Use Of Reabsorbable Screw And Plate In Mandibular Fracture

Objectives: To evaluate the outcome with the use of poly-l-lactide(PLLA) miniplate system and to study the complication of the system forthe treatment of mandibular fracture.Patients and Methods: In this prospective study,20patients undergoingopen surgical reduction of mandibular fracture in the Department of Oraland Maxillofacial Surgery, Wuhan Union Hospital between February2011and January2013were included. Patients with condylar, infectedor comminuted fractures, tumors or pathological fractures andimmunocompromised were excluded from the study. The patients weretreated with biodegradable Poly-L-Lactic Acid (PLLA) screw. The plateswere placed on the Champy’s ideal line of osteosynthesis. Intermaxillaryfixation was given patients for3weeks. Fixation of the screw and plateswere done according to the instruction from the manufacturer. Thepatients were advised to take soft diet for6weeks postoperatively. All theclinical and radiological findings of the patients were recordedpreoperatively and1,3,6and12months after the surgery. The OutcomeAssessment Indices for Mandibular Injuries were according to ClinicalPractice Guidelines for Oral and Maxillofacial Surgery (AAOMSParCare2012).Results: A total number of28biodegradable PPLA plates was applied in20patients. The mean age of the patient was41.5years (17to66years).The average time interval between fracture and closed reduction is3.3days. There were2patients (10%) with infections, one each on angle andparasymphysis. The infection was generally seen within1monthpostoperatively. Malunion was prevalent in2patients (10%) in theparasymphyseal region. One of the patients (5%) with malunion underwent re-surgery and fixation with titanium screw and plate. Theother patient with malunion refused for the re-surgery and had developedmalocclusion,(5%) which was corrected after grinding.Conclusion: Biodegradable materials have some material-relatedcomplications in the mandible. The data is comparable with titaniumscrew and plate taken from literatures. The material needs to be usedcautiously in case of load bearing area as more complications seen inparasymphysis. Further controlled trial need to be carried out to exactlycompare biodegradable plate with titanium screw and plate.