Simplified transoral load-bearing osteosynthesis with preformed mandible reconstruction plates

Abstract

Transcutaneous submandibular approaches are the preferred technique for the application of load-bearing mandibular osteosynthesis plates. However, an extraoral approach is associated with several shortcomings, like the risk of harming the facial nerve and scarring. This technical note presents a specialized mandibular reconstruction plate (MatrixMANDIBLE Preformed Reconstruction Plate [Synthes Maxillofacial, Paoli, PA]), simplifying the transoral application by its design with a preformed curvature along the lateral surface of the mandible. The application of wide-spanning plates reaching from the posterior margin of the ramus even into the contralateral body region is facilitated. Transoral application of preformed mandibular reconstruction plates seems to be a promising option to bypass external incisions and to reduce operating room time.

Keywords: facial nerve preservation; load-bearing osteosynthesis; mandibular fracture; preformed reconstruction plate; transoral approach.

Figure 1

(A) Hemimandibular MMPRP [Synthes Maxillofacial, Paoli, PA] placement for bridging the ramus and body region. The MMPRP underpasses the mental nerve unilaterally (unilateral crossway situation). Screw fixation of the reconstruction plate at the ipsilateral ramus and parasymphysis/symphysis. (B) MMPRP placement for extended bridging of the ramus, the body, and the symphyseal region. The MMPRP underpasses both mental nerves (bilateral crossway situation). Screw fixation of the reconstruction plate at the ipsilateral ramus and contralateral body, past the mental foramen. Abbreviation: MMPRP, MatrixMANDIBLE Preformed Reconstruction Plate.

Figure 2

Patient with a comminuted fracture of the left mandibular body, representing a unilateral crossway situation. (A) Operative findings. (B) MMF screws and wires provide for mandibulomaxillary fixation and the single fragments are fixed after reduction by using miniplates. (C) MMPRP [Synthes Maxillofacial, Paoli, PA] is finally applied after it is threaded underneath the mental nerve loop overhead the lateroinferior border of the mandible. (D) Preoperative CT imaging. (E) Postoperative CT imaging showing good adaption and fit of the plate. Abbreviations: CT, computed tomography; MMF, maxillomandibular fixation; MMPRP, MatrixMANDIBLE Preformed Reconstruction Plate.

Figure 3

Bilateral crossway situation with a defect area at the right parasymphyseal region. (A) MMPRP is threaded underneath the ipsilateral (right) mental nerve loop. The arrow indicates the initial backward movement of the posterior plate end. (B) The plate is moved further backward (arrow) under upward rotation of its posterior end. (C) After the anterior plate end nearly reaches a midline position, the plate is slid forward again to thread the anterior plate end underneath the contralateral (left) nerve loop (arrow) on its passage to the body region. (D) MMPRP [Synthes Maxillofacial, Paoli, PA] in its final position, reaching from posterior margin of the ipsilateral ramus into the contralateral body region. Abbreviation: MMPRP, MatrixMANDIBLE Preformed Reconstruction Plate.