony movements are not performed. Differences exist in both intraoperative application and postoperative management of masticatory function. This is partially a US government work. There are no restrictions on its use.