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  SPECIFICATION
ATLAS OF CRANIOMAXILLOFACIAL OSTEOSYNTHESIS 2e (hb) 2009
Author: FRANZ HAERLE
ISBN: 9783131164926
Year: 2009
Publisher: THIEME MEDICAL & SCIENTIFIC PUBLISHERS (PVT) LTD.
Category: SURGERY & TRAUMA
Edition: 1
Format: Hard Cover
Language: English
Pages: 226
 ABOUT THE TITLE
Now in a long awaited second edition, this groundbreaking atlas of osteosynthesis in craniomaxillofacial and oral surgery has been fully updated to reflect new techniques, applications, instruments, and materials. Illustrated in detailed, highly instructive full-color drawings, the book covers key a
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 TABLE OF CONTENTS
1 Anatomical Aspects and Biomechanical
Considerations for the Body of the Mandible,
the Midface, and the Cranium. . . . . . . . . . . . . . . . . 1
Maxime Champy and Patrick Blez
Anatomical Considerations . . . . . . . . . . . . . . . . . . . 1
The Mandible. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Midface and the Cranial Bones . . . . . . . . . . 2
Biomechanical Principles . . . . . . . . . . . . . . . . . . . . . 3
Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Masticatory Stress Distribution in the
Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Definition of an Ideal Osteosynthesis Line on
the Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Other Therapeutic Applications . . . . . . . . . . . . . 5
Biomechanics and Principles of Surgical
Repair in the Midface and Cranium by
Microplates or Miniplates (Traumatology
and Deformities) . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2 Biomechanics of Fractures of the Condylar Region
and Principles of Repair . . . . . . . . . . . . . . . . . . . . . . 8
Christophe Meyer
3 Sublingual Hematoma: Pathognomic of Fracture
of the Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Ingo N. Springer and Franz Haerle
4 Bone Repair and Fracture Healing. . . . . . . . . . . . . . 12
Franz Haerle
Structure of Facial Bone . . . . . . . . . . . . . . . . . . . . . . 12
Fracture Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Indirect Bone Healing (Secondary Osseous and
Soft-Tissue Healing) . . . . . . . . . . . . . . . . . . . . . . . 13
Direct Bone Healing (Primary Osseous
Healing) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Pseudoarthrosis. . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Craniomaxillofacial Bone Healing. . . . . . . . . . . . 18
5 Surgical Approaches . . . . . . . . . . . . . . . . . . . . . . . . . 19
Franz Haerle
Biomechanical Principles . . . . . . . . . . . . . . . . . . . . . 19
Extraoral Incision . . . . . . . . . . . . . . . . . . . . . . . . . 20
Intraoral Incisions . . . . . . . . . . . . . . . . . . . . . . . . . 20
Mandible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Mandible Intraoral Vestibular Approach . . . . . . 23
Mandible Intraoral Marginal Rim Incision . . . . 24
Mandible Combined
Intraoral–Transbuccal Approach. . . . . . . . . . . . . 24
Mandible Extraoral Submandibular Approach. 25
Mid and Upper Face . . . . . . . . . . . . . . . . . . . . . . . . . 29
Maxilla Intraoral Vestibular and Marginal
Rim Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Lower Eyelid Approach . . . . . . . . . . . . . . . . . . . . 29
Upper Lid Blepharoplasty Approach . . . . . . . . . 29
Brow Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Coronal Approach . . . . . . . . . . . . . . . . . . . . . . . . . 30
6 Materials and Instrumentation . . . . . . . . . . . . . . . . 32
Leen M. de Zeeuw and Oliver Scheunemann
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Osteosynthesis Technique and
Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Screws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Plates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Locking Systems . . . . . . . . . . . . . . . . . . . . . . . . . . 34
7 Mandibular Fractures Including Atrophied
Mandible. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Hans-Dieter Pape, Klaus Louis Gerlach, and
Maxime Champy
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Time of Treatment . . . . . . . . . . . . . . . . . . . . . . . . 35
Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Re-establishment of Occlusion . . . . . . . . . . . . . . 35
Gingiva Incision. . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Miniplate Choice . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Miniplate Osteosynthesis. . . . . . . . . . . . . . . . . . . 36
Different Areas Require
Special Measures. . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
The Interforaminal Area. . . . . . . . . . . . . . . . . . . . 37
The Canine and Premolar Area . . . . . . . . . . . . . . 38
The Molar Area and the Angle of the Mandib le 38
The Ramus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Multiple Fractures. . . . . . . . . . . . . . . . . . . . . . . . . 40
Medicinal Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Postoperative Care . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Special Fracture Situations. . . . . . . . . . . . . . . . . . . . 40
Mandible Fractures in Children. . . . . . . . . . . . . . 40
The Edentulous Atrophied Mandible . . . . . . . . . 41
Defect and Comminuted Fractures. . . . . . . . . . . 42
Teeth in the Fracture Line . . . . . . . . . . . . . . . . . . . . 42
8 Hooks for Intermaxillary Immobilization . . . . . . . 44
Hendrik Terheyden
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Immobilization by Wiring . . . . . . . . . . . . . . . . . . . 44
Immobilization Using Hooks . . . . . . . . . . . . . . . . . 44
Miniscrew Hooks . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ligatures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
9 Principles of Application of Lag Screws . . . . . . . . 46
Franz Haerle
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Toulouse Mini Lag Screw . . . . . . . . . . . . . . . . . . . . 46
Cortical Lag Screw . . . . . . . . . . . . . . . . . . . . . . . . . . 46
True Lag Screw. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Position Screw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Indications for Lag Screw Osteosynthesis . . . . . . 50
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
10 Guided Lag Screw Technique in Mandibular
Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Gregory C. Chotkowski
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
The Surgical Technique . . . . . . . . . . . . . . . . . . . . . . 54
Stabilization of the Occlusion . . . . . . . . . . . . . . 54
Surgical Approach . . . . . . . . . . . . . . . . . . . . . . . . 54
Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
General Fixation Technique . . . . . . . . . . . . . . . . 55
Specific Applications of the Guided Lag Screw
Fixation Technique. . . . . . . . . . . . . . . . . . . . . . . . 55
Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
11 Condylar Base and Neck Fractures: What is to be
Done?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Franz Haerle, Uwe Eckelt, Klaus Louis Gerlach,
Guenter Lauer, Tateyuki Iizuka, Andreas Neff,
Michael Rasse, Christian Krenkel,
Juergen Reuther, and Christophe Meyer
12 Condylar Neck Fractures: Lag Screws . . . . . . . . . . 60
Uwe Eckelt
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Indication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Surgical Technique. . . . . . . . . . . . . . . . . . . . . . . . . . 62
Removal of Osteosynthesis Material. . . . . . . . . . . 65
13 Condylar Neck Fracture Miniplates: Extraoral
Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Tateyuki Iizuka and Christian Lindqvist
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Indication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Surgical Approaches . . . . . . . . . . . . . . . . . . . . . . . . 68
Surgical Technique. . . . . . . . . . . . . . . . . . . . . . . . . . 68
The Preauricular Approach. . . . . . . . . . . . . . . . . 68
The Retromandibular Approach . . . . . . . . . . . . 69
Rhytidectomy, Face-lift Approach . . . . . . . . . . . 70
Osteosynthesis Technique . . . . . . . . . . . . . . . . . . . 71
Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
14 Condylar Neck Fracture Miniplates: Intraoral
Approach. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Klaus Louis Gerlach and Steffen Mokros
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Surgical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Advantages of Technique . . . . . . . . . . . . . . . . . . . . 77
15 Condylar Neck Fractures: Delta-Shaped Plate
and Endoscopic Approach. . . . . . . . . . . . . . . . . . . . 78
Guenter Lauer
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Surgical Approach . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
16 Condylar Neck Fractures: Lag Screw Plates . . . . . 85
Juergen Reuther
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
17 Osteosynthesis of Condylar Head Fractures
by Retroauricular Approach . . . . . . . . . . . . . . . . . . 88
Andreas Neff
The Retroauricular Approach. . . . . . . . . . . . . . . . . 88
Osteosynthesis of Condylar Head Fractures. . . . . 88
18 Condylar Head Fractures: Screw and Pin Fixation 93
Michael Rasse
Auricular Approach . . . . . . . . . . . . . . . . . . . . . . . . . 93
Osteosynthesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
19 Midface Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Klaus Louis Gerlach and Hans-Dieter Pape
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Fractures of the Zygoma . . . . . . . . . . . . . . . . . . . . . 95
Le Fort I Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Le Fort II Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Le Fort III Fractures . . . . . . . . . . . . . . . . . . . . . . . . . 97
20 Naso-ethmoid Fractures . . . . . . . . . . . . . . . . . . . . . 99
Peter Ward Booth
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Anatomical Considerations. . . . . . . . . . . . . . . . . . . 99
Clinical Examination . . . . . . . . . . . . . . . . . . . . . . . . 99
Radiological Examination . . . . . . . . . . . . . . . . . . . . 101
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Surgical Exposure . . . . . . . . . . . . . . . . . . . . . . . . 101
Reduction and Stabilization . . . . . . . . . . . . . . . . 101
Bone Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Detached Canthus . . . . . . . . . . . . . . . . . . . . . . . . 102
21 Panfacial Fractures: Planning an Organized
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Rudolf R.M. Bos
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Treatment Planning . . . . . . . . . . . . . . . . . . . . . . . . . 105
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
22 Osteotomies of the Mandible . . . . . . . . . . . . . . . . . 109
Paul J.W. Stoelinga
Sagittal Split Osteotomy. . . . . . . . . . . . . . . . . . . . . . 109
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Vertical Ramus Osteotomy . . . . . . . . . . . . . . . . . . . 110
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Body (Step) Osteotomies . . . . . . . . . . . . . . . . . . . . . 112
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Anterior Subapical Segmental Osteotomy. . . . . . . 113
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Genioplasties and Midline Symphyseal
Osteotomies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
23 Osteotomies of the Maxilla . . . . . . . . . . . . . . . . . . . 116
Paul J.W. Stoelinga
Anterior Maxillary Segmental Osteotomy. . . . . . . 116
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Posterior Maxillary Segmental Osteotomy . . . . . . 116
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Le Fort I Osteotomy. . . . . . . . . . . . . . . . . . . . . . . . . . 117
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Quadrangular Osteotomy. . . . . . . . . . . . . . . . . . . . . 117
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Le Fort II Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . 119
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Le Fort III Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . 120
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Osteotomies in Cleft Lip and Palate Patients. . . . . 120
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
24 Orthognathic Surgery Distance Screws . . . . . . . . . 124
Konrad Wangerin and Henning Gropp
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Clinical Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . 124
Radiographic Diagnosis . . . . . . . . . . . . . . . . . . . . 124
Model Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Simulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Skeletal Stability . . . . . . . . . . . . . . . . . . . . . . . . . . 126
25 The Adjustable Miniplate for
Sagittal Split Ramus Osteotomy . . . . . . . . . . . . . . . 129
Ulrich Joos
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
26 Craniofacial Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 131
Hermann F. Sailer
Hypertelorism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Correction of Craniosynostosis . . . . . . . . . . . . . . . . 132
Occipital Corrections. . . . . . . . . . . . . . . . . . . . . . . 134
High Midface Osteotomies. . . . . . . . . . . . . . . . . . . . 134
Segmented Frontofacial Advancement
Including Le Fort III Plus Le Fort I Osteotomy
in Two Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
27 Application of Resorbable Plates, Screws and
Pins for the Treatment of Midface and Condylar
Neck Fractures, and Correction of
Craniosynostoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Klaus Louis Gerlach and Uwe Eckelt
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Resorb-X. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Principles of Osteosynthesis . . . . . . . . . . . . . . . . . . 138
Midface Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Condylar Neck Fractures . . . . . . . . . . . . . . . . . . . . . 139
Craniosynostoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
28 Drill-free Screws . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Klaus Louis Gerlach and Wolfgang Heidemann
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
29 Reconstructive Preprosthetic Surgery and
Implantology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
John I. Cawood
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Anatomical Consequences of Jaw Atrophy . . . . . . 144
Interarch Changes . . . . . . . . . . . . . . . . . . . . . . . . . 144
Muscle Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Mucosal Changes. . . . . . . . . . . . . . . . . . . . . . . . . . 146
Facial Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Pre-implant Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 146
Atrophic Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Class IV Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Anterior Maxillary Osteoplasty to Broaden the
Narrow Maxillary Ridge . . . . . . . . . . . . . . . . . . . . 152
Class V Maxilla. . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Class VI Maxilla . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Atrophic Mandible. . . . . . . . . . . . . . . . . . . . . . . . 158
Class II and Class III Mandible . . . . . . . . . . . . . . 158
Class IV Mandible. . . . . . . . . . . . . . . . . . . . . . . . . 159
Class V Mandible . . . . . . . . . . . . . . . . . . . . . . . . . 159
Class VI Mandible. . . . . . . . . . . . . . . . . . . . . . . . . 159
Oral Rehabilitation. . . . . . . . . . . . . . . . . . . . . . . . . . 159
30 Bone Graft and Membrane Stabilization in
Implantology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Franz Haerle and Hendrik Terheyden
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
31 Alveolar Bone Distraction . . . . . . . . . . . . . . . . . . . . 162
Johannes Hidding and Joachim E. Zoeller
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Clinical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
32 Mandible Alveolar Bone Reconstruction by
Endodistraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Christian Krenkel
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Materials and Method. . . . . . . . . . . . . . . . . . . . . . . 166
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
33 Mesh Fixation of Bone. . . . . . . . . . . . . . . . . . . . . . . 170
Bodo Hoffmeister
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Traumatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Orthognathic Surgery . . . . . . . . . . . . . . . . . . . . . . . 172
Surgical Applications. . . . . . . . . . . . . . . . . . . . . . . . 172
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
34 Mandibular Reconstruction with Free,
Nonvascularized Bone Grafts . . . . . . . . . . . . . . . . . 174
Hans-Dieter Pape and Klaus Louis Gerlach
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
35 Intraoral Distraction Osteogenesis of the Mandible
and the Maxilla. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Konrad Wangerin, Henning Gropp,
Winfried Kretschmer, and Werner Zoder
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Mandib ular Distraction in Congenital
Malformation or Acquired Deficiency . . . . . . . . . 177
Body Deficiency . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Ramus Deficiency. . . . . . . . . . . . . . . . . . . . . . . . . 180
Combinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Distraction in Orthognathic Surgery. . . . . . . . . . . 181
Mandibular Retrognathia . . . . . . . . . . . . . . . . . . 181
Maxillary Retrognathia . . . . . . . . . . . . . . . . . . . . 184
Transversal Mandibular Deficiency. . . . . . . . . . 186
Transversal Maxillary Deficiency . . . . . . . . . . . 188
Combinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
36 Microsurgical Anastomosis of the Fibula Bone . . 191
Friedrich W. Neukam, Rainer Schmelzeisen, and
Emeka Nkenke
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Anatomical Considerations. . . . . . . . . . . . . . . . . . . 191
Preoperative Diagnostics for Graft Shaping. . . . . 192
Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Graft Fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
37 Microsurgical Anastomosis of the Scapula Bone. 196
Rainer Schmelzeisen and Friedrich W. Neukam
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Anatomical Considerations. . . . . . . . . . . . . . . . . . . 196
Harvesting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
Mandibular Reconstruction . . . . . . . . . . . . . . . . . . 197
Reconstruction of the Maxilla and Midface . . . . . 198
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
38 Titanium Plate Removal: Yes or No? . . . . . . . . . . . 202
Hendrik Terheyden and Maxime Champy
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Corrosion and Metal Release from Titanium
Plates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
Toxicity and Accumulation in the Body . . . . . . . . 202
Inflammatory Response . . . . . . . . . . . . . . . . . . . . . 203
Sensitivity to Titanium . . . . . . . . . . . . . . . . . . . . . . 203
Carcinogenity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Diagnostic and Therapeutic Radiation Scattering 204
Stress Shielding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Conclusion and Ethical Considerations. . . . . . . . . 204
39 Complications: Causes and Management. . . . . . . 205
Klaus Louis Gerlach, Hans-Dieter Pape, and
Maxime Champy
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Suture Dehiscences . . . . . . . . . . . . . . . . . . . . . . . . . 205
Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Delayed Union (Pseudarthrosis, Fibrous Union). 206
Malocclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Damage to Dental Roots . . . . . . . . . . . . . . . . . . . . . 206
Damage to the Inferior Alveolar Nerve. . . . . . . . . 206
Angle Fractures: One or Two Plates? . . . . . . . . . . 207
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
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