2017-18 HSC Section 3 Green Book

Plastic and Reconstructive Surgery • January 2016

Stryker SMARTLock system. Twenty-three patients (19 male patients and four female patients) were included in the study after the exclusion criteria were applied. The mean age of the patients was 30.7 years. All patients were treated for trauma to the maxilla or mandible. All patients were placed into either wire maxillomandibular fixation or heavy elastics. The average duration of wire maxillomandibular fixation or heavy elastics was 31.4 days (range, 12 to 50 days). Mean length of follow-up was 59 days (range, 41 to 96 days). Medical comorbidities (Table 2) were identi- fied in 18 patients (78.3 percent), whereas five patients (21.7) did not have any medical condi- tions. Of the 18 patients with medical comor- bidities, 14 patients (77.8 percent) had a single medical comorbidity and four patients (22.2 per- cent) had more than one comorbidity. The medi- cal comorbidities are summarized in Table 3 and include smoking, psychiatric disease, diabetes mellitus type 2, and hypertension. Twenty-one patients sustained a total of 35 mandibular fractures, and two patients had a total of three Le Fort fractures (Table 3). One patient had a Le Fort III fracture and one patient had a combination of Le Fort II and Le Fort III frac- tures. Of the patients with mandibular fractures, 13 patients had a single fracture and eight patients had multiple mandible fractures (Table 4). The amount of time to place and remove the hybrid maxillomandibular fixation system was recorded (Table 5). Placement time was recorded for 19 of the 23 patients. The average placement time for the hybrid maxillomandibular fixation system was 14.4 minutes (range, 9 to 24.7 min- utes) and the average time to place each screw was 61.8 seconds. Removal time was recorded for 12 of the 23 patients. The average time to remove

mucosal overgrowth or if the patient could not tol- erate removal because of discomfort. An example of the system after placement is shown in Figure 1. Clinical Documentation Review of the patients’ medical and dental charts was performed and the following data were collected for each patient: (1) age, (2) sex, (3) fracture location, (4) number of minutes to place the SMARTLock system, (5) number of minutes to remove the system, and (6) complications. All data were entered into a Microsoft Excel spread- sheet (Microsoft Corp., Redmond, Wash.). Cone-Beam Computed Tomographic Assessment of Screws on Tooth Roots Postoperative cone-beam computed tomo- graphic examination was performed on all patients on the day of surgery using i-CAT (Imag- ing Sciences International, LLC, Hatfield, Pa.). The Digital Imaging and Communications in Medicine data were imported into the software program i-CATVision (Imaging Sciences). Axial, coronal, and sagittal views were used to determine screw proximity to root structure. Cost Comparison A cost comparison was performed to evaluate the use of the SMARTLock system versus tradi- tional arch bars. This was performed to determine whether or not there is a cost benefit of using the hybrid system even though the system is more expensive. Results Thirty-five patients were treated from Septem- ber of 2013 through February of 2014 using the

Fig. 1. Example of hybrid maxillomandibular fixation after placement. Notice that some arms of the systemhave beenmoved to avoid place- ment of the screw into tooth roots.

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