OBJECTIVE: The condylar region is one of the most frequent sites for mandibular fractures, with direct application of miniplates being the most commonly used open-fixation technique today. Yet, anatomic and biomechanical limitations continue to make this application technically challenging with a considerable complication rate. We sought to analyze such incongruencies with respect to the complex biomechanical behavior of the mandible. STUDY DESIGN: Individual human mandible geometry, the specific bone density distribution, and the position and orientation of the masticatory muscles were evaluated by performing computed tomography scans and a sequential dissection of the cadaver mandible. Three-dimensional finite-element analysis was performed for different fracture sites, osteosynthesis plates, and loading conditions. RESULTS: Osteosynthesis of fractures of the condylar neck with 1 or 2 miniplates of a diameter of 2.35 x 1.00 mm was found to be an insufficient fixation method. This also applies for plates (3.60 x 1.54 mm), according to Pape et al,(8) when used in singular fashion (high condylar neck fractures excepted). In cases of singular occlusal contacts in the molar region (particularly at the contralateral side of the fracture), the highest stress values inside the mandible and osteosynthetic devices could be observed. With even the static yield limit of titanium being exceeded in such cases, consecutive rapid failure of the miniplates becomes most likely when loading of the condylar region caused by bite forces cannot be prevented. CONCLUSION: We strongly recommend the use, whenever possible, of 2 plates in the manner described by Pape et al(8) for osteosynthesis of fractures of the condylar neck in combination with bicortically placed screws. The stiffness of a singular osteosynthesis plate made of titanium in a diametrical dimension of approximately 5.0 x 1.75 mm was found to be equivalent to the physiological bone stiffness in the investigated fracture sites. The actual stiffness of such a fixation plate is approximately 3 times higher than the stiffness of devices commonly in use.
OBJECTIVE: The condylar region is one of the most frequent sites for mandibular fractures, with direct application of miniplates being the most commonly used open-fixation technique today. Yet, anatomic and biomechanical limitations continue to make this application technically challenging with a considerable complication rate. We sought to analyze such incongruencies with respect to the complex biomechanical behavior of the mandible. STUDY DESIGN: Individual human mandible geometry, the specific bone density distribution, and the position and orientation of the masticatory muscles were evaluated by performing computed tomography scans and a sequential dissection of the cadaver mandible. Three-dimensional finite-element analysis was performed for different fracture sites, osteosynthesis plates, and loading conditions. RESULTS:Osteosynthesis of fractures of the condylar neck with 1 or 2 miniplates of a diameter of 2.35 x 1.00 mm was found to be an insufficient fixation method. This also applies for plates (3.60 x 1.54 mm), according to Pape et al,(8) when used in singular fashion (high condylar neck fractures excepted). In cases of singular occlusal contacts in the molar region (particularly at the contralateral side of the fracture), the highest stress values inside the mandible and osteosynthetic devices could be observed. With even the static yield limit of titanium being exceeded in such cases, consecutive rapid failure of the miniplates becomes most likely when loading of the condylar region caused by bite forces cannot be prevented. CONCLUSION: We strongly recommend the use, whenever possible, of 2 plates in the manner described by Pape et al(8) for osteosynthesis of fractures of the condylar neck in combination with bicortically placed screws. The stiffness of a singular osteosynthesis plate made of titanium in a diametrical dimension of approximately 5.0 x 1.75 mm was found to be equivalent to the physiological bone stiffness in the investigated fracture sites. The actual stiffness of such a fixation plate is approximately 3 times higher than the stiffness of devices commonly in use.
Authors: Lucas Cavalieri-Pereira; Guilherme Spagnol; Cássio Edvard Sverzut; Márcio de Moraes; Alexandre Elias Trivellato Journal: Oral Maxillofac Surg Date: 2018-01-17