By Bernd Spiessl M.D., D.D.S. (auth.)
The inflexible internaI fixation of mandibular fractures has develop into a greatly ac cepted perform between eu surgeons. The warning or maybe outright re jection voiced at a congress of the German Society of Maxillofacial Sur Seventies is not any longer universal. via a technique of geons held within the overdue severe evaluation and implementation, inflexible internaI fixation has develop into a longtime remedy modality at a variety of facilities, particularly in Switzer land, the Federal Republic of Germany, and the Netherlands. through comparability, the strategy has acquired little or no recognition in North the USA and the Anglo-Saxon international locations. usually, surgeons in those nations proceed to regard mandibular fractures through intermaxillary fixation, most likely supplemented by means of interosseous wires. Many contemporary edi tions of surgical texts verify this. in recent times, notwithstanding, there seems to be a surge of curiosity in equipment of functionally solid internaI fixation, particularly within the u . s ., and AO/ ASIF guideline classes are more and more prominent. This e-book is meant to help direction members of their classes and practi cal workouts and in addition to lead the scientific practitioner within the software of AO/ ASIF rules. Basel, September 1988 B.SPIESSL VII Acknowledgments i've got acquired aid from many resources. The colleagues of the earlier two decades who've contributed to the case fabric upon which this guide is predicated are too quite a few to credits by way of name.
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Extra info for Internal Fixation of the Mandible: A Manual of AO/ASIF Principles
Depending on the site, the remodelling lasts several months; in a long tubular bone, substantially longer. For example, in a femur it takes approximately 2 years before the progress of remodelling allows the removal of a plate without risk. On a microscopic level, an absolutely perfect realignment of the fracture fragments may rarely be reached. Gap zones between the fragments are neighbored by contact areas. If the contact areas give enough support to immobilize together with the implant the fracture area, then blood vesseIs may sprout into the immobilized gaps as early as in 1-2 weeks and lamellar bone is deposited onto the fragment ends (Fig.
1967). A single scratch has no consequences, since the passive layer will regenerate in an electrolyte environment within a short time. In the case of instability, however, screw heads and plate fret against each other with each loading cyc1e. This destroys the passive layer before it has a chance to regenerate and results in a continuing corrosion process. Fretting of titanium implants leads to a grayish staining of the surrounding tissues, but no adverse tissue reactions re sult. Steel, even stainless steel, presents obvious signs of corrosion, when the passive layer is continuously destroyed.
In cases where mandibular continuity is disrupted and intermaxillary fixation is not part of the treatment plan, the neutralization of these forees is necessary in order to achieve a funtionally stable reduction. The most reliable way to neutralize the forees is by restoring the tension and pressure trajectories of the mandible. A variety of methods and techniques may be used to implement this principle, depending on the location and type of the fracture. The tension trajectory along the alveolar border can be reconstructed with a splint placed in a dentuIaus area of the mandible or with a small plate applied behind the molars in the area of the oblique line.
Internal Fixation of the Mandible: A Manual of AO/ASIF Principles by Bernd Spiessl M.D., D.D.S. (auth.)