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OP-Journal 2013; 29(2): 164-174
DOI: 10.1055/s-0033-1350819
Georg Thieme Verlag KG Stuttgart · New York

Zur Osteosynthese bei Frakturen im zahnlosen atrophen Unterkiefer – Möglichkeiten zum Hardware Downsizing, Lingual Plating

On the Osteosynthesis of Atrophic Mandible Fractures – Options for Hardware Downsizing, Lingual Plating
Carl-Peter Cornelius
,
Florian Andreas Probst
,
Jean Paul Christian Rathgeber
,
Marc Metzger
Further Information

Publication History

Publication Date:
20 January 2014 (online)

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Zusammenfassung

Die Frakturbehandlung im zahnlosen atrophen Unterkiefer ist problematisch. Dies hat seine Gründe in lokalen Faktoren, wie der reduzierten ossären Quantität und Qualität sowie in altersassoziierten Komorbiditäten. Die Therapiemöglichkeiten reichen von minimalistisch konservativen Ansätzen über die Applikation von Miniplatten unter Verwendung transoraler chirurgischer Zugänge bis hin zur aggressiven transfazial-submandibulären Dissektion mit Reposition und Montage von Makro- bzw. Rekonstruktionsplatten. Wenn Rekonstruktionsplattensysteme mit einem hochatrophen „Pencilbone“-Unterkiefer zusammentreffen, wird ein „Overengineering“ deutlich, da die Massivität des Osteosynthesematerials und der residuale Knochen in krassem Missverhältnis zueinander stehen. Wegen der hohen Stabilität der mit Rekonstruktionsplatten überbrückten Frakturen gelten diese jedoch nach wie vor als Referenz für Vergleiche mit anderen internen Fixationsverfahren bzw. Plattenvarianten und Konstrukten.

Abstract

The management of atrophic mandible fractures is challenging. This is attributed to local factors like impaired bone quality and quantity as well as to age-related comorbidities. Therapeutic options range from minimalistic non-operative approaches over the transoral application of miniplates to extended submandibular approaches with application of reconstruction plates. Stabilising a “pencil-bone” mandible with a large macroplate may appear like “over-engineering” due to the size discrepancy between bone and plate. However, treatment of atrophic mandible fractures with reconstruction plates can still be considered as the standard because of the high stability that is achievable.

 

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