[Hybrid osteosynthesis in orthognathic surgery: 28 cases of Le Fort I osteotomy].
BACKGROUND
The use of resorbable materials in orthognathic surgery is presently the object of numerous clinical and experimental studies. Their main drawbacks are their lack of rigidity and induced chronic inflammatory reactions. The purpose of this study was to propose and to test an original system of hybrid osteosynthesis associating a single titanium plate with three resorbable plates in Le Fort I osteotomies in the absence of maxillary expansion, or two titanium plates with two resorbable plates in case of maxillary expansion.


METHODS
Our retrospective study concerned 28 patients operated between 2002 and 2005. A clinical follow-up of over one year detected the specific complications of the hybrid system and a cephalometric study analyzed the secondary relapse 5 months after surgery. These results were compared to the literature.


RESULTS
One case of mobility and a case of instability of the jaw were observed, along with 5 cases of local chronic inflammatory reaction. The radiological results found a secondary sub-clinical relapse. The removal of the titanium material under local anesthesia was performed without difficulties in ambulatory care, which avoided a new hospitalization for the patient and a new general anesthesia.


CONCLUSIONS
The hybrid system allowed obtaining a postoperative stability of the jaw comparable to that obtained by the exclusive use of titanium plates with an acceptable morbidity. This method of osteosynthesis combined the advantages of the resorbable material (removal of titanium plates under local anesthesia) and of titanium material (stability of the procedure). However this method requires a good experience of working with resorbable material, a good follow-up, and cooperative patients. These encouraging results urge us to extend the indications to mandibular sagittal osteotomy and to bi-maxillary osteotomies.
Caquant
L
L
Service de chirurgie maxillofaciale, stomatologique et plastique de la face, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France. ludovic.caquant@chu-lyon.fr
Freidel
M
M
Bouletreau
P
P
Breton
P
P
D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures; D001672:Biocompatible Materials / Q000737:chemistry; D001860:Bone Plates; D002508:Cephalometry; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019344:Lactic Acid / Q000737:chemistry; D008297:Male; D008312:Malocclusion, Angle Class II / Q000473:pathology / Q000601:surgery; D008313:Malocclusion, Angle Class III / Q000473:pathology / Q000601:surgery; D008437:Maxilla / Q000601:surgery*; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods*; D010155:Palatal Expansion Technique; D011100:Polyglycolic Acid / Q000737:chemistry; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011108:Polymers / Q000737:chemistry; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D014025:Titanium / Q000737:chemistry; D014945:Wound Healing / Q000502:physiology
D001672:Biocompatible Materials; D011108:Polymers; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid; D014025:Titanium