Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis

Аннотация

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of anendoscope. Weselectedandretrospectivelystudied18patients(12malesand6females)with unilateralmandibularsubcondylarfractureswhovisitedtheWonjuSeveranceChristianHospital.The meanageofthepatientswas43.43±15.76years.PatientsunderwentORIFwithtrapeziumminiplate applicationthroughanintraoralincisionundergeneralanesthesia. Theclinicalandradiographic findingsofthefracturedsidewerecomparedwiththoseofthenon-operatedsideat6monthsfollow- up.Allocclusionsbecamestable,andtransientfunctionaldisturbancesdisappearedwithin6months ofperiodicfollow-up.Functionalmandibularmovementrecoveredwithinthenormalrange,with Citation:Jung,S.;Nam,O.H.;Fang, anaverage mouthopening of41.5 mm, protrusion of7.5 mm, and lateralexcursion of7 mm at Y.-Q.;Dusmukhamedov,S.;Lee,C. 6months.Radiographiccontrolsandstatisticalanalysisconfirmedadecentanatomicalreduction ReliabilityofaTrapeziumMiniplate inall18cases. Inconclusion,theuseofatrapeziumminiplatewithendoscope-assistedORIFin withEndoscope-AssistedInternal mandibularsubcondylarfracturescanbeusefulforfixationandfunctionalrecovery. FixationinMandibularSubcondylar Fractures:AThree-Dimensional Keywords:trapeziumplate;endoscope;mandibularsubcondylarfracture;fracturehealing;fracture Analysis.J.Clin.Med.2022,11,207. https://doi.org/10.3390/ fixation;openreductionandinternalfixation jcm11010207 AcademicEditor:Anne MarieKuijpers-Jagtman 1. Introduction Received:30November2021 The optimal treatment protocol for open reduction and internal fixation (ORIF) of Accepted:25December2021 mandibularcondylarandsubcondylarfractureshasbeendebatedoverdecades. Many Published:31December2021 studiesoncondylarfracturesurgeryhaveintroducedvarioussurgicalapproachestothe Publisher’sNote:MDPIstaysneutral condylarregion,andverifiedthattheintraoralapproachhastheleastpostoperativemor- withregardtojurisdictionalclaimsin bidity[1–3].Theapplicationofminiplatesfixedwithscrewsisconsideredthegoldstandard publishedmapsandinstitutionalaffil- forORIFinmandibularsurgery[4,5]. Thus,numerousminiplatedesignshavebeenintro- iations. ducedduringthepastdecades,andrecently,theirefficacieshavebeenstudiedtoexamine biomechanicalstabilityandsurgicalsimplicity[6–9]. Previousbiomechanicalstudieshave confirmedthereliabilityofcondylefixationviatwominiplatesforsubcondylarfracturesfor withstandingthecompressionandtensionforceswithinphysiologicallimitations.[10,11]. Copyright: © 2021 by the authors. Meyeratal.[12]demonstratedthatthetrapezoidalplateprovidedsufficientrigidityforthe Licensee MDPI, Basel, Switzerland. fixationofsubcondylarfractures. Darwichetal.[13]claimedthattrapezoidalplatesare This article is an open access article superiortotwominiplates. distributed under the terms and Recently,withtheemergenceofendoscopy-assistedsurgery,problemsofinadequate conditionsoftheCreativeCommons surgicalviewandlimitedworkspace,whicharecriticaldisadvantagesofintraoralsurgery, Attribution(CCBY)license(https:// have been overcome [14–16]. Endoscopy-assisted open reduction and internal fixation creativecommons.org/licenses/by/ (EAORIF) of mandibular condylar fractures has resulted in satisfactory postoperative 4.0/). J.Clin.Med.2022,11,207.https://doi.org/10.3390/jcm11010207 https://www.mdpi.com/journal/jcm J.Clin.Med.2022,11,207 2of10 outcomes[17]. ApreviousstudyregardingtheminiplatesysteminEAORIFshowedthat biodegradableplatesareasreliableasmetalminiplates[18]. However,thereareinsufficient dataforappropriateminiplatedesignsforEAORIF.Therefore,thepresentstudyevaluated theclinicaluseofanewlydevelopedsingletrapeziumminiplate(JeilCo.,Seoul,Korea) appliedthroughatransoralendoscopy-assistedapproachandattemptedtopresentclinical andthreedimensional(3D)anaylsisfollow-upresults. 2. MaterialsandMethods Weretrospectivelyreviewedpatientswhohadundergoneauniformsurgicaltech- nique between 2015 and 2018, consisting of an endoscopy-assisted transoral approach withcombinationfixationusingamono-corticalsingletrapeziumminiplate,withatleast 6monthsofpostoperativefollow-up. Atotalof18patientswithmandibularsubcondylar fractures(12malesand6females)between18–70yearsold(meanage43.83yearsold)were included. All patients underwent surgery at the Department of Oral and Maxillofacial Surgery of the Wonju Severance Christian Hospital. The study protocol was reviewed andapprovedbytheInstitutionalReviewBoardofYonseiUniversityWonjuSeverance ChristianHospital,Wonju,Korea(CR319018). Inthetrapeziumplate,theplatearmsweredesignedaccordingtotheideallineof osteosynthesisintroducedinMeyer’sstudy[19]. Bothverticalarmsweredesignedparallel tothecompressionlines,whiletheupperandlowerhorizontallinesweredesignedalong the traction lines. Two types of trapezium plates were designed, which differed in the upperarmsize. Thearmsweresimilar,butwereselectivelyusedinhighandlowcondylar fractures. Theplatewas1mmthick, 13.2mmlong, and4–5.2mmwideatth