ORTOGNATİK CERRAHİ SONRASI OSTEOSENTEZ TİTANYUM MİNİPLAKLARIN ÇIKARILMA NEDENLERİ VE İNSİDANSI

Yıl 2022, , 390 - 394, 26.12.2022

Ömer Ülker , Ahmet Emin Demirbaş , Nükhet Kütük , Erdem Kılıc , Alper Alkan

https://doi.org/10.34108/eujhs.957425

Cited By: 1

Öz

Bu çalışma ile ortognatik cerrahi sonrası osteosentez plağının çıkarılmasının insidansı ve nedenleri araştırıldı. Çalışmaya Erciyes Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi Hastanesi'nde Nisan 2011-Şubat 2017 tarihleri arasında ortognatik cerrahi geçiren 250 hasta (141 kadın ve 109 erkek) dahil edilmiştir. Hastaların takip dosyaları, operasyon notları ve radyografik görüntüleri geriye dönük olarak incelendi. Ameliyat tarihleri, yaş, cinsiyet, maloklüzyon tipi, fiksasyon ve ortognatik cerrahi teknikleri sınıflandırıldı. Osteosentez titanyum mini plağın çıkarılma insidansı ve nedenleri, yerleştirme ile çıkarma arasındaki ortalama süre belirlendi. Hastaların ortalama yaşı 22.9 ± 6.5 [en küçük: 17; en büyük: 55]. Ondört hastada (%5.6) fiksasyona bağlı komplikasyonlar gelişti. Plak enfeksiyonu (dokuz vaka- %3.6) ve plağın açığa çıkması (beş vaka- %2,0) nedeniyle plaklar çıkarıldı. Kullanılan toplam plak sayısı 1242'dir [800 (%64)’ü maksillada ve 442 (%36)’si mandibulada]. Fiksasyon materyali ile ilgili komplikasyonlar nedeniyle maksilla [11 (%1.3)] ve mandibuladan [12 (%2.7)] yirmi üç plak çıkarıldı. Ortalama plak çıkarma süresi 11.21± 8.21ay (en düşük:3- en yüksek:34ay)’dı. Osteosentez plakları ortognatik cerrahi sonrası enfeksiyon ve plağın açığa çıkması nedeniyle çıkarılmalıdır. Komplikasyon ortaya çıkmadıkça yerinde bırakılmalıdır.

Anahtar Kelimeler

Enfeksiyon, ortognatik cerrahi, osteosentez plaklarının çıkarılması, plağın açığa çıkması, titanyum miniplak

INCIDENCE AND CAUSES OF OSTEOSYNTHESIS TITANIUM MINIPLATE REMOVAL FOLLOWING ORTHOGNATHIC SURGERY

Öz

This paper investigated the incidenceand causes of osteosynthesis plate removal after orthognathic surgery. The sample consisted of 250 patients (141 women and 109 men) who underwent orthognathic surgery between April 2011 and February 2017 at the Oral and Maxillofacial Surgery Hospital of the Faculty of Dentistry of Erciyes University. Follow-up files, operation notes, and radiographic images were reviewed retrospectively. Operation dates, age, sex, malocclusion type, fixation methods, and orthognathic surgery methods were classified. The incidence and causes of osteosynthesis titanium miniplate removal and the average time between placement and removal were determined. Patients had a mean age of 22.9 ± 6.5 [min: 17; max: 55]. Fourteen patients (5.6%) developed fixation-related complications. They underwent plate removal due to plate-infections (nine cases- 3.6%) or plate exposure (five cases- 2.0%). The total number of plates used was 1242 [800 (64%) in the maxilla and 442 (36%) in the mandible]. Twenty-three plates were removed from the maxilla [11 (1.3%)] or mandible [12 (2.7%)] due to fixation material-related complications. The mean plate removal time was 11.21± 8.21 months (min:3- max:34 months). Osteosynthesis plates should be removed due to infections and plate exposure after orthognathic surgery. There should be left in place unless complications arise.

Anahtar Kelimeler

Infection, orthognathic surgery, osteosynthesis plate removal, plate exposure, titanium miniplate

Kaynakça

• Sailer HF, Haers PE, Gratz KW. The Le Fort I osteotomy as a surgical approach for removal of tumours of the midface. J Craniomaxillofac Surg 1999;27:1-6.
• Kim SG, Park SS. Incidence of complications and problems related to orthognathicsurgery.J Oral Maxillofac Surg 2007;65:2438-2444.
• Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg 1978;6:14-21.
• Kellman RM, Schilli W. Plate fixation of fractures of the mid and upper face. Otolaryngol Clin North Am 1987;20:559-572.
• Brown JS, Trotter M, Cliffe J, Ward-Booth RP, Williams ED. The fate of miniplates infacial trauma and orthognathic surgery: a retrospective study. Br J Oral Maxillofac Surg 1989;27:306-315.
• Ellis E, Dean J. Rigid fixation of mandibular condyle fractures. Oral Surg Oral Med Oral Pathol 1993;76:6-15.
• Schmidt BL, Perrott DH, Mahan D, Kearns G. The removal of plates and screws after Le Fort I osteotomy. J Oral Maxillofac Surg 1998;56:184-188.
• Mosbah MR, Oloyede D, Koppel DA, Moos KF, Stenhouse D. Miniplate removal in traumaand orthognathic surgery a retrospective study. Int J Oral Maxillofac Surg 2003;32:148-151.
• Norholt SE, Pedersen TK, Jensen J. Le Fort I miniplate osteosynthesis: a randomized, prospective study comparing resorbable PLLA/PGA with titanium. Int J Oral Maxillofac Surg 2004;33:245-252.
• Cheung LK, Chow LK, Chiu WK. A randomized controlled trial of resorbable versus titanium fixation for orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:386-397.
• O'Connell J, Murphy C, Ikeagwuani O, Adley C, Kearns G. The fate of titanium miniplates and screws used in maxillofacial surgery: a 10-year retrospective study. Int J Oral Maxillofac Surg 2009;38:731-735.
• Haraji A, Motamedi MH, Moharamnejad N. Causes and incidence of miniplate removal following Le Fort I osteotomy. Eplasty 2009;12:422-426.
• Ho MW, Boyle MA, Cooper JC, Dodd MD, Richardson D. Surgical complications of segmental Le Fort I osteotomy. Br J Oral Maxillofac Surg 2011;49:562-566.
• Falter B, Schepers S, Vrielinck L, Lambrichts I, Politis C. Plate removal following orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2011;112:737-743.
• Little M, Langford RJ, Bhanji A, Farr D. Plate removal following orthognathic surgery. J Craniomaxillofacial Surgery 2015;43:1705-1709.
• Widar F, Afshari M, Rasmusson L, Dahlin C, Kashani H. Incidence and risk factorspredisposing plate removal following orthognathic surgery. Oral Surg Oral Med, Oral Pathol Oral Radiol 2017;124:231-239.
• Sukegawa S, Kanno T, Manabe Y, et al. Is the removal of osteosynthesis plates after orthognathic surgery necessary? Retrospective long-term follow-up study. Int J Oral Maxillofac Surg 2018; 47:1581-1586.
• Rai KK, Shivakumar HR, Sonar MD. Transient facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible: a review of incidence and management. J Oral Maxillofac Surg 2008;66:373-378.
• Ow A, Cheung LK. Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis: an evidence-based review. J Oral Maxillofac Surg 2009;67:2344-2353.
• Kuhlefelt M, Laine P, Suominen-Taipale L, et al.Risk factors contributing to symptomatic miniplate removal: a retrospective study of 153 bilateral sagittal split osteotomy patients. Int J Oral Maxillofac Surg 2010;39:430-435.
• Borstlap WA, Stoelinga PJ, Hoppenreijs TJ, van’t Hof MA. Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Int J Oral Maxillofac Surg 2004;33:433-441.
• Alpha C, O’Ryan F, Silva A, Poor D. The incidence of postoperative wound healing problems following sagittal ramus osteotomies stabilized with miniplates and monocortical screws. J Oral Maxillofac Surg 2006;64:659-668.
• Theodossy T, Jackson O, Petrie A, Lloyd T. Risk factors contributing to symptomatic plate removal following sagittal split osteotomy. Int J Oral Maxillofac Surg. 2006;35:598-601.
• Friscia M, Sbordone C, Petrocelli M, et al. Complications after orthognatic surgery: our experience on 423 cases. Oral Maxillofac surg. 2017;21:171-177.
• Chow LK, Singh B, Chiu WK, Samman N. Prevalence of postoperative complications after orthognathic surgery: a 15-year review. J Oral Maxillofac Surg. 2007;65:984-992.
• Gómez-Barrachina R, Montiel-Company JM, García-Sanz V, et al. Almerich-Silla JM, Paredes Gallardo V, Bellot-Arcís C. Titanium plate removal in orthognathic surgery: prevalence, causes and risk factors. A systematic literature review and meta-analysis. Int J Oral Maxillofac Surg, 2020;49:770-778.
• Verweij JP, Houppermans PN, Gooris P, Mensink G, Van Merkesteyn JP. Risk factors Titanium plate removal in orthognathic surgery for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis. J Craniomaxillo-fac Surg 2016;44:1170-1180.
• Baas EM, Van Gemert BP, Bierenbroodspot F, Milstein DM, de Lange J. Patient discom- fort and other side effects after bilateral sagittal split osteotomy or distraction osteo-genesis of the mandible: a randomized clin-ical trial. Int J Oral Maxillofac Surg 2015;44:1119-1124.
• Shin NR, Oh JS, Shin SH, Kim SG. Removal of miniplates following facial trauma and orthognathic surgery: a 3-year study. Oral Biol Res 2018;42:222-227.