[Medical Station] Precautions for using nail plates in mandibular reconstruction-Ningbo Cibei Medical Treatment Appliance Co.,Ltd.

Mandibular defects refer to mandibular defects caused by mandibular tumors, tumor surgery, and trauma. Mandibular defects can directly affect the patient's oral function and appearance. The reconstruction and repair treatment of mandibular defects first need to restore the shape of the mandible. On this basis, denture repair and occlusal function reconstruction are performed to maintain the balance of the oral and jaw system, so as to maintain the smoothness of the upper respiratory tract and achieve true functional reconstruction of the mandible.

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

1. If titanium plates are used for mandibular reconstruction (it is recommended to use titanium plates with a thickness of 2.0 or above), more than 3 titanium nails (locking or non-locking titanium nails can be selected) need to be implanted in the remaining mandibular ends on both sides for bilateral cortical fixation [1]. It is recommended to use a measuring ruler to measure the depth of the mandibular nail track before selecting titanium nails to prevent the titanium nails from being implanted too deep and damaging the medial blood vessels to ensure bilateral cortical fixation.

2. If a small titanium plate is selected, two small titanium plates (thickness recommended to be above 1.0MM) need to be placed between the remaining mandibular bone and the transplanted bone block to ensure stability (it should be noted that the stress and tension of the two titanium plates are evenly shared). More than 2 titanium nails are required for unilateral cortical fixation of each grafted bone segment, but it is not recommended to implant too many titanium nails to avoid affecting the blood supply of the grafted bone.

Possible complications related to the selection and use of nail plates during mandibular reconstruction include:

1. Delayed healing and nonunion of bone graft

Improper selection, implantation location, or use of titanium nails and plates may cause the titanium plates to be unable to bear stress or bear uneven stress, resulting in delayed healing of the grafted bone and nonunion.

2. Bone resorption

The stress-shielding effect of the mandibular reconstruction plate can also lead to local resorption of the grafted bone.

3. Exposed titanium plate

Improper understanding of the indications for the combined use of mandibular reconstruction plates and soft tissue flaps may cause exposure of the titanium plate. The soft tissue flap wrapping the titanium plate should be sufficiently thick and tension-free.

4.Titanium nails are loose

During the operation, due to unstable hand holding or power tool errors when using power tools, the titanium plate and titanium nails may easily become loose. In order to prevent the titanium nail from loosening, the tools supplied by the manufacturer should be selected during the operation, minimally invasive operations should be advocated, and attention should be paid to flushing and cooling of the power equipment during the drilling process. The radial circular runout of the handpiece output of the power tool rotary motion type should meet the requirement that when the set speed is ≤3000r/min, it should not be greater than 0.20mm. [2]

5. Titanium plate breaks

It is mainly related to the improper shaping operation of the titanium plate during the operation. During the operation, you should choose the tools provided by the manufacturer and bend the titanium plate according to the steps, paying special attention to avoid repeated bending. Repeated bending of the titanium plate can cause metal fatigue, scratches, stress concentration, etc., leading to fractures during the bending process or during the operation or after the operation. A mandibular reconstruction plate that lacks bone support will inevitably break. Simple mandibular reconstruction plate implantation without bone grafting should not be used as a permanent repair method for mandibular defects.

[Medical Station] Precautions for using nail plates in mandibular reconstruction

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