Transgingival lag-screw osteosynthesis of alveolar process fracture

Abstract

Fracture of the alveolar process is a common injury. In some cases, traditional fixation may not be possible. The teeth needed for splinting or mandibulo-maxillary fixation may be missing. The fracture line and soft tissue injury may jeopardize the blood supply of the broken bone. In these extreme and rare situations, the best rehabilitation is needed to avoid the loss of hard and soft tissues, and a secondary reconstruction is required. Between January 2003 and December 2006, of 468 cranio-facial trauma patients studied, alveolar process fracture was reported in 28 (6%) cases. In six (1%) cases, the anatomy of the fracture lines, and the position and number of the remaining teeth made splinting and mandibulo-maxillary fixation impossible. Patients were treated with a transgingival lag-screw (TLS) osteosynthesis. All patients healed well with no complications. There was no bone or tooth loss in the surgical area, and broken fragments were not absorbed. The TLS technique is recommended for alveolar fractures when the blood supply is jeopardized and dental splinting or mandibulo-maxillary fixation is not possible. There is no need for flap reflection.

Maxillofacial trauma is common and requires diagnosis, sometimes emergency intervention, and appropriate treatment . Fracture of the alveolar process is a common injury, comprising 2–8% of all cranio-facial injuries . Often the nearby soft tissue and teeth are damaged, making the situation more severe .

Traditionally, composite splinting or mandibulo-maxillary fixation (MMF) with arch bars or bone screws are used to immobilize the broken fragments . In some cases, traditional fixation of the fractured piece is not possible. The teeth needed for splinting or MMF may be missing. The fracture line and soft tissue injury may jeopardize the blood supply of the broken fragments requiring repositioning and fixation. In these extreme and rare situations, the best rehabilitation is needed to avoid the loss of hard and soft tissue, making a secondary reconstruction necessary. The lag-screw technique, developed by AO/ASIF in the 1960s, is an ideal way of stabilising fragments if the anatomy allows its use . It is a widely used technique in oral and maxillofacial surgery . In this study, the transgingival lag-screw (TLS) is introduced as an alternative method to splinting and traditional plate osteosynthesis.

Materials and methods

Of 468 cranio-facial trauma patients studied between January 2003 and December 2006, 46 (10%) patients sustained dento-alveolar injuries, and in 28 (6%) alveolar process fracture was reported. In six (1%) cases, the anatomy of the fracture lines, and the position and number of the remaining teeth made splinting and MMF impossible. Patient data is given in Table 1 and the position of the fracture is shown in Figs 1 and 2 .

Table 1
Patient data and results.
No. Age (years) Sex Injury Treatment No. of screws Anaesthesia Tooth/bone loss Rehabilitation
1. 42 Male Bilateral alveolar fracture of the anterior maxilla TLS on left side, micro plate OS on right side 3 General No Removable prosthesis
2. 55 Male Alveolar fracture of the anterior maxilla, zygomatic fracture, Angle of the mandible fracture TLS, miniplate OS of zygoma and mandible 2 General No Patient refused
3. 28 Female Fracture of the alveolar process in the anterior left maxilla, mandible neck fracture TLS, miniplate OS mandible 2 General No Implant
4. 71 Male Right alveolar fracture of the anterior maxilla TLS 3 Local No Removable prosthesis
5. 48 Female Left alveolar fracture of the anterior maxilla TLS 2 Local No Removable prosthesis
6. 59 Male Fracture of palate on the right side Fracture of the right maxilla, and zygoma TLS, miniplate OS zygoma 3 General No Patient refused

Feb 8, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Transgingival lag-screw osteosynthesis of alveolar process fracture
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