Christian Deininger (Salzburg / AT), Marco Necchi (Salzburg / AT; Sterzing / IT), Susanne Deininger (Salzburg / AT), Valeska Hofmann (Salzburg / AT; Tübingen / DE), Jan Pruszak (Salzburg / AT), Eva Steidle-Kloc (Salzburg / AT), Teresa Gruber (Salzburg / AT), Sebastian Marcus Deininger (Salzburg / AT), Florian Wichlas (Salzburg / AT)
Abstract text (incl. references and figure legends)
Background
The lack of resources limits the treatment of craniomaxillofacial fractures (CMF) in low-income countries (LIC). Barton bandage and/or interdental wiring are considered being gold standar. The fracture reduction is maintained by permanent occlusion for 6 weeks, which often leads to limited compliance and dissatisfying results. Furthermore, in these conditions the healing of nasopharyngeal fistula is difficult. During humanitarian missions CMF need to be treated by trauma surgeons. The aim of this cadaver-based study is to evaluate the feasibility of the use of an external face fixator (EFF) for the treatment of CMF, its biomechanical values and to define the optimal pin insertion points and angles.
Material and methods
See Fig. 1. A commercially available AO hand fixator was used. CMF type Le Fort 1-3 with split fracture of the hard palate were treated with EFF on 13 anatomical specimens. The pins were placed in specific anatomical regions. The maximal pull-out force [N] of the pins was analysed by a tensile force gauge. As a reference, Fmax of the mandibular pins was evaluated. Computer tomography (CT) scans were performed on the healthy, fractured and EFF-treated skulls. After reduction and EFF placement an adequate reposition was shown in the CT scans.
Results
The pull-out forces of the single pins showed good purchase compared to the mandibular pins in the biomechanical pull-out testing. The best drilling angles for the supraorbital pins is between -10 and 35°.
Conclusions
The operation technique is feasible, and the stability of the EFF is sufficient for maintaining the reduction. The required pins can be safely inserted into the described areas and a good reduction result can be achieved. Fig.2
The EFF offers a feasible alternative to the non-surgical treatment of CMF in LIC. Thus, the gap between the open reduction and internal fixation techniques (mini-plates) used in High-income countries and the Barton bandage used in LIC can be closed.
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