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Mandible osteosynthesis by endooral access


Author: Sîrbu Dumitru
Degree:doctor of medicine
Speciality: 14.00.21 - Stomatology
Year:2009
Scientific adviser: Valentin Topalo
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:
Scientific council:

Status

The thesis was presented on the 17 December, 2008
Approved by NCAA on the 26 February, 2009

Abstract

Adobe PDF document – 0.34 Mb / in romanian

Thesis

CZU 616.716.4-001.5-089

Adobe PDF document 3.37 Mb / in romanian
166 pages

Keywords

Trauma, fracture, mandible, osteosynthesis, aproach, miniplate, screw, steel wire

Summary

The improvement of patients treatment with mandible fractures and their early recovery in present has been actual. The purpose of this paper includes the surgical treatment efficiency improvement of mandible fracture patients and mandible osteosynthesis method establishment by endooral approach and their efficiency study.

The studies on mandible osteosynthesis results analysis by endooral approach have been based. According to study purpose an objectives the patients were selected into 2 groups: the first group (main) – 95 operated patients by endooral approach, the second one (control) – 47 operated patients by exooral approach. Both grpups were divided into three subgroups depending of the fixation device (miniplates, metal wire, screws). The result of mandible osteosynthesis by endooral approach the main group were compared with those of the same subgroups from the control one. The osteosynthesis method of mandible was improved and proposed 9 inventions. Many criteria for the result establishment were used: presence or absence of the pathologic mobility of the parts, post operatory oedema level and its regression dynamics, the intensity of post operatory algic syndrome, occlusion maintenance in correct position, dynamics of innervation recovery in the alveolar inferior nerve surface, terms of functional recovery, possible complications and their prophylaxis, pre and after operator radiologic examination in dynamics, statistic analiysis.

Conclusion: The established mandible osteosynthesis methods by endooral approach are effective and they improve the surgical treatment efficiency of mandible fractures patients. This one is referred to endooral approach advantages comparative with exooral approach. The combination of mandible osteosynthesis method with titanium titanium miniplates, which are net superior to metallic wire and screws which are demonstrated in this study. They permit the removement of the long term intermaxillar immobilization disadvantages. The application by endooral approach of 2 miniplates (functional stabile ostesynthesis) due to fractured mandible biomechanics, permit the removement of the intermaxillar immobilization immediately post operatory. This was the way to early recovery of the patients. The absence of intraoperatory and postoperatory complications of the patients in dynamics in the study confirm the viability of the used ostesynthesis methods.

Many clinical situations of the mandible fractures in the study leaded to the new treatment algorithms of the mandible fracture patients. These algorithms give practitioners especially for young one, in the specciality terminology to improve of the methods of treatment and choosing the optimal one.