【Medical Station】Precautions for using nail plates in mandibular reconstruction-Ningbo Cibei Medical Equipment Co., Ltd.

Mandibular defect refers to mandibular defects caused by mandibular tumors and postoperative trauma. Mandibular defects can directly affect the patient's oral function and appearance. The reconstruction and repair treatment of mandible defects first requires restoring the appearance of the mandible. On this basis, denture repair and occlusal function reconstruction are carried out to maintain the balance of the oral and jaw system to facilitate the unblocking of the upper respiratory tract and achieve true mandible function reconstruction.

For patients with mandibular reconstruction, titanium plates or small titanium plates should be used.

1. If you choose a mandible reconstruction titanium plate (it is recommended to use a thickness of 2.0 or above), and more than 3 titanium nails must be implanted at the left end of the mandible (locked or non-locked titanium nails) for bilateral cortical fixation [1]. It is recommended to use a measuring ruler to measure the depth of the jaw nail path before choosing a titanium nail to avoid excessively implanting the titanium nails and damage the medial blood vessels and ensure bilateral cortical fixation.

2. If a small titanium plate is selected, two small titanium plates should be placed between the remaining mandible and the grafted bone block (the thickness is recommended to be more than 1.0MM) to ensure stability (the balanced sharing of stress and tension of the 2 titanium plates should be paid attention to). For all bone grafting segments, more than 2 titanium nails are required for unilateral cortical fixation, but it is not recommended to implant too much titanium nails to avoid affecting the blood flow of the grafted bone.

The possible complications related to nail plate selection and use during mandibular reconstruction include:

1. Bone transplantation delays healing and bone nonunion

Improper selection, implantation position or use of titanium nails and titanium plates may cause titanium plates to be unable to bear stress or uneven stress, which will cause delayed healing of bone grafting and non-union.

2. Bone resorption

Stress occlusion of mandibular reconstruction plates can also lead to local absorption of grafted bones.

3. Titanium plate exposed

Improper indications for the use of mandibular reconstruction plate and soft tissue flap can cause exposure of titanium plates. The soft tissue flap that wraps the titanium plate should be ensured to be sufficiently thick and without tension.

4. Titanium nails loose

During operation, due to unstable handheld hands or errors in power tools when using power tools, it is easy to cause loosening of titanium plates and titanium nails. To avoid loosening of titanium nails, the manufacturer's supporting tools should be selected during the operation, minimally invasive operation should be advocated, and attention should be paid to flushing and cooling throughout the drilling process of the power equipment. The radial circular jump of the mobile phone output of the power tool rotary motion type should meet the requirements. When the set speed is ≤3000r/min, it will not be greater than 0.20mm. [2]

5. Titanium plate breakage

It is mainly related to the improper shaping operation of titanium plates during the operation. During the operation, the manufacturer should be selected to bending the titanium plate according to the steps, and pay special attention to avoid repeated bending. Repeated bending of titanium plates can cause metal fatigue, scratches, stress concentration, etc. to cause breakage during or during the bending process; mandible reconstruction plates without bone support will inevitably break, and the implantation of a simple mandible reconstruction plate without bone transplantation should not be used as an eternal repair method for mandible defects.

【Medical Station】Precautions for using nail plates in mandibular reconstruction

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